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Yasuda T, Sakurazawa N, Kuge K, Omori J, Arai H, Kakinuma D, Watanabe M, Suzuki H, Iwakiri K, Yoshida H. Protein-losing enteropathy caused by a jejunal ulcer after an internal hernia in Petersen's space: A case report. World J Clin Cases 2022; 10:323-330. [PMID: 35071535 PMCID: PMC8727264 DOI: 10.12998/wjcc.v10.i1.323] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/21/2021] [Revised: 07/29/2021] [Accepted: 11/29/2021] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND The incidence of internal hernias has recently increased in concordance with the popularization of laparoscopic surgery. Of particular concern are internal hernias occurring in Petersen's space, a space that is surgically created after treatment for gastric cancer and obesity. These hernias cause devastating sequelae, such as massive intestinal necrosis, fatal Roux limb necrosis, and superior mesenteric vein thrombus. In addition, protein-losing enteropathy (PLE) is a rare syndrome involving gastrointestinal protein loss, although its relationship with internal Petersen’s hernias remains unknown.
CASE SUMMARY A 75-year-old man with a history of laparotomy for early gastric cancer developed Petersen's hernia 1 year and 5 mo after surgery. He was successfully treated by reducing the incarcerated small intestine and closure of Petersen’s defect without resection of the small intestine. Approximately 3 mo after his surgery for Petersen’s hernia, he developed bilateral leg edema and hypoalbuminemia. He was diagnosed with PLE with an alpha-1 antitrypsin clearance of 733 mL/24 h. Double-balloon enteroscopy revealed extensive jejunal ulceration as the etiology, and it facilitated minimum bowel resection. Pathological analysis showed extensive jejunal ulceration and collagen hyperplasia with nonspecific inflammation of all layers without lymphangiectasia, lymphoma, or vascular abnormalities. His postoperative course was unremarkable, and his bilateral leg edema and hypoalbuminemia improved after 1 mo. There was no relapse over the 5-year follow-up period.
CONCLUSION PLE and extensive jejunal ulceration may occur after Petersen's hernia. Double-balloon enteroscopy helps identify and resect these lesions.
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Affiliation(s)
- Tomohiko Yasuda
- Department of Gastrointestinal Surgery, Nippon Medical School Chiba Hokusoh Hospital, Chiba 270-1694, Japan
| | - Nobuyuki Sakurazawa
- Department of Gastrointestinal and Hepato-Biliary-Pancreatic Surgery, Nippon Medical School, Tokyo 113-8603, Japan
| | - Komei Kuge
- Department of Gastrointestinal Surgery, Nippon Medical School Chiba Hokusoh Hospital, Chiba 270-1694, Japan
| | - Jun Omori
- Department of Gastroenterology, Nippon Medical School, Tokyo 113-8603, Japan
| | - Hiroki Arai
- Department of Gastrointestinal Surgery, Nippon Medical School Chiba Hokusoh Hospital, Chiba 270-1694, Japan
| | - Daisuke Kakinuma
- Department of Gastrointestinal Surgery, Nippon Medical School Chiba Hokusoh Hospital, Chiba 270-1694, Japan
| | - Masanori Watanabe
- Department of Gastrointestinal Surgery, Nippon Medical School Chiba Hokusoh Hospital, Chiba 270-1694, Japan
| | - Hideyuki Suzuki
- Department of Gastrointestinal Surgery, Nippon Medical School Chiba Hokusoh Hospital, Chiba 270-1694, Japan
| | - Katsuhiko Iwakiri
- Department of Gastroenterology, Nippon Medical School, Tokyo 113-8603, Japan
| | - Hiroshi Yoshida
- Department of Gastrointestinal and Hepato-Biliary-Pancreatic Surgery, Nippon Medical School, Tokyo 113-8603, Japan
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Sunakawa T, Ito N, Moriyasu R, Seki N, Takeuchi D, Sasahara K. Smooth muscle degeneration of the mesenteric and branching veins causing ischemic enteritis: a case report. Surg Case Rep 2022; 8:1. [PMID: 34982272 PMCID: PMC8727666 DOI: 10.1186/s40792-021-01353-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2021] [Accepted: 12/17/2021] [Indexed: 11/10/2022] Open
Abstract
Background Ischemic bowel injuries are generally caused by arteriosclerosis, thromboembolism, or vasculitis. Ischemic enteritis is less common than ischemic colitis because of the rich collateral arteries of the small intestine. In the present case, smooth muscle degeneration of the mesenteric to the submucosal veins caused ischemic enteritis and small bowel obstruction. Case presentation An 85-year-old woman with recurrent enteritis eventually developed small bowel obstruction. We performed laparoscopic partial resection of the small intestine. The pathological findings revealed smooth muscle degeneration of the mesenteric veins that caused ischemic enteritis. Venous changes were detected not only in the injured region, but also in a part of the normal region of the resected specimen. She continued to experience some minor symptoms postoperatively; however, these symptoms subsided in a short period with medicine discontinuation. Conclusion This report shows the possibility that a disease causes ischemic enteritis with unique venous pathological changes and may recur postoperatively.
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Affiliation(s)
- Taiki Sunakawa
- Department of Surgery, Aizawa Hospital, 2-5-1Honjo, Matsumoto, Japan. .,Department of Pathology, Aizawa Hospital, 2-5-1Honjo, Matsumoto, Japan.
| | - Nobuo Ito
- Department of Pathology, Aizawa Hospital, 2-5-1Honjo, Matsumoto, Japan
| | - Ryo Moriyasu
- Department of Surgery, Aizawa Hospital, 2-5-1Honjo, Matsumoto, Japan
| | - Nobuya Seki
- Department of Surgery, Aizawa Hospital, 2-5-1Honjo, Matsumoto, Japan
| | - Daisuke Takeuchi
- Department of Surgery, Aizawa Hospital, 2-5-1Honjo, Matsumoto, Japan
| | - Kotaro Sasahara
- Department of Surgery, Aizawa Hospital, 2-5-1Honjo, Matsumoto, Japan
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Pérez-Cuadrado Robles E, Pinho R, González-Suárez B, Mão-de-Ferro S, Chagas C, Esteban Delgado P, Carretero C, Figueiredo P, Rosa B, García-Lledó J, Nogales Ó, Ponte A, Andrade P, Juanmartiñena-Fernández JF, San-Juan-Acosta M, Lopes S, Prieto-Frías C, Egea Valenzuela J, Caballero N, Valdivieso-Cortázar E, Cardoso H, Gálvez C, Almeida N, Borque Barrera P, Gómez Rodríguez BJ, Sánchez Ceballos FL, Bernardes C, Alonso-Aguirre PA, Argüelles Arias F, Mascarenhas Saraiva M, Pérez-Cuadrado Martínez E. Small bowel enteroscopy - A joint clinical guideline by the Spanish and Portuguese small-bowel study groups. REVISTA ESPANOLA DE ENFERMEDADES DIGESTIVAS 2021; 112:309-318. [PMID: 32188259 DOI: 10.17235/reed.2020.7020/2020] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
The present evidence-based guidelines are focused on the use of device-assisted enteroscopy in the management of small-bowel diseases. A panel of experts selected by the Spanish and Portuguese small-bowel study groups reviewed the available evidence focusing on the main indications of this technique, its role in the management algorithm of each indication, and its diagnostic and therapeutic yield. A set of recommendations was issued accordingly.
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Affiliation(s)
| | - Rolando Pinho
- Gastroenterología, Centro Hospitalar de Vila Nova de Gaia e Espinho, Portugal
| | | | - Susana Mão-de-Ferro
- Gastroenterology Department, Instituto Português de Oncologia de Lisboa. E.P.E., Portugal
| | | | | | | | - Pedro Figueiredo
- Gastroenterology , Centro Hospitalar e Universitário de Coimbra, Portugal
| | - Bruno Rosa
- Gastroenterology, Hospital Senhora da Oliveira, Portugal
| | | | - Óscar Nogales
- Aparato Digestivo, Hospital General Universitario Gregorio Marañón, España
| | - Ana Ponte
- Centro Hospitalar Vila Nova de GaiaEspinho, Portugal
| | | | | | | | - Sandra Lopes
- Gastroenterology, Centro Hospitalar e Universitário de Coimbra, Portugal
| | | | | | - Noemí Caballero
- Gastrointestinal Endoscopy, Hospital Universitario Germans Trias i Pujol, Spain
| | | | | | - Consuelo Gálvez
- Gastroenterología, Hospital Clínico Universitario de Valencia, Spain
| | - Nuno Almeida
- Gastroenterology , Centro Hospitalar e Universitário de Coimbra, Portugal
| | - Pilar Borque Barrera
- Aparato Digestivo. Unidad de Endoscopia, Hospital Universitario Nuestra Sra. de Candelaria, España
| | | | | | - Carlos Bernardes
- Gastroenterology, Hospital de Santo António dos Capuchos, Centro Hospitalar Universitário de Lisboa Central, Portugal
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Clinical Features of Ischemic Enteritis Diagnosed by Double-Balloon Endoscopy. Can J Gastroenterol Hepatol 2021; 2021:8875564. [PMID: 33954155 PMCID: PMC8062203 DOI: 10.1155/2021/8875564] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/19/2020] [Revised: 03/23/2021] [Accepted: 04/01/2021] [Indexed: 01/28/2023] Open
Abstract
INTRODUCTION Ischemic enteritis (IE) is a relatively rare small bowel disease that is diagnosed via double-balloon endoscopy (DBE), although the lack of established diagnostic criteria can make it difficult to confirm the diagnosis. This study aimed to describe the clinical characteristics, endoscopic imaging features, and treatments for IE at our center. Patients and Methods. We retrospectively searched the DBE database (1,521 patients) at Nagoya University Hospital for patients with IE and collected data regarding endoscopic findings, clinical background, and histological findings. The cases were categorized according to whether they involved transient or stenotic IE. RESULTS The DBE database included 24 patients (14 men) with IE. Transient IE was identified in 9 patients, and stenotic IE was identified in 15. Half of the patients had a history of cerebrovascular and cardiovascular disease. A granular structure at the ulcer base was the most frequently observed DBE finding at the stenotic site. Enterography using the contrast medium revealed that transient IE had a similar stenotic lesion length, relative to stenotic IE, although stenotic IE had a significantly higher stenosis ratio (81% vs. 63%, P=0.033). Small bowel enteroclysis revealed the "lead pipe" sign (11 patients), thumbprinting (3 patients), and the serrated lumen sign (1 patient). Only 1 patient with stenotic IE experienced recurrence after conservative treatment. CONCLUSION During DBE, IE was characterized by cannular stenosis with extended and variable ulceration types, which spread over the edge of the stenosis, and a granular appearance at the ulcer base. These findings may help guide the diagnosis of IE.
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Sun SL, Wang XY, Chu CN, Liu BC, Li QR, Ding WW. Predictors of irreversible intestinal resection in patients with acute mesenteric venous thrombosis. World J Gastroenterol 2020; 26:3625-3637. [PMID: 32742131 PMCID: PMC7366062 DOI: 10.3748/wjg.v26.i25.3625] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/11/2020] [Revised: 05/26/2020] [Accepted: 06/09/2020] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Acute mesenteric venous thrombosis (AMVT) can cause a poor prognosis. Prompt transcatheter thrombolysis (TT) can achieve early mesenteric revascularization. However, irreversible intestinal ischemia still occurs and the mechanism is still unclear.
AIM To evaluate the clinical outcomes of and to identify predictive factors for irreversible intestinal ischemia requiring surgical resection in AMVT patients treated by TT.
METHODS The records of consecutive patients with AMVT treated by TT from January 2010 to October 2017 were retrospectively analyzed. We compared patients who required resection of irreversible intestinal ischemia to patients who did not require.
RESULTS Among 58 patients, prompt TT was carried out 28.5 h after admission. A total of 42 (72.4%) patients underwent arteriovenous combined thrombolysis, and 16 (27.6%) underwent arterial thrombolysis alone. The overall 30-d mortality rate was 8.6%. Irreversible intestinal ischemia was indicated in 32 (55.2%) patients, who had a higher 30-d mortality and a longer in-hospital stay than patients without resection. The significant independent predictors of irreversible intestinal ischemia were Acute Physiology and Chronic Health Evaluation (APACHE) II score (odds ratio = 2.368, 95% confidence interval: 1.047-5.357, P = 0.038) and leukocytosis (odds ratio = 2.058, 95% confidence interval: 1.085-3.903, P = 0.027). Using the receiver operating characteristic curve, the cutoff values of the APACHE II score and leukocytosis for predicting the onset of irreversible intestinal ischemia were calculated to be 8.5 and 12 × 109/L, respectively.
CONCLUSION Prompt TT could achieve a favorable outcome in AMVT patients. High APACHE II score and leukocytosis can significantly predict the occurrence of irreversible intestinal ischemia. Therefore, close monitoring of these factors may help with the early identification of patients with irreversible intestinal ischemia, in whom ultimately surgical resection is required, before the initiation of TT.
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Affiliation(s)
- Shi-Long Sun
- Division of Trauma and Surgical Intensive Care Unit, Research Institute of General Surgery, Jinling Hospital, Medical School of Nanjing University, Nanjing 210002, Jiangsu Province, China
| | - Xin-Yu Wang
- Division of Trauma and Surgical Intensive Care Unit, Research Institute of General Surgery, Jinling Hospital, Medical School of Nanjing University, Nanjing 210002, Jiangsu Province, China
| | - Cheng-Nan Chu
- Division of Trauma and Surgical Intensive Care Unit, Research Institute of General Surgery, Jinling Hospital, Medical School of Nanjing University, Nanjing 210002, Jiangsu Province, China
| | - Bao-Chen Liu
- Division of Trauma and Surgical Intensive Care Unit, Research Institute of General Surgery, Jinling Hospital, Medical School of Nanjing University, Nanjing 210002, Jiangsu Province, China
| | - Qiu-Rong Li
- Division of Trauma and Surgical Intensive Care Unit, Research Institute of General Surgery, Jinling Hospital, Medical School of Nanjing University, Nanjing 210002, Jiangsu Province, China
| | - Wei-Wei Ding
- Division of Trauma and Surgical Intensive Care Unit, Research Institute of General Surgery, Jinling Hospital, Medical School of Nanjing University, Nanjing 210002, Jiangsu Province, China
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Pérez-Cuadrado-Robles E, Pinho R, Gonzalez B, Mão de Ferro S, Chagas C, Esteban Delgado P, Carretero C, Figueiredo P, Rosa B, García Lledó J, Nogales Ó, Ponte A, Andrade P, Juanmartiñena-Fernández JF, San-Juan-Acosta M, Lopes S, Prieto-Frías C, Egea-Valenzuela J, Caballero N, Valdivieso-Cortazar E, Cardoso H, Gálvez C, Almeida N, Borque Barrera P, Gómez-Rodríguez BJ, Sánchez Ceballos F, Bernardes C, Alonso P, Argüelles-Arias F, Mascarenhas Saraiva M, Pérez-Cuadrado-Martínez E. Small Bowel Enteroscopy - A Joint Clinical Guideline from the Spanish and Portuguese Small Bowel Study Groups. GE-PORTUGUESE JOURNAL OF GASTROENTEROLOGY 2020; 27:324-335. [PMID: 32999905 DOI: 10.1159/000507375] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/01/2020] [Accepted: 03/19/2020] [Indexed: 12/13/2022]
Abstract
The present evidence-based guidelines are focused on the use of device-assisted enteroscopy in the management of small-bowel diseases. A panel of experts selected by the Spanish and Portuguese small bowel study groups reviewed the available evidence focusing on the main indications of this technique, its role in the management algorithm of each indication and on its diagnostic and therapeutic yields. A set of recommendations were issued accordingly.
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Affiliation(s)
| | - Rolando Pinho
- Department of Gastroenterology, Centro Hospitalar de Vila Nova de Gaia e Espinho, Vila Nova de Gaia, Portugal
| | - Begoña Gonzalez
- Department of Gastroenterology. Endoscopy Unit, ICMDiM, Hospital Clínic, Barcelona, Spain
| | - Susana Mão de Ferro
- Department of Gastroenterology, Instituto Português de Oncologia de Lisboa Francisco Gentil EPE, Lisbon, Portugal
| | - Cristina Chagas
- Department of Gastroenterology, Hospital de Egas Moniz, Centro Hospitalar de Lisboa Ocidental, Lisbon, Portugal
| | | | - Cristina Carretero
- Department of Gastroenterology, University of Navarra Clinic, Pamplona, Spain
| | - Pedro Figueiredo
- Gastroenterology Unit, Centro Hospitalar e Universitário de Coimbra, Coimbra, Portugal.,Faculty of Medicine, University of Coimbra, Coimbra, Portugal
| | - Bruno Rosa
- Department of Gastroenterology, Hospital da Senhora da Oliveira, Guimarães, Portugal.,Life and Health Sciences Research Institute, School of Medicine, University of Minho, ICVS/3B's, PT Government Associate Laboratory, Braga/Guimarães, Portugal
| | - Javier García Lledó
- Department of Gastroenterology, Endoscopy Unit, Hospital General Universitario Gregorio Marañón, Madrid, Spain
| | - Óscar Nogales
- Department of Gastroenterology, Endoscopy Unit, Hospital General Universitario Gregorio Marañón, Madrid, Spain
| | - Ana Ponte
- Department of Gastroenterology, Centro Hospitalar de Vila Nova de Gaia e Espinho, Vila Nova de Gaia, Portugal
| | - Patrícia Andrade
- Department of Gastroenterology, Centro Hospitalar São João, Porto, Portugal
| | | | - Mileidis San-Juan-Acosta
- Department of Gastroenterology, Gastrointestinal Endoscopy Unit, Hospital Universitario Nuestra Señora de Candelaria, Candelaria, Tenerife, Spain
| | - Sandra Lopes
- Gastroenterology Unit, Centro Hospitalar e Universitário de Coimbra, Coimbra, Portugal.,Faculty of Medicine, University of Coimbra, Coimbra, Portugal
| | - César Prieto-Frías
- Department of Gastroenterology, University of Navarra Clinic, Pamplona, Spain
| | - Juan Egea-Valenzuela
- Unit of Gastrointestinal Endoscopy, Department of Digestive Disease, Hospital Clínico Universitario Virgen de la Arrixaca, Murcia, Spain
| | - Noemí Caballero
- Department of Gastrointestinal Endoscopy, Hospital Universitario Germans Trias i Pujol, Badalona, Spain
| | | | - Hélder Cardoso
- Department of Gastroenterology, Centro Hospitalar São João, Porto, Portugal
| | - Consuelo Gálvez
- Department of Gastroenterology. Hospital Clínico Universitario de Valencia, Valencia, Spain
| | - Nuno Almeida
- Gastroenterology Unit, Centro Hospitalar e Universitário de Coimbra, Coimbra, Portugal.,Faculty of Medicine, University of Coimbra, Coimbra, Portugal
| | - Pilar Borque Barrera
- Department of Gastroenterology, Gastrointestinal Endoscopy Unit, Hospital Universitario Nuestra Señora de Candelaria, Candelaria, Tenerife, Spain
| | - Blas José Gómez-Rodríguez
- Department of Gastroenterology, Hospital Universitario Virgen Macarena, Universidad de Sevilla, Sevilla, Spain
| | | | - Carlos Bernardes
- Department of Gastroenterology, Hospital de Santo António dos Capuchos, Centro Hospitalar Universitário de Lisboa Central, Lisbon, Portugal
| | - Pedro Alonso
- Department of Gastroenterology, Complejo Hospitalario Universitario de A Coruña, A Coruña, Spain
| | - Federico Argüelles-Arias
- Department of Gastroenterology, Hospital Universitario Virgen Macarena, Universidad de Sevilla, Sevilla, Spain
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Experience with Balloon Dilatation in Crohn's and Non-Crohn's Benign Small-Bowel Strictures: Is There a Difference? Gastroenterol Res Pract 2019; 2019:1262595. [PMID: 31198420 PMCID: PMC6526561 DOI: 10.1155/2019/1262595] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/26/2018] [Revised: 03/06/2019] [Accepted: 03/21/2019] [Indexed: 11/17/2022] Open
Abstract
Background/Aim Endoscopic balloon dilation (EBD) has been effective for small-bowel strictures in patients with Crohn's disease (CD). However, its efficacy and indication for small-bowel strictures in non-CD patients have not been established. This study evaluated the clinical efficacy and safety of EBD for small-bowel strictures in non-CD patients compared with CD patients. Methods Ninety-eight consecutive patients (mean age, 53 years; average observation period, 45 months) with small-bowel strictures diagnosed by double-balloon endoscopy were retrospectively evaluated at Hiroshima University Hospital from August 2003 to April 2017. The average number of procedures, short-term and long-term EBD success rates, and safety profiles between the non-CD and CD groups were examined. Results Surgery was selected as the initial treatment in 44 cases (45%) (non-CD group, 27 (61%); CD group, 17 (39%)) as EBD is not indicated. Fourteen non-CD patients had strictures due to malignant tumors, while 13 patients had benign strictures. Twenty-three patients (non-CD, 12; CD, 11) underwent EBD. Forty-three EBD procedures were performed for 17 stricture sites (average: 2.5 procedures/site) in non-CD patients and 41 EBD procedures for 18 stricture sites (average: 2.3 procedures/site) in CD patients. The short-term success rate was 100% (23/23), whereas the long-term success rate was 92% (11/12) in non-CD patients and 82% (9/11) in CD patients. No significant differences in the surgery-free rate occurred between both groups. Furthermore, one adverse event, bleeding after EBD, was encountered in the non-CD group (8%, 1/12). Conclusion EBD for small-bowel strictures demonstrated good clinical outcomes in non-CD patients.
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8
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Iwai N, Handa O, Naito Y, Dohi O, Okayama T, Yoshida N, Kamada K, Uchiyama K, Ishikawa T, Takagi T, Konishi H, Itoh Y. Stenotic Ischemic Enteritis with Concomitant Hepatic Portal Venous Gas and Pneumatosis Cystoides Intestinalis. Intern Med 2018; 57:1995-1999. [PMID: 29491303 PMCID: PMC6096024 DOI: 10.2169/internalmedicine.0367-17] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/19/2022] Open
Abstract
A 69-year-old man was admitted to a hospital with complaints of abdominal pain. Computed tomography showed hepatic portal venous gas and pneumatosis cystoides intestinalis. Conservative treatment was effective; however, after discharge, he developed complaints of vomiting. Fluoroscopic enteroclysis revealed a stricture in the jejunum necessitating admission to our hospital. Transoral balloon-assisted enteroscopy showed a circumferential ulcer with a stricture. The stricture was surgically resected, and a histopathological examination was consistent with ischemic enteritis. Stenotic ischemic enteritis should be considered among the differential diagnoses in a patient presenting with hepatic portal venous gas and pneumatosis cystoides intestinalis showing small intestinal obstruction.
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Affiliation(s)
- Naoto Iwai
- Department of Molecular Gastroenterology and Hepatology, Graduate School of Medical Science, Kyoto Prefectural University of Medicine, Japan
| | - Osamu Handa
- Department of Molecular Gastroenterology and Hepatology, Graduate School of Medical Science, Kyoto Prefectural University of Medicine, Japan
| | - Yuji Naito
- Department of Molecular Gastroenterology and Hepatology, Graduate School of Medical Science, Kyoto Prefectural University of Medicine, Japan
| | - Osamu Dohi
- Department of Molecular Gastroenterology and Hepatology, Graduate School of Medical Science, Kyoto Prefectural University of Medicine, Japan
| | - Tetsuya Okayama
- Department of Molecular Gastroenterology and Hepatology, Graduate School of Medical Science, Kyoto Prefectural University of Medicine, Japan
| | - Naohisa Yoshida
- Department of Molecular Gastroenterology and Hepatology, Graduate School of Medical Science, Kyoto Prefectural University of Medicine, Japan
| | - Kazuhiro Kamada
- Department of Molecular Gastroenterology and Hepatology, Graduate School of Medical Science, Kyoto Prefectural University of Medicine, Japan
| | - Kazuhiko Uchiyama
- Department of Molecular Gastroenterology and Hepatology, Graduate School of Medical Science, Kyoto Prefectural University of Medicine, Japan
| | - Takeshi Ishikawa
- Department of Molecular Gastroenterology and Hepatology, Graduate School of Medical Science, Kyoto Prefectural University of Medicine, Japan
| | - Tomohisa Takagi
- Department of Molecular Gastroenterology and Hepatology, Graduate School of Medical Science, Kyoto Prefectural University of Medicine, Japan
| | - Hideyuki Konishi
- Department of Molecular Gastroenterology and Hepatology, Graduate School of Medical Science, Kyoto Prefectural University of Medicine, Japan
| | - Yoshito Itoh
- Department of Molecular Gastroenterology and Hepatology, Graduate School of Medical Science, Kyoto Prefectural University of Medicine, Japan
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9
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Baars JE, Theyventhiran R, Aepli P, Saxena P, Kaffes AJ. Double-balloon enteroscopy-assisted dilatation avoids surgery for small bowel strictures: A systematic review. World J Gastroenterol 2017; 23:8073-8081. [PMID: 29259383 PMCID: PMC5725302 DOI: 10.3748/wjg.v23.i45.8073] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/19/2017] [Revised: 09/17/2017] [Accepted: 10/17/2017] [Indexed: 02/06/2023] Open
Abstract
AIM To evaluate the therapeutic role of double-balloon enteroscopy (DBE) in small bowel strictures and to propose a standard approach to small bowel strictures.
METHODS Systematic review of studies involving DBE in patients with small bowel strictures. Only studies limited to small bowel strictures were included and those with ileo-colonic strictures were excluded.
RESULTS In total 13 studies were included, in which 310 patients were dilated. The average follow-up time was 31.8 mo per patient. The complication rate was 4.8% per patient and 2.6% per dilatation. Surgery was avoided in 80% of patients. After the first dilatation, 46% were treated with re-dilatation and only 17% required surgery.
CONCLUSION DBE-assisted dilatation avoids surgery in 80% of patients with small bowel strictures and is safe and effective. We propose a standardized approach to small bowel strictures.
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Affiliation(s)
- Judith E Baars
- AW Morrow Gastroenterology and Liver Centre, Royal Prince Alfred Hospital, Camperdown, Sydney NSW 2050, Australia
| | - Ruben Theyventhiran
- AW Morrow Gastroenterology and Liver Centre, Royal Prince Alfred Hospital, Camperdown, Sydney NSW 2050, Australia
| | - Patrick Aepli
- AW Morrow Gastroenterology and Liver Centre, Royal Prince Alfred Hospital, Camperdown, Sydney NSW 2050, Australia
| | - Payal Saxena
- AW Morrow Gastroenterology and Liver Centre, Royal Prince Alfred Hospital, Camperdown, Sydney NSW 2050, Australia
| | - Arthur J Kaffes
- AW Morrow Gastroenterology and Liver Centre, Royal Prince Alfred Hospital, Camperdown, Sydney NSW 2050, Australia
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10
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Yamamoto H, Ogata H, Matsumoto T, Ohmiya N, Ohtsuka K, Watanabe K, Yano T, Matsui T, Higuchi K, Nakamura T, Fujimoto K. Clinical Practice Guideline for Enteroscopy. Dig Endosc 2017; 29:519-546. [PMID: 28370422 DOI: 10.1111/den.12883] [Citation(s) in RCA: 89] [Impact Index Per Article: 12.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
Management of small bowel diseases has evolved since the advent of capsule endoscopy (CE) and balloon-assisted enteroscopy (BAE). One of the most common indications for enteroscopy is obscure gastrointestinal bleeding (OGIB), followed by small bowel stenosis, tumors, and inflammatory bowel disease. Although enteroscopes have been regarded as useful tools, correct guidelines are required to ensure that we manipulate these enteroscopes safely and efficiently in clinical practice. Herein, the Japanese Gastroenterological Endoscopy Society has developed 'Clinical Practice Guidelines for Enteroscopy' in collaboration with the Japanese Society of Gastroenterology, the Japanese Gastroenterological Association, and the Japanese Association for Capsule Endoscopy. These guidelines are based on the evidence available until now, but small bowel endoscopy is a relatively new technology, so the guidelines include recommendations based on a consensus reached among experts when the evidence has not been considered sufficient. These guidelines were not designed to be disease-based, but focus on how we should use small bowel CE and BAE in everyday clinical practice.
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Affiliation(s)
| | - Haruhiko Ogata
- Japan Gastroenterological Endoscopy Society
- Japanese Society of Gastroenterology
| | - Takayuki Matsumoto
- Japan Gastroenterological Endoscopy Society
- Japanese Gastroenterological Association
| | - Naoki Ohmiya
- Japan Gastroenterological Endoscopy Society
- Japanese Association for Capsule Endoscopy
| | - Kazuo Ohtsuka
- Japan Gastroenterological Endoscopy Society
- Japanese Gastroenterological Association
| | - Kenji Watanabe
- Japanese Society of Gastroenterology
- Japanese Association for Capsule Endoscopy
| | - Tomonori Yano
- Japan Gastroenterological Endoscopy Society
- Japanese Association for Capsule Endoscopy
| | - Toshiyuki Matsui
- Japan Gastroenterological Endoscopy Society
- Japanese Gastroenterological Association
| | - Kazuhide Higuchi
- Japan Gastroenterological Endoscopy Society
- Japanese Society of Gastroenterology
| | - Tetsuya Nakamura
- Japan Gastroenterological Endoscopy Society
- Japanese Society of Gastroenterology
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11
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Abstract
OPINION STATEMENT The small bowel is a challenging area for endoscopic evaluation and therapy due to its length and angulated configuration. A small lumen diameter and segmental peristalsis made it a perfect fit for examination by a novel ingestible wireless camera in a capsule. The development of capsule endoscopy changed the diagnosis and management of bleeding lesions, ulcers, and tumors deep in the small bowel, allowing earlier diagnosis with excellent patient acceptance. Device-assisted enteroscopy revolutionized small bowel therapy, particularly management of bleeding, Peutz-Jeghers polyposis, and tumor marking for minimally invasive surgery. Small bowel stricture dilation in select patients is safe and effective. Tools for a spectrum of small bowel therapies are available but remain suboptimal to tackle lesions on angulated folds deep in the small bowel. Universal terminology to describe the endoscopic appearance of vascular lesions will facilitate studies of endoscopic and medical therapy. The future holds improvements in imaging, easier advancement through the small bowel, and therapeutic capacity. This review focuses on methods of small bowel endoscopy, therapy, and outcomes.
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Affiliation(s)
- Dejan Micic
- Division of Gastroenterology, Hepatology and Nutrition, University of Chicago, 5841 South Maryland Avenue, S401 MC 4080, Chicago, IL, 60637, USA
| | - Carol E Semrad
- Division of Gastroenterology, Hepatology and Nutrition, University of Chicago, 5841 South Maryland Avenue, S401 MC 4080, Chicago, IL, 60637, USA.
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12
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Affiliation(s)
- Ken Kawakami
- Second Department of Internal Medicine, Osaka Medical College, Japan
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13
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Jeong WS, Song HJ, Na SY, Boo SJ, Kim HU, Kim J, Choi GM. Acute extensive ischemic enteritis in a young man diagnosed with wireless capsule endoscopy: a case report. THE KOREAN JOURNAL OF GASTROENTEROLOGY 2013; 61:160-5. [PMID: 23575235 DOI: 10.4166/kjg.2013.61.3.160] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Abstract
Ischemic enteritis is caused by either the interruption or significant reduction of arterial inflow to the small intestine. Risk factors are old age, diabetes mellitus and cardiovascular disease. It is very rare in young patients. We experienced a 21-year-old man with recurrent acute ischemic enteritis who was diagnosed with capsule endoscopy. He had previously taken medications for pulmonary hypertension and obstruction of both carotid arteries, and about 20 months earlier, he had been admitted due to hematochezia. Two sessions of angiography did not reveal the cause of hematochezia. At that time, capsule endoscopy showed mucosal edema and erythema in the terminal ileum, suggesting healed ischemic enteritis. The patient was admitted again due to hematochezia. Abdominal computed tomography showed focal celiac trunk stenosis and diffuse wall thickening of the small intestine, suggesting ischemic enteritis. Capsule endoscopy showed multiple active ulcers and severe hemorrhage with exudate, extending from the proximal jejunum to the terminal ileum. Using capsule endoscopy, the patient was diagnosed with acute extensive ischemic enteritis. Because endoscopic images of ischemic enteritis have rarely been reported, we report a case of a 21-year-old man who was diagnosed acute extensive ischemic enteritis with capsule endoscopy.
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Affiliation(s)
- Woo Seong Jeong
- Departments of Internal Medicine and Radiology, Jeju National University School of Medicine, Jeju, Korea
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