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Hirata I, Tsuboi A, Matsubara Y, Sumioka A, Takasago T, Tanaka H, Yamashita K, Takigawa H, Urabe Y, Oka S. Clinical usefulness and acceptability of small-bowel capsule endoscopy with panoramic imaging compared with axial imaging in Japanese patients. DEN OPEN 2025; 5:e389. [PMID: 38845631 PMCID: PMC11154819 DOI: 10.1002/deo2.389] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 03/26/2024] [Revised: 04/25/2024] [Accepted: 05/05/2024] [Indexed: 06/09/2024]
Abstract
Objectives We aimed to evaluate the usefulness and acceptability of CapsoCam Plus (CapsoCam) in Japanese patients. Methods This retrospective single-center study enrolled 930 patients with suspected small-bowel bleeding (SSBB) who underwent capsule endoscopy. Thirty-three patients using CapsoCam and PillCam SB3 (SB3) were matched using propensity score matching. The diagnostic yield and the acceptability of CapsoCam were evaluated. Results There was no SSBB case where capsule endoscopy was performed within 48 h of bleeding. CapsoCam had a significantly higher observation rate of the entire small bowel (97% vs. 73%, p = 0.006) and Vater's papilla (82% vs. 15%, p < 0.001) than SB3. The reading time of CapsoCam was significantly longer than that of SB3 (30 vs. 25 min, p < 0.001), and CapsoCam's time from the capsule endoscopy swallowing to read completion was longer than that of SB3 (37 vs. 12 h, p < 0.001). The two groups showed no difference in the capsule endoscopy findings according to the P classification. Notably, 85% of the patients using CapsoCam reported examination distress as "not at all" or "almost not," and 94% reported swallowing difficulty as "very easy" or "easy." Conclusions CapsoCam took time to read; however, it is a well-tolerated examination with a high observation rate of Vater's papilla and entire small-bowel mucosa. Detectability of bleeding sources was comparable in both modalities for cases of occult SSBB and overt SSBB more than 48 h after bleeding. CapsoCam is a useful modality for patients with SSBB.
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Affiliation(s)
- Issei Hirata
- Department of GastroenterologyGraduate School of Biomedical and Health SciencesHiroshima UniversityHiroshimaJapan
| | - Akiyoshi Tsuboi
- Department of GastroenterologyGraduate School of Biomedical and Health SciencesHiroshima UniversityHiroshimaJapan
| | - Yuka Matsubara
- Department of GastroenterologyGraduate School of Biomedical and Health SciencesHiroshima UniversityHiroshimaJapan
| | - Akihiko Sumioka
- Department of GastroenterologyGraduate School of Biomedical and Health SciencesHiroshima UniversityHiroshimaJapan
| | - Takeshi Takasago
- Department of GastroenterologyGraduate School of Biomedical and Health SciencesHiroshima UniversityHiroshimaJapan
| | - Hidenori Tanaka
- Department of GastroenterologyGraduate School of Biomedical and Health SciencesHiroshima UniversityHiroshimaJapan
| | - Ken Yamashita
- Department of GastroenterologyGraduate School of Biomedical and Health SciencesHiroshima UniversityHiroshimaJapan
| | - Hidehiko Takigawa
- Department of GastroenterologyGraduate School of Biomedical and Health SciencesHiroshima UniversityHiroshimaJapan
| | - Yuji Urabe
- Department of GastroenterologyGraduate School of Biomedical and Health SciencesHiroshima UniversityHiroshimaJapan
| | - Shiro Oka
- Department of GastroenterologyGraduate School of Biomedical and Health SciencesHiroshima UniversityHiroshimaJapan
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Babbar S, Debordeaux M. Examining the Impact of a GI Hospitalist Model on the Outcomes of Double-Balloon Enteroscopy: A Single-Center Retrospective Study. Dig Dis Sci 2024:10.1007/s10620-024-08552-0. [PMID: 38940976 DOI: 10.1007/s10620-024-08552-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/19/2024] [Accepted: 06/24/2024] [Indexed: 06/29/2024]
Abstract
BACKGROUND A GI hospitalist (GIH) is a physician who practices in the inpatient setting performing consultations and endoscopic procedures. Obscure small bowel bleeding is a common inpatient diagnosis that is difficult to manage and associated with longer hospitalizations. Having an onsite GIH physician with expertise in video capsule endoscopy (VCE) and double-balloon enteroscopy (DBE) has the potential to improve patient outcomes. AIMS This study will be the first to explore how implementing a GIH model and providing a GIH with training in DBE can affect the outcomes of patients with small bowel pathology. METHODS We performed a retrospective study of patients who received an inpatient DBE at an academic medical center before and after initiation of a GIH model and credentialing of a GIH in DBE. We compared outcomes, including procedure volumes, diagnostic and therapeutic yields, procedure duration, time to procedure, and length of stay. RESULTS There was a 46.5% increase in the number of DBEs performed by the GIH. The diagnostic yield increased from 56.3 to 74.0% (OR 2.2, 95% CI 1.2-4.2), and the proportion of DBEs with a therapeutic intervention increased from 38.0 to 65.4% (OR 3.1, 95% CI 1.4-7.0). The total procedure time increased from 77.8 to 96.4 min (p < 0.05) with a GIH. CONCLUSION Having a GIH perform inpatient DBEs was associated with an increased number of procedures, duration of procedures, diagnostic yield, and therapeutic interventions. The onsite presence of a GIH with competency in DBE improves the care of hospitalized patients with small bowel pathology.
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Affiliation(s)
- Shaili Babbar
- New York University Grossman School of Medicine, NYU Langone Health, 550 First Avenue, New York, NY, USA.
| | - Melissa Debordeaux
- Division of Gastroenterology & Hepatology, Department of Medicine, NYU Langone Health, New York, NY, USA
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3
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Saha B, Danielson AP, Mundell WC. 49-Year-Old Man With Melena and Abdominal Pain. Mayo Clin Proc 2024; 99:992-996. [PMID: 38520448 DOI: 10.1016/j.mayocp.2023.09.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/10/2023] [Revised: 09/04/2023] [Accepted: 09/06/2023] [Indexed: 03/25/2024]
Affiliation(s)
- Bibek Saha
- Resident in Internal Medicine, Mayo Clinic School of Graduate Medical Education, Rochester, MN
| | - Alex P Danielson
- Resident in Internal Medicine, Mayo Clinic School of Graduate Medical Education, Rochester, MN
| | - William C Mundell
- Advisor to residents and Consultant in Hospital Internal Medicine, Mayo Clinic, Rochester, MN.
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Damjanovska S, Karb D, Chen A, Margevicius S, Fu P, Isenberg G. Patients on Antithrombotic Agents with Small Bowel Bleeding -Yield of Small Bowel Capsule Endoscopy and Subsequent Management. Dig Dis Sci 2024; 69:2140-2146. [PMID: 38637455 PMCID: PMC11162371 DOI: 10.1007/s10620-024-08433-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/19/2024] [Accepted: 04/09/2024] [Indexed: 04/20/2024]
Abstract
BACKGROUND AND AIMS Small bowel gastrointestinal bleeding (GIB) is associated with multiple blood transfusions, prolonged and/or multiple hospital admissions, utilization of significant healthcare resources, and negative effects on patient quality of life. There is a well-recognized association between antithrombotic medications and small bowel GIB. We aimed to identify the diagnostic yield of small bowel capsule endoscopy (SBCE) in patients on antithrombotic medications and the impact of SBCE on treatment course. METHODS The electronic medical records of nineteen hundred eighty-six patients undergoing SBCE were retrospectively reviewed. RESULTS The diagnostic yield for detecting stigmata of recent bleeding and/or actively bleeding lesions in SBCE was higher in patients that were on antiplatelet agents (21.6%), patients on anticoagulation (22.5%), and in patients that had their SBCE performed while they were inpatient (21.8%), when compared to the patients not on antiplatelet agents (12.1%), patients not on anticoagulation (13.5%), and with patients that had their SBCE performed in the outpatient setting (12%). Of 318 patients who had stigmata of recent bleeding and/or actively bleeding lesion(s) identified on SBCE, SBCE findings prompted endoscopic evaluation (small bowel enteroscopy, esophagogastroduodenoscopy (EGD), and/or colonoscopy) in 25.2%, with endoscopic hemostasis attempted in 52.5%. CONCLUSIONS Our study, the largest conducted to date, emphasizes the importance of performing SBCE as part of the evaluation for suspected small bowel bleeding, particularly in patients taking antithrombotic therapy, and especially during their inpatient hospital stay.
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Affiliation(s)
- Sofi Damjanovska
- Division of Gastroenterology and Liver Disease, University Hospitals Cleveland Medical Center, Case Western Reserve University, 11100 Euclid Avenue, Cleveland, OH, 44106, USA.
| | - Daniel Karb
- Department of Gastroenterology, Hepatology and Nutrition, Cleveland Clinic, Cleveland, OH, USA
| | - Allen Chen
- School of Medicine, Case Western Reserve University, Cleveland, OH, USA
| | - Seunghee Margevicius
- Department of Population and Quantitative Health Sciences, School of Medicine, Case Western Reserve University, Cleveland, OH, USA
| | - Pingfu Fu
- Department of Population and Quantitative Health Sciences, School of Medicine, Case Western Reserve University, Cleveland, OH, USA
| | - Gerard Isenberg
- Division of Gastroenterology and Liver Disease, University Hospitals Cleveland Medical Center, Case Western Reserve University, 11100 Euclid Avenue, Cleveland, OH, 44106, USA
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Cacioppa LM, Floridi C, Bruno A, Rossini N, Valeri T, Borgheresi A, Inchingolo R, Cortese F, Novelli G, Felicioli A, Torresi M, Boscarato P, Ottaviani L, Giovagnoni A. Extravasated contrast volumetric assessment on computed tomography angiography in gastrointestinal bleeding: A useful predictor of positive angiographic findings. World J Radiol 2024; 16:115-127. [PMID: 38845606 PMCID: PMC11151896 DOI: 10.4329/wjr.v16.i5.115] [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: 01/30/2024] [Revised: 03/19/2024] [Accepted: 04/16/2024] [Indexed: 05/24/2024] Open
Abstract
BACKGROUND Gastrointestinal bleeding (GIB) is a severe and potentially life-threatening condition, especially in cases of delayed treatment. Computed tomography angiography (CTA) plays a pivotal role in the early identification of upper and lower GIB and in the prompt treatment of the haemorrhage. AIM To determine whether a volumetric estimation of the extravasated contrast at CTA in GIB may be a predictor of subsequent positive angiographic findings. METHODS In this retrospective single-centre study, 35 patients (22 men; median age 69 years; range 16-92 years) admitted to our institution for active GIB detected at CTA and further submitted to catheter angiography between January 2018 and February 2022 were enrolled. Twenty-three (65.7%) patients underwent endoscopy before CTA. Bleeding volumetry was evaluated in both arterial and venous phases via a semi-automated dedicated software. Bleeding rate was obtained from volume change between the two phases and standardised for unit time. Patients were divided into two groups, according to the angiographic signs and their concordance with CTA. RESULTS Upper bleeding accounted for 42.9% and lower GIB for 57.1%. Mean haemoglobin value at the admission was 7.7 g/dL. A concordance between positive CTA and direct angiographic bleeding signs was found in 19 (54.3%) cases. Despite no significant differences in terms of bleeding volume in the arterial phase (0.55 mL vs 0.33 mL, P = 0.35), a statistically significant volume increase in the venous phase was identified in the group of patients with positive angiography (2.06 mL vs 0.9 mL, P = 0.02). In the latter patient group, a significant increase in bleeding rate was also detected (2.18 mL/min vs 0.19 mL/min, P = 0.02). CONCLUSION In GIB of any origin, extravasated contrast volumetric analysis at CTA could be a predictor of positive angiography and may help in avoiding further unnecessary procedures.
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Affiliation(s)
- Laura Maria Cacioppa
- Division of Interventional Radiology, Department of Radiological Sciences, University Politecnica Delle Marche, Ancona 60126, Italy
- Department of Clinical, Special and Dental Sciences, University Politecnica Delle Marche, Ancona 60126, Italy
- Laura Maria Cacioppa and Chiara Floridi
| | - Chiara Floridi
- Division of Interventional Radiology, Department of Radiological Sciences, University Politecnica Delle Marche, Ancona 60126, Italy
- Department of Clinical, Special and Dental Sciences, University Politecnica Delle Marche, Ancona 60126, Italy
- Division of Radiology, Department of Radiological Sciences, University Hospital "Azienda Ospedaliero Universitaria Delle Marche", Ancona 60126, Italy
- Laura Maria Cacioppa and Chiara Floridi
| | - Alessandra Bruno
- Department of Clinical, Special and Dental Sciences, University Politecnica Delle Marche, Ancona 60126, Italy
| | - Nicolò Rossini
- Department of Clinical, Special and Dental Sciences, University Politecnica Delle Marche, Ancona 60126, Italy
| | - Tommaso Valeri
- Department of Clinical, Special and Dental Sciences, University Politecnica Delle Marche, Ancona 60126, Italy
| | - Alessandra Borgheresi
- Department of Clinical, Special and Dental Sciences, University Politecnica Delle Marche, Ancona 60126, Italy
| | - Riccardo Inchingolo
- Interventional Radiology Unit, "F Miulli" Regional General Hospital, Acquaviva delle Fonti 70021, Italy
| | - Francesco Cortese
- Interventional Radiology Unit, "F Miulli" Regional General Hospital, Acquaviva delle Fonti 70021, Italy
| | | | - Alessandro Felicioli
- Division of Interventional Radiology, Department of Radiological Sciences, University Politecnica Delle Marche, Ancona 60126, Italy
| | - Mario Torresi
- Division of Interventional Radiology, Department of Radiological Sciences, University Politecnica Delle Marche, Ancona 60126, Italy
| | - Pietro Boscarato
- Division of Interventional Radiology, Department of Radiological Sciences, University Politecnica Delle Marche, Ancona 60126, Italy
| | - Letizia Ottaviani
- Division of Radiology, Department of Radiological Sciences, University Hospital "Azienda Ospedaliero Universitaria Delle Marche", Ancona 60126, Italy
| | - Andrea Giovagnoni
- Department of Clinical, Special and Dental Sciences, University Politecnica Delle Marche, Ancona 60126, Italy
- Division of Radiology, Department of Radiological Sciences, University Hospital "Azienda Ospedaliero Universitaria Delle Marche", Ancona 60126, Italy
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Riccioni ME, Marmo C. Outpatient management of obscure gastrointestinal bleeding: A new perspective in high-risk patients. World J Gastroenterol 2024; 30:2502-2504. [PMID: 38817662 PMCID: PMC11135410 DOI: 10.3748/wjg.v30.i19.2502] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/17/2024] [Revised: 04/08/2024] [Accepted: 04/25/2024] [Indexed: 05/20/2024] Open
Abstract
Mid-gastrointestinal bleeding accounts for approximately 5%-10% of all gastrointestinal bleeding cases, and vascular lesions represent the most frequent cause. The rebleeding rate for these lesions is quite high (about 42%). We hereby recommend that scheduled outpatient management of these patients could reduce the risk of rebleeding episodes.
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Affiliation(s)
- Maria Elena Riccioni
- Digestive Endoscopy Unit, Fondazione Policlinico Universitario Agostino Gemelli, IRCCS, Università Cattolica del Sacro Cuore, Largo Agostino Gemelli, Rome 00168, Italy
| | - Clelia Marmo
- CEMAD Centro Malattie Dell’Apparato Digerente, Fondazione Policlinico Universitario Agostino Gemelli, IRCCS, Università Cattolica del Sacro Cuore, Largo Agostino Gemelli, Rome 00168, Italy
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7
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Nielsen AB, Jensen MD, Brodersen JB, Kjeldsen J, Laursen CB, Konge L, Laursen SB. More than 20 procedures are necessary to learn small bowel capsule endoscopy: Learning curve pilot study of 535 trainee cases. Endosc Int Open 2024; 12:E697-E703. [PMID: 38812698 PMCID: PMC11136552 DOI: 10.1055/a-2308-1613] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/27/2023] [Accepted: 03/13/2024] [Indexed: 05/31/2024] Open
Abstract
Background and study aims The number of procedures needed to acquire a sufficient level of skills to perform an unassisted evaluation of small bowel capsule endoscopy (SBCE) is unknown. We aimed to establish learning curves, diagnostic accuracy, and the number of procedures needed for reviewing small bowel capsule endoscopies unassisted. Methods An expert panel developed a 1-day course including lessons (examination, anatomy, and pathology) and hands-on training. After completing the course, participants received 50 cases in a randomized sequence. An interactive questionnaire about landmarks, findings, and diagnosis followed each case. After submitting the questionnaire, participants received feedback. Data are presented using CUSUM (cumulative sum control chart) learning curves and sensitivity/specificity analyses compared with expert opinions. Results We included 22 gastroenterologists from 11 different Danish hospitals. A total of 535 cases were reviewed (mean: 28; range: 11-50). CUSUM plots demonstrated learning progression for diagnosis and findings during the course, but none of the participants reached a learning plateau with sufficient competencies. The sensitivity for all findings was 65% (95% confidence interval [CI] 0.51-0.82) for the first 20 procedures and 67% (95% CI 0.58-0.73) from case 21 until completion or dropout. The specificity was 63% (95% CI 0.52-0.74) for the first 20 procedures and 57% (95% CI 0.37-0.77) for the rest. Conclusions Our data indicate that learning SBCE may be more difficult than previously recognized due to low discriminative abilities after 20 cases except for the identification of CD. This indicates that 20 SBCE cases may not be sufficient to achieve competency for reviewing SBCE without supervision.
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Affiliation(s)
- Anders Bo Nielsen
- Research Unit of Medical Education, Department of Clinical Research, University of Southern Denmark, Odense, Denmark
- Department of Medical Gastroenterology, Odense University Hospital, Odense, Denmark
- Research Unit of OPEN - Open Patient data Explorative Network, University of Southern Denmark Department of Clinical Research, Odense, Denmark
- Department of Anesthesiology and Intensive Care, Svendborg, Odense University Hospital, Odense, Denmark
| | - Michael Dam Jensen
- Department of Regional Health Research, University of Southern Denmark, Odense, Denmark
- Internal Medicine, Section of Gastroenterology, Hospital South West Jutland, Esbjerg, Denmark
| | - Jacob Broder Brodersen
- Department of Regional Health Research, University of Southern Denmark, Odense, Denmark
- Internal Medicine, Section of Gastroenterology, Hospital South West Jutland, Esbjerg, Denmark
| | - Jens Kjeldsen
- Department of Medical Gastroenterology, Odense University Hospital, Odense, Denmark
- University of Southern Denmark Department of Clinical Research, Odense, Denmark
| | - Christian B. Laursen
- Department of Respiratory Medicine, Odense University Hospital, Odense, Denmark
- Odense Respiratory Research Unit (ODIN), University of Southern Denmark Department of Clinical Research, Odense, Denmark
| | - Lars Konge
- Research Unit of Medical Education, Department of Clinical Research, University of Southern Denmark, Odense, Denmark
- Copenhagen Academy for Medical Education and Simulation, Capital Region of Denmark, Copenhagen, Denmark
| | - Stig Borbjerg Laursen
- Department of Medical Gastroenterology, Odense University Hospital, Odense, Denmark
- University of Southern Denmark Department of Clinical Research, Odense, Denmark
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Dagnesses Fonseca JO, Danes Grases JE, Luengo Batres P, Calvo Espino P. Digestive bleeding due to jejunal diverticula: diagnosis and management. BMJ Case Rep 2024; 17:e259089. [PMID: 38688577 PMCID: PMC11085889 DOI: 10.1136/bcr-2023-259089] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/02/2024] Open
Abstract
A jejunal diverticular haemorrhage is the second most common complication of jejunum diverticula. It can manifest clinically as acute upper gastrointestinal bleeding and is common to imitate acute rectal bleeding. Bleeding is usually associated with or without haemodynamic stability. Its diagnosis is challenging, requiring imaging examinations. Treatment is conservative management or surgery.
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Affiliation(s)
- Javier Oscar Dagnesses Fonseca
- General Surgery, Hospital Universitario de Móstoles, Madrid, Spain
- General Surgery, Universidad Francisco de Vitoria, Pozuelo de Alarcon, Spain
| | | | | | - Pablo Calvo Espino
- General Surgery, Hospital Universitario de Móstoles, Madrid, Spain
- General Surgery, Universidad Francisco de Vitoria, Pozuelo de Alarcon, Spain
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Martinov Nestorov J, Sokic-Milutinovic A, Pavlovic Markovic A, Krstic M. Could Capsule Endoscopy Be Useful in Detection of Suspected Small Bowel Bleeding and IBD-10 Years of Single Center Experience. Diagnostics (Basel) 2024; 14:862. [PMID: 38732278 PMCID: PMC11083052 DOI: 10.3390/diagnostics14090862] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2024] [Revised: 04/12/2024] [Accepted: 04/14/2024] [Indexed: 05/13/2024] Open
Abstract
A retrospective study in patients who underwent video capsule endoscopy (VCE) between 2006 and 2016 was conducted in the Clinic for gastroenterology and Hepatology, University Clinical Center of Serbia. A total of 245 patients underwent VCE. In 198 patients the indication was obscure gastrointestinal bleeding (OGIB), with 92 patients having overt and the other 106 occult bleeding. The remaining 47 patients underwent VCE due to suspected small bowel (SB) disease (i.e., Von Hippel-Lindau syndrome, familial adenomatous polyposis, Peutz Jeghers syndrome, Crohn's disease, prolonged diarrhea, abdominal pain, congenital lymphangiectasia, protein-losing enteropathy, tumors, refractory celiac disease, etc.). VCE identified a source of bleeding in 38.9% of patients (in the obscure overt group in 48.9% of patients, and in the obscure occult group in 30.2% of patients). The most common findings were angiodysplasias, tumors, Meckel's diverticulum and Crohn's disease. In the smaller group of patients with an indication other than OGIB, 38.3% of patients had positive VCE findings. The most common indication is OGIB, and the best candidates are patients with overt bleeding; patients with IBD should be evaluated in this setting.
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Affiliation(s)
- Jelena Martinov Nestorov
- School of Medicine, University of Belgrade, 11000 Belgrade, Serbia; (A.S.-M.); (A.P.M.); (M.K.)
- Clinic for Gastroenterology and Hepatology, University Clinical Center of Serbia, 11000 Belgrade, Serbia
| | - Aleksandra Sokic-Milutinovic
- School of Medicine, University of Belgrade, 11000 Belgrade, Serbia; (A.S.-M.); (A.P.M.); (M.K.)
- Clinic for Gastroenterology and Hepatology, University Clinical Center of Serbia, 11000 Belgrade, Serbia
| | - Aleksandra Pavlovic Markovic
- School of Medicine, University of Belgrade, 11000 Belgrade, Serbia; (A.S.-M.); (A.P.M.); (M.K.)
- Clinic for Gastroenterology and Hepatology, University Clinical Center of Serbia, 11000 Belgrade, Serbia
| | - Miodrag Krstic
- School of Medicine, University of Belgrade, 11000 Belgrade, Serbia; (A.S.-M.); (A.P.M.); (M.K.)
- Clinic for Gastroenterology and Hepatology, University Clinical Center of Serbia, 11000 Belgrade, Serbia
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Thakral D, Stein DJ, Saltzman JR. Diagnosis of Occult and Obscure Gastrointestinal Bleeding. Gastrointest Endosc Clin N Am 2024; 34:317-329. [PMID: 38395486 DOI: 10.1016/j.giec.2023.09.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/25/2024]
Abstract
Occult and obscure bleeding are challenging conditions to manage; however, recent advances in gastroenterology and endoscopy have improved our diagnostic and therapeutic capabilities. Obscure gastrointestinal (GI) bleeding is an umbrella category of bleeding of unknown origin that persists or recurs after endoscopic evaluation of the entire bowel fails to reveal a bleeding source. This review details the evaluation of patients with occult and obscure GI bleeding and offers diagnostic algorithms. The treatment of GI bleeding depends on the type and location of the bleeding lesion and an overview of how to manage these conditions is presented.
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Affiliation(s)
- Durga Thakral
- Division of Gastroenterology, Hepatology and Endoscopy, Brigham and Women's Hospital and Harvard Medical School, 75 Francis Street, Boston, MA 02115, USA
| | - Daniel Joseph Stein
- Division of Gastroenterology, Hepatology and Endoscopy, Brigham and Women's Hospital and Harvard Medical School, 75 Francis Street, Boston, MA 02115, USA
| | - John R Saltzman
- Division of Gastroenterology, Hepatology and Endoscopy, Brigham and Women's Hospital and Harvard Medical School, 75 Francis Street, Boston, MA 02115, USA.
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11
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Vargas-Potes CJ, Zapata-Vásquez IL, Rojas-Rojas NE, Rojas-Rodríguez CA. Clinical impact of capsule endoscopy on patients with suspected small bowel bleeding: Experience at a highly specialized hospital in Colombia. REVISTA DE GASTROENTEROLOGIA DE MEXICO (ENGLISH) 2024; 89:222-231. [PMID: 37833138 DOI: 10.1016/j.rgmxen.2023.04.014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/07/2022] [Accepted: 04/25/2023] [Indexed: 10/15/2023]
Abstract
INTRODUCTION AND AIMS Capsule endoscopy is part of the diagnostic approach to patients with suspected small bowel bleeding and data on its clinical impact are still limited in developing countries. The primary aim of the present study was to determine its impact on subsequent diagnostic and therapeutic decisions. MATERIAL AND METHODS A retrospective study was conducted that included all the patients that underwent capsule endoscopy with the PillCam™ SB 3 Capsule system due to suspected small bowel bleeding treated at the Hospital Universitario Fundación Valle del Lili between January 2011 and December 2020. RESULTS A total of 158 patients met the inclusion criteria. Mean patient age was 63 years (interquartile range [IQR], 52-74), 53.6% of the patients were women, and high blood pressure was the most frequent comorbidity (43.7%). The main indication was overt bleeding (58.2%). Of all the capsule endoscopies carried out, 63.9% showed lesions that were potentially responsible for bleeding. Medical or surgical treatment was indicated in 63.3% of the case total. Rebleeding at 6 months occurred in 15 patients and there were 2 deaths due to gastrointestinal bleeding at 6 months. CONCLUSIONS Capsule endoscopy has a high impact on patients with suspected small bowel bleeding, with respect to clinical decision-making, as well as rebleeding, hospitalization, and mortality outcomes. The positivity rate of lesions potentially responsible for bleeding was similar to that reported in developed countries.
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Affiliation(s)
- C J Vargas-Potes
- Departamento de Medicina Interna, Facultad de Ciencias de la Salud, Universidad Icesi, Cali, Valle del Cauca, Colombia.
| | - I L Zapata-Vásquez
- Centro de Investigaciones Clínicas (CIC), Fundación Valle del Lili, Cali, Valle del Cauca, Colombia
| | - N E Rojas-Rojas
- Centro de Investigaciones Clínicas (CIC), Fundación Valle del Lili, Cali, Valle del Cauca, Colombia
| | - C A Rojas-Rodríguez
- Departamento de Gastroenterología, Fundación Valle del Lili, Cali, Valle del Cauca, Colombia
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Ye YC, Sung KY, Chang TE, Wu PS, Wang YP, Luo JC, Hou MC, Lu CL. Early double-balloon enteroscopy was not related to better clinical outcomes in patients with suspected overt small bowel bleeding. J Chin Med Assoc 2024; 87:377-383. [PMID: 38335460 DOI: 10.1097/jcma.0000000000001067] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/12/2024] Open
Abstract
BACKGROUND Device-assisted enteroscopy has been used for over 20 years for the management of patients with suspected small bowel bleeding. Unlike esophagogastroduodenoscopy and colonoscopy, the appropriate timing of enteroscopy is still unknown. In recent guidelines, early enteroscopy is suggested to maximize diagnostic yield and therapeutic yield in patients with suspected small bowel bleeding. However, few studies have identified its influence on clinical outcomes, including mortality or rebleeding rate. We conducted this study to evaluate the influence of the timing of double-balloon enteroscopy on clinical outcomes in patients with suspected small bowel bleeding. METHODS Patients with overt small bowel bleeding who underwent double-balloon enteroscopy from January 2013 to February 2021 were retrospectively reviewed. Patients were categorized into an early enteroscopy group (≤14 days) and a nonearly enteroscopy group (>14 days). Clinical outcomes, including short-term mortality and rebleeding rate, long-term mortality and rebleeding rate, diagnostic yield, and therapeutic yield, were analyzed. RESULTS A total of 100 patients (mean age, 66.2 years; 53% male) were included, and 44 patients were stratified into the early enteroscopy group. The diagnostic yield, therapeutic yield, mortality, and rebleeding rate were similar between two groups. In multivariate conditional logistic regression analysis, there were no significant differences between two groups regarding the 30-day rebleeding rate (adjusted odds ratio [aOR], 1.43; 95% CI, 0.47-4.33), 90-day rebleeding rate (aOR, 1.18; 95% CI, 0.47-2.94), 30-day mortality rate (aOR, 1.29; 95% CI, 0.21-8.13), 90-day mortality rate (aOR, 1.94; 95% CI, 0.48-7.87), and 90-day bleeding-related mortality (aOR, 2.18; 95% CI, 0.24-19.52). The Kaplan-Meier survival curve analysis showed that the timing of DBE was not associated with the long-term rebleeding rate or mortality rate ( p = 0.57 and 0.83, respectively). CONCLUSION The timing of enteroscopy did not influence the clinical outcomes, including the short-term mortality rate, short-term rebleeding rate, long-term mortality rate, and rebleeding rate, in patients with suspected overt small bowel bleeding.
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Affiliation(s)
- Yong-Cheng Ye
- Endoscopy Center For Diagnosis and Treatment, Department of Medicine, Taipei Veterans General Hospital, Taipei, Taiwan, ROC
- Division of Gastroenterology, Department of Medicine, Taipei Veterans General Hospital, Taipei, Taiwan, ROC
- Faculty of Medicine, School of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan, ROC
| | - Kuan-Yi Sung
- Endoscopy Center For Diagnosis and Treatment, Department of Medicine, Taipei Veterans General Hospital, Taipei, Taiwan, ROC
- Division of Gastroenterology, Department of Medicine, Taipei Veterans General Hospital, Taipei, Taiwan, ROC
- Faculty of Medicine, School of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan, ROC
| | - Tien-En Chang
- Endoscopy Center For Diagnosis and Treatment, Department of Medicine, Taipei Veterans General Hospital, Taipei, Taiwan, ROC
- Division of Gastroenterology, Department of Medicine, Taipei Veterans General Hospital, Taipei, Taiwan, ROC
- Faculty of Medicine, School of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan, ROC
| | - Pei-Shan Wu
- Endoscopy Center For Diagnosis and Treatment, Department of Medicine, Taipei Veterans General Hospital, Taipei, Taiwan, ROC
- Division of Gastroenterology, Department of Medicine, Taipei Veterans General Hospital, Taipei, Taiwan, ROC
- Faculty of Medicine, School of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan, ROC
| | - Yen-Po Wang
- Endoscopy Center For Diagnosis and Treatment, Department of Medicine, Taipei Veterans General Hospital, Taipei, Taiwan, ROC
- Division of Gastroenterology, Department of Medicine, Taipei Veterans General Hospital, Taipei, Taiwan, ROC
- Faculty of Medicine, School of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan, ROC
- Institute of Brain Science, School of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan, ROC
| | - Jiing-Chyuan Luo
- Division of Gastroenterology, Department of Medicine, Taipei Veterans General Hospital, Taipei, Taiwan, ROC
- Faculty of Medicine, School of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan, ROC
| | - Ming-Chih Hou
- Endoscopy Center For Diagnosis and Treatment, Department of Medicine, Taipei Veterans General Hospital, Taipei, Taiwan, ROC
- Division of Gastroenterology, Department of Medicine, Taipei Veterans General Hospital, Taipei, Taiwan, ROC
- Faculty of Medicine, School of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan, ROC
| | - Ching-Liang Lu
- Endoscopy Center For Diagnosis and Treatment, Department of Medicine, Taipei Veterans General Hospital, Taipei, Taiwan, ROC
- Division of Gastroenterology, Department of Medicine, Taipei Veterans General Hospital, Taipei, Taiwan, ROC
- Faculty of Medicine, School of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan, ROC
- Institute of Brain Science, School of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan, ROC
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13
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Tojo A, Sujino T, Hayashi Y, Kamiya KJLL, Sato M, Hinako S, Yoshimatsu Y, Kinoshita S, Kiyohara H, Mikami Y, Takabayashi K, Kato M, Ogata H, Kanai T, Hosoe N. Video capsule endoscopy in overt and occult obscure gastrointestinal bleeding: Insights from a single-center, observational study in Japan. DEN OPEN 2024; 4:e354. [PMID: 38567032 PMCID: PMC10985219 DOI: 10.1002/deo2.354] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 12/08/2023] [Revised: 02/15/2024] [Accepted: 03/08/2024] [Indexed: 04/04/2024]
Abstract
Objective This study aimed to evaluate the use of video capsule endoscopy (VCE) in patients with obscure gastrointestinal bleeding (OGIB), compare cases of overt and occult OGIB, assess the rates of balloon-assisted enteroscopy (BAE) interventions and rebleeding, and identify predictive markers of positive VCE findings. Methods Medical records of 430 patients who underwent VCE for OGIB between 2004 and 2022 were analyzed. Occult OGIB was defined as IDA or positive fecal occult blood, whereas overt OGIB was defined as clinically imperceptible bleeding. We retrospectively analyzed demographics, VCE findings based on Saurin classification (P0, P1, and P2), outcome of BAE interventions, and rebleeding rates. Results A total of 253 patients with overt OGIB and 177 with occult OGIB were included. P1 findings were predominant in both groups, with a similar distribution. The percentage of patients receiving conservative therapy was higher in P1 than in P2 for both overt and occult OGIB. BAE was more frequently performed in P2 than in P1 VCE (83.0% vs. 35.3% in overt OGIB, 84.4% vs. 24.4% in occult OGIB). The percentage of positive findings and intervention in total BAE performed patients were comparable in P1 and P2 of overt OGIB, whereas these percentages in P2 were more than P1 of occult OGIB. Conclusion VCE effectively identified OGIB lesions requiring intervention, particularly occult OGIB lesions, potentially reducing unnecessary BAE. Rebleeding rates varied according to the VCE findings, emphasizing the importance of follow-up in high-risk patients.
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Affiliation(s)
- Anna Tojo
- Division of Gastroenterology and HepatologyDepartment of Internal MedicineSchool of MedicineKeio UniversityTokyoJapan
- Center for Diagnostic and Therapeutic EndoscopySchool of MedicineKeio UniversityTokyoJapan
| | - Tomohisa Sujino
- Center for Diagnostic and Therapeutic EndoscopySchool of MedicineKeio UniversityTokyoJapan
| | - Yukie Hayashi
- Division of Gastroenterology and HepatologyDepartment of Internal MedicineSchool of MedicineKeio UniversityTokyoJapan
- Center for Diagnostic and Therapeutic EndoscopySchool of MedicineKeio UniversityTokyoJapan
| | - Kenji J L Limpias Kamiya
- Division of Gastroenterology and HepatologyDepartment of Internal MedicineSchool of MedicineKeio UniversityTokyoJapan
| | - Moe Sato
- Division of Gastroenterology and HepatologyDepartment of Internal MedicineSchool of MedicineKeio UniversityTokyoJapan
- Center for Diagnostic and Therapeutic EndoscopySchool of MedicineKeio UniversityTokyoJapan
| | - Sakurai Hinako
- Division of Gastroenterology and HepatologyDepartment of Internal MedicineSchool of MedicineKeio UniversityTokyoJapan
- Center for Diagnostic and Therapeutic EndoscopySchool of MedicineKeio UniversityTokyoJapan
| | - Yusuke Yoshimatsu
- Division of Gastroenterology and HepatologyDepartment of Internal MedicineSchool of MedicineKeio UniversityTokyoJapan
| | | | - Hiroki Kiyohara
- Division of Gastroenterology and HepatologyDepartment of Internal MedicineSchool of MedicineKeio UniversityTokyoJapan
| | - Yohei Mikami
- Division of Gastroenterology and HepatologyDepartment of Internal MedicineSchool of MedicineKeio UniversityTokyoJapan
| | - Kaoru Takabayashi
- Center for Diagnostic and Therapeutic EndoscopySchool of MedicineKeio UniversityTokyoJapan
| | - Motohiko Kato
- Center for Diagnostic and Therapeutic EndoscopySchool of MedicineKeio UniversityTokyoJapan
| | - Haruhiko Ogata
- Center for Diagnostic and Therapeutic EndoscopySchool of MedicineKeio UniversityTokyoJapan
| | - Takanori Kanai
- Division of Gastroenterology and HepatologyDepartment of Internal MedicineSchool of MedicineKeio UniversityTokyoJapan
| | - Naoki Hosoe
- Center for Diagnostic and Therapeutic EndoscopySchool of MedicineKeio UniversityTokyoJapan
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14
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Banjoya S, Minato Y, Kimoto Y, Kano Y, Sakuno T, Ono K, Osawa M, Horiuchi H, Morikawa T, Ohata K. A case of small bowel aneurysm hemorrhage with submucosal tumor-like findings. DEN OPEN 2024; 4:e335. [PMID: 38264464 PMCID: PMC10803887 DOI: 10.1002/deo2.335] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 12/12/2023] [Revised: 01/05/2024] [Accepted: 01/11/2024] [Indexed: 01/25/2024]
Abstract
A 51-year-old woman visited our hospital with the chief complaint of tarry stools. Contrast-enhanced abdominal computed tomography revealed leakage of contrast medium into the lumen of the small intestine. Subsequently, a double-balloon endoscopy was performed, which revealed a submucosal mass-like lesion in the jejunum. Although hemostasis was attempted with clips, complete hemostasis was difficult to achieve, and angiographic embolization was performed. Nevertheless, the anemia progressed, and a small bowel resection was performed. Histopathological examination led to a diagnosis of a ruptured submucosal aneurysm of the small intestine. Endoscopic hemostasis is often difficult to achieve for submucosal aneurysms in the intestine. The submucosal tumor-like finding observed on endoscopy in submucosal aneurysms is termed an "SMT-like sign" and is considered an important finding to diagnose aneurysms.
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Affiliation(s)
- Susumu Banjoya
- Department of Gastrointestinal EndoscopyNTT Medical Center TokyoTokyoJapan
| | - Yohei Minato
- Department of Gastrointestinal EndoscopyNTT Medical Center TokyoTokyoJapan
| | - Yoshiaki Kimoto
- Department of Gastrointestinal EndoscopyNTT Medical Center TokyoTokyoJapan
| | - Yuki Kano
- Department of Gastrointestinal EndoscopyNTT Medical Center TokyoTokyoJapan
| | - Takashi Sakuno
- Department of Gastrointestinal EndoscopyNTT Medical Center TokyoTokyoJapan
| | - Kohei Ono
- Department of Gastrointestinal EndoscopyNTT Medical Center TokyoTokyoJapan
| | - Marie Osawa
- Department of RadiologyNTT Medical Center TokyoTokyoJapan
| | - Hajime Horiuchi
- Department of Diagnostic PathologyNTT Medical Center TokyoTokyoJapan
| | - Teppei Morikawa
- Department of Diagnostic PathologyNTT Medical Center TokyoTokyoJapan
| | - Ken Ohata
- Department of Gastrointestinal EndoscopyNTT Medical Center TokyoTokyoJapan
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15
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Damjanovska S, Isenberg G. Endoscopic Treatment of Small Bowel Bleeding. Gastrointest Endosc Clin N Am 2024; 34:331-343. [PMID: 38395487 DOI: 10.1016/j.giec.2023.09.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/25/2024]
Abstract
Approximately 5% of all gastrointestinal (GI) bleeding originates from the small bowel. Endoscopic therapy of small bowel bleeding should only be undertaken after consideration of the different options, and the risks, benefits, and alternatives of each option. Endoscopic therapy options for small bowel bleeding are like those treatments used for other forms of bleeding in the upper and lower GI tract. Available endoscopic treatment options include thermal therapy (eg, argon plasma coagulation and bipolar cautery), mechanical therapy (eg, hemoclips), and medical therapy (eg, diluted epinephrine injection). Patients with complicated comorbidities would benefit from evaluation and planning of available treatment options, including conservative and/or medical treatments, beyond endoscopic therapy.
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Affiliation(s)
- Sofi Damjanovska
- Department of Medicine, University Hospitals Cleveland Medical Center/Case Western Reserve University, 11100 Euclid Avenue, Cleveland, OH 44106, USA
| | - Gerard Isenberg
- Division of Gastroenterology and Liver Disease, University Hospitals Cleveland Medical Center/Case Western Reserve University, 11100 Euclid Avenue, Cleveland, OH 44106, USA.
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16
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Mulita F, Leivaditis V, Verras GI, Pitros C, Dimopoulos P, Katsakiori PF, Dafnomili D, Tchabashvili L, Tasios K, Kehagias D, Antzoulas A, Papadoulas S, Koletsis E. Secondary aortoenteric fistula: a narrative review of the view of the surgeon. Arch Med Sci Atheroscler Dis 2024; 9:e66-e71. [PMID: 38846053 PMCID: PMC11155463 DOI: 10.5114/amsad/186358] [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: 01/31/2024] [Accepted: 03/21/2024] [Indexed: 06/09/2024] Open
Abstract
Aortoenteric fistula (AEF) is defined as the abnormal communication between the aorta and the gastrointestinal tract. AEFs are divided into primary and secondary usually after abdominal aortic aneurysm (AAA) recovery and are a rare but quite dangerous cause of gastrointestinal bleeding that the general surgeon may face during his/her career. Secondary AEF was first described in 1953 to a 44-year-old woman 3 months after an AAA operation. This review presents the role of the surgeon in the management of secondary aortoenteric fistulas. AEFs are a rare but fatal gastrointestinal bleeding cause that the general surgeon may be asked to manage. Diagnosis requires the combination of strong clinical suspicion and the presence of a history of AAA surgery. Although a vascular surgery case, general surgeons play a role in choosing the technique of restoring the intestinal tract, which seems to be significantly related to subsequent morbidity and mortality.
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Affiliation(s)
- Francesk Mulita
- Department of Surgery, General University Hospital of Patras, Patras, Greece
| | - Vasileios Leivaditis
- Department of Cardiothoracic and Vascular Surgery, WestpfalzKlinikum, Kaiserslautern, Germany
| | | | - Christos Pitros
- Department of Vascular Surgery, General University Hospital of Patras, Patras, Greece
| | - Platon Dimopoulos
- Department of Interventional Radiology, General University Hospital of Patras, Patras, Greece
| | | | - Danai Dafnomili
- Department of Surgery, General University Hospital of Patras, Patras, Greece
| | - Levan Tchabashvili
- Department of Surgery, General University Hospital of Patras, Patras, Greece
| | - Konstantinos Tasios
- Department of Surgery, General University Hospital of Patras, Patras, Greece
| | - Dimitrios Kehagias
- Department of Surgery, General University Hospital of Patras, Patras, Greece
| | - Andreas Antzoulas
- Department of Surgery, General University Hospital of Patras, Patras, Greece
| | - Spyros Papadoulas
- Department of Vascular Surgery, General University Hospital of Patras, Patras, Greece
| | - Efstratios Koletsis
- Department of Cardiothoracic Surgery, General University Hospital of Patras, Patras, Greece
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17
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Ghoshal UC, Mishra P, Mathur A, Reddy SP, Fatima B, Misra A. Capsule endoscopy for obscure gastrointestinal bleed in the tropics: A single-center experience on 350 patients. Indian J Gastroenterol 2024:10.1007/s12664-024-01526-0. [PMID: 38517665 DOI: 10.1007/s12664-024-01526-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/24/2023] [Accepted: 01/03/2024] [Indexed: 03/24/2024]
Abstract
BACKGROUND Obscure gastrointestinal bleed (OGIB), now called small bowel bleed (SBB), comprises 5% to 10% of all gastrointestinal (GI) bleed episodes and capsule endoscopy (CE) is a tool for its evaluation. Studies on CE in a large sample of SBB patients from the tropics are limited. METHODS We did a retrospective analysis of a prospectively maintained database of patients with SBB undergoing CE using PillCam or MiroCam CE. RESULTS Of 350 patients (age 52.4 ± 17.4 years; 248 [70.9%] male) undergoing CE, 243 (69.4%) and 107 (30.6%) had overt and occult SBB, respectively. CE detected lesions in 244 (69.7%) patients (single lesion in 172 [49.1%]; multiple in 72 [20.6%]). The single lesions included vascular malformations (52, 14.9%), ulcer/erosion (47, 13.4%), tumor (24, 6.9%), hookworm (19, 5.4%), stricture (15, 4.3%), hemobilia (1, 0.3%) and blood without identifiable lesion (9, 2.6%). Of 72 with multiple lesions, ulcer with stricture was the commonest finding (n = 43, 12.3%). No abnormality was detected in 106 (30.3%) patients. The frequency of lesion detection was comparable among patients with overt and occult SBB (173/243, 71.2% vs. 71/107, 66.3%, respectively; p = 0.4). Younger patients (0 to 39 years) more often had multiple lesions on CE than the older (≥ 40 years) ones (26/76, 34.2% vs. 46/228, 20.2%, respectively; p = 0.001). CONCLUSION CE has a high diagnostic yield in SBB in the tropics, regardless of the type of bleed or of CE brand and the duration of recording. Multiple lesions associated with SBB are commoner among younger (< 40 years) patients.
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Affiliation(s)
- Uday C Ghoshal
- Department of Gastroenterology, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Raebareli Road, Lucknow, 226 014, India.
- Institute of Gastrosciences and Liver Transplantation, Apollo Multispeciality Hospitals, Kolkata, 700 054, India.
| | - Piyush Mishra
- Department of Gastroenterology, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Raebareli Road, Lucknow, 226 014, India
| | - Akash Mathur
- Department of Gastroenterology, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Raebareli Road, Lucknow, 226 014, India
| | - Sai Prathap Reddy
- Department of Gastroenterology, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Raebareli Road, Lucknow, 226 014, India
| | - Bushra Fatima
- Department of Gastroenterology, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Raebareli Road, Lucknow, 226 014, India
| | - Asha Misra
- Department of Gastroenterology, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Raebareli Road, Lucknow, 226 014, India
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18
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Sengupta N, Kastenberg DM, Bruining DH, Latorre M, Leighton JA, Brook OR, Wells ML, Guglielmo FF, Naringrekar HV, Gee MS, Soto JA, Park SH, Yoo DC, Ramalingam V, Huete A, Khandelwal A, Gupta A, Allen BC, Anderson MA, Dane BR, Sokhandon F, Grand DJ, Tse JR, Fidler JL. The Role of Imaging for GI Bleeding: ACG and SAR Consensus Recommendations. Radiology 2024; 310:e232298. [PMID: 38441091 DOI: 10.1148/radiol.232298] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/07/2024]
Abstract
Gastrointestinal (GI) bleeding is the most common GI diagnosis leading to hospitalization within the United States. Prompt diagnosis and treatment of GI bleeding is critical to improving patient outcomes and reducing high health care utilization and costs. Radiologic techniques including CT angiography, catheter angiography, CT enterography, MR enterography, nuclear medicine red blood cell scan, and technetium-99m pertechnetate scintigraphy (Meckel scan) are frequently used to evaluate patients with GI bleeding and are complementary to GI endoscopy. However, multiple management guidelines exist, which differ in the recommended utilization of these radiologic examinations. This variability can lead to confusion as to how these tests should be used in the evaluation of GI bleeding. In this document, a panel of experts from the American College of Gastroenterology and Society of Abdominal Radiology provide a review of the radiologic examinations used to evaluate for GI bleeding including nomenclature, technique, performance, advantages, and limitations. A comparison of advantages and limitations relative to endoscopic examinations is also included. Finally, consensus statements and recommendations on technical parameters and utilization of radiologic techniques for GI bleeding are provided. © Radiological Society of North America and the American College of Gastroenterology, 2024. Supplemental material is available for this article. This article is being published concurrently in American Journal of Gastroenterology and Radiology. The articles are identical except for minor stylistic and spelling differences in keeping with each journal's style. Citations from either journal can be used when citing this article. See also the editorial by Lockhart in this issue.
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Affiliation(s)
- Neil Sengupta
- From the Department of Gastroenterology and Hepatology, University of Chicago Pritzker School of Medicine, Chicago, Ill (N.S.); Department of Gastroenterology and Hepatology (D.M.K.) and Department of Radiology (F.F.G., H.V.N.), Thomas Jefferson University Hospital, Philadelphia, Pa; Department of Gastroenterology and Hepatology (D.H.B.) and Department of Radiology (M.L.W., A.K., J.L.F.), Mayo Clinic, 200 First St SW, Rochester, MN 55905; Department of Gastroenterology and Hepatology (M.L.) and Department of Radiology (B.R.D.), NYU Langone Medical Center, New York, NY; Department of Gastroenterology and Hepatology, Mayo Clinic Arizona, Scottsdale, Ariz (J.A.L.); Department of Radiology, Beth Israel Deaconess Medical Center, Boston, Mass (O.R.B., V.R.); Department of Radiology, Massachusetts General Hospital, Boston, Mass (M.S.G., M.A.A.); Department of Radiology, Boston University Medical Center, Boston, Mass (J.A.S., A.G.); Department of Radiology, Asan Medical Center, Seoul, South Korea (S.H.P.); Department of Radiology, Warren Alpert Medical School of Brown University, Rhode Island Hospital, Providence, RI (D.C.Y., D.J.G.); Department of Radiology, Pontificia Universidad Católica de Chile, Santiago, Chile (A.H.); Department of Radiology, Duke University Medical Center, Durham, NC (B.C.A.); Department of Radiology, William Beaumont University Hospital, Royal Oak, Mich (F.S.); and Department of Radiology, Stanford University School of Medicine, Stanford, Calif (J.R.T.)
| | - David M Kastenberg
- From the Department of Gastroenterology and Hepatology, University of Chicago Pritzker School of Medicine, Chicago, Ill (N.S.); Department of Gastroenterology and Hepatology (D.M.K.) and Department of Radiology (F.F.G., H.V.N.), Thomas Jefferson University Hospital, Philadelphia, Pa; Department of Gastroenterology and Hepatology (D.H.B.) and Department of Radiology (M.L.W., A.K., J.L.F.), Mayo Clinic, 200 First St SW, Rochester, MN 55905; Department of Gastroenterology and Hepatology (M.L.) and Department of Radiology (B.R.D.), NYU Langone Medical Center, New York, NY; Department of Gastroenterology and Hepatology, Mayo Clinic Arizona, Scottsdale, Ariz (J.A.L.); Department of Radiology, Beth Israel Deaconess Medical Center, Boston, Mass (O.R.B., V.R.); Department of Radiology, Massachusetts General Hospital, Boston, Mass (M.S.G., M.A.A.); Department of Radiology, Boston University Medical Center, Boston, Mass (J.A.S., A.G.); Department of Radiology, Asan Medical Center, Seoul, South Korea (S.H.P.); Department of Radiology, Warren Alpert Medical School of Brown University, Rhode Island Hospital, Providence, RI (D.C.Y., D.J.G.); Department of Radiology, Pontificia Universidad Católica de Chile, Santiago, Chile (A.H.); Department of Radiology, Duke University Medical Center, Durham, NC (B.C.A.); Department of Radiology, William Beaumont University Hospital, Royal Oak, Mich (F.S.); and Department of Radiology, Stanford University School of Medicine, Stanford, Calif (J.R.T.)
| | - David H Bruining
- From the Department of Gastroenterology and Hepatology, University of Chicago Pritzker School of Medicine, Chicago, Ill (N.S.); Department of Gastroenterology and Hepatology (D.M.K.) and Department of Radiology (F.F.G., H.V.N.), Thomas Jefferson University Hospital, Philadelphia, Pa; Department of Gastroenterology and Hepatology (D.H.B.) and Department of Radiology (M.L.W., A.K., J.L.F.), Mayo Clinic, 200 First St SW, Rochester, MN 55905; Department of Gastroenterology and Hepatology (M.L.) and Department of Radiology (B.R.D.), NYU Langone Medical Center, New York, NY; Department of Gastroenterology and Hepatology, Mayo Clinic Arizona, Scottsdale, Ariz (J.A.L.); Department of Radiology, Beth Israel Deaconess Medical Center, Boston, Mass (O.R.B., V.R.); Department of Radiology, Massachusetts General Hospital, Boston, Mass (M.S.G., M.A.A.); Department of Radiology, Boston University Medical Center, Boston, Mass (J.A.S., A.G.); Department of Radiology, Asan Medical Center, Seoul, South Korea (S.H.P.); Department of Radiology, Warren Alpert Medical School of Brown University, Rhode Island Hospital, Providence, RI (D.C.Y., D.J.G.); Department of Radiology, Pontificia Universidad Católica de Chile, Santiago, Chile (A.H.); Department of Radiology, Duke University Medical Center, Durham, NC (B.C.A.); Department of Radiology, William Beaumont University Hospital, Royal Oak, Mich (F.S.); and Department of Radiology, Stanford University School of Medicine, Stanford, Calif (J.R.T.)
| | - Melissa Latorre
- From the Department of Gastroenterology and Hepatology, University of Chicago Pritzker School of Medicine, Chicago, Ill (N.S.); Department of Gastroenterology and Hepatology (D.M.K.) and Department of Radiology (F.F.G., H.V.N.), Thomas Jefferson University Hospital, Philadelphia, Pa; Department of Gastroenterology and Hepatology (D.H.B.) and Department of Radiology (M.L.W., A.K., J.L.F.), Mayo Clinic, 200 First St SW, Rochester, MN 55905; Department of Gastroenterology and Hepatology (M.L.) and Department of Radiology (B.R.D.), NYU Langone Medical Center, New York, NY; Department of Gastroenterology and Hepatology, Mayo Clinic Arizona, Scottsdale, Ariz (J.A.L.); Department of Radiology, Beth Israel Deaconess Medical Center, Boston, Mass (O.R.B., V.R.); Department of Radiology, Massachusetts General Hospital, Boston, Mass (M.S.G., M.A.A.); Department of Radiology, Boston University Medical Center, Boston, Mass (J.A.S., A.G.); Department of Radiology, Asan Medical Center, Seoul, South Korea (S.H.P.); Department of Radiology, Warren Alpert Medical School of Brown University, Rhode Island Hospital, Providence, RI (D.C.Y., D.J.G.); Department of Radiology, Pontificia Universidad Católica de Chile, Santiago, Chile (A.H.); Department of Radiology, Duke University Medical Center, Durham, NC (B.C.A.); Department of Radiology, William Beaumont University Hospital, Royal Oak, Mich (F.S.); and Department of Radiology, Stanford University School of Medicine, Stanford, Calif (J.R.T.)
| | - Jonathan A Leighton
- From the Department of Gastroenterology and Hepatology, University of Chicago Pritzker School of Medicine, Chicago, Ill (N.S.); Department of Gastroenterology and Hepatology (D.M.K.) and Department of Radiology (F.F.G., H.V.N.), Thomas Jefferson University Hospital, Philadelphia, Pa; Department of Gastroenterology and Hepatology (D.H.B.) and Department of Radiology (M.L.W., A.K., J.L.F.), Mayo Clinic, 200 First St SW, Rochester, MN 55905; Department of Gastroenterology and Hepatology (M.L.) and Department of Radiology (B.R.D.), NYU Langone Medical Center, New York, NY; Department of Gastroenterology and Hepatology, Mayo Clinic Arizona, Scottsdale, Ariz (J.A.L.); Department of Radiology, Beth Israel Deaconess Medical Center, Boston, Mass (O.R.B., V.R.); Department of Radiology, Massachusetts General Hospital, Boston, Mass (M.S.G., M.A.A.); Department of Radiology, Boston University Medical Center, Boston, Mass (J.A.S., A.G.); Department of Radiology, Asan Medical Center, Seoul, South Korea (S.H.P.); Department of Radiology, Warren Alpert Medical School of Brown University, Rhode Island Hospital, Providence, RI (D.C.Y., D.J.G.); Department of Radiology, Pontificia Universidad Católica de Chile, Santiago, Chile (A.H.); Department of Radiology, Duke University Medical Center, Durham, NC (B.C.A.); Department of Radiology, William Beaumont University Hospital, Royal Oak, Mich (F.S.); and Department of Radiology, Stanford University School of Medicine, Stanford, Calif (J.R.T.)
| | - Olga R Brook
- From the Department of Gastroenterology and Hepatology, University of Chicago Pritzker School of Medicine, Chicago, Ill (N.S.); Department of Gastroenterology and Hepatology (D.M.K.) and Department of Radiology (F.F.G., H.V.N.), Thomas Jefferson University Hospital, Philadelphia, Pa; Department of Gastroenterology and Hepatology (D.H.B.) and Department of Radiology (M.L.W., A.K., J.L.F.), Mayo Clinic, 200 First St SW, Rochester, MN 55905; Department of Gastroenterology and Hepatology (M.L.) and Department of Radiology (B.R.D.), NYU Langone Medical Center, New York, NY; Department of Gastroenterology and Hepatology, Mayo Clinic Arizona, Scottsdale, Ariz (J.A.L.); Department of Radiology, Beth Israel Deaconess Medical Center, Boston, Mass (O.R.B., V.R.); Department of Radiology, Massachusetts General Hospital, Boston, Mass (M.S.G., M.A.A.); Department of Radiology, Boston University Medical Center, Boston, Mass (J.A.S., A.G.); Department of Radiology, Asan Medical Center, Seoul, South Korea (S.H.P.); Department of Radiology, Warren Alpert Medical School of Brown University, Rhode Island Hospital, Providence, RI (D.C.Y., D.J.G.); Department of Radiology, Pontificia Universidad Católica de Chile, Santiago, Chile (A.H.); Department of Radiology, Duke University Medical Center, Durham, NC (B.C.A.); Department of Radiology, William Beaumont University Hospital, Royal Oak, Mich (F.S.); and Department of Radiology, Stanford University School of Medicine, Stanford, Calif (J.R.T.)
| | - Michael L Wells
- From the Department of Gastroenterology and Hepatology, University of Chicago Pritzker School of Medicine, Chicago, Ill (N.S.); Department of Gastroenterology and Hepatology (D.M.K.) and Department of Radiology (F.F.G., H.V.N.), Thomas Jefferson University Hospital, Philadelphia, Pa; Department of Gastroenterology and Hepatology (D.H.B.) and Department of Radiology (M.L.W., A.K., J.L.F.), Mayo Clinic, 200 First St SW, Rochester, MN 55905; Department of Gastroenterology and Hepatology (M.L.) and Department of Radiology (B.R.D.), NYU Langone Medical Center, New York, NY; Department of Gastroenterology and Hepatology, Mayo Clinic Arizona, Scottsdale, Ariz (J.A.L.); Department of Radiology, Beth Israel Deaconess Medical Center, Boston, Mass (O.R.B., V.R.); Department of Radiology, Massachusetts General Hospital, Boston, Mass (M.S.G., M.A.A.); Department of Radiology, Boston University Medical Center, Boston, Mass (J.A.S., A.G.); Department of Radiology, Asan Medical Center, Seoul, South Korea (S.H.P.); Department of Radiology, Warren Alpert Medical School of Brown University, Rhode Island Hospital, Providence, RI (D.C.Y., D.J.G.); Department of Radiology, Pontificia Universidad Católica de Chile, Santiago, Chile (A.H.); Department of Radiology, Duke University Medical Center, Durham, NC (B.C.A.); Department of Radiology, William Beaumont University Hospital, Royal Oak, Mich (F.S.); and Department of Radiology, Stanford University School of Medicine, Stanford, Calif (J.R.T.)
| | - Flavius F Guglielmo
- From the Department of Gastroenterology and Hepatology, University of Chicago Pritzker School of Medicine, Chicago, Ill (N.S.); Department of Gastroenterology and Hepatology (D.M.K.) and Department of Radiology (F.F.G., H.V.N.), Thomas Jefferson University Hospital, Philadelphia, Pa; Department of Gastroenterology and Hepatology (D.H.B.) and Department of Radiology (M.L.W., A.K., J.L.F.), Mayo Clinic, 200 First St SW, Rochester, MN 55905; Department of Gastroenterology and Hepatology (M.L.) and Department of Radiology (B.R.D.), NYU Langone Medical Center, New York, NY; Department of Gastroenterology and Hepatology, Mayo Clinic Arizona, Scottsdale, Ariz (J.A.L.); Department of Radiology, Beth Israel Deaconess Medical Center, Boston, Mass (O.R.B., V.R.); Department of Radiology, Massachusetts General Hospital, Boston, Mass (M.S.G., M.A.A.); Department of Radiology, Boston University Medical Center, Boston, Mass (J.A.S., A.G.); Department of Radiology, Asan Medical Center, Seoul, South Korea (S.H.P.); Department of Radiology, Warren Alpert Medical School of Brown University, Rhode Island Hospital, Providence, RI (D.C.Y., D.J.G.); Department of Radiology, Pontificia Universidad Católica de Chile, Santiago, Chile (A.H.); Department of Radiology, Duke University Medical Center, Durham, NC (B.C.A.); Department of Radiology, William Beaumont University Hospital, Royal Oak, Mich (F.S.); and Department of Radiology, Stanford University School of Medicine, Stanford, Calif (J.R.T.)
| | - Haresh V Naringrekar
- From the Department of Gastroenterology and Hepatology, University of Chicago Pritzker School of Medicine, Chicago, Ill (N.S.); Department of Gastroenterology and Hepatology (D.M.K.) and Department of Radiology (F.F.G., H.V.N.), Thomas Jefferson University Hospital, Philadelphia, Pa; Department of Gastroenterology and Hepatology (D.H.B.) and Department of Radiology (M.L.W., A.K., J.L.F.), Mayo Clinic, 200 First St SW, Rochester, MN 55905; Department of Gastroenterology and Hepatology (M.L.) and Department of Radiology (B.R.D.), NYU Langone Medical Center, New York, NY; Department of Gastroenterology and Hepatology, Mayo Clinic Arizona, Scottsdale, Ariz (J.A.L.); Department of Radiology, Beth Israel Deaconess Medical Center, Boston, Mass (O.R.B., V.R.); Department of Radiology, Massachusetts General Hospital, Boston, Mass (M.S.G., M.A.A.); Department of Radiology, Boston University Medical Center, Boston, Mass (J.A.S., A.G.); Department of Radiology, Asan Medical Center, Seoul, South Korea (S.H.P.); Department of Radiology, Warren Alpert Medical School of Brown University, Rhode Island Hospital, Providence, RI (D.C.Y., D.J.G.); Department of Radiology, Pontificia Universidad Católica de Chile, Santiago, Chile (A.H.); Department of Radiology, Duke University Medical Center, Durham, NC (B.C.A.); Department of Radiology, William Beaumont University Hospital, Royal Oak, Mich (F.S.); and Department of Radiology, Stanford University School of Medicine, Stanford, Calif (J.R.T.)
| | - Michael S Gee
- From the Department of Gastroenterology and Hepatology, University of Chicago Pritzker School of Medicine, Chicago, Ill (N.S.); Department of Gastroenterology and Hepatology (D.M.K.) and Department of Radiology (F.F.G., H.V.N.), Thomas Jefferson University Hospital, Philadelphia, Pa; Department of Gastroenterology and Hepatology (D.H.B.) and Department of Radiology (M.L.W., A.K., J.L.F.), Mayo Clinic, 200 First St SW, Rochester, MN 55905; Department of Gastroenterology and Hepatology (M.L.) and Department of Radiology (B.R.D.), NYU Langone Medical Center, New York, NY; Department of Gastroenterology and Hepatology, Mayo Clinic Arizona, Scottsdale, Ariz (J.A.L.); Department of Radiology, Beth Israel Deaconess Medical Center, Boston, Mass (O.R.B., V.R.); Department of Radiology, Massachusetts General Hospital, Boston, Mass (M.S.G., M.A.A.); Department of Radiology, Boston University Medical Center, Boston, Mass (J.A.S., A.G.); Department of Radiology, Asan Medical Center, Seoul, South Korea (S.H.P.); Department of Radiology, Warren Alpert Medical School of Brown University, Rhode Island Hospital, Providence, RI (D.C.Y., D.J.G.); Department of Radiology, Pontificia Universidad Católica de Chile, Santiago, Chile (A.H.); Department of Radiology, Duke University Medical Center, Durham, NC (B.C.A.); Department of Radiology, William Beaumont University Hospital, Royal Oak, Mich (F.S.); and Department of Radiology, Stanford University School of Medicine, Stanford, Calif (J.R.T.)
| | - Jorge A Soto
- From the Department of Gastroenterology and Hepatology, University of Chicago Pritzker School of Medicine, Chicago, Ill (N.S.); Department of Gastroenterology and Hepatology (D.M.K.) and Department of Radiology (F.F.G., H.V.N.), Thomas Jefferson University Hospital, Philadelphia, Pa; Department of Gastroenterology and Hepatology (D.H.B.) and Department of Radiology (M.L.W., A.K., J.L.F.), Mayo Clinic, 200 First St SW, Rochester, MN 55905; Department of Gastroenterology and Hepatology (M.L.) and Department of Radiology (B.R.D.), NYU Langone Medical Center, New York, NY; Department of Gastroenterology and Hepatology, Mayo Clinic Arizona, Scottsdale, Ariz (J.A.L.); Department of Radiology, Beth Israel Deaconess Medical Center, Boston, Mass (O.R.B., V.R.); Department of Radiology, Massachusetts General Hospital, Boston, Mass (M.S.G., M.A.A.); Department of Radiology, Boston University Medical Center, Boston, Mass (J.A.S., A.G.); Department of Radiology, Asan Medical Center, Seoul, South Korea (S.H.P.); Department of Radiology, Warren Alpert Medical School of Brown University, Rhode Island Hospital, Providence, RI (D.C.Y., D.J.G.); Department of Radiology, Pontificia Universidad Católica de Chile, Santiago, Chile (A.H.); Department of Radiology, Duke University Medical Center, Durham, NC (B.C.A.); Department of Radiology, William Beaumont University Hospital, Royal Oak, Mich (F.S.); and Department of Radiology, Stanford University School of Medicine, Stanford, Calif (J.R.T.)
| | - Seong Ho Park
- From the Department of Gastroenterology and Hepatology, University of Chicago Pritzker School of Medicine, Chicago, Ill (N.S.); Department of Gastroenterology and Hepatology (D.M.K.) and Department of Radiology (F.F.G., H.V.N.), Thomas Jefferson University Hospital, Philadelphia, Pa; Department of Gastroenterology and Hepatology (D.H.B.) and Department of Radiology (M.L.W., A.K., J.L.F.), Mayo Clinic, 200 First St SW, Rochester, MN 55905; Department of Gastroenterology and Hepatology (M.L.) and Department of Radiology (B.R.D.), NYU Langone Medical Center, New York, NY; Department of Gastroenterology and Hepatology, Mayo Clinic Arizona, Scottsdale, Ariz (J.A.L.); Department of Radiology, Beth Israel Deaconess Medical Center, Boston, Mass (O.R.B., V.R.); Department of Radiology, Massachusetts General Hospital, Boston, Mass (M.S.G., M.A.A.); Department of Radiology, Boston University Medical Center, Boston, Mass (J.A.S., A.G.); Department of Radiology, Asan Medical Center, Seoul, South Korea (S.H.P.); Department of Radiology, Warren Alpert Medical School of Brown University, Rhode Island Hospital, Providence, RI (D.C.Y., D.J.G.); Department of Radiology, Pontificia Universidad Católica de Chile, Santiago, Chile (A.H.); Department of Radiology, Duke University Medical Center, Durham, NC (B.C.A.); Department of Radiology, William Beaumont University Hospital, Royal Oak, Mich (F.S.); and Department of Radiology, Stanford University School of Medicine, Stanford, Calif (J.R.T.)
| | - Don C Yoo
- From the Department of Gastroenterology and Hepatology, University of Chicago Pritzker School of Medicine, Chicago, Ill (N.S.); Department of Gastroenterology and Hepatology (D.M.K.) and Department of Radiology (F.F.G., H.V.N.), Thomas Jefferson University Hospital, Philadelphia, Pa; Department of Gastroenterology and Hepatology (D.H.B.) and Department of Radiology (M.L.W., A.K., J.L.F.), Mayo Clinic, 200 First St SW, Rochester, MN 55905; Department of Gastroenterology and Hepatology (M.L.) and Department of Radiology (B.R.D.), NYU Langone Medical Center, New York, NY; Department of Gastroenterology and Hepatology, Mayo Clinic Arizona, Scottsdale, Ariz (J.A.L.); Department of Radiology, Beth Israel Deaconess Medical Center, Boston, Mass (O.R.B., V.R.); Department of Radiology, Massachusetts General Hospital, Boston, Mass (M.S.G., M.A.A.); Department of Radiology, Boston University Medical Center, Boston, Mass (J.A.S., A.G.); Department of Radiology, Asan Medical Center, Seoul, South Korea (S.H.P.); Department of Radiology, Warren Alpert Medical School of Brown University, Rhode Island Hospital, Providence, RI (D.C.Y., D.J.G.); Department of Radiology, Pontificia Universidad Católica de Chile, Santiago, Chile (A.H.); Department of Radiology, Duke University Medical Center, Durham, NC (B.C.A.); Department of Radiology, William Beaumont University Hospital, Royal Oak, Mich (F.S.); and Department of Radiology, Stanford University School of Medicine, Stanford, Calif (J.R.T.)
| | - Vijay Ramalingam
- From the Department of Gastroenterology and Hepatology, University of Chicago Pritzker School of Medicine, Chicago, Ill (N.S.); Department of Gastroenterology and Hepatology (D.M.K.) and Department of Radiology (F.F.G., H.V.N.), Thomas Jefferson University Hospital, Philadelphia, Pa; Department of Gastroenterology and Hepatology (D.H.B.) and Department of Radiology (M.L.W., A.K., J.L.F.), Mayo Clinic, 200 First St SW, Rochester, MN 55905; Department of Gastroenterology and Hepatology (M.L.) and Department of Radiology (B.R.D.), NYU Langone Medical Center, New York, NY; Department of Gastroenterology and Hepatology, Mayo Clinic Arizona, Scottsdale, Ariz (J.A.L.); Department of Radiology, Beth Israel Deaconess Medical Center, Boston, Mass (O.R.B., V.R.); Department of Radiology, Massachusetts General Hospital, Boston, Mass (M.S.G., M.A.A.); Department of Radiology, Boston University Medical Center, Boston, Mass (J.A.S., A.G.); Department of Radiology, Asan Medical Center, Seoul, South Korea (S.H.P.); Department of Radiology, Warren Alpert Medical School of Brown University, Rhode Island Hospital, Providence, RI (D.C.Y., D.J.G.); Department of Radiology, Pontificia Universidad Católica de Chile, Santiago, Chile (A.H.); Department of Radiology, Duke University Medical Center, Durham, NC (B.C.A.); Department of Radiology, William Beaumont University Hospital, Royal Oak, Mich (F.S.); and Department of Radiology, Stanford University School of Medicine, Stanford, Calif (J.R.T.)
| | - Alvaro Huete
- From the Department of Gastroenterology and Hepatology, University of Chicago Pritzker School of Medicine, Chicago, Ill (N.S.); Department of Gastroenterology and Hepatology (D.M.K.) and Department of Radiology (F.F.G., H.V.N.), Thomas Jefferson University Hospital, Philadelphia, Pa; Department of Gastroenterology and Hepatology (D.H.B.) and Department of Radiology (M.L.W., A.K., J.L.F.), Mayo Clinic, 200 First St SW, Rochester, MN 55905; Department of Gastroenterology and Hepatology (M.L.) and Department of Radiology (B.R.D.), NYU Langone Medical Center, New York, NY; Department of Gastroenterology and Hepatology, Mayo Clinic Arizona, Scottsdale, Ariz (J.A.L.); Department of Radiology, Beth Israel Deaconess Medical Center, Boston, Mass (O.R.B., V.R.); Department of Radiology, Massachusetts General Hospital, Boston, Mass (M.S.G., M.A.A.); Department of Radiology, Boston University Medical Center, Boston, Mass (J.A.S., A.G.); Department of Radiology, Asan Medical Center, Seoul, South Korea (S.H.P.); Department of Radiology, Warren Alpert Medical School of Brown University, Rhode Island Hospital, Providence, RI (D.C.Y., D.J.G.); Department of Radiology, Pontificia Universidad Católica de Chile, Santiago, Chile (A.H.); Department of Radiology, Duke University Medical Center, Durham, NC (B.C.A.); Department of Radiology, William Beaumont University Hospital, Royal Oak, Mich (F.S.); and Department of Radiology, Stanford University School of Medicine, Stanford, Calif (J.R.T.)
| | - Ashish Khandelwal
- From the Department of Gastroenterology and Hepatology, University of Chicago Pritzker School of Medicine, Chicago, Ill (N.S.); Department of Gastroenterology and Hepatology (D.M.K.) and Department of Radiology (F.F.G., H.V.N.), Thomas Jefferson University Hospital, Philadelphia, Pa; Department of Gastroenterology and Hepatology (D.H.B.) and Department of Radiology (M.L.W., A.K., J.L.F.), Mayo Clinic, 200 First St SW, Rochester, MN 55905; Department of Gastroenterology and Hepatology (M.L.) and Department of Radiology (B.R.D.), NYU Langone Medical Center, New York, NY; Department of Gastroenterology and Hepatology, Mayo Clinic Arizona, Scottsdale, Ariz (J.A.L.); Department of Radiology, Beth Israel Deaconess Medical Center, Boston, Mass (O.R.B., V.R.); Department of Radiology, Massachusetts General Hospital, Boston, Mass (M.S.G., M.A.A.); Department of Radiology, Boston University Medical Center, Boston, Mass (J.A.S., A.G.); Department of Radiology, Asan Medical Center, Seoul, South Korea (S.H.P.); Department of Radiology, Warren Alpert Medical School of Brown University, Rhode Island Hospital, Providence, RI (D.C.Y., D.J.G.); Department of Radiology, Pontificia Universidad Católica de Chile, Santiago, Chile (A.H.); Department of Radiology, Duke University Medical Center, Durham, NC (B.C.A.); Department of Radiology, William Beaumont University Hospital, Royal Oak, Mich (F.S.); and Department of Radiology, Stanford University School of Medicine, Stanford, Calif (J.R.T.)
| | - Avneesh Gupta
- From the Department of Gastroenterology and Hepatology, University of Chicago Pritzker School of Medicine, Chicago, Ill (N.S.); Department of Gastroenterology and Hepatology (D.M.K.) and Department of Radiology (F.F.G., H.V.N.), Thomas Jefferson University Hospital, Philadelphia, Pa; Department of Gastroenterology and Hepatology (D.H.B.) and Department of Radiology (M.L.W., A.K., J.L.F.), Mayo Clinic, 200 First St SW, Rochester, MN 55905; Department of Gastroenterology and Hepatology (M.L.) and Department of Radiology (B.R.D.), NYU Langone Medical Center, New York, NY; Department of Gastroenterology and Hepatology, Mayo Clinic Arizona, Scottsdale, Ariz (J.A.L.); Department of Radiology, Beth Israel Deaconess Medical Center, Boston, Mass (O.R.B., V.R.); Department of Radiology, Massachusetts General Hospital, Boston, Mass (M.S.G., M.A.A.); Department of Radiology, Boston University Medical Center, Boston, Mass (J.A.S., A.G.); Department of Radiology, Asan Medical Center, Seoul, South Korea (S.H.P.); Department of Radiology, Warren Alpert Medical School of Brown University, Rhode Island Hospital, Providence, RI (D.C.Y., D.J.G.); Department of Radiology, Pontificia Universidad Católica de Chile, Santiago, Chile (A.H.); Department of Radiology, Duke University Medical Center, Durham, NC (B.C.A.); Department of Radiology, William Beaumont University Hospital, Royal Oak, Mich (F.S.); and Department of Radiology, Stanford University School of Medicine, Stanford, Calif (J.R.T.)
| | - Brian C Allen
- From the Department of Gastroenterology and Hepatology, University of Chicago Pritzker School of Medicine, Chicago, Ill (N.S.); Department of Gastroenterology and Hepatology (D.M.K.) and Department of Radiology (F.F.G., H.V.N.), Thomas Jefferson University Hospital, Philadelphia, Pa; Department of Gastroenterology and Hepatology (D.H.B.) and Department of Radiology (M.L.W., A.K., J.L.F.), Mayo Clinic, 200 First St SW, Rochester, MN 55905; Department of Gastroenterology and Hepatology (M.L.) and Department of Radiology (B.R.D.), NYU Langone Medical Center, New York, NY; Department of Gastroenterology and Hepatology, Mayo Clinic Arizona, Scottsdale, Ariz (J.A.L.); Department of Radiology, Beth Israel Deaconess Medical Center, Boston, Mass (O.R.B., V.R.); Department of Radiology, Massachusetts General Hospital, Boston, Mass (M.S.G., M.A.A.); Department of Radiology, Boston University Medical Center, Boston, Mass (J.A.S., A.G.); Department of Radiology, Asan Medical Center, Seoul, South Korea (S.H.P.); Department of Radiology, Warren Alpert Medical School of Brown University, Rhode Island Hospital, Providence, RI (D.C.Y., D.J.G.); Department of Radiology, Pontificia Universidad Católica de Chile, Santiago, Chile (A.H.); Department of Radiology, Duke University Medical Center, Durham, NC (B.C.A.); Department of Radiology, William Beaumont University Hospital, Royal Oak, Mich (F.S.); and Department of Radiology, Stanford University School of Medicine, Stanford, Calif (J.R.T.)
| | - Mark A Anderson
- From the Department of Gastroenterology and Hepatology, University of Chicago Pritzker School of Medicine, Chicago, Ill (N.S.); Department of Gastroenterology and Hepatology (D.M.K.) and Department of Radiology (F.F.G., H.V.N.), Thomas Jefferson University Hospital, Philadelphia, Pa; Department of Gastroenterology and Hepatology (D.H.B.) and Department of Radiology (M.L.W., A.K., J.L.F.), Mayo Clinic, 200 First St SW, Rochester, MN 55905; Department of Gastroenterology and Hepatology (M.L.) and Department of Radiology (B.R.D.), NYU Langone Medical Center, New York, NY; Department of Gastroenterology and Hepatology, Mayo Clinic Arizona, Scottsdale, Ariz (J.A.L.); Department of Radiology, Beth Israel Deaconess Medical Center, Boston, Mass (O.R.B., V.R.); Department of Radiology, Massachusetts General Hospital, Boston, Mass (M.S.G., M.A.A.); Department of Radiology, Boston University Medical Center, Boston, Mass (J.A.S., A.G.); Department of Radiology, Asan Medical Center, Seoul, South Korea (S.H.P.); Department of Radiology, Warren Alpert Medical School of Brown University, Rhode Island Hospital, Providence, RI (D.C.Y., D.J.G.); Department of Radiology, Pontificia Universidad Católica de Chile, Santiago, Chile (A.H.); Department of Radiology, Duke University Medical Center, Durham, NC (B.C.A.); Department of Radiology, William Beaumont University Hospital, Royal Oak, Mich (F.S.); and Department of Radiology, Stanford University School of Medicine, Stanford, Calif (J.R.T.)
| | - Bari R Dane
- From the Department of Gastroenterology and Hepatology, University of Chicago Pritzker School of Medicine, Chicago, Ill (N.S.); Department of Gastroenterology and Hepatology (D.M.K.) and Department of Radiology (F.F.G., H.V.N.), Thomas Jefferson University Hospital, Philadelphia, Pa; Department of Gastroenterology and Hepatology (D.H.B.) and Department of Radiology (M.L.W., A.K., J.L.F.), Mayo Clinic, 200 First St SW, Rochester, MN 55905; Department of Gastroenterology and Hepatology (M.L.) and Department of Radiology (B.R.D.), NYU Langone Medical Center, New York, NY; Department of Gastroenterology and Hepatology, Mayo Clinic Arizona, Scottsdale, Ariz (J.A.L.); Department of Radiology, Beth Israel Deaconess Medical Center, Boston, Mass (O.R.B., V.R.); Department of Radiology, Massachusetts General Hospital, Boston, Mass (M.S.G., M.A.A.); Department of Radiology, Boston University Medical Center, Boston, Mass (J.A.S., A.G.); Department of Radiology, Asan Medical Center, Seoul, South Korea (S.H.P.); Department of Radiology, Warren Alpert Medical School of Brown University, Rhode Island Hospital, Providence, RI (D.C.Y., D.J.G.); Department of Radiology, Pontificia Universidad Católica de Chile, Santiago, Chile (A.H.); Department of Radiology, Duke University Medical Center, Durham, NC (B.C.A.); Department of Radiology, William Beaumont University Hospital, Royal Oak, Mich (F.S.); and Department of Radiology, Stanford University School of Medicine, Stanford, Calif (J.R.T.)
| | - Farnoosh Sokhandon
- From the Department of Gastroenterology and Hepatology, University of Chicago Pritzker School of Medicine, Chicago, Ill (N.S.); Department of Gastroenterology and Hepatology (D.M.K.) and Department of Radiology (F.F.G., H.V.N.), Thomas Jefferson University Hospital, Philadelphia, Pa; Department of Gastroenterology and Hepatology (D.H.B.) and Department of Radiology (M.L.W., A.K., J.L.F.), Mayo Clinic, 200 First St SW, Rochester, MN 55905; Department of Gastroenterology and Hepatology (M.L.) and Department of Radiology (B.R.D.), NYU Langone Medical Center, New York, NY; Department of Gastroenterology and Hepatology, Mayo Clinic Arizona, Scottsdale, Ariz (J.A.L.); Department of Radiology, Beth Israel Deaconess Medical Center, Boston, Mass (O.R.B., V.R.); Department of Radiology, Massachusetts General Hospital, Boston, Mass (M.S.G., M.A.A.); Department of Radiology, Boston University Medical Center, Boston, Mass (J.A.S., A.G.); Department of Radiology, Asan Medical Center, Seoul, South Korea (S.H.P.); Department of Radiology, Warren Alpert Medical School of Brown University, Rhode Island Hospital, Providence, RI (D.C.Y., D.J.G.); Department of Radiology, Pontificia Universidad Católica de Chile, Santiago, Chile (A.H.); Department of Radiology, Duke University Medical Center, Durham, NC (B.C.A.); Department of Radiology, William Beaumont University Hospital, Royal Oak, Mich (F.S.); and Department of Radiology, Stanford University School of Medicine, Stanford, Calif (J.R.T.)
| | - David J Grand
- From the Department of Gastroenterology and Hepatology, University of Chicago Pritzker School of Medicine, Chicago, Ill (N.S.); Department of Gastroenterology and Hepatology (D.M.K.) and Department of Radiology (F.F.G., H.V.N.), Thomas Jefferson University Hospital, Philadelphia, Pa; Department of Gastroenterology and Hepatology (D.H.B.) and Department of Radiology (M.L.W., A.K., J.L.F.), Mayo Clinic, 200 First St SW, Rochester, MN 55905; Department of Gastroenterology and Hepatology (M.L.) and Department of Radiology (B.R.D.), NYU Langone Medical Center, New York, NY; Department of Gastroenterology and Hepatology, Mayo Clinic Arizona, Scottsdale, Ariz (J.A.L.); Department of Radiology, Beth Israel Deaconess Medical Center, Boston, Mass (O.R.B., V.R.); Department of Radiology, Massachusetts General Hospital, Boston, Mass (M.S.G., M.A.A.); Department of Radiology, Boston University Medical Center, Boston, Mass (J.A.S., A.G.); Department of Radiology, Asan Medical Center, Seoul, South Korea (S.H.P.); Department of Radiology, Warren Alpert Medical School of Brown University, Rhode Island Hospital, Providence, RI (D.C.Y., D.J.G.); Department of Radiology, Pontificia Universidad Católica de Chile, Santiago, Chile (A.H.); Department of Radiology, Duke University Medical Center, Durham, NC (B.C.A.); Department of Radiology, William Beaumont University Hospital, Royal Oak, Mich (F.S.); and Department of Radiology, Stanford University School of Medicine, Stanford, Calif (J.R.T.)
| | - Justin R Tse
- From the Department of Gastroenterology and Hepatology, University of Chicago Pritzker School of Medicine, Chicago, Ill (N.S.); Department of Gastroenterology and Hepatology (D.M.K.) and Department of Radiology (F.F.G., H.V.N.), Thomas Jefferson University Hospital, Philadelphia, Pa; Department of Gastroenterology and Hepatology (D.H.B.) and Department of Radiology (M.L.W., A.K., J.L.F.), Mayo Clinic, 200 First St SW, Rochester, MN 55905; Department of Gastroenterology and Hepatology (M.L.) and Department of Radiology (B.R.D.), NYU Langone Medical Center, New York, NY; Department of Gastroenterology and Hepatology, Mayo Clinic Arizona, Scottsdale, Ariz (J.A.L.); Department of Radiology, Beth Israel Deaconess Medical Center, Boston, Mass (O.R.B., V.R.); Department of Radiology, Massachusetts General Hospital, Boston, Mass (M.S.G., M.A.A.); Department of Radiology, Boston University Medical Center, Boston, Mass (J.A.S., A.G.); Department of Radiology, Asan Medical Center, Seoul, South Korea (S.H.P.); Department of Radiology, Warren Alpert Medical School of Brown University, Rhode Island Hospital, Providence, RI (D.C.Y., D.J.G.); Department of Radiology, Pontificia Universidad Católica de Chile, Santiago, Chile (A.H.); Department of Radiology, Duke University Medical Center, Durham, NC (B.C.A.); Department of Radiology, William Beaumont University Hospital, Royal Oak, Mich (F.S.); and Department of Radiology, Stanford University School of Medicine, Stanford, Calif (J.R.T.)
| | - Jeff L Fidler
- From the Department of Gastroenterology and Hepatology, University of Chicago Pritzker School of Medicine, Chicago, Ill (N.S.); Department of Gastroenterology and Hepatology (D.M.K.) and Department of Radiology (F.F.G., H.V.N.), Thomas Jefferson University Hospital, Philadelphia, Pa; Department of Gastroenterology and Hepatology (D.H.B.) and Department of Radiology (M.L.W., A.K., J.L.F.), Mayo Clinic, 200 First St SW, Rochester, MN 55905; Department of Gastroenterology and Hepatology (M.L.) and Department of Radiology (B.R.D.), NYU Langone Medical Center, New York, NY; Department of Gastroenterology and Hepatology, Mayo Clinic Arizona, Scottsdale, Ariz (J.A.L.); Department of Radiology, Beth Israel Deaconess Medical Center, Boston, Mass (O.R.B., V.R.); Department of Radiology, Massachusetts General Hospital, Boston, Mass (M.S.G., M.A.A.); Department of Radiology, Boston University Medical Center, Boston, Mass (J.A.S., A.G.); Department of Radiology, Asan Medical Center, Seoul, South Korea (S.H.P.); Department of Radiology, Warren Alpert Medical School of Brown University, Rhode Island Hospital, Providence, RI (D.C.Y., D.J.G.); Department of Radiology, Pontificia Universidad Católica de Chile, Santiago, Chile (A.H.); Department of Radiology, Duke University Medical Center, Durham, NC (B.C.A.); Department of Radiology, William Beaumont University Hospital, Royal Oak, Mich (F.S.); and Department of Radiology, Stanford University School of Medicine, Stanford, Calif (J.R.T.)
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19
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Alali AA, Almadi MA, Barkun AN. Review article: Advances in the management of lower gastrointestinal bleeding. Aliment Pharmacol Ther 2024; 59:632-644. [PMID: 38158721 DOI: 10.1111/apt.17859] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/01/2023] [Revised: 10/15/2023] [Accepted: 12/19/2023] [Indexed: 01/03/2024]
Abstract
BACKGROUND Lower gastrointestinal bleeding (LGIB) is a common emergency with substantial associated morbidity and mortality. Elective colonoscopy plays an essential role in management, with an even more important role for radiology in the acute setting. Recent advances in the management of patients with LGIB warrant review as the management has recently evolved. AIMS To provide a comprehensive and updated overview of advances in the approach to patients with LGIB METHODS: We performed a comprehensive literature search to examine the current data for this narrative review supplemented by expert opinion. RESULTS The incidence of LGIB is increasing worldwide, partly related to an ageing population and the increasing use of antithrombotics. Diverticulosis continues to be the most common aetiology of LGIB. Pre-endoscopic risk stratification tools, especially the Oakland score, can aid appropriate patient triage. Adequate resuscitation continues to form the basis of management, while appropriate management of antithrombotics is crucial to balance the risk of worsening bleeding against increased cardiovascular risk. Radiological imaging plays an essential role in the diagnosis and treatment of acute LGIB, especially among unstable patients. Colonoscopy remains the gold-standard test for the elective management of stable patients. CONCLUSIONS The management of LGIB has evolved significantly in recent years, with a shift towards radiological interventions for unstable patients while reserving elective colonoscopy for stable patients. A multidisciplinary approach is essential to optimise the outcomes of patients with LGIB.
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Affiliation(s)
- Ali A Alali
- Department of Medicine, Faculty of Medicine, Kuwait University, Jabriya, Kuwait
| | - Majid A Almadi
- Division of Gastroenterology, King Khalid University Hospital, King Saud University, Riyadh, Saudi Arabia
- Division of Gastroenterology, The McGill University Health Center, Montreal General Hospital, McGill University, Montreal, Canada
| | - Alan N Barkun
- Division of Gastroenterology, The McGill University Health Center, Montreal General Hospital, McGill University, Montreal, Canada
- Division of Clinical Epidemiology, The McGill University Health Center, Montreal General Hospital, McGill University, Montreal, Canada
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20
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Sengupta N, Kastenberg DM, Bruining DH, Latorre M, Leighton JA, Brook OR, Wells ML, Guglielmo FF, Naringrekar HV, Gee MS, Soto JA, Park SH, Yoo DC, Ramalingam V, Huete A, Khandelwal A, Gupta A, Allen BC, Anderson MA, Dane BR, Sokhandon F, Grand DJ, Tse JR, Fidler JL. The Role of Imaging for Gastrointestinal Bleeding: Consensus Recommendations From the American College of Gastroenterology and Society of Abdominal Radiology. Am J Gastroenterol 2024; 119:438-449. [PMID: 38857483 DOI: 10.14309/ajg.0000000000002631] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/05/2023] [Accepted: 12/12/2023] [Indexed: 06/12/2024]
Abstract
Gastrointestinal (GI) bleeding is the most common GI diagnosis leading to hospitalization within the United States. Prompt diagnosis and treatment of GI bleeding is critical to improving patient outcomes and reducing high healthcare utilization and costs. Radiologic techniques including computed tomography angiography, catheter angiography, computed tomography enterography, magnetic resonance enterography, nuclear medicine red blood cell scan, and technetium-99m pertechnetate scintigraphy (Meckel scan) are frequently used to evaluate patients with GI bleeding and are complementary to GI endoscopy. However, multiple management guidelines exist which differ in the recommended utilization of these radiologic examinations. This variability can lead to confusion as to how these tests should be used in the evaluation of GI bleeding. In this document, a panel of experts from the American College of Gastroenterology and Society of Abdominal Radiology provide a review of the radiologic examinations used to evaluate for GI bleeding including nomenclature, technique, performance, advantages, and limitations. A comparison of advantages and limitations relative to endoscopic examinations is also included. Finally, consensus statements and recommendations on technical parameters and utilization of radiologic techniques for GI bleeding are provided.
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Affiliation(s)
- Neil Sengupta
- Department of Gastroenterology and Hepatology, University of Chicago, Chicago, Illinois, USA
| | - David M Kastenberg
- Department of Gastroenterology and Hepatology, Thomas Jefferson University, Philadelphia, Pennsylvania, USA
| | - David H Bruining
- Department of Gastroenterology and Hepatology, Mayo Clinic, Rochester, Minnesota, USA
| | - Melissa Latorre
- Department of Gastroenterology and Hepatology, New York University Langone Health, New York City, New York, USA
| | - Jonathan A Leighton
- Department of Gastroenterology and Hepatology, Mayo Clinic, Scottsdale, Arizona, USA
| | - Olga R Brook
- Department of Radiology, Beth Israel Deaconess Medical Center, Boston, Massachusetts, USA
| | - Michael L Wells
- Department of Radiology, Mayo Clinic, Rochester, Minnesota, USA
| | - Flavius F Guglielmo
- Department of Radiology, Thomas Jefferson University, Philadelphia, Pennsylvania, USA
| | - Haresh V Naringrekar
- Department of Radiology, Thomas Jefferson University, Philadelphia, Pennsylvania, USA
| | - Michael S Gee
- Department of Radiology, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Jorge A Soto
- Department of Radiology, Boston University, Boston, Massachusetts, USA
| | - Seong Ho Park
- Department of Radiology, Asan Medical Center, Seoul, South Korea
| | - Don C Yoo
- Department of Radiology, Warren Alpert Medical School of Brown University, Providence, Rhode Island, USA
| | - Vijay Ramalingam
- Department of Radiology, Beth Israel Deaconess Medical Center, Boston, Massachusetts, USA
| | - Alvaro Huete
- Department of Radiology, Pontifical Catholic University of Chile, Santiago, Chile
| | | | - Avneesh Gupta
- Department of Radiology, Boston University, Boston, Massachusetts, USA
| | - Brian C Allen
- Department of Radiology, Duke University, Durham, North Carolina, USA
| | - Mark A Anderson
- Department of Radiology, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Bari R Dane
- Department of Radiology, New York University Langone Health, New York City, New York, USA
| | - Farnoosh Sokhandon
- Department of Radiology, William Beaumont University Hospital, Royal Oak, Michigan, USA
| | - David J Grand
- Department of Radiology, Warren Alpert Medical School of Brown University, Providence, Rhode Island, USA
| | - Justin R Tse
- Department of Radiology, Stanford University, Stanford, California, USA
| | - Jeff L Fidler
- Department of Radiology, Mayo Clinic, Rochester, Minnesota, USA
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21
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Jayant D, Goyal M, Thakur V, Sahu S, Babu B, Subbiah Nagaraj S, Tandup C, Behera A. Advanced and Metastatic Gastrointestinal Stromal Tumors Presenting With Surgical Emergencies Managed With Surgical Resection: A Case Series. Cureus 2024; 16:e53851. [PMID: 38465042 PMCID: PMC10924631 DOI: 10.7759/cureus.53851] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/03/2024] [Indexed: 03/12/2024] Open
Abstract
Advanced and metastatic gastrointestinal stromal tumors (GISTs) presenting with surgical emergencies are rare. Neoadjuvant imatinib being the treatment of choice for non-metastatic advanced disease with a proven role in downstaging the disease may not be feasible in patients presenting with bleeding and obstruction. We present a case series with retrospective analysis of a prospectively maintained database of patients with advanced and metastatic GISTs presenting with surgical emergencies. Clinical characteristics, imaging and endoscopic findings, surgical procedures, histological findings, and outcomes in these patients were studied. Four patients were included in this case series, with three males and one female (age range: 24-60 years). Two patients presented with melena; one with hemodynamic instability despite multiple blood transfusions underwent urgent exploratory laparotomy for bleeding gastric GIST, while the other underwent surgical exploration after careful evaluation given the recurrent, metastatic disease with a stable metabolic response on six months of imatinib. One patient with metastatic jejunal GIST who presented with an umbilical nodule and intestinal obstruction was given a trial of non-operative management for 72 hours, but due to non-resolution of obstruction, segmental jejunal en bloc resection with the dome of the urinary bladder with reconstruction and metastasectomy was needed. The patient with advanced gastric GIST who presented with gastric outlet obstruction was resuscitated, and an attempt of endoscopic naso-jejunal tube placement was tried, which failed, and exploration was needed. The mean length of hospital stay was 7.5 days. Histopathological examination confirmed GIST in all four patients with microscopic negative resection margins. All patients were started on imatinib with dose escalation to 800 mg in the patient with recurrent and metastatic disease; however, the patient with bleeding gastric GIST experienced severe adverse effects of imatinib and discontinued the drug shortly. All four patients are disease-free on follow-ups of 15 months, 48 months for the patient with advanced non-metastatic disease, and six and 24 months for the patients with metastatic disease. In the era of tyrosine kinase inhibitor (TKI) therapy for advanced and metastatic disease, upfront surgery is usually reserved for surgical emergencies only. Surgical resection, the cornerstone for the treatment of resectable GIST, may also be clinically relevant in metastatic settings, although it requires a careful and individualized approach.
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Affiliation(s)
- Divij Jayant
- General Surgery, Postgraduate Institute of Medical Education and Research, Chandigarh, IND
| | - Mrinal Goyal
- General Surgery, Postgraduate Institute of Medical Education and Research, Chandigarh, IND
| | - Vipul Thakur
- General Surgery, Postgraduate Institute of Medical Education and Research, Chandigarh, IND
| | - Swapnesh Sahu
- General Surgery, Postgraduate Institute of Medical Education and Research, Chandigarh, IND
| | - Basil Babu
- General Surgery, Postgraduate Institute of Medical Education and Research, Chandigarh, IND
| | - Satish Subbiah Nagaraj
- General Surgery, Postgraduate Institute of Medical Education and Research, Chandigarh, IND
| | - Cherring Tandup
- General Surgery, Postgraduate Institute of Medical Education and Research, Chandigarh, IND
| | - Arunanshu Behera
- General Surgery, Postgraduate Institute of Medical Education and Research, Chandigarh, IND
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22
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Tang D, Lim R, Korman L, Forbes J, Ellsbury K, Auh S, Trivedi A, Chen CC, Hughes M, Wank S. Performance of capsule endoscopy for the detection of small intestinal neuroendocrine tumors in familial carcinoid: a prospective single-site study. Gastrointest Endosc 2024; 99:227-236. [PMID: 37838323 DOI: 10.1016/j.gie.2023.08.024] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/02/2023] [Revised: 08/30/2023] [Accepted: 08/31/2023] [Indexed: 10/16/2023]
Abstract
BACKGROUND AND AIMS Small-bowel neuroendocrine tumors (NETs) are slow growing, clinically silent tumors whose prognosis depends on disease stage. Members of kindreds with a familial form of small intestinal NETs (SI-NETs) represent a high-risk population for whom early detection improves disease outcome. Our aim was to determine the utility of small-bowel capsule endoscopy (SB-CE) for screening high-risk asymptomatic relatives from kindreds with familial carcinoid. METHODS One hundred seventy-four asymptomatic subjects with a family history (≥2 family members) of SI-NETs were screened under Protocol NCT00646022, Natural History of Familial Carcinoid Tumor at the National Institutes of Health. All patients were imaged with SB-CE and 18fluoro-dihydroxphenylalanine (18F-DOPA) positron emission tomography (PET)/CT, and results were independently analyzed. Patients with a positive imaging study underwent surgical exploration. RESULTS Thirty-five of 174 asymptomatic subjects screened for SI-NETs were positive on either SB-CE or 18F-DOPA PET. Thirty-two of 35 patients with a positive study were confirmed at surgery. SB-CE was positive in 28 of 32 patients with confirmed tumors for a per-patient sensitivity of 87.5%. SB-CE had a specificity of 97.3% and a negative predictive value of 96.5%. The average tumor number and size were 7.7 and 5.0 mm, respectively, and 81.2% of patients had multiple tumors. 18F-DOPA PET/CT had a similar sensitivity of 84% versus surgery. CONCLUSIONS SB-CE is a sensitive and specific method comparable with 18F-DOPA PET/CT for screening high-risk patients with familial SI-NET. (Clinical trial registration number: NCT00646022.).
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Affiliation(s)
- Derek Tang
- Digestive Disease Branch, National Institutes of Health, Bethesda, Maryland, USA; Kaiser Permanente, Anaheim, California, USA
| | - Ramona Lim
- Digestive Disease Branch, National Institutes of Health, Bethesda, Maryland, USA; Division of Gastroenterology, Hepatology and Endoscopy, Brigham and Women's Hospital, Boston, Massachusetts, USA; Division of Population Sciences, Dana-Farber Cancer Institute, Boston, Massachusetts, USA; Harvard Medical School, Boston, Massachusetts, USA
| | - Louis Korman
- Digestive Disease Branch, National Institutes of Health, Bethesda, Maryland, USA
| | - Joanne Forbes
- Digestive Disease Branch, National Institutes of Health, Bethesda, Maryland, USA
| | - Kristen Ellsbury
- Digestive Disease Branch, National Institutes of Health, Bethesda, Maryland, USA
| | - Sungyoung Auh
- Office of the Clinical Director, National Institutes of Health, Bethesda, Maryland, USA
| | - Apurva Trivedi
- Digestive Disease Branch, National Institutes of Health, Bethesda, Maryland, USA; Hospital at Westlake Medical Center, Austin, Texas, USA
| | - Clara C Chen
- National Institute of Diabetes and Digestive and Kidney Diseases, Nuclear Medicine Division, Clinical Center, National Institutes of Health, Bethesda, Maryland, USA
| | - Marybeth Hughes
- Surgery Branch, National Cancer Institute, National Institutes of Health, Bethesda, Maryland, USA; Surgical Oncology, East Virginia Medical School, Norfolk, Virginia, USA
| | - Stephen Wank
- Digestive Disease Branch, National Institutes of Health, Bethesda, Maryland, USA
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Pohl J, Kahya S, Heise M, Faiss S, Müller N. [Episodic bleeding events due to arteriovenous malformation (AVM) in the region of the distal ileum in a young male patient]. INNERE MEDIZIN (HEIDELBERG, GERMANY) 2024; 65:172-175. [PMID: 37542011 DOI: 10.1007/s00108-023-01556-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 06/12/2023] [Indexed: 08/06/2023]
Abstract
We report the case of a 32-year-old male patient who presented with episodic, self-limiting gastrointestinal bleeding events. After both esophagogastroduodenoscopy (EGD) and colonoscopy remained unremarkable, capsule endoscopy revealed an unexplained mucosal lesion that presented as an ulcerated process on spiral enteroscopy. Appropriate enteroscopic ink marking was followed by surgical partial resection of the distal ileum, with histopathology revealing evidence of an arteriovenous malformation (AVM). This case emphasizes the importance of deep enteroscopy both in the diagnosis and to facilitate therapeutic resection in rare gastrointestinal bleeding events affecting young people.
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Affiliation(s)
- Jessica Pohl
- Bundeswehrkrankenhaus Berlin, Scharnhorststr. 13, 10115, Berlin, Deutschland.
| | - Serkut Kahya
- Bundeswehrkrankenhaus Berlin, Scharnhorststr. 13, 10115, Berlin, Deutschland
| | - Michael Heise
- Sana Klinikum Lichtenberg, 10365, Lichtenberg, Deutschland, Fanningerstraße 32
| | - Siegbert Faiss
- Sana Klinikum Lichtenberg, 10365, Lichtenberg, Deutschland, Fanningerstraße 32
| | - Nicole Müller
- Bundeswehrkrankenhaus Berlin, Scharnhorststr. 13, 10115, Berlin, Deutschland
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24
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Sey M, Hsia C, Jairath V. Thalidomide for Bleeding from Small-Intestinal Angiodysplasia. N Engl J Med 2024; 390:479-480. [PMID: 38294986 DOI: 10.1056/nejmc2314599] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/02/2024]
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25
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Hirata I, Tsuboi A, Matsubara Y, Sumioka A, Takasago T, Tanaka H, Yamashita K, Takigawa H, Kotachi T, Yuge R, Urabe Y, Oka S. Long-term outcomes of patients with obscure gastrointestinal bleeding after negative capsule endoscopy. J Gastroenterol Hepatol 2024; 39:165-171. [PMID: 37837361 DOI: 10.1111/jgh.16379] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/12/2023] [Revised: 09/15/2023] [Accepted: 09/28/2023] [Indexed: 10/16/2023]
Abstract
BACKGROUND AND AIM Although small-bowel capsule endoscopy (CE) is widely used for obscure gastrointestinal bleeding (OGIB), long-term outcomes for OGIB patients after negative CE remain unclear. Herein, we defined negative CE as P0 (no bleeding potential) or P1 (less likely to bleed), based on the P classification using CE. We aimed to clarify long-term outcomes of patients with OGIB after negative CE. METHODS This single-center observational study enrolled 461 consecutive patients with OGIB who underwent CE from March 2014 to October 2021 and were followed up for >1 year. We examined rebleeding rates and predictive factors. RESULTS Two hundred and twenty-four (49%) patients had P0, and 237 (51%) had P1 findings. Rebleeding occurred in 9% and 16% of patients in the P0 and P1 groups, respectively. Two patients in the P0 group and 15 in the P1 group showed rebleeding from the small bowel. The rate of small-bowel rebleeding was significantly lower in the P0 group than that in the P1 group (1% vs 6%, P = 0.002), as was the cumulative rebleeding rate (P = 0.004). In the multivariate analysis, history of endoscopic hemostasis (hazard ratio [HR] = 15.958, 95% confidence interval [CI]:4.950-51.447, P < 0.001) and P1 CE findings (HR = 9.989, 95% CI: 2.077-48.030, P = 0.004) were independently predicted small-bowel rebleeding. CONCLUSIONS OGIB with P0 CE findings rarely showed rebleeding from the small bowel. Rebleeding may occur in patients with OGIB. Patients with history of endoscopic hemostasis for small-bowel lesions or P1 CE findings should be followed up intensively.
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Affiliation(s)
- Issei Hirata
- Department of Gastroenterology, Graduate School of Biomedical and Health Sciences, Hiroshima University, Hiroshima, Japan
| | - Akiyoshi Tsuboi
- Department of Gastroenterology, Graduate School of Biomedical and Health Sciences, Hiroshima University, Hiroshima, Japan
| | - Yuka Matsubara
- Department of Gastroenterology, Graduate School of Biomedical and Health Sciences, Hiroshima University, Hiroshima, Japan
| | - Akihiko Sumioka
- Department of Gastroenterology, Graduate School of Biomedical and Health Sciences, Hiroshima University, Hiroshima, Japan
| | - Takeshi Takasago
- Department of Gastroenterology, Graduate School of Biomedical and Health Sciences, Hiroshima University, Hiroshima, Japan
| | - Hidenori Tanaka
- Department of Gastroenterology, Graduate School of Biomedical and Health Sciences, Hiroshima University, Hiroshima, Japan
| | - Ken Yamashita
- Department of Gastroenterology, Graduate School of Biomedical and Health Sciences, Hiroshima University, Hiroshima, Japan
| | - Hidehiko Takigawa
- Department of Gastroenterology, Graduate School of Biomedical and Health Sciences, Hiroshima University, Hiroshima, Japan
| | - Takahiro Kotachi
- Department of Gastroenterology, Graduate School of Biomedical and Health Sciences, Hiroshima University, Hiroshima, Japan
| | - Ryo Yuge
- Department of Gastroenterology, Graduate School of Biomedical and Health Sciences, Hiroshima University, Hiroshima, Japan
| | - Yuji Urabe
- Department of Gastrointestinal Endoscopy and Medicine, Hiroshima University Hospital, Hiroshima, Japan
| | - Shiro Oka
- Department of Gastroenterology, Graduate School of Biomedical and Health Sciences, Hiroshima University, Hiroshima, Japan
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Mohn F, Szwargulski P, Kaul MG, Graeser M, Mummert T, Krishnan KM, Knopp T, Adam G, Salamon J, Riedel C. Real-time multi-contrast magnetic particle imaging for the detection of gastrointestinal bleeding. Sci Rep 2023; 13:22976. [PMID: 38151569 PMCID: PMC10752888 DOI: 10.1038/s41598-023-50041-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2023] [Accepted: 12/14/2023] [Indexed: 12/29/2023] Open
Abstract
Gastrointestinal bleeding, as a potentially life-threatening condition, is typically diagnosed by radiation-based imaging modalities like computed tomography or more invasively catheter-based angiography. Endoscopy enables examination of the upper gastrointestinal tract and the colon but not of the entire small bowel. Magnetic Particle Imaging (MPI) enables non-invasive, volumetric imaging without ionizing radiation. The aim of this study was to evaluate the feasibility of detecting gastrointestinal bleeding by single- and multi-contrast MPI using human-sized organs. A 3D-printed small bowel phantom and porcine small bowel specimens were prepared with a defect within the bowel wall as the source of a bleeding. For multi-contrast MPI, the bowel lumen was filled with an intestinal tracer representing an orally administered tracer. MPI was performed to evaluate the fluid exchange between the vascular compartment of the bowel wall and the lumen while a blood pool tracer was applied. Leakage of the blood pool tracer was observed to the bowel lumen. Multi-contrast MPI enabled co-registration of both tracers at the same location within the bowel lumen indicating gastrointestinal bleeding. Single- and multi-contrast MPI are feasible to visualize gastrointestinal bleeding. Therefore, MPI might emerge as a useful tool for radiation-free detection of bleeding within the entire gastrointestinal tract.
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Affiliation(s)
- Fabian Mohn
- Section for Biomedical Imaging, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
- Institute for Biomedical Imaging, Hamburg University of Technology, Hamburg, Germany
| | - Patryk Szwargulski
- Section for Biomedical Imaging, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
- Institute for Biomedical Imaging, Hamburg University of Technology, Hamburg, Germany
| | - Michael G Kaul
- Department of Diagnostic and Interventional Radiology and Nuclear Medicine, University Medical Center Hamburg-Eppendorf, Martinistrasse 52, 20246, Hamburg, Germany
| | - Matthias Graeser
- Section for Biomedical Imaging, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
- Institute for Biomedical Imaging, Hamburg University of Technology, Hamburg, Germany
- Fraunhofer Research Institution for Individualized and Cell-based Medical Engineering, IMTE, Lübeck, Germany
- Institute of Medical Engineering, University of Lübeck, Lübeck, Germany
| | - Tobias Mummert
- Department of Diagnostic and Interventional Radiology and Nuclear Medicine, University Medical Center Hamburg-Eppendorf, Martinistrasse 52, 20246, Hamburg, Germany
| | - Kannan M Krishnan
- Department of Materials Science and Engineering, University of Washington, Seattle, USA
| | - Tobias Knopp
- Section for Biomedical Imaging, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
- Institute for Biomedical Imaging, Hamburg University of Technology, Hamburg, Germany
| | - Gerhard Adam
- Department of Diagnostic and Interventional Radiology and Nuclear Medicine, University Medical Center Hamburg-Eppendorf, Martinistrasse 52, 20246, Hamburg, Germany
| | - Johannes Salamon
- Department of Diagnostic and Interventional Radiology and Nuclear Medicine, University Medical Center Hamburg-Eppendorf, Martinistrasse 52, 20246, Hamburg, Germany
| | - Christoph Riedel
- Department of Diagnostic and Interventional Radiology and Nuclear Medicine, University Medical Center Hamburg-Eppendorf, Martinistrasse 52, 20246, Hamburg, Germany.
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Vulasala SS, Virarkar M, Gopireddy D, Waters R, Alkhasawneh A, Awad Z, Maxwell J, Ramani N, Kumar S, Onteddu N, Morani AC. Small Bowel Neuroendocrine Neoplasms-A Review. J Comput Assist Tomogr 2023:00004728-990000000-00270. [PMID: 38110305 DOI: 10.1097/rct.0000000000001541] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2023]
Abstract
ABSTRACT Neuroendocrine neoplasms (NENs) are rapidly evolving small bowel tumors, and the patients are asymptomatic at the initial stages. Metastases are commonly observed at the time of presentation and diagnosis. This review addresses the small bowel NEN (SB-NEN) and its molecular, histological, and imaging features, which aid diagnosis and therapy guidance. Somatic cell number alterations and epigenetic mutations are studied to be responsible for sporadic and familial SB-NEN. The review also describes the grading of SB-NEN in addition to rare histological findings such as mixed neuroendocrine-non-NENs. Anatomic and nuclear imaging with conventional computed tomography, magnetic resonance imaging, computed tomographic enterography, and positron emission tomography are adopted in clinical practice for diagnosing, staging, and follow-up of NEN. Along with the characteristic imaging features of SB-NEN, the therapeutic aspects of imaging, such as peptide receptor radionuclide therapy, are discussed in this review.
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Affiliation(s)
- Sai Swarupa Vulasala
- From the Department of Radiology, University of Florida College of Medicine, Jacksonville
| | - Mayur Virarkar
- Department of Radiology, University of Florida College of Medicine, Jacksonville, FL
| | - Dheeraj Gopireddy
- Department of Radiology, University of Florida College of Medicine, Jacksonville, FL
| | - Rebecca Waters
- Department of Pathology, University of Texas MD Anderson Cancer Center, Houston, TX
| | | | - Ziad Awad
- Surgery, University of Florida College of Medicine, Jacksonville, FL
| | - Jessica Maxwell
- Department of Surgical Oncology, University of Texas MD Anderson Cancer Center
| | - Nisha Ramani
- Department of Pathology, Michael E. DeBakey VA Medical Center, Houston, TX
| | - Sindhu Kumar
- Department of Radiology, University of Florida College of Medicine, Jacksonville, FL
| | - Nirmal Onteddu
- Department of Internal Medicine, University of Florida College of Medicine, Jacksonville, FL
| | - Ajaykumar C Morani
- Department of Diagnostic Radiology, University of Texas MD Anderson Cancer Center, Houston, TX
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Xiao NJ, Ning SB. Application of balloon-assisted enteroscopy in treatment of small intestinal diseases. Shijie Huaren Xiaohua Zazhi 2023; 31:960-964. [DOI: 10.11569/wcjd.v31.i23.960] [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: 09/28/2023] [Revised: 11/01/2023] [Accepted: 11/19/2023] [Indexed: 12/08/2023] Open
Abstract
This review focuses on the application of balloon-assisted enteroscopy in the treatment of small bowel diseases which mainly include small bowel bleeding, benign small bowel stenosis, benign small bowel tumors, malignant small bowel obstruction, and foreign body retention in the small intestine. The operations involved in the treatments for those diseases include enteroscopic sclerotherapy injection, argon plasma coagulation, and endoscopic clip ligation; endoscopic balloon dilation and endoscopic stricturotomy; endoscopic mucosal resection, endoscopic submucosal dissection, and endoscopic full-thickness resection; and self-expanding metal stent placement and small intestinal foreign body retrieval, respectively.
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Affiliation(s)
- Nian-Jun Xiao
- Department of Gastroenterology and Hepatology, Air Force Medical Center, Air Force Medical University, Beijing 100142, China
| | - Shou-Bin Ning
- Department of Gastroenterology and Hepatology, Air Force Medical Center, Air Force Medical University, Beijing 100142, China
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Kessler J, Pham R, Pedersoli F, Ma H, Boas FE, Kidambi TD. Computed Tomography Angiography and Conventional Angiography for the Diagnosis and Treatment of Non-variceal Gastrointestinal Bleeding at a Tertiary Cancer Center. Cureus 2023; 15:e51031. [PMID: 38264383 PMCID: PMC10804205 DOI: 10.7759/cureus.51031] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/24/2023] [Indexed: 01/25/2024] Open
Abstract
INTRODUCTION To evaluate the diagnostic value of computed tomography angiography (CTA) and conventional angiography (CA) and the therapeutic value of transarterial embolization for acute gastrointestinal bleeding in patients with malignancy. METHODS A retrospective review of 100 patients who underwent CTA and/or CA for gastrointestinal bleeding at a comprehensive cancer center between the years 2011-2021 was performed. Clinical and patient outcome data were collected and analyzed using Kruskal-Wallis tests for continuous variables and chi-square tests or Fisher's exact tests (whichever is appropriate) for categorical variables in univariate analysis. All tests were two-sided at a significance level of 0.05. Analyses were performed using SAS version 9.4 (SAS Institute, Cary, NC). RESULTS Fifty-two percent of our patients underwent CTA alone, 29% underwent CA alone, and 19% underwent both procedures. Overall, CTA was positive in 11.3% (8/71) of patients and CA was positive in 22.9% (11/38) of patients. Of patients who underwent both studies, 52.6% (10/19) were positive for both. ICU admission was associated with CTA and/or CA positivity (p=0.015). Of 48 patients with data for embolization, 50% of patients underwent transarterial embolization for bleeding, 11 patients had identifiable bleeding on CA, and 13 patients underwent prophylactic embolization at the site of suspected bleeding. Rebleeding following embolization was found in 33.3% (8/24) of patients, including six patients who underwent prophylactic embolization and two patients who were treated for visualized bleeding. CONCLUSION CTA and CA are two critical studies for patients with GI bleeding and a history of malignancy. Neither alone can effectively exclude an identifiable source of bleeding. In patients with a history of malignancy, transarterial embolization may be an effective treatment of both angiographically visible and occult sources of GI bleeding.
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Affiliation(s)
- Jonathan Kessler
- Department of Radiology, City of Hope Comprehensive Cancer Center, Duarte, USA
| | - Richard Pham
- School of Medicine, University of California Riverside School of Medicine, Riverside, USA
| | - Frederico Pedersoli
- Department of Radiology, City of Hope Comprehensive Cancer Center, Duarte, USA
| | - Huiyan Ma
- Department of Epidemiology and Statistics, City of Hope Comprehensive Cancer Center, Duarte, USA
| | - F Edward Boas
- Department of Radiology, City of Hope Comprehensive Cancer Center, Duarte, USA
| | - Trilokesh D Kidambi
- Department of Medicine, Division of Gastroenterology, City of Hope Comprehensive Cancer Center, Duarte, USA
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Affiliation(s)
- Loren Laine
- From Yale School of Medicine, New Haven, and Veterans Affairs Connecticut Healthcare System, West Haven - both in Connecticut
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Chen H, Wu S, Tang M, Zhao R, Zhang Q, Dai Z, Gao Y, Yang S, Li Z, Du Y, Yang A, Zhong L, Lu L, Xu L, Shen X, Liu S, Zhong J, Li X, Lu H, Xiong H, Shen Y, Chen H, Gong S, Xue H, Ge Z. Thalidomide for Recurrent Bleeding Due to Small-Intestinal Angiodysplasia. N Engl J Med 2023; 389:1649-1659. [PMID: 37913505 DOI: 10.1056/nejmoa2303706] [Citation(s) in RCA: 7] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/03/2023]
Abstract
BACKGROUND Recurrent bleeding from the small intestine accounts for 5 to 10% of cases of gastrointestinal bleeding and remains a therapeutic challenge. Thalidomide has been evaluated for the treatment of recurrent bleeding due to small-intestinal angiodysplasia (SIA), but confirmatory trials are lacking. METHODS We conducted a multicenter, double-blind, randomized, placebo-controlled trial to investigate the efficacy and safety of thalidomide for the treatment of recurrent bleeding due to SIA. Eligible patients with recurrent bleeding (at least four episodes of bleeding during the previous year) due to SIA were randomly assigned to receive thalidomide at an oral daily dose of 100 mg or 50 mg or placebo for 4 months. Patients were followed for at least 1 year after the end of the 4-month treatment period. The primary end point was effective response, which was defined as a reduction of at least 50% in the number of bleeding episodes that occurred during the year after the end of thalidomide treatment as compared with the number that occurred during the year before treatment. Key secondary end points were cessation of bleeding without rebleeding, blood transfusion, hospitalization because of bleeding, duration of bleeding, and hemoglobin levels. RESULTS Overall, 150 patients underwent randomization: 51 to the 100-mg thalidomide group, 49 to the 50-mg thalidomide group, and 50 to the placebo group. The percentages of patients with an effective response in the 100-mg thalidomide group, 50-mg thalidomide group, and placebo group were 68.6%, 51.0%, and 16.0%, respectively (P<0.001 for simultaneous comparison across the three groups). The results of the analyses of the secondary end points supported those of the primary end point. Adverse events were more common in the thalidomide groups than in the placebo group overall; specific events included constipation, somnolence, limb numbness, peripheral edema, dizziness, and elevated liver-enzyme levels. CONCLUSIONS In this placebo-controlled trial, treatment with thalidomide resulted in a reduction in bleeding in patients with recurrent bleeding due to SIA. (Funded by the National Natural Science Foundation of China and the Shanghai Municipal Education Commission, Gaofeng Clinical Medicine; ClinicalTrials.gov number, NCT02707484.).
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Affiliation(s)
- Huimin Chen
- From the Division of Gastroenterology and Hepatology, Shanghai Jiao-Tong University School of Medicine Renji Hospital, Shanghai Institute of Digestive Disease, Key Laboratory of Gastroenterology and Hepatology, Ministry of Health (Shanghai Jiao-Tong University) (Huimin Chen, S.W., M.T., R.Z., Q.Z., Z.D., Y.G., X.L., H.L., H. Xiong, Y.S., Haiying Chen, S.G., H. Xue, Z.G.), the Department of Gastroenterology and Hepatology, Changhai Hospital, Naval Medical University (Z.L., Y.D.), the Department of Gastroenterology, Huashan Hospital (L.Z.), and the Department of Gastroenterology and Hepatology, Zhongshan Hospital (X.S.), Fudan University, the Department of Gastroenterology, Shanghai General Hospital, Shanghai Jiao-Tong University School of Medicine (L.L.), the Department of Gastroenterology, Xinhua Hospital, Shanghai Jiao-Tong University School of Medicine (L.X.), and the Department of Gastroenterology, Ruijin Hospital, Shanghai Jiao-Tong University School of Medicine (J.Z.), Shanghai, the Department of Gastroenterology, Xinqiao Hospital, Army Medical University, Chongqing (S.Y.), the Department of Gastroenterology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing (A.Y.), and the Department of Gastroenterology, Guangdong Provincial Key Laboratory of Gastroenterology, Nanfang Hospital, Southern Medical University, Guangzhou (S.L.) - all in China
| | - Shan Wu
- From the Division of Gastroenterology and Hepatology, Shanghai Jiao-Tong University School of Medicine Renji Hospital, Shanghai Institute of Digestive Disease, Key Laboratory of Gastroenterology and Hepatology, Ministry of Health (Shanghai Jiao-Tong University) (Huimin Chen, S.W., M.T., R.Z., Q.Z., Z.D., Y.G., X.L., H.L., H. Xiong, Y.S., Haiying Chen, S.G., H. Xue, Z.G.), the Department of Gastroenterology and Hepatology, Changhai Hospital, Naval Medical University (Z.L., Y.D.), the Department of Gastroenterology, Huashan Hospital (L.Z.), and the Department of Gastroenterology and Hepatology, Zhongshan Hospital (X.S.), Fudan University, the Department of Gastroenterology, Shanghai General Hospital, Shanghai Jiao-Tong University School of Medicine (L.L.), the Department of Gastroenterology, Xinhua Hospital, Shanghai Jiao-Tong University School of Medicine (L.X.), and the Department of Gastroenterology, Ruijin Hospital, Shanghai Jiao-Tong University School of Medicine (J.Z.), Shanghai, the Department of Gastroenterology, Xinqiao Hospital, Army Medical University, Chongqing (S.Y.), the Department of Gastroenterology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing (A.Y.), and the Department of Gastroenterology, Guangdong Provincial Key Laboratory of Gastroenterology, Nanfang Hospital, Southern Medical University, Guangzhou (S.L.) - all in China
| | - Mingyu Tang
- From the Division of Gastroenterology and Hepatology, Shanghai Jiao-Tong University School of Medicine Renji Hospital, Shanghai Institute of Digestive Disease, Key Laboratory of Gastroenterology and Hepatology, Ministry of Health (Shanghai Jiao-Tong University) (Huimin Chen, S.W., M.T., R.Z., Q.Z., Z.D., Y.G., X.L., H.L., H. Xiong, Y.S., Haiying Chen, S.G., H. Xue, Z.G.), the Department of Gastroenterology and Hepatology, Changhai Hospital, Naval Medical University (Z.L., Y.D.), the Department of Gastroenterology, Huashan Hospital (L.Z.), and the Department of Gastroenterology and Hepatology, Zhongshan Hospital (X.S.), Fudan University, the Department of Gastroenterology, Shanghai General Hospital, Shanghai Jiao-Tong University School of Medicine (L.L.), the Department of Gastroenterology, Xinhua Hospital, Shanghai Jiao-Tong University School of Medicine (L.X.), and the Department of Gastroenterology, Ruijin Hospital, Shanghai Jiao-Tong University School of Medicine (J.Z.), Shanghai, the Department of Gastroenterology, Xinqiao Hospital, Army Medical University, Chongqing (S.Y.), the Department of Gastroenterology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing (A.Y.), and the Department of Gastroenterology, Guangdong Provincial Key Laboratory of Gastroenterology, Nanfang Hospital, Southern Medical University, Guangzhou (S.L.) - all in China
| | - Ran Zhao
- From the Division of Gastroenterology and Hepatology, Shanghai Jiao-Tong University School of Medicine Renji Hospital, Shanghai Institute of Digestive Disease, Key Laboratory of Gastroenterology and Hepatology, Ministry of Health (Shanghai Jiao-Tong University) (Huimin Chen, S.W., M.T., R.Z., Q.Z., Z.D., Y.G., X.L., H.L., H. Xiong, Y.S., Haiying Chen, S.G., H. Xue, Z.G.), the Department of Gastroenterology and Hepatology, Changhai Hospital, Naval Medical University (Z.L., Y.D.), the Department of Gastroenterology, Huashan Hospital (L.Z.), and the Department of Gastroenterology and Hepatology, Zhongshan Hospital (X.S.), Fudan University, the Department of Gastroenterology, Shanghai General Hospital, Shanghai Jiao-Tong University School of Medicine (L.L.), the Department of Gastroenterology, Xinhua Hospital, Shanghai Jiao-Tong University School of Medicine (L.X.), and the Department of Gastroenterology, Ruijin Hospital, Shanghai Jiao-Tong University School of Medicine (J.Z.), Shanghai, the Department of Gastroenterology, Xinqiao Hospital, Army Medical University, Chongqing (S.Y.), the Department of Gastroenterology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing (A.Y.), and the Department of Gastroenterology, Guangdong Provincial Key Laboratory of Gastroenterology, Nanfang Hospital, Southern Medical University, Guangzhou (S.L.) - all in China
| | - Qingwei Zhang
- From the Division of Gastroenterology and Hepatology, Shanghai Jiao-Tong University School of Medicine Renji Hospital, Shanghai Institute of Digestive Disease, Key Laboratory of Gastroenterology and Hepatology, Ministry of Health (Shanghai Jiao-Tong University) (Huimin Chen, S.W., M.T., R.Z., Q.Z., Z.D., Y.G., X.L., H.L., H. Xiong, Y.S., Haiying Chen, S.G., H. Xue, Z.G.), the Department of Gastroenterology and Hepatology, Changhai Hospital, Naval Medical University (Z.L., Y.D.), the Department of Gastroenterology, Huashan Hospital (L.Z.), and the Department of Gastroenterology and Hepatology, Zhongshan Hospital (X.S.), Fudan University, the Department of Gastroenterology, Shanghai General Hospital, Shanghai Jiao-Tong University School of Medicine (L.L.), the Department of Gastroenterology, Xinhua Hospital, Shanghai Jiao-Tong University School of Medicine (L.X.), and the Department of Gastroenterology, Ruijin Hospital, Shanghai Jiao-Tong University School of Medicine (J.Z.), Shanghai, the Department of Gastroenterology, Xinqiao Hospital, Army Medical University, Chongqing (S.Y.), the Department of Gastroenterology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing (A.Y.), and the Department of Gastroenterology, Guangdong Provincial Key Laboratory of Gastroenterology, Nanfang Hospital, Southern Medical University, Guangzhou (S.L.) - all in China
| | - Zihao Dai
- From the Division of Gastroenterology and Hepatology, Shanghai Jiao-Tong University School of Medicine Renji Hospital, Shanghai Institute of Digestive Disease, Key Laboratory of Gastroenterology and Hepatology, Ministry of Health (Shanghai Jiao-Tong University) (Huimin Chen, S.W., M.T., R.Z., Q.Z., Z.D., Y.G., X.L., H.L., H. Xiong, Y.S., Haiying Chen, S.G., H. Xue, Z.G.), the Department of Gastroenterology and Hepatology, Changhai Hospital, Naval Medical University (Z.L., Y.D.), the Department of Gastroenterology, Huashan Hospital (L.Z.), and the Department of Gastroenterology and Hepatology, Zhongshan Hospital (X.S.), Fudan University, the Department of Gastroenterology, Shanghai General Hospital, Shanghai Jiao-Tong University School of Medicine (L.L.), the Department of Gastroenterology, Xinhua Hospital, Shanghai Jiao-Tong University School of Medicine (L.X.), and the Department of Gastroenterology, Ruijin Hospital, Shanghai Jiao-Tong University School of Medicine (J.Z.), Shanghai, the Department of Gastroenterology, Xinqiao Hospital, Army Medical University, Chongqing (S.Y.), the Department of Gastroenterology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing (A.Y.), and the Department of Gastroenterology, Guangdong Provincial Key Laboratory of Gastroenterology, Nanfang Hospital, Southern Medical University, Guangzhou (S.L.) - all in China
| | - Yunjie Gao
- From the Division of Gastroenterology and Hepatology, Shanghai Jiao-Tong University School of Medicine Renji Hospital, Shanghai Institute of Digestive Disease, Key Laboratory of Gastroenterology and Hepatology, Ministry of Health (Shanghai Jiao-Tong University) (Huimin Chen, S.W., M.T., R.Z., Q.Z., Z.D., Y.G., X.L., H.L., H. Xiong, Y.S., Haiying Chen, S.G., H. Xue, Z.G.), the Department of Gastroenterology and Hepatology, Changhai Hospital, Naval Medical University (Z.L., Y.D.), the Department of Gastroenterology, Huashan Hospital (L.Z.), and the Department of Gastroenterology and Hepatology, Zhongshan Hospital (X.S.), Fudan University, the Department of Gastroenterology, Shanghai General Hospital, Shanghai Jiao-Tong University School of Medicine (L.L.), the Department of Gastroenterology, Xinhua Hospital, Shanghai Jiao-Tong University School of Medicine (L.X.), and the Department of Gastroenterology, Ruijin Hospital, Shanghai Jiao-Tong University School of Medicine (J.Z.), Shanghai, the Department of Gastroenterology, Xinqiao Hospital, Army Medical University, Chongqing (S.Y.), the Department of Gastroenterology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing (A.Y.), and the Department of Gastroenterology, Guangdong Provincial Key Laboratory of Gastroenterology, Nanfang Hospital, Southern Medical University, Guangzhou (S.L.) - all in China
| | - Shiming Yang
- From the Division of Gastroenterology and Hepatology, Shanghai Jiao-Tong University School of Medicine Renji Hospital, Shanghai Institute of Digestive Disease, Key Laboratory of Gastroenterology and Hepatology, Ministry of Health (Shanghai Jiao-Tong University) (Huimin Chen, S.W., M.T., R.Z., Q.Z., Z.D., Y.G., X.L., H.L., H. Xiong, Y.S., Haiying Chen, S.G., H. Xue, Z.G.), the Department of Gastroenterology and Hepatology, Changhai Hospital, Naval Medical University (Z.L., Y.D.), the Department of Gastroenterology, Huashan Hospital (L.Z.), and the Department of Gastroenterology and Hepatology, Zhongshan Hospital (X.S.), Fudan University, the Department of Gastroenterology, Shanghai General Hospital, Shanghai Jiao-Tong University School of Medicine (L.L.), the Department of Gastroenterology, Xinhua Hospital, Shanghai Jiao-Tong University School of Medicine (L.X.), and the Department of Gastroenterology, Ruijin Hospital, Shanghai Jiao-Tong University School of Medicine (J.Z.), Shanghai, the Department of Gastroenterology, Xinqiao Hospital, Army Medical University, Chongqing (S.Y.), the Department of Gastroenterology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing (A.Y.), and the Department of Gastroenterology, Guangdong Provincial Key Laboratory of Gastroenterology, Nanfang Hospital, Southern Medical University, Guangzhou (S.L.) - all in China
| | - Zhaoshen Li
- From the Division of Gastroenterology and Hepatology, Shanghai Jiao-Tong University School of Medicine Renji Hospital, Shanghai Institute of Digestive Disease, Key Laboratory of Gastroenterology and Hepatology, Ministry of Health (Shanghai Jiao-Tong University) (Huimin Chen, S.W., M.T., R.Z., Q.Z., Z.D., Y.G., X.L., H.L., H. Xiong, Y.S., Haiying Chen, S.G., H. Xue, Z.G.), the Department of Gastroenterology and Hepatology, Changhai Hospital, Naval Medical University (Z.L., Y.D.), the Department of Gastroenterology, Huashan Hospital (L.Z.), and the Department of Gastroenterology and Hepatology, Zhongshan Hospital (X.S.), Fudan University, the Department of Gastroenterology, Shanghai General Hospital, Shanghai Jiao-Tong University School of Medicine (L.L.), the Department of Gastroenterology, Xinhua Hospital, Shanghai Jiao-Tong University School of Medicine (L.X.), and the Department of Gastroenterology, Ruijin Hospital, Shanghai Jiao-Tong University School of Medicine (J.Z.), Shanghai, the Department of Gastroenterology, Xinqiao Hospital, Army Medical University, Chongqing (S.Y.), the Department of Gastroenterology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing (A.Y.), and the Department of Gastroenterology, Guangdong Provincial Key Laboratory of Gastroenterology, Nanfang Hospital, Southern Medical University, Guangzhou (S.L.) - all in China
| | - Yiqi Du
- From the Division of Gastroenterology and Hepatology, Shanghai Jiao-Tong University School of Medicine Renji Hospital, Shanghai Institute of Digestive Disease, Key Laboratory of Gastroenterology and Hepatology, Ministry of Health (Shanghai Jiao-Tong University) (Huimin Chen, S.W., M.T., R.Z., Q.Z., Z.D., Y.G., X.L., H.L., H. Xiong, Y.S., Haiying Chen, S.G., H. Xue, Z.G.), the Department of Gastroenterology and Hepatology, Changhai Hospital, Naval Medical University (Z.L., Y.D.), the Department of Gastroenterology, Huashan Hospital (L.Z.), and the Department of Gastroenterology and Hepatology, Zhongshan Hospital (X.S.), Fudan University, the Department of Gastroenterology, Shanghai General Hospital, Shanghai Jiao-Tong University School of Medicine (L.L.), the Department of Gastroenterology, Xinhua Hospital, Shanghai Jiao-Tong University School of Medicine (L.X.), and the Department of Gastroenterology, Ruijin Hospital, Shanghai Jiao-Tong University School of Medicine (J.Z.), Shanghai, the Department of Gastroenterology, Xinqiao Hospital, Army Medical University, Chongqing (S.Y.), the Department of Gastroenterology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing (A.Y.), and the Department of Gastroenterology, Guangdong Provincial Key Laboratory of Gastroenterology, Nanfang Hospital, Southern Medical University, Guangzhou (S.L.) - all in China
| | - Aiming Yang
- From the Division of Gastroenterology and Hepatology, Shanghai Jiao-Tong University School of Medicine Renji Hospital, Shanghai Institute of Digestive Disease, Key Laboratory of Gastroenterology and Hepatology, Ministry of Health (Shanghai Jiao-Tong University) (Huimin Chen, S.W., M.T., R.Z., Q.Z., Z.D., Y.G., X.L., H.L., H. Xiong, Y.S., Haiying Chen, S.G., H. Xue, Z.G.), the Department of Gastroenterology and Hepatology, Changhai Hospital, Naval Medical University (Z.L., Y.D.), the Department of Gastroenterology, Huashan Hospital (L.Z.), and the Department of Gastroenterology and Hepatology, Zhongshan Hospital (X.S.), Fudan University, the Department of Gastroenterology, Shanghai General Hospital, Shanghai Jiao-Tong University School of Medicine (L.L.), the Department of Gastroenterology, Xinhua Hospital, Shanghai Jiao-Tong University School of Medicine (L.X.), and the Department of Gastroenterology, Ruijin Hospital, Shanghai Jiao-Tong University School of Medicine (J.Z.), Shanghai, the Department of Gastroenterology, Xinqiao Hospital, Army Medical University, Chongqing (S.Y.), the Department of Gastroenterology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing (A.Y.), and the Department of Gastroenterology, Guangdong Provincial Key Laboratory of Gastroenterology, Nanfang Hospital, Southern Medical University, Guangzhou (S.L.) - all in China
| | - Liang Zhong
- From the Division of Gastroenterology and Hepatology, Shanghai Jiao-Tong University School of Medicine Renji Hospital, Shanghai Institute of Digestive Disease, Key Laboratory of Gastroenterology and Hepatology, Ministry of Health (Shanghai Jiao-Tong University) (Huimin Chen, S.W., M.T., R.Z., Q.Z., Z.D., Y.G., X.L., H.L., H. Xiong, Y.S., Haiying Chen, S.G., H. Xue, Z.G.), the Department of Gastroenterology and Hepatology, Changhai Hospital, Naval Medical University (Z.L., Y.D.), the Department of Gastroenterology, Huashan Hospital (L.Z.), and the Department of Gastroenterology and Hepatology, Zhongshan Hospital (X.S.), Fudan University, the Department of Gastroenterology, Shanghai General Hospital, Shanghai Jiao-Tong University School of Medicine (L.L.), the Department of Gastroenterology, Xinhua Hospital, Shanghai Jiao-Tong University School of Medicine (L.X.), and the Department of Gastroenterology, Ruijin Hospital, Shanghai Jiao-Tong University School of Medicine (J.Z.), Shanghai, the Department of Gastroenterology, Xinqiao Hospital, Army Medical University, Chongqing (S.Y.), the Department of Gastroenterology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing (A.Y.), and the Department of Gastroenterology, Guangdong Provincial Key Laboratory of Gastroenterology, Nanfang Hospital, Southern Medical University, Guangzhou (S.L.) - all in China
| | - Lungen Lu
- From the Division of Gastroenterology and Hepatology, Shanghai Jiao-Tong University School of Medicine Renji Hospital, Shanghai Institute of Digestive Disease, Key Laboratory of Gastroenterology and Hepatology, Ministry of Health (Shanghai Jiao-Tong University) (Huimin Chen, S.W., M.T., R.Z., Q.Z., Z.D., Y.G., X.L., H.L., H. Xiong, Y.S., Haiying Chen, S.G., H. Xue, Z.G.), the Department of Gastroenterology and Hepatology, Changhai Hospital, Naval Medical University (Z.L., Y.D.), the Department of Gastroenterology, Huashan Hospital (L.Z.), and the Department of Gastroenterology and Hepatology, Zhongshan Hospital (X.S.), Fudan University, the Department of Gastroenterology, Shanghai General Hospital, Shanghai Jiao-Tong University School of Medicine (L.L.), the Department of Gastroenterology, Xinhua Hospital, Shanghai Jiao-Tong University School of Medicine (L.X.), and the Department of Gastroenterology, Ruijin Hospital, Shanghai Jiao-Tong University School of Medicine (J.Z.), Shanghai, the Department of Gastroenterology, Xinqiao Hospital, Army Medical University, Chongqing (S.Y.), the Department of Gastroenterology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing (A.Y.), and the Department of Gastroenterology, Guangdong Provincial Key Laboratory of Gastroenterology, Nanfang Hospital, Southern Medical University, Guangzhou (S.L.) - all in China
| | - Leiming Xu
- From the Division of Gastroenterology and Hepatology, Shanghai Jiao-Tong University School of Medicine Renji Hospital, Shanghai Institute of Digestive Disease, Key Laboratory of Gastroenterology and Hepatology, Ministry of Health (Shanghai Jiao-Tong University) (Huimin Chen, S.W., M.T., R.Z., Q.Z., Z.D., Y.G., X.L., H.L., H. Xiong, Y.S., Haiying Chen, S.G., H. Xue, Z.G.), the Department of Gastroenterology and Hepatology, Changhai Hospital, Naval Medical University (Z.L., Y.D.), the Department of Gastroenterology, Huashan Hospital (L.Z.), and the Department of Gastroenterology and Hepatology, Zhongshan Hospital (X.S.), Fudan University, the Department of Gastroenterology, Shanghai General Hospital, Shanghai Jiao-Tong University School of Medicine (L.L.), the Department of Gastroenterology, Xinhua Hospital, Shanghai Jiao-Tong University School of Medicine (L.X.), and the Department of Gastroenterology, Ruijin Hospital, Shanghai Jiao-Tong University School of Medicine (J.Z.), Shanghai, the Department of Gastroenterology, Xinqiao Hospital, Army Medical University, Chongqing (S.Y.), the Department of Gastroenterology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing (A.Y.), and the Department of Gastroenterology, Guangdong Provincial Key Laboratory of Gastroenterology, Nanfang Hospital, Southern Medical University, Guangzhou (S.L.) - all in China
| | - Xizhong Shen
- From the Division of Gastroenterology and Hepatology, Shanghai Jiao-Tong University School of Medicine Renji Hospital, Shanghai Institute of Digestive Disease, Key Laboratory of Gastroenterology and Hepatology, Ministry of Health (Shanghai Jiao-Tong University) (Huimin Chen, S.W., M.T., R.Z., Q.Z., Z.D., Y.G., X.L., H.L., H. Xiong, Y.S., Haiying Chen, S.G., H. Xue, Z.G.), the Department of Gastroenterology and Hepatology, Changhai Hospital, Naval Medical University (Z.L., Y.D.), the Department of Gastroenterology, Huashan Hospital (L.Z.), and the Department of Gastroenterology and Hepatology, Zhongshan Hospital (X.S.), Fudan University, the Department of Gastroenterology, Shanghai General Hospital, Shanghai Jiao-Tong University School of Medicine (L.L.), the Department of Gastroenterology, Xinhua Hospital, Shanghai Jiao-Tong University School of Medicine (L.X.), and the Department of Gastroenterology, Ruijin Hospital, Shanghai Jiao-Tong University School of Medicine (J.Z.), Shanghai, the Department of Gastroenterology, Xinqiao Hospital, Army Medical University, Chongqing (S.Y.), the Department of Gastroenterology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing (A.Y.), and the Department of Gastroenterology, Guangdong Provincial Key Laboratory of Gastroenterology, Nanfang Hospital, Southern Medical University, Guangzhou (S.L.) - all in China
| | - Side Liu
- From the Division of Gastroenterology and Hepatology, Shanghai Jiao-Tong University School of Medicine Renji Hospital, Shanghai Institute of Digestive Disease, Key Laboratory of Gastroenterology and Hepatology, Ministry of Health (Shanghai Jiao-Tong University) (Huimin Chen, S.W., M.T., R.Z., Q.Z., Z.D., Y.G., X.L., H.L., H. Xiong, Y.S., Haiying Chen, S.G., H. Xue, Z.G.), the Department of Gastroenterology and Hepatology, Changhai Hospital, Naval Medical University (Z.L., Y.D.), the Department of Gastroenterology, Huashan Hospital (L.Z.), and the Department of Gastroenterology and Hepatology, Zhongshan Hospital (X.S.), Fudan University, the Department of Gastroenterology, Shanghai General Hospital, Shanghai Jiao-Tong University School of Medicine (L.L.), the Department of Gastroenterology, Xinhua Hospital, Shanghai Jiao-Tong University School of Medicine (L.X.), and the Department of Gastroenterology, Ruijin Hospital, Shanghai Jiao-Tong University School of Medicine (J.Z.), Shanghai, the Department of Gastroenterology, Xinqiao Hospital, Army Medical University, Chongqing (S.Y.), the Department of Gastroenterology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing (A.Y.), and the Department of Gastroenterology, Guangdong Provincial Key Laboratory of Gastroenterology, Nanfang Hospital, Southern Medical University, Guangzhou (S.L.) - all in China
| | - Jie Zhong
- From the Division of Gastroenterology and Hepatology, Shanghai Jiao-Tong University School of Medicine Renji Hospital, Shanghai Institute of Digestive Disease, Key Laboratory of Gastroenterology and Hepatology, Ministry of Health (Shanghai Jiao-Tong University) (Huimin Chen, S.W., M.T., R.Z., Q.Z., Z.D., Y.G., X.L., H.L., H. Xiong, Y.S., Haiying Chen, S.G., H. Xue, Z.G.), the Department of Gastroenterology and Hepatology, Changhai Hospital, Naval Medical University (Z.L., Y.D.), the Department of Gastroenterology, Huashan Hospital (L.Z.), and the Department of Gastroenterology and Hepatology, Zhongshan Hospital (X.S.), Fudan University, the Department of Gastroenterology, Shanghai General Hospital, Shanghai Jiao-Tong University School of Medicine (L.L.), the Department of Gastroenterology, Xinhua Hospital, Shanghai Jiao-Tong University School of Medicine (L.X.), and the Department of Gastroenterology, Ruijin Hospital, Shanghai Jiao-Tong University School of Medicine (J.Z.), Shanghai, the Department of Gastroenterology, Xinqiao Hospital, Army Medical University, Chongqing (S.Y.), the Department of Gastroenterology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing (A.Y.), and the Department of Gastroenterology, Guangdong Provincial Key Laboratory of Gastroenterology, Nanfang Hospital, Southern Medical University, Guangzhou (S.L.) - all in China
| | - Xiaobo Li
- From the Division of Gastroenterology and Hepatology, Shanghai Jiao-Tong University School of Medicine Renji Hospital, Shanghai Institute of Digestive Disease, Key Laboratory of Gastroenterology and Hepatology, Ministry of Health (Shanghai Jiao-Tong University) (Huimin Chen, S.W., M.T., R.Z., Q.Z., Z.D., Y.G., X.L., H.L., H. Xiong, Y.S., Haiying Chen, S.G., H. Xue, Z.G.), the Department of Gastroenterology and Hepatology, Changhai Hospital, Naval Medical University (Z.L., Y.D.), the Department of Gastroenterology, Huashan Hospital (L.Z.), and the Department of Gastroenterology and Hepatology, Zhongshan Hospital (X.S.), Fudan University, the Department of Gastroenterology, Shanghai General Hospital, Shanghai Jiao-Tong University School of Medicine (L.L.), the Department of Gastroenterology, Xinhua Hospital, Shanghai Jiao-Tong University School of Medicine (L.X.), and the Department of Gastroenterology, Ruijin Hospital, Shanghai Jiao-Tong University School of Medicine (J.Z.), Shanghai, the Department of Gastroenterology, Xinqiao Hospital, Army Medical University, Chongqing (S.Y.), the Department of Gastroenterology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing (A.Y.), and the Department of Gastroenterology, Guangdong Provincial Key Laboratory of Gastroenterology, Nanfang Hospital, Southern Medical University, Guangzhou (S.L.) - all in China
| | - Hong Lu
- From the Division of Gastroenterology and Hepatology, Shanghai Jiao-Tong University School of Medicine Renji Hospital, Shanghai Institute of Digestive Disease, Key Laboratory of Gastroenterology and Hepatology, Ministry of Health (Shanghai Jiao-Tong University) (Huimin Chen, S.W., M.T., R.Z., Q.Z., Z.D., Y.G., X.L., H.L., H. Xiong, Y.S., Haiying Chen, S.G., H. Xue, Z.G.), the Department of Gastroenterology and Hepatology, Changhai Hospital, Naval Medical University (Z.L., Y.D.), the Department of Gastroenterology, Huashan Hospital (L.Z.), and the Department of Gastroenterology and Hepatology, Zhongshan Hospital (X.S.), Fudan University, the Department of Gastroenterology, Shanghai General Hospital, Shanghai Jiao-Tong University School of Medicine (L.L.), the Department of Gastroenterology, Xinhua Hospital, Shanghai Jiao-Tong University School of Medicine (L.X.), and the Department of Gastroenterology, Ruijin Hospital, Shanghai Jiao-Tong University School of Medicine (J.Z.), Shanghai, the Department of Gastroenterology, Xinqiao Hospital, Army Medical University, Chongqing (S.Y.), the Department of Gastroenterology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing (A.Y.), and the Department of Gastroenterology, Guangdong Provincial Key Laboratory of Gastroenterology, Nanfang Hospital, Southern Medical University, Guangzhou (S.L.) - all in China
| | - Hua Xiong
- From the Division of Gastroenterology and Hepatology, Shanghai Jiao-Tong University School of Medicine Renji Hospital, Shanghai Institute of Digestive Disease, Key Laboratory of Gastroenterology and Hepatology, Ministry of Health (Shanghai Jiao-Tong University) (Huimin Chen, S.W., M.T., R.Z., Q.Z., Z.D., Y.G., X.L., H.L., H. Xiong, Y.S., Haiying Chen, S.G., H. Xue, Z.G.), the Department of Gastroenterology and Hepatology, Changhai Hospital, Naval Medical University (Z.L., Y.D.), the Department of Gastroenterology, Huashan Hospital (L.Z.), and the Department of Gastroenterology and Hepatology, Zhongshan Hospital (X.S.), Fudan University, the Department of Gastroenterology, Shanghai General Hospital, Shanghai Jiao-Tong University School of Medicine (L.L.), the Department of Gastroenterology, Xinhua Hospital, Shanghai Jiao-Tong University School of Medicine (L.X.), and the Department of Gastroenterology, Ruijin Hospital, Shanghai Jiao-Tong University School of Medicine (J.Z.), Shanghai, the Department of Gastroenterology, Xinqiao Hospital, Army Medical University, Chongqing (S.Y.), the Department of Gastroenterology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing (A.Y.), and the Department of Gastroenterology, Guangdong Provincial Key Laboratory of Gastroenterology, Nanfang Hospital, Southern Medical University, Guangzhou (S.L.) - all in China
| | - Yufeng Shen
- From the Division of Gastroenterology and Hepatology, Shanghai Jiao-Tong University School of Medicine Renji Hospital, Shanghai Institute of Digestive Disease, Key Laboratory of Gastroenterology and Hepatology, Ministry of Health (Shanghai Jiao-Tong University) (Huimin Chen, S.W., M.T., R.Z., Q.Z., Z.D., Y.G., X.L., H.L., H. Xiong, Y.S., Haiying Chen, S.G., H. Xue, Z.G.), the Department of Gastroenterology and Hepatology, Changhai Hospital, Naval Medical University (Z.L., Y.D.), the Department of Gastroenterology, Huashan Hospital (L.Z.), and the Department of Gastroenterology and Hepatology, Zhongshan Hospital (X.S.), Fudan University, the Department of Gastroenterology, Shanghai General Hospital, Shanghai Jiao-Tong University School of Medicine (L.L.), the Department of Gastroenterology, Xinhua Hospital, Shanghai Jiao-Tong University School of Medicine (L.X.), and the Department of Gastroenterology, Ruijin Hospital, Shanghai Jiao-Tong University School of Medicine (J.Z.), Shanghai, the Department of Gastroenterology, Xinqiao Hospital, Army Medical University, Chongqing (S.Y.), the Department of Gastroenterology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing (A.Y.), and the Department of Gastroenterology, Guangdong Provincial Key Laboratory of Gastroenterology, Nanfang Hospital, Southern Medical University, Guangzhou (S.L.) - all in China
| | - Haiying Chen
- From the Division of Gastroenterology and Hepatology, Shanghai Jiao-Tong University School of Medicine Renji Hospital, Shanghai Institute of Digestive Disease, Key Laboratory of Gastroenterology and Hepatology, Ministry of Health (Shanghai Jiao-Tong University) (Huimin Chen, S.W., M.T., R.Z., Q.Z., Z.D., Y.G., X.L., H.L., H. Xiong, Y.S., Haiying Chen, S.G., H. Xue, Z.G.), the Department of Gastroenterology and Hepatology, Changhai Hospital, Naval Medical University (Z.L., Y.D.), the Department of Gastroenterology, Huashan Hospital (L.Z.), and the Department of Gastroenterology and Hepatology, Zhongshan Hospital (X.S.), Fudan University, the Department of Gastroenterology, Shanghai General Hospital, Shanghai Jiao-Tong University School of Medicine (L.L.), the Department of Gastroenterology, Xinhua Hospital, Shanghai Jiao-Tong University School of Medicine (L.X.), and the Department of Gastroenterology, Ruijin Hospital, Shanghai Jiao-Tong University School of Medicine (J.Z.), Shanghai, the Department of Gastroenterology, Xinqiao Hospital, Army Medical University, Chongqing (S.Y.), the Department of Gastroenterology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing (A.Y.), and the Department of Gastroenterology, Guangdong Provincial Key Laboratory of Gastroenterology, Nanfang Hospital, Southern Medical University, Guangzhou (S.L.) - all in China
| | - Shuai Gong
- From the Division of Gastroenterology and Hepatology, Shanghai Jiao-Tong University School of Medicine Renji Hospital, Shanghai Institute of Digestive Disease, Key Laboratory of Gastroenterology and Hepatology, Ministry of Health (Shanghai Jiao-Tong University) (Huimin Chen, S.W., M.T., R.Z., Q.Z., Z.D., Y.G., X.L., H.L., H. Xiong, Y.S., Haiying Chen, S.G., H. Xue, Z.G.), the Department of Gastroenterology and Hepatology, Changhai Hospital, Naval Medical University (Z.L., Y.D.), the Department of Gastroenterology, Huashan Hospital (L.Z.), and the Department of Gastroenterology and Hepatology, Zhongshan Hospital (X.S.), Fudan University, the Department of Gastroenterology, Shanghai General Hospital, Shanghai Jiao-Tong University School of Medicine (L.L.), the Department of Gastroenterology, Xinhua Hospital, Shanghai Jiao-Tong University School of Medicine (L.X.), and the Department of Gastroenterology, Ruijin Hospital, Shanghai Jiao-Tong University School of Medicine (J.Z.), Shanghai, the Department of Gastroenterology, Xinqiao Hospital, Army Medical University, Chongqing (S.Y.), the Department of Gastroenterology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing (A.Y.), and the Department of Gastroenterology, Guangdong Provincial Key Laboratory of Gastroenterology, Nanfang Hospital, Southern Medical University, Guangzhou (S.L.) - all in China
| | - Hanbing Xue
- From the Division of Gastroenterology and Hepatology, Shanghai Jiao-Tong University School of Medicine Renji Hospital, Shanghai Institute of Digestive Disease, Key Laboratory of Gastroenterology and Hepatology, Ministry of Health (Shanghai Jiao-Tong University) (Huimin Chen, S.W., M.T., R.Z., Q.Z., Z.D., Y.G., X.L., H.L., H. Xiong, Y.S., Haiying Chen, S.G., H. Xue, Z.G.), the Department of Gastroenterology and Hepatology, Changhai Hospital, Naval Medical University (Z.L., Y.D.), the Department of Gastroenterology, Huashan Hospital (L.Z.), and the Department of Gastroenterology and Hepatology, Zhongshan Hospital (X.S.), Fudan University, the Department of Gastroenterology, Shanghai General Hospital, Shanghai Jiao-Tong University School of Medicine (L.L.), the Department of Gastroenterology, Xinhua Hospital, Shanghai Jiao-Tong University School of Medicine (L.X.), and the Department of Gastroenterology, Ruijin Hospital, Shanghai Jiao-Tong University School of Medicine (J.Z.), Shanghai, the Department of Gastroenterology, Xinqiao Hospital, Army Medical University, Chongqing (S.Y.), the Department of Gastroenterology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing (A.Y.), and the Department of Gastroenterology, Guangdong Provincial Key Laboratory of Gastroenterology, Nanfang Hospital, Southern Medical University, Guangzhou (S.L.) - all in China
| | - Zhizheng Ge
- From the Division of Gastroenterology and Hepatology, Shanghai Jiao-Tong University School of Medicine Renji Hospital, Shanghai Institute of Digestive Disease, Key Laboratory of Gastroenterology and Hepatology, Ministry of Health (Shanghai Jiao-Tong University) (Huimin Chen, S.W., M.T., R.Z., Q.Z., Z.D., Y.G., X.L., H.L., H. Xiong, Y.S., Haiying Chen, S.G., H. Xue, Z.G.), the Department of Gastroenterology and Hepatology, Changhai Hospital, Naval Medical University (Z.L., Y.D.), the Department of Gastroenterology, Huashan Hospital (L.Z.), and the Department of Gastroenterology and Hepatology, Zhongshan Hospital (X.S.), Fudan University, the Department of Gastroenterology, Shanghai General Hospital, Shanghai Jiao-Tong University School of Medicine (L.L.), the Department of Gastroenterology, Xinhua Hospital, Shanghai Jiao-Tong University School of Medicine (L.X.), and the Department of Gastroenterology, Ruijin Hospital, Shanghai Jiao-Tong University School of Medicine (J.Z.), Shanghai, the Department of Gastroenterology, Xinqiao Hospital, Army Medical University, Chongqing (S.Y.), the Department of Gastroenterology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing (A.Y.), and the Department of Gastroenterology, Guangdong Provincial Key Laboratory of Gastroenterology, Nanfang Hospital, Southern Medical University, Guangzhou (S.L.) - all in China
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Yaghoobi M, Tan J, Alshammari YTATA, Scandrett K, Mofrad K, Takwoingi Y. Video capsule endoscopy versus computed tomography enterography in assessing suspected small bowel bleeding: a systematic review and diagnostic test accuracy meta-analysis. Eur J Gastroenterol Hepatol 2023; 35:1253-1262. [PMID: 37773777 DOI: 10.1097/meg.0000000000002651] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/01/2023]
Abstract
Both computed tomography enterography (CTE) and video capsule endoscopy (VCE) are used in identifying small intestinal pathology in patients with suspected small bowel bleeding (SSBB) following normal upper gastrointestinal endoscopy and colonoscopy. Evidence of the comparative accuracy of these two modalities is crucial for clinical and healthcare decision-making. Comprehensive electronic searches were performed for studies on CTE and/or VCE with reference standard(s). Study selection, data extraction and quality assessment were completed by two authors independently. The QUADAS-2 and QUADAS-C tools were used to assess risk of bias, and applicability. Meta-analysis was performed using a bivariate model to obtain summary estimates of sensitivity, specificity, positive and negative likelihood ratios. Twenty-five studies involving 1986 patients with SSBB were included. Four of these were head-to-head comparison of CTE and VCE. Overall, VCE provided significantly higher sensitivity of 0.74 (95% CI: 0.61-0.83) versus 0.47 (95% CI: 0.32-0.62) for CTE, while CTE showed significantly higher specificity of 0.94 (95% CI: 0.64-0.99) versus 0.53 (95% CI: .36-0.69) for VCE. The positive likelihood ratio of CTE was 7.36 (95% CI: 0.97-56.01) versus 1.58 (95% CI: 1.15-2.15) for VCE and the negative likelihood ratio was 0.49 (95% CI: 0.33-0.72) for VCE versus 0.56 (0.40-0.79) for CTE. A secondary analysis of only head-to-head comparative studies gave results that were similar to the main analysis. Certainty of evidence was moderate. Neither VCE nor CTE is a perfect test for identifying etiology of SSBB in small intestine. VCE was more sensitive while CTE was more specific. Clinicians should choose the appropriate modality depending on whether better sensitivity or specificity is required in each clinical scenario.
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Affiliation(s)
- Mohammad Yaghoobi
- Division of Gastroenterology, McMaster University
- Department of Health Research Methods, Evidence, and Impact (HEI), McMaster University
- Cochrane GUT
- The Farncombe Family Digestive Health Research Institute, Hamilton, Ontario, Canada
| | - Julie Tan
- Division of Gastroenterology, McMaster University
| | | | - Katie Scandrett
- University of Birmingham Institute of Applied Health Research, Birmingham, UK
| | | | - Yemisi Takwoingi
- University of Birmingham Institute of Applied Health Research, Birmingham, UK
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Giordano A, Escapa M, Urpí-Ferreruela M, Casanova G, Fernández-Esparrach G, Ginès À, Llach J, González-Suárez B. Diagnostic accuracy of artificial intelligence-aided capsule endoscopy (TOP100) in overt small bowel bleeding. Surg Endosc 2023; 37:7658-7666. [PMID: 37495849 PMCID: PMC10520091 DOI: 10.1007/s00464-023-10273-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2023] [Accepted: 07/02/2023] [Indexed: 07/28/2023]
Abstract
BACKGROUND Capsule endoscopy (CE) is the first-choice exploration in case of overt small bowel bleeding (SBB). An early CE is known to increase diagnostic yield, but long reading times may delay therapeutics. The study evaluates the diagnostic performance of the artificial intelligence tool TOP100 in patients with overt SBB undergoing early CE with Pillcam SB3. METHODS Patients who underwent early CE (up to 14 days from the bleeding episode) for suspected overt SBB were included. One experienced endoscopist prospectively performed standard reading (SR) and a second blind experienced endoscopist performed a TOP100-based reading (TR). The primary endpoint was TR diagnostic accuracy for lesions with high bleeding potential (P2). RESULTS A total of 111 patients were analyzed. The most common clinical presentation was melena (64%). CE showed angiodysplasias in 40.5% of patients (45/111). In per-patient analysis, TR showed a sensitivity of 90.48% (95% CI 82.09-95.80), specificity of 100% (95% CI 87.23-100) with a PPV of 100% (95% CI 94.01-100), NPV of 77.14% (95% CI 63.58-86.71) and diagnostic accuracy of 92.79 (86.29-96.84). At multivariate analysis, adequate intestinal cleansing was the only independent predictor of concordance between TR and SR (OR 2.909, p = 0.019). The median reading time for SR and TR was 23 min (18.0-26.8) and 1.9 min (range 1.7-2.1), respectively (p < 0.001). CONCLUSIONS TOP100 provides a fast-reading mode for early CE in case of overt small bowel bleeding. It identifies most patients with active bleeding and angiodysplasias, aiding in the prioritization of therapeutic procedures. However, its accuracy in detecting ulcers, varices and P1 lesions seems insufficient.
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Affiliation(s)
- Antonio Giordano
- Endoscopy Unit, Gastroenterology Department, ICMDM, Hospital Clínic de Barcelona, Barcelona, Spain
- Faculty of Medicine, University of Barcelona, Barcelona, Spain
| | - Miriam Escapa
- Endoscopy Unit, Gastroenterology Department, ICMDM, Hospital Clínic de Barcelona, Barcelona, Spain
| | - Miquel Urpí-Ferreruela
- Endoscopy Unit, Gastroenterology Department, ICMDM, Hospital Clínic de Barcelona, Barcelona, Spain
- Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Spain
| | - Gherzon Casanova
- Endoscopy Unit, Gastroenterology Department, ICMDM, Hospital Clínic de Barcelona, Barcelona, Spain
- Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Spain
| | - Gloria Fernández-Esparrach
- Endoscopy Unit, Gastroenterology Department, ICMDM, Hospital Clínic de Barcelona, Barcelona, Spain
- Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Spain
- Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (CIBEREHD), Barcelona, Spain
- Faculty of Medicine, University of Barcelona, Barcelona, Spain
| | - Àngels Ginès
- Endoscopy Unit, Gastroenterology Department, ICMDM, Hospital Clínic de Barcelona, Barcelona, Spain
- Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Spain
- Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (CIBEREHD), Barcelona, Spain
- Faculty of Medicine, University of Barcelona, Barcelona, Spain
| | - Josep Llach
- Endoscopy Unit, Gastroenterology Department, ICMDM, Hospital Clínic de Barcelona, Barcelona, Spain
- Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Spain
- Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (CIBEREHD), Barcelona, Spain
- Faculty of Medicine, University of Barcelona, Barcelona, Spain
| | - Begoña González-Suárez
- Endoscopy Unit, Gastroenterology Department, ICMDM, Hospital Clínic de Barcelona, Barcelona, Spain.
- Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Spain.
- Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (CIBEREHD), Barcelona, Spain.
- Faculty of Medicine, University of Barcelona, Barcelona, Spain.
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Huang L, Hao L, Lou X, Lu Y. A female with recurrent gastrointestinal bleeding: an obscure diminutive lesion requiring a massive blood transfusion. REVISTA ESPANOLA DE ENFERMEDADES DIGESTIVAS 2023; 115:590. [PMID: 37539586 DOI: 10.17235/reed.2023.9853/2023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 08/05/2023]
Abstract
Obscure gastrointestinal bleeding (OGIB) is bleeding of unknown origin after a negative initial or primary colonoscopy and upper endoscopy result. Small bowel bleeding accounts for 5% of GI bleeding but it is the most prominent cause of OGIB. We present a case with an obscure diminutive polypoid vascular anomaly of small intestine. In this case, intraoperative enteroscopy seems to be the last trump card for OGIB, especially for large amount loss of blood. It not only helped to find the obscure cause for bleeding, but also preserved the small intestine.
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Affiliation(s)
- Lingyu Huang
- Gastrointestinal Endoscopy, The Sixth Affiliated Hospital. Sun Yat-sen University
| | - Lixiao Hao
- Digestive Endoscopy , Shanghai Shuguang Hospital. Shanghai University of Chinese Medicine
| | - Xiaoying Lou
- Pathology, The Sixth Affiliated Hospital. Sun Yat-sen University
| | - Yi Lu
- Gastrointestinal Endoscopy, The Sixth Affiliated Hospital. Sun Yat-sen University, China
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Hiraki S, Sato F, Okada I, Osugi M, Watanabe Y, Ichinose Y. Successful treatment of multiple microbleeds in a large area of the small bowel by transcatheter arterial embolization using imipenem/cilastatin as embolization material. Radiol Case Rep 2023; 18:3026-3031. [PMID: 37441451 PMCID: PMC10333106 DOI: 10.1016/j.radcr.2023.06.020] [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: 05/24/2023] [Revised: 06/04/2023] [Accepted: 06/08/2023] [Indexed: 07/15/2023] Open
Abstract
A 44-year-old man with chronic idiopathic pseudo-intestinal obstruction and lumbar disc herniation presented with orthostatic dizziness, black vomiting, and stools. He was suspected to have an ulcer caused by nonsteroidal anti-inflammatory drugs and treated conservatively but continued to have transfusion-dependent anemia. Trans-arterial contrast-enhanced computed tomography showed multiple microbleeds in the small intestine. We diffusely embolized 7 small intestine branches of the superior mesenteric artery using imipenem/cilastatin on 2 separate occasions. This stopped the bleeding, and the patient progressed well without ischemic complications and was discharged on the 25th postoperative day. Transcatheter arterial embolization with imipenem/cilastatin may be a viable treatment option for patients with multiple small bowel bleeds in a large area of the small intestine that are unresponsive to conservative treatment or endoscopic methods.
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Affiliation(s)
- Sakiko Hiraki
- Department of Radiology, National Hospital Organization Disaster Medical Center, 3256, Midoricho, Tachikawa, Tokyo, 190-0014, Japan
| | - Fumie Sato
- Department of Radiology, National Hospital Organization Disaster Medical Center, 3256, Midoricho, Tachikawa, Tokyo, 190-0014, Japan
| | - Ichiro Okada
- Department of Critical Care Medicine and Trauma, National Hospital Organization Disaster Medical Center, Tachikawa, Tokyo, Japan
| | - Masaya Osugi
- Department of Radiology, National Hospital Organization Disaster Medical Center, 3256, Midoricho, Tachikawa, Tokyo, 190-0014, Japan
| | - Yoshiya Watanabe
- Department of Radiology, National Hospital Organization Disaster Medical Center, 3256, Midoricho, Tachikawa, Tokyo, 190-0014, Japan
| | - Yoshiaki Ichinose
- Department of Radiology, National Hospital Organization Disaster Medical Center, 3256, Midoricho, Tachikawa, Tokyo, 190-0014, Japan
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Sonnenberg A, Yoo ER, Bakis G. Illusion of endoscopic success in instances of spontaneous disease resolution. Gastrointest Endosc 2023; 98:437-440. [PMID: 37150415 DOI: 10.1016/j.gie.2023.05.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/28/2023] [Revised: 04/25/2023] [Accepted: 05/01/2023] [Indexed: 05/09/2023]
Affiliation(s)
- Amnon Sonnenberg
- The Portland VA Medical Center; Division of Gastroenterology and Hepatology, Oregon Health & Science University, Portland, Oregon, USA
| | - Eric R Yoo
- The Portland VA Medical Center; Division of Gastroenterology and Hepatology, Oregon Health & Science University, Portland, Oregon, USA
| | - Gennadiy Bakis
- The Portland VA Medical Center; Division of Gastroenterology and Hepatology, Oregon Health & Science University, Portland, Oregon, USA
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Goltstein LCMJ, Rooijakkers MJP, Hoeks M, Li WWL, van Wely MH, Rodwell L, van Royen N, Drenth JPH, van Geenen EJM. Effectiveness of aortic valve replacement in Heyde syndrome: a meta-analysis. Eur Heart J 2023; 44:3168-3177. [PMID: 37555393 PMCID: PMC10471563 DOI: 10.1093/eurheartj/ehad340] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/04/2022] [Revised: 03/22/2023] [Accepted: 04/13/2023] [Indexed: 08/10/2023] Open
Abstract
AIMS Heyde syndrome is the co-occurrence of aortic stenosis, acquired von Willebrand syndrome, and gastrointestinal bleeding. Aortic valve replacement has been demonstrated to resolve all three associated disorders. A systematic review and meta-analysis were performed to obtain best estimates of the effect of aortic valve replacement on acquired von Willebrand syndrome and gastrointestinal bleeding. METHODS AND RESULTS A literature search was performed to identify articles on Heyde syndrome and aortic valve replacement up to 25 October 2022. Primary outcomes were the proportion of patients with recovery of acquired von Willebrand syndrome within 24 h (T1), 24-72 h (T2), 3-21 days (T3), and 4 weeks to 2 years (T4) after aortic valve replacement and the proportion of patients with cessation of gastrointestinal bleeding. Pooled proportions and risk ratios were calculated using random-effects models. Thirty-three studies (32 observational studies and one randomized controlled trial) on acquired von Willebrand syndrome (n = 1054), and 11 observational studies on gastrointestinal bleeding (n = 300) were identified. One study reported on both associated disorders (n = 6). The pooled proportion of Heyde patients with acquired von Willebrand syndrome recovery was 86% (95% CI, 79%-91%) at T1, 90% (74%-96%) at T2, 92% (84%-96%) at T3, and 87% (67%-96%) at T4. The pooled proportion of Heyde patients with gastrointestinal bleeding cessation was 73% (62%-81%). Residual aortic valve disease was associated with lower recovery rates of acquired von Willebrand syndrome (RR 0.20; 0.05-0.72; P = 0.014) and gastrointestinal bleeding (RR 0.57; 0.40-0.81; P = 0.002). CONCLUSION Aortic valve replacement is associated with rapid recovery of the bleeding diathesis in Heyde syndrome and gastrointestinal bleeding cessation. Residual valve disease compromises clinical benefits.
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Affiliation(s)
- Lia C M J Goltstein
- Department of Gastroenterology and Hepatology, Radboud University Medical Center, Geert Grooteplein Zuid 10, P.O. Box 9101, 6500 HB, Nijmegen, The Netherlands
| | - Maxim J P Rooijakkers
- Department of Cardiology, Radboud University Medical Center, Geert Grooteplein Zuid 10, P.O. Box 9101, 6500 HB, Nijmegen, The Netherlands
| | - Marlijn Hoeks
- Department of Haematology, Radboud University Medical Center, Geert Grooteplein Zuid 10, P.O. Box 9101, 6500 HB, Nijmegen, The Netherlands
| | - Wilson W L Li
- Department of Cardiothoracic Surgery, Radboud University Medical Center, Geert Grooteplein Zuid 10, P.O. Box 9101, 6500 HB, Nijmegen, The Netherlands
| | - Marleen H van Wely
- Department of Cardiology, Radboud University Medical Center, Geert Grooteplein Zuid 10, P.O. Box 9101, 6500 HB, Nijmegen, The Netherlands
| | - Laura Rodwell
- Department of Health Evidence, Radboud Institute for Health Sciences, Radboud University Medical Center, Section Biostatistics, Geert Grooteplein Zuid 10, P.O. Box 9101, 6500 HB, Nijmegen, The Netherlands
| | - Niels van Royen
- Department of Cardiology, Radboud University Medical Center, Geert Grooteplein Zuid 10, P.O. Box 9101, 6500 HB, Nijmegen, The Netherlands
| | - Joost P H Drenth
- Department of Gastroenterology and Hepatology, Radboud University Medical Center, Geert Grooteplein Zuid 10, P.O. Box 9101, 6500 HB, Nijmegen, The Netherlands
| | - Erwin-Jan M van Geenen
- Department of Gastroenterology and Hepatology, Radboud University Medical Center, Geert Grooteplein Zuid 10, P.O. Box 9101, 6500 HB, Nijmegen, The Netherlands
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Nakamura M, Yamamura T, Maeda K, Sawada T, Ishikawa E, Furukawa K, Iida T, Mizutani Y, Yamao K, Ishikawa T, Honda T, Ishigami M, Kawashima H. Clinical characteristics of Dieulafoy's lesion in the small bowel diagnosed and treated by double-balloon endoscopy. BMC Gastroenterol 2023; 23:290. [PMID: 37620810 PMCID: PMC10464443 DOI: 10.1186/s12876-023-02913-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/15/2023] [Accepted: 08/03/2023] [Indexed: 08/26/2023] Open
Abstract
BACKGROUND Obscure gastrointestinal bleeding refers to bleeding for which the source cannot be ascertained even through balloon-assisted endoscopy. In certain instances, Dieulafoy's lesion in the small bowel is presumed to be the underlying cause. AIM This retrospective study aimed to elucidate the clinical characteristics of Dieulafoy's lesion in the small bowel as diagnosed via double-balloon endoscopy while also exploring the feasibility of predicting bleeding from Dieulafoy's lesion prior to endoscopy in cases of obscure gastrointestinal bleeding. METHODS A comprehensive analysis of our database was conducted, identifying 38 patients who received a diagnosis of Dieulafoy's lesion and subsequently underwent treatment via double-balloon endoscopy. The clinical background, diagnosis, and treatment details of patients with Dieulafoy's lesion were carefully examined. RESULTS The median age of the 38 patients was 72 years, and 50% of the patients were male. A total of 26 (68%) patients exhibited a high comorbidity index. The upper jejunum and lower ileum were the most frequently reported locations for the occurrence of Dieulafoy's lesion in the small bowel. The detected Dieulafoy's lesions exhibited active bleeding (n = 33) and an exposed vessel with plaque on the surface (n = 5). Rebleeding after endoscopic treatment occurred in 8 patients (21%, median period: 7 days, range: 1-366 days). We conducted an analysis to determine the definitive nature of the initial double-balloon endoscopy diagnosis. Multivariate analysis revealed that hematochezia of ≥ 2 episodes constituted the independent factor associated with ≥ 2 double-balloon endoscopy diagnoses. Additionally, we explored factors associated with rebleeding following endoscopic treatment. Although the number of hemoclips utilized displayed a likely association, multivariate analysis did not identify any independent factor associated with rebleeding. CONCLUSION If a patient encounters multiple instances of hematochezia, promptly scheduling balloon-assisted endoscopy, equipped with optional instruments without delay is advised, after standard endoscopic evaluation with esophagogastroduodenoscopy and colonoscopy is unrevealing.
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Affiliation(s)
- Masanao Nakamura
- Department of Endoscopy, Nagoya University Hospital, 65 Tsurumai-cho, Showa-ku, Nagoya, 466-8550, Japan.
| | - Takeshi Yamamura
- Department of Gastroenterology and Hepatology, Nagoya University Graduate School of Medicine, 65 Tsurumai-cho, Showa-ku, Nagoya, 466-8550, Japan
| | - Keiko Maeda
- Department of Gastroenterology and Hepatology, Nagoya University Graduate School of Medicine, 65 Tsurumai-cho, Showa-ku, Nagoya, 466-8550, Japan
| | - Tsunaki Sawada
- Department of Endoscopy, Nagoya University Hospital, 65 Tsurumai-cho, Showa-ku, Nagoya, 466-8550, Japan
| | - Eri Ishikawa
- Department of Gastroenterology and Hepatology, Nagoya University Graduate School of Medicine, 65 Tsurumai-cho, Showa-ku, Nagoya, 466-8550, Japan
| | - Kazuhiro Furukawa
- Department of Gastroenterology and Hepatology, Nagoya University Graduate School of Medicine, 65 Tsurumai-cho, Showa-ku, Nagoya, 466-8550, Japan
| | - Tadashi Iida
- Department of Gastroenterology and Hepatology, Nagoya University Graduate School of Medicine, 65 Tsurumai-cho, Showa-ku, Nagoya, 466-8550, Japan
| | - Yasuyuki Mizutani
- Department of Gastroenterology and Hepatology, Nagoya University Graduate School of Medicine, 65 Tsurumai-cho, Showa-ku, Nagoya, 466-8550, Japan
| | - Kentaro Yamao
- Department of Endoscopy, Nagoya University Hospital, 65 Tsurumai-cho, Showa-ku, Nagoya, 466-8550, Japan
| | - Takuya Ishikawa
- Department of Gastroenterology and Hepatology, Nagoya University Graduate School of Medicine, 65 Tsurumai-cho, Showa-ku, Nagoya, 466-8550, Japan
| | - Takashi Honda
- Department of Gastroenterology and Hepatology, Nagoya University Graduate School of Medicine, 65 Tsurumai-cho, Showa-ku, Nagoya, 466-8550, Japan
| | - Masatoshi Ishigami
- Department of Gastroenterology and Hepatology, Nagoya University Graduate School of Medicine, 65 Tsurumai-cho, Showa-ku, Nagoya, 466-8550, Japan
| | - Hiroki Kawashima
- Department of Gastroenterology and Hepatology, Nagoya University Graduate School of Medicine, 65 Tsurumai-cho, Showa-ku, Nagoya, 466-8550, Japan
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Dukmak ON, Ayyad M, Gabajah M, Dabbas F, Budair A, Emar M, Maraqa M, Joubran F. Duodenal Hemangioma as a Rare Cause of Gastrointestinal Bleeding: A Case Report and Literature Review. Cureus 2023; 15:e43293. [PMID: 37692602 PMCID: PMC10492641 DOI: 10.7759/cureus.43293] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/10/2023] [Indexed: 09/12/2023] Open
Abstract
Duodenal hemangiomas are benign vascular tumors caused by haphazard vascular proliferation within the duodenal wall. Although rare, duodenal hemangiomas could lead to rapidly progressive life-threatening gastrointestinal (GI) bleeding that requires urgent intervention. The diagnosis of duodenal hemangioma often requires direct visualization of the lesion either endoscopically or surgically, as well as histopathological examination. Treatment options include endoscopic resection, laser coagulation, sclerotherapy, or in a specific subset of patients, open or laparoscopic surgical intervention. We herein report a case of a 46-year-old female presenting with signs and symptoms of chronic GI bleeding. The patient underwent upper endoscopy and was found to have an ulcerated mass in the proximal duodenum consistent with the diagnosis of duodenal hemangioma. This case highlights the importance of including duodenal hemangioma in the differential of upper GI bleeding. It also underscores the significance of surgical intervention in treating duodenal hemangioma, as well as the crucial role of employing endoscopy in the diagnostic and therapeutic management of this condition.
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Yang J, Zhou L, Xu D, Fan Y, Zhang H. Endoscopic injection sclerotherapy for treating recurrent bleeding of small bowel angioectasias. BMC Gastroenterol 2023; 23:233. [PMID: 37434106 PMCID: PMC10334616 DOI: 10.1186/s12876-023-02836-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/19/2022] [Accepted: 05/26/2023] [Indexed: 07/13/2023] Open
Abstract
BACKGROUND There is still no consensus on the preferred endoscopic therapy for small bowel angioectasias (SBAs). The aim of this study was to evaluate effectiveness and safety of endoscopic injection sclerotherapy (EIS) for treating recurrent bleeding of SBAs. METHODS Sixty-six adult patients diagnosed with SBAs by capsule endoscopy (CE) or double-balloon enterscopy (DBE) examinations were enrolled in this retrospective study from September 2013 to September 2021. The patients were divided into an EIS group (35 cases) and a control group (31 cases) according to whether they underwent EIS treatment. Clinical characteristics, medical histories, lesion characteristics, main laboratory indicators, treatments, and outcomes were collected. The rates of re-bleeding, re-admission, and red blood cell (RBC) transfusion were compared between different groups after discharge. The rates of hospitalization and RBC transfusion were compared between before admission and after discharge in both groups. Odds ratios (ORs) and 95% confidence intervals (CIs) were used in the multivariate logistic regression analysis to assess relative factors for re-bleeding. RESULTS All the rates of re-bleeding, re-admission and RBC transfusion after discharge in the EIS group were significantly lower than those in the control group (all P < 0.05). The rates of hospitalization and RBC transfusion after discharge were significantly lower than those before admission in the EIS group (both P < 0.05), while those did not reach significant differences in the control group (both P > 0.05). Multivariate logistic regression analysis showed that RBC transfusion before admission (OR, 5.655; 95% CI, 1.007-31.758, P = 0.049) and multiple lesions (≥ 3) (OR, 17.672; 95% CI, 2.246-139.060, P = 0.006) were significant risk factors of re-bleeding, while EIS treatment (OR, 0.037; 95% CI, 0.005-0.260, P < 0.001) was a significant protective factor. No endoscopic adverse events were observed during hospitalization and none of the enrolled patients died within 12 months after discharge. CONCLUSION EIS treatment had good effectiveness and safety for treating recurrent bleeding of SBAs, which could be considered as one of the first-line endoscopic treatment options for SBAs.
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Affiliation(s)
- Jing Yang
- Department of Gastroenterology, The Central Hospital of Wuhan, Tongji Medical College, Huazhong University of Science and Technology, No.26, Shengli Street, Jiang'an District, Wuhan, Hubei Province, 430014, China
| | - Lei Zhou
- Department of Gastroenterology, The Central Hospital of Wuhan, Tongji Medical College, Huazhong University of Science and Technology, No.26, Shengli Street, Jiang'an District, Wuhan, Hubei Province, 430014, China
| | - Dan Xu
- Department of Gastroenterology, The Central Hospital of Wuhan, Tongji Medical College, Huazhong University of Science and Technology, No.26, Shengli Street, Jiang'an District, Wuhan, Hubei Province, 430014, China
| | - Yan Fan
- Department of Gastroenterology, The Central Hospital of Wuhan, Tongji Medical College, Huazhong University of Science and Technology, No.26, Shengli Street, Jiang'an District, Wuhan, Hubei Province, 430014, China.
| | - Heng Zhang
- Department of Gastroenterology, The Central Hospital of Wuhan, Tongji Medical College, Huazhong University of Science and Technology, No.26, Shengli Street, Jiang'an District, Wuhan, Hubei Province, 430014, China.
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Aryan M, Venkata KVR, Colvin T, Daley L, Patel P, Beasley TM, Nunley B, Baldwin N, Ahmed AM, Kyanam Kabir Baig KR, Mönkemüller K, Peter S. Early intervention with double balloon enteroscopy for higher yield for inpatient overt obscure gastrointestinal bleeding: A propensity matched analysis. JGH Open 2023; 7:509-515. [PMID: 37496818 PMCID: PMC10366483 DOI: 10.1002/jgh3.12943] [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: 04/20/2023] [Revised: 06/26/2023] [Accepted: 06/30/2023] [Indexed: 07/28/2023]
Abstract
Background and Aim Overt obscure gastrointestinal bleeding (OOGIB) is defined as continued bleeding with unknown source despite esophagogastroduodenoscopy (EGD) and colonoscopy evaluation. Small bowel evaluation through video capsule endoscopy (VCE) or double balloon enteroscopy (DBE) is often warranted. We studied the timing of DBE in hospitalized OOGIB patients regarding diagnostic yield, therapeutic yield, and GI rebleeding. Methods We performed a retrospective review of DBEs performed at a tertiary medical center between November 2012 and December 2020. The inclusion criterion was first admission for OOGIB undergoing DBE. Those without previous EGD or colonoscopy were excluded. Patients were stratified into two groups: DBE performed within 72 h of OOGIB (emergent) and beyond 72 h of OOGIB (nonemergent). Propensity score matching was used to adjust for the difference in patients in the two groups. Logistic regression analysis was used to assess factors associated with diagnostic and therapeutic yield. Kaplan-Meir survival curve showed GI bleed-free survival following initial bleed and was compared using the log rank test. Results A total of 154 patients met the inclusion criterion, of which 62 had emergent DBE and 92 had nonemergent DBE. The propensity-score-matched sample consisted of 112 patients, with 56 patients each in the emergent and nonemergent groups. Univariate and multivariable logistic regression analysis showed a significant association between VCE and emergent DBE and diagnostic and therapeutic yield (P < 0.05). Emergent DBE patients had increased GI bleed-free survival compared to those in the nonemergent group (P = 0.009). Conclusion Our data demonstrate that emergent DBE during inpatient OOGIB can impact the overall diagnostic yield, therapeutic yield, and GI rebleeding post DBE.
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Affiliation(s)
- Mahmoud Aryan
- Department of Internal MedicineUniversity of Alabama at BirminghamBirminghamAlabamaUSA
| | - Krishna V R Venkata
- Department of Internal MedicineUniversity of Alabama at Birmingham MontgomeryMontgomeryAlabamaUSA
| | - Tyler Colvin
- Department of Internal MedicineUniversity of Alabama at BirminghamBirminghamAlabamaUSA
| | - Lauren Daley
- Department of Internal MedicineUniversity of Alabama at BirminghamBirminghamAlabamaUSA
| | - Parth Patel
- Department of Internal MedicineUniversity of Alabama at BirminghamBirminghamAlabamaUSA
| | - T. Mark Beasley
- Department of Veteran's AffairsBirmingham/Atlanta VA Geriatric Research, Education, & Clinical CenterBirminghamAlabamaUSA
- Department of BiostaticsUniversity of Alabama at BirminghamBirminghamAlabamaUSA
| | - Benjamin Nunley
- Department of Gastroenterology and HepatologyUniversity of Alabama at BirminghamBirminghamAlabamaUSA
| | - Nicholas Baldwin
- Department of Gastroenterology and HepatologyUniversity of Alabama at BirminghamBirminghamAlabamaUSA
| | - Ali M Ahmed
- Department of Gastroenterology and HepatologyUniversity of Alabama at BirminghamBirminghamAlabamaUSA
| | | | - Klaus Mönkemüller
- GastroenterologyAmeos Klinikum University Teaching HospitalHalberstadtGermany
| | - Shajan Peter
- Department of Gastroenterology and HepatologyUniversity of Alabama at BirminghamBirminghamAlabamaUSA
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Okamoto S, Matsui Y, Sakae H, Oshima K, Hiraki T. A Case of Small Bowel Arteriovenous Malformation Diagnosed Using Multiphase CT Angiography and Digital Subtraction Angiography. Cureus 2023; 15:e42644. [PMID: 37644925 PMCID: PMC10461457 DOI: 10.7759/cureus.42644] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/29/2023] [Indexed: 08/31/2023] Open
Abstract
Small bowel arteriovenous malformation (AVM) is a rare vascular lesion, which should be considered in patients presenting with gastrointestinal bleeding, as it is a high-flow arterial lesion that can cause life-threatening bleeding. Although a primary endoscopic examination is performed in cases of suspected small bowel bleeding, the diagnosis of the causal lesion is sometimes difficult. We are presenting a case of small bowel AVM that could not be diagnosed endoscopically but was successfully detected using multiphase CT images with an appropriate protocol. The AVM diagnosis was confirmed using digital subtraction angiography. An endovascular coil is placed in the draining vein as a surgical resection marker. The AVM was resected successfully without any complications.
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Affiliation(s)
| | - Yusuke Matsui
- Radiology, Faculty of Medicine, Dentistry and Pharmaceutical Sciences, Okayama University, Okayama, JPN
| | | | | | - Takao Hiraki
- Radiology, Faculty of Medicine, Dentistry and Pharmaceutical Sciences, Okayama University, Okayama, JPN
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Kim JH, Nam SJ. Prediction models for recurrence in patients with small bowel bleeding. World J Clin Cases 2023; 11:3949-3957. [PMID: 37388787 PMCID: PMC10303624 DOI: 10.12998/wjcc.v11.i17.3949] [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: 12/27/2022] [Revised: 04/10/2023] [Accepted: 05/15/2023] [Indexed: 06/12/2023] Open
Abstract
Obscure gastrointestinal bleeding (OGIB) has traditionally been defined as gastrointestinal bleeding whose source remains unidentified after bidirectional endoscopy. OGIB can present as overt bleeding or occult bleeding, and small bowel lesions are the most common causes. The small bowel can be evaluated using capsule endoscopy, device-assisted enteroscopy, computed tomography enterography, or magnetic resonance enterography. Once the cause of small-bowel bleeding is identified and targeted therapeutic intervention is completed, the patient can be managed with routine visits. However, diagnostic tests may produce negative results, and some patients with small bowel bleeding, regardless of diagnostic findings, may experience rebleeding. Predicting those at risk of rebleeding can help clinicians form individualized surveillance plans. Several studies have identified different factors associated with rebleeding, and a limited number of studies have attempted to create prediction models for recurrence. This article describes prediction models developed so far for identifying patients with OGIB who are at greater risk of rebleeding. These models may aid clinicians in forming tailored patient management and surveillance.
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Affiliation(s)
- Ji Hyun Kim
- Division of Gastroenterology and Hepatology, Department of Internal Medicine, Kangwon National University School of Medicine, Chuncheon 24341, South Korea
| | - Seung-Joo Nam
- Division of Gastroenterology and Hepatology, Department of Internal Medicine, Kangwon National University School of Medicine, Chuncheon 24341, South Korea
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Xiong Y, Yan J, Yan G, Feng L, Li Y, He S, Li R, Tan G, Feng B. Case report: An unusual case of small bowel bleeding and common iliac artery pseudoaneurysm caused by an unnoticed swallowed toothpick. Front Med (Lausanne) 2023; 10:1182746. [PMID: 37359020 PMCID: PMC10285080 DOI: 10.3389/fmed.2023.1182746] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2023] [Accepted: 05/17/2023] [Indexed: 06/28/2023] Open
Abstract
Gastrointestinal (GI) bleeding is a common clinical condition that can be caused by a variety of reasons. Bleeding can occur anywhere in the GI tract, and it usually presents as vomiting of blood, melena or black stools. We herein present a case of a 48-year-old man who was ultimately diagnosed with perforation of the lower ileum, pseudoaneurysm of the right common iliac artery, lower ileum-right common iliac artery fistula, and pelvic abscess caused by accidental ingestion of a toothpick. This case suggests that accidental ingestion of a toothpick may also be the cause of GI bleeding in some patients. For patients with unexplained GI bleeding, especially those with small bowel bleeding, a rational and combined use of gastroduodenoscopy, colonoscopy, unenhanced and contrast-enhanced abdominal CT can help detect the causes of GI bleeding and improve diagnostic accuracy.
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Affiliation(s)
- Yao Xiong
- Division of Gastroenterology and Hepatology, Suining Central Hospital, Suining, Sichuan, China
| | - Jing Yan
- Department of Radiology, Suining Central Hospital, Suining, Sichuan, China
| | - Gaowu Yan
- Department of Radiology, Suining Central Hospital, Suining, Sichuan, China
| | - Lei Feng
- Division of Gastroenterology and Hepatology, Suining Central Hospital, Suining, Sichuan, China
| | - Yong Li
- Department of Radiology, Suining Central Hospital, Suining, Sichuan, China
| | - Suyu He
- Department of Radiology, Suining Central Hospital, Suining, Sichuan, China
| | - Ruyi Li
- Department of Radiology, Lixian People's Hospital, Aba, Sichuan, China
| | - Gangcheng Tan
- Department of Radiology, Lixian People's Hospital, Aba, Sichuan, China
| | - Bo Feng
- Department of Radiology, Lixian People's Hospital, Aba, Sichuan, China
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Bouchette P, Lakra R, Haydel S, Hudson CT. Duodenal Metastasis From Primary Lung Adenocarcinoma: A Diagnostic and Therapeutic Challenge. Cureus 2023; 15:e40821. [PMID: 37485141 PMCID: PMC10362982 DOI: 10.7759/cureus.40821] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/14/2023] [Indexed: 07/25/2023] Open
Abstract
Distant metastasis from primary lung cancer is mostly seen in the liver, brain, adrenal glands and bones. Small bowel, specifically duodenum is a relatively unusual site for distant metastasis from lung carcinoma. This case reports a rare scenario of upper gastrointestinal bleeding caused by duodenal metastasis by a primary lung adenocarcinoma. A 43-year-old woman presented to the emergency department with complaints of progressive hemoptysis for the past three weeks. Esophagogastroduodenoscopy (EGD) revealed a 2.5 cm x 2.5 cm fungating villous mass-like structure in the first portion of the duodenum, with a normal-appearing esophagus and stomach. Biopsies were performed, which were histologically consistent with poorly differentiated malignant. The immunohistochemical (IHC) staining was consistent with metastatic disease from primary lung adenocarcinoma. Due to its rarity, there are no solidified guidelines for the management of duodenal metastasis from lung carcinoma. Our case was challenging due to the extensive metastasis and low functional status of the patient and was ultimately managed with home hospice.
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Affiliation(s)
- Philip Bouchette
- Internal Medicine, Louisiana State University Health Sciences Center, Shreveport, USA
| | - Rachaita Lakra
- Internal Medicine, Louisiana State University Health Sciences Center, Shreveport, USA
| | - Seth Haydel
- Internal Medicine, Leonard J. Chabert Medical Center, Houma, USA
| | - Catherine T Hudson
- Gastroenterology, Louisiana State University Health New Orleans, New Orleans, USA
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Sofia MA, Dwight P, Zaineb S, Christopher S. Intraoperative push enteroscopy for treatment of occult small bowel bleed due to hemorrhagic bleed and tumor: a report of two cases. J Surg Case Rep 2023; 2023:rjad271. [PMID: 37397061 PMCID: PMC10314713 DOI: 10.1093/jscr/rjad271] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2023] [Accepted: 04/25/2023] [Indexed: 07/04/2023] Open
Abstract
Small bowel bleeds, while uncommon, are often challenging with regard to diagnosis and therapeutic intervention. This is primarily due to their occult nature, the location offending lesions and limitations of current technology used to assess them. This review highlights two patients who presented with signs and symptoms of a small bowel bleed, where initial diagnostic workups were inconclusive, and intraoperative enteroscopy served a diagnostic and therapeutic role. We discuss the current literature on intraoperative endoscopy and propose an algorithm that introduces intraoperative enteroscopy earlier as a viable curative option, particularly in a rural setting. This case series proposes considerations for earlier introduction of intraoperative enteroscopy for diagnosis and treatment of small bowel bleeds.
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Affiliation(s)
| | | | - Shatawi Zaineb
- Division of General Surgery, Memorial Hospital West, Pembroke Pines, FL, USA
| | - Seaver Christopher
- Correspondence address. Division of General Surgery, Memorial Hospital West, Pembroke Pines 33028, USA. Tel: 305-322-6650; Fax: 954-447-5344; E-mail:
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Pennazio M, Cortegoso Valdivia P, Triantafyllou K, Gralnek IM. Diagnosis and management of small-bowel bleeding. Best Pract Res Clin Gastroenterol 2023; 64-65:101844. [PMID: 37652647 DOI: 10.1016/j.bpg.2023.101844] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/23/2023] [Accepted: 07/02/2023] [Indexed: 09/02/2023]
Abstract
Small-bowel (SB) bleeding is a challenging problem for the clinician, presenting many pitfalls in both diagnosis and subsequent treatment. Videocapsule endoscopy (VCE) and device-assisted enteroscopy (DAE) have revolutionized the approach to the patient with SB bleeding, allowing for the endoscopic diagnosis and management of what was previously only a surgical matter. The patients' assessment in SB bleeding is of foremost importance, as treatment success relies on a detailed evaluation of clinical history, suspicion for underlying lesions, and a careful selection and timing of diagnostic and therapeutic tools. This review will summarize current state-of-the-art evidence and practice points, to provide the clinician with a comprehensive guide towards the management of SB bleeding.
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Affiliation(s)
- Marco Pennazio
- University Division of Gastroenterology, City of Health and Science University Hospital, University of Turin, Turin, Italy.
| | - Pablo Cortegoso Valdivia
- Gastroenterology and Endoscopy Unit, University Hospital of Parma, University of Parma, Parma, Italy
| | - Konstantinos Triantafyllou
- Hepatogastroenterology Unit, Second Department of Propaedeutic Internal Medicine, Medical School, National and Kapodistrian University of Athens, Attikon University General Hospital, Athens, Greece
| | - Ian M Gralnek
- Ellen and Pinchas Mamber Institute of Gastroenterology and Hepatology, Emek Medical Center, Afula, Israel; Rappaport Faculty of Medicine, Technion Israel Institute of Technology, Haifa, Israel
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Yamamoto H, Despott EJ, González-Suárez B, Pennazio M, Mönkemüller K. The evolving role of device-assisted enteroscopy: The state of the art as of August 2023. Best Pract Res Clin Gastroenterol 2023; 64-65:101858. [PMID: 37652651 DOI: 10.1016/j.bpg.2023.101858] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 09/02/2023]
Abstract
Device-assisted enteroscopy (DAE), balloon-assisted enteroscopy (BAE) in particular, has become a routine endoscopic procedure which has revolutionized our approach to small-bowel disease. Evidence demonstrating the efficacy and safety of BAE spans over 22-years of experience, making it an established pillar of minimally invasive care. The robust evidence for BAE's safety and efficacy has now been incorporated into international clinical guidelines, technical reviews, benchmarking performance measures and curricula. The more recently introduced motorized spiral enteroscopy (MSE) which had replaced the previous manual version, abruptly ended its 7-year stint in clinical practice, when it was withdrawn and recalled from the market by its manufacturing company in July 2023, due to several associated serious adverse events (including fatalities). This article, written by the original developer of double-balloon enteroscopy (DBE) and other recognized international experts and pioneers in this field, focuses mainly on the technical aspects, evolving indications, and equipment-related technological advances. Despite the very recent withdrawal of MSE from clinical practice, for completeness, this technology and its technique is still briefly covered here, albeit importantly, along with a short description of reported, associated, serious adverse events which have contributed to its withdrawal/recall from the market and clinical practice.
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Affiliation(s)
- Hironori Yamamoto
- Department of Medicine, Division of Gastroenterology, Jichi Medical University, Shimotsuke, Tochigi, Japan.
| | - Edward J Despott
- Royal Free Unit for Endoscopy, The Royal Free Hospital and University College London (UCL) Institute for Liver and Digestive Health, London, UK
| | - Begoña González-Suárez
- Department of Gastroenterology, Hospital Clinic of Barcelona, University of Barcelona, Barcelona, Spain
| | - Marco Pennazio
- University Division of Gastroenterology, City of Health and Science University Hospital, University of Turin, Turin, Italy
| | - Klaus Mönkemüller
- Division of Gastroenterology "Prof. Carolina Olano", Universidad de La República, Montevideo, Uruguay; Division of Endoscopy, Ameos Teaching University Hospital, Halberstadt, Germany; Department of Gastroenterology, Virginia Tech Carilion School of Medicine, Virginia, USA
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Oka P, Ray M, Sidhu R. Small Bowel Bleeding: Clinical Diagnosis and Management in the Elderly. Expert Rev Gastroenterol Hepatol 2023:1-8. [PMID: 37184832 DOI: 10.1080/17474124.2023.2214726] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 05/16/2023]
Abstract
INTRODUCTION With the global increase in life expectancy, there is an increase in gastrointestinal presentations in the elderly. Small bowel bleeding (SBB) is a cause of significant morbidity in the elderly requiring multiple hospital visits, investigations and potentially expensive therapy. AREAS COVERED In this review we will outline the different modalities which are used for the diagnosis and management of SBB. We will also discuss the common causes of SBB in the elderly. EXPERT OPINION SBB in elderly has a significant impact on the quality of life of the elderly. Larger randomized studies in the elderly are urgently required to help guide clinicians on the best and most cost-effective treatment algorithm in this challenging cohort.
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Affiliation(s)
- Priya Oka
- Department of Gastroenterology, University of Sheffield, Sheffield, UK
- Department of Infection, Immunity and Cardiovascular Disease, Royal Hallamshire Hospital, Sheffield, UK
| | - Meghna Ray
- Department of Gastroenterology, University of Sheffield, Sheffield, UK
- Department of Infection, Immunity and Cardiovascular Disease, Royal Hallamshire Hospital, Sheffield, UK
| | - Reena Sidhu
- Department of Gastroenterology, University of Sheffield, Sheffield, UK
- Department of Infection, Immunity and Cardiovascular Disease, Royal Hallamshire Hospital, Sheffield, UK
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Urgesi R, Pagnini C, De Angelis F, Di Paolo MC, Pallotta L, Fanello G, Villotti G, Vitale MA, Battisti P, Graziani MG. Application of validated bleeding risk scores for atrial fibrillation in obscure gastrointestinal bleeding patients increases videocapsule endoscopy's diagnostic yield: a retrospective monocentric study. Int J Colorectal Dis 2023; 38:120. [PMID: 37160495 DOI: 10.1007/s00384-023-04412-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 04/24/2023] [Indexed: 05/11/2023]
Abstract
BACKGROUND Videocapsule endoscopy (VCE) is considered the gold standard for overt and obscure gastrointestinal bleeding (OGIB), after negative upper and lower endoscopy. Nonetheless, VCE's diagnostic yield is suboptimal, and it represents a costly, time-consuming, and often not easily available technique. In order to evaluate bleeding risk in patients with atrial fibrillation, several scoring systems have been proposed, but their utilization outside the original clinical setting has rarely been explored. The aim of the study is to evaluate potential role of bleeding risk scoring systems in predicting the occurrence of positive findings at VCE examination, and therefore in increasing VCE diagnostic yield. METHODS Data from consecutive patients undergoing VCE between April 2015 and June 2020 were retrospectively retrieved, and clinical and demographic characteristics were collected. HAS-BLED, ATRIA, and ORBIT scores were calculated, and patients were considered at low or high risk of bleeding accordingly. Discriminative ability of the scores for positive VCE findings has been evaluated by area under receiver operator characteristic curve (AUC) calculation. Diagnostic yield of scores in high- and low-risk patients was calculated. RESULTS A total of 413 patients underwent VCE examination, among which 368 (89%) for OGIB. Positive findings were observed in 246 patients (67%), with angiodysplasias being the most frequent lesion (92%). The three scores displayed similar consistent discriminative ability for positive VCE findings (mean AUC = 0.69), and identified high-risk group of patients in which VCE has a higher diagnostic yield. CONCLUSIONS In the present retrospective study, bleeding scores accurately discriminated patients with higher probability of positive findings at VCE examination. Bleeding scores utilization may help in the management of patients with OGIB, with a potential consistent resource optimization and cost-saving.
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Affiliation(s)
- Riccardo Urgesi
- Gastroenterology and Digestive Endoscopy Unit, S. Giovanni Addolorata Hospital, Via Dell'Amba Aradam 9, 00184, Rome, Italy
| | - Cristiano Pagnini
- Gastroenterology and Digestive Endoscopy Unit, S. Giovanni Addolorata Hospital, Via Dell'Amba Aradam 9, 00184, Rome, Italy.
| | | | - Maria Carla Di Paolo
- Gastroenterology and Digestive Endoscopy Unit, S. Giovanni Addolorata Hospital, Via Dell'Amba Aradam 9, 00184, Rome, Italy
| | - Lorella Pallotta
- Gastroenterology and Digestive Endoscopy Unit, S. Giovanni Addolorata Hospital, Via Dell'Amba Aradam 9, 00184, Rome, Italy
| | - Gianfranco Fanello
- Gastroenterology and Digestive Endoscopy Unit, S. Giovanni Addolorata Hospital, Via Dell'Amba Aradam 9, 00184, Rome, Italy
| | - Giuseppe Villotti
- Gastroenterology and Digestive Endoscopy Unit, S. Giovanni Addolorata Hospital, Via Dell'Amba Aradam 9, 00184, Rome, Italy
| | - Mario Alessandro Vitale
- Gastroenterology and Digestive Endoscopy Unit, S. Giovanni Addolorata Hospital, Via Dell'Amba Aradam 9, 00184, Rome, Italy
| | - Paola Battisti
- Internal Medicine and Dysmetabolic Diseases Unit, S. Giovanni Addolorata Hospital, Rome, Italy
| | - Maria Giovanna Graziani
- Gastroenterology and Digestive Endoscopy Unit, S. Giovanni Addolorata Hospital, Via Dell'Amba Aradam 9, 00184, Rome, Italy
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