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Baltes P, Dray X, Riccioni ME, Pérez-Cuadrado-Robles E, Fedorov E, Wiedbrauck F, Chetcuti Zammit S, Cadoni S, Bruno M, Rondonotti E, Johansson GW, Mussetto A, Beaumont H, Perrod G, McNamara D, Plevris J, Spada C, Pinho R, Rosa B, Hervas N, Leenhardt R, Marmo C, Esteban-Delgado P, Ivanova E, Keuchel M. Small-bowel capsule endoscopy in patients with Meckel's diverticulum: clinical features, diagnostic workup, and findings. A European multicenter I-CARE study. Gastrointest Endosc 2022; 97:917-926.e3. [PMID: 36572128 DOI: 10.1016/j.gie.2022.12.014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/23/2022] [Revised: 11/29/2022] [Accepted: 12/14/2022] [Indexed: 02/08/2023]
Abstract
BACKGROUND AND AIMS Meckel's diverticulum (MD) may remain silent or be associated with adverse events such as GI bleeding. The main aim of this study was to evaluate indicative small-bowel capsule endoscopy (SBCE) findings, and the secondary aim was to describe clinical presentation in patients with MD. METHODS This retrospective European multicenter study included patients with MD undergoing SBCE from 2001 until July 2021. RESULTS Sixty-nine patients with a confirmed MD were included. Median age was 32 years with a male-to-female ratio of approximately 3:1. GI bleeding or iron-deficiency anemia was present in nearly all patients. Mean hemoglobin was 7.63 ± 1.8 g/dL with a transfusion requirement of 52.2%. Typical capsule endoscopy (CE) findings were double lumen (n = 49 [71%]), visible entrance into the MD (n = 49 [71%]), mucosal webs (n = 30 [43.5%]), and bulges (n = 19 [27.5%]). Two or more of these findings were seen in 48 patients (69.6%). Ulcers were detected in 52.2% of patients (n = 36). In 63.8% of patients (n = 44), a combination of double lumen and visible entrance into the MD was evident, additionally revealing ulcers in 39.1% (n = 27). Mean percent SB transit time for the first indicative image of MD was 57% of the total SB transit time. CONCLUSIONS Diagnosis of MD is rare and sometimes challenging, and a preoperative criterion standard does not exist. In SBCE, the most frequent findings were double-lumen sign and visible diverticular entrance, sometimes together with ulcers.
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Affiliation(s)
- Peter Baltes
- Clinic for Internal Medicine, Agaplesion Bethesda Krankenhaus Bergedorf, Hamburg, Germany.
| | - Xavier Dray
- Sorbonne University, Centre for Digestive Endoscopy, Hospital Saint Antoine, APHP, Paris, France
| | - Maria Elena Riccioni
- Digestive Endoscopy Unit, Fondazione Policlinico Universitario Agostino Gemelli, IRCCS, Università Cattolica del Sacro Cuore, Roma, Italy
| | | | - Evgeny Fedorov
- Department of Surgical Gastroenterology and Endoscopy, Moscow University Hospital N31, Pirogov Russia National Research Medical University, Moscow, Russian Federation
| | - Felix Wiedbrauck
- Department of Gastroenterology, Allgemeines Krankenhaus Celle, Celle, Germany
| | | | - Sergio Cadoni
- Digestive Endoscopy Unit, CTO Hospital, Iglesias, Italy
| | - Mauro Bruno
- University Division of Gastroenterology, University Hospital City of Science and Health Turin, Turin, Italy
| | | | | | | | - Hanneke Beaumont
- Department of Gastroenterology and Hepatology, Amsterdam UMC, location VUmc, Amsterdam, the Netherlands
| | - Guillaume Perrod
- Department of Gastroenterology, Georges Pompidou European Hospital, Paris, France
| | - Deirdre McNamara
- Department of Gastroenterology, Tallaght University Hospital and School of Medicine Trinity College Dublin, Dublin, Ireland
| | - John Plevris
- Endoscopy Unit, The Royal Infirmary of Edinburgh, University of Edinburgh, Scotland
| | - Cristiano Spada
- Digestive Endoscopy Unit, Fondazione Policlinico Universitario Agostino Gemelli, IRCCS, Università Cattolica del Sacro Cuore, Roma, Italy; Digestive Endoscopy Unit, Fondazione Poliambulanza, Brescia, Italy
| | - Rolando Pinho
- Gastroenterology Department, Vila Nova de Gaia/Espinho-Hospital Centre, Vila Nova de Gaia, Portugal
| | - Bruno Rosa
- Gastroenterology Department, Hospital da Senhora da Oliveira, Guimarães, Portugal
| | - Nerea Hervas
- Department of Gastroenterology, Complejo Hospitalario Navarra, Pamplona, Spain
| | - Romain Leenhardt
- Sorbonne University, Centre for Digestive Endoscopy, Hospital Saint Antoine, APHP, Paris, France
| | - Clelia Marmo
- Digestive Endoscopy Unit, Fondazione Policlinico Universitario Agostino Gemelli, IRCCS, Università Cattolica del Sacro Cuore, Roma, Italy
| | | | - Ekaterina Ivanova
- Department of Surgical Gastroenterology and Endoscopy, Moscow University Hospital N31, Pirogov Russia National Research Medical University, Moscow, Russian Federation
| | - Martin Keuchel
- Clinic for Internal Medicine, Agaplesion Bethesda Krankenhaus Bergedorf, Hamburg, Germany; Clinic for Gastroenterology, Asklepios Klinik Altona, Hamburg, Germany
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Wu J, Huang Z, Wu H, Ji M, Wang Y, Tang Z, Huang Y. The diagnostic value of video capsule endoscopy for Meckel's diverticulum in children. REVISTA ESPANOLA DE ENFERMEDADES DIGESTIVAS 2020; 112:429-433. [PMID: 32450705 DOI: 10.17235/reed.2020.6708/2019] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
BACKGROUND Meckel's diverticulum (MD) is the most common congenital anomaly of the gastrointestinal tract and is also an important cause of bloody stool and anemia in children. However, there are few data about video capsule endoscopy (VCE) for MD in children. This study aimed to evaluate the diagnostic value of VCE for MD in children. MATERIALS AND METHODS children who underwent VCE for obscure gastrointestinal bleeding from October 1st 2015 to August 31st 2019 at the Children's Hospital of Fudan University were included in this retrospective study. Medical data, VCE data and Meckel's scans, etc. were collected for each patient. RESULTS sixteen patients were diagnosed with MD by VCE, including 13 males and 3 females. The age of the patients ranged from 4 years to 13 years, with an average of 7.8 ± 2.7 years. Lower gastrointestinal tract bleeding was the main symptom for patients with MD, including hematochezia (75 %) and melena (25 %). Of the VCE findings, 14 patients had double lumen signs and 2 showed protruding lesions. Among the 16 patients diagnosed with MD by VCE, 14 patients were diagnosed with MD by Meckel's scan, 3 with MD by abdominal enhanced CT and 14 patients were diagnosed with MD by surgery. During the follow-up, bleeding occurred sporadically in patient 12 and the reason is still unknown. CONCLUSIONS VCE is useful for the diagnosis of MD and should be used as a valuable and less invasive examination to confirm or establish a diagnosis.
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Affiliation(s)
- Jie Wu
- Gastroenterology, Children's Hospital of Fudan University
| | - Zhiheng Huang
- Gastroenterology, Children's Hospital of Fudan University,
| | - Ha Wu
- Nuclear Medicine, Children's Hospital of Fudan University
| | - Min Ji
- Radiology, Children's Hospital of Fudan University
| | - Yuhuan Wang
- Gastroenterology, Children's Hospital of Fudan University
| | - Zifei Tang
- Gastroenterology, Children's Hospital of Fudan University
| | - Ying Huang
- Gastroenterology, Children's Hospital of Fudan University
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Abstract
OBJECTIVE We described a case series of patients diagnosed with Meckel's diverticulum using capsule endoscopy (CE), reviewed the literature, and aimed to reveal the common CE characteristics of Meckel's diverticulum. MATERIALS AND METHODS We reviewed a case series of Meckel's diverticulum in the Department of Gastroenterology, Beijing Shijitan Hospital Affliated to the Capital Medical University. In each case, primary upper endoscopy and colonoscopy failed to reveal a reason to explain the complaints (hematochezia in three cases and abdominal pain in one). CE (Pillcam SB2, Given Imaging, Yoqneam, Israel) was chosen as the next diagnostic test of choice and Meckel's diverticulum was detected by CE. Then, endoscopic characteristics and follow-up of Meckel's diverticulum were analyzed. RESULTS 4 patients were enrolled. CE revealed Meckel's diverticulum in patients with different features. In case 1, CE revealed a typically double lumen sign and diaphragm sign, with visible blood. In case 2 and case 3, CE revealed a protruding lesion with/without erosion. In case 4, CE revealed multiple caved lesions, double lumen sign and capsule retention in an abnormal blind end for over 2 hours. CONCLUSION Except double lumen sign, partial disappearance of normal mucosa and capsule retention, other CE findings could be used for the diagnosis of Meckel's diverticulum, such as protruding lesion, caved lesion, solitary polyp and stenosing lesion.
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Affiliation(s)
- Lin Lin
- a Department of Gastroenterology , Beijing Shijitan Hospital Affliated to the Capital Medical University , Beijing , PR China
| | - Kuiliang Liu
- a Department of Gastroenterology , Beijing Shijitan Hospital Affliated to the Capital Medical University , Beijing , PR China
| | - Hong Liu
- a Department of Gastroenterology , Beijing Shijitan Hospital Affliated to the Capital Medical University , Beijing , PR China
| | - Jing Wu
- a Department of Gastroenterology , Beijing Shijitan Hospital Affliated to the Capital Medical University , Beijing , PR China
| | - Yaopeng Zhang
- b Department of Gastroenterology , Peking University Third Hospital , Beijing , PR China
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Schlag C, Menzel C, Nennstiel S, Neu B, Phillip V, Schuster T, Schmid RM, von Delius S. Emergency video capsule endoscopy in patients with acute severe GI bleeding and negative upper endoscopy results. Gastrointest Endosc 2015; 81:889-95. [PMID: 25432532 DOI: 10.1016/j.gie.2014.09.035] [Citation(s) in RCA: 34] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/20/2014] [Accepted: 09/10/2014] [Indexed: 02/08/2023]
Abstract
BACKGROUND In mid-GI bleeding, video capsule endoscopy (VCE) shows the best diagnostic yield for ongoing overt bleeding. To date, the utility of VCE in acute severe GI bleeding has been analyzed rarely. OBJECTIVE To evaluate the impact of VCE when performed on patients with acute severe GI bleeding immediately after an initial negative upper endoscopy result. DESIGN Prospective study. SETTING Tertiary-care center. PATIENTS Patients with melena, dark-red or maroon stool, hemodynamic instability, drop of hemoglobin level ≥2 g/dL/day, and/or need of transfusion ≥2 units of packed red blood cells per day were included. INTERVENTIONS After a negative upper endoscopy result, emergency VCE was performed by immediate endoscopic placement of the video capsule into the duodenum. MAIN OUTCOME MEASUREMENTS Rate of patients in whom emergency VCE correctly guided further diagnostic and therapeutic procedures. RESULTS Upper endoscopy showed the source of bleeding in 68 of 88 patients (77%). In the remaining 20 patients (23%), emergency VCE was performed, which was feasible in 19 of 20 patients (95%; 95% confidence interval [CI], 75%-99%). Emergency VCE correctly guided further diagnostic and therapeutic procedures in 17 of 20 patients (85%; 95% CI, 62%-97%) and showed a diagnostic yield of 75% (95% CI, 51%-91%). LIMITATIONS Single-center study, small sample size. CONCLUSION In patients with acute severe GI bleeding and negative upper endoscopy results, emergency VCE can be useful for the immediate detection of the bleeding site and is able to guide further therapy. (Clinical trial registration number: NCT01584869.)
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