1
|
Feasibility and Safety of Mesocolon Excision with Medical Imaging: A Systematic Review and Meta-Analysis. COMPUTATIONAL INTELLIGENCE AND NEUROSCIENCE 2023; 2023:6198625. [PMID: 36851940 PMCID: PMC9966824 DOI: 10.1155/2023/6198625] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 08/24/2022] [Revised: 09/16/2022] [Accepted: 09/29/2022] [Indexed: 02/20/2023]
Abstract
The development of new technologies based on electronic intelligent images is a very active research and promotion of new technologies in recent years. This article mainly summarizes the basic concept, development, and technology of electronic intelligent imaging technology, as well as the research, promotion, and application of electronic intelligent imaging technology in clinical treatment. It especially emphasizes the practicality and application of electronic intelligent imaging technology in the current clinical operation process and conducts a meta-analysis of the current mesorectal excision, so as to provide more scientific and professional guidance for clinical surgery. The results of the meta-analysis showed that 3291 documents were initially obtained and duplicate documents were deleted by searching for keywords in mesocolon excision. We excluded 2399 subjects and articles whose interventions did not meet the inclusion criteria of this study after reading the title and abstract. Then, we obtained 892 papers that may meet the inclusion criteria through preliminary screening. We further optimized the search strategy based on selection criteria and data integrity filtering principles and finally determined 111 references. 100 articles that did not meet the requirements were excluded, and 11 articles were finally included for meta-analysis. Medical imaging can effectively improve the therapeutic effect of mesocolon excision and reduce the occurrence of complications. Therefore, it is very important to combine medical intelligent images for preoperative evaluation, and the development of the combination of surgical treatment and medical images should not be underestimated in the future.
Collapse
|
2
|
Systemic manifestations - do not forget the small bowel. Curr Opin Gastroenterol 2021; 37:234-244. [PMID: 33606400 DOI: 10.1097/mog.0000000000000717] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/10/2022]
Abstract
PURPOSE OF REVIEW Systemic diseases can afflict the small bowel (SB) but be challenging to diagnose. In this review, we aim to provide a broad overview of these conditions and to summarise their management. RECENT FINDINGS Small bowel capsule endoscopy (SBCE) is an important modality to investigate pathology in the SB. SB imaging can be complementary to SBCE for mural and extramural involvement and detection of multiorgan involvement or lymphadenopathy. Device assisted enteroscopy provides a therapeutic arm, to SBCE enabling histology and therapeutics to be carried out. SUMMARY SB endoscopy is essential in the diagnosis, management and monitoring of these multi-system conditions. Collaboration across SB centres to combine experience will help to improve the management of some of these rarer SB conditions.
Collapse
|
3
|
Misra V, Agrawal R, Misra SP. Portal hypertensive vasculopathy - An entity worth remembering with non-neoplastic gastrointestinal lesions. INDIAN J PATHOL MICR 2021; 64:S32-S42. [PMID: 34135136 DOI: 10.4103/ijpm.ijpm_201_21] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
Portal hypertensive vasculopathy (PHV) represents an increase in the pressure in the portal circulation. This increased pressure leads to changes in the mucosa that can be appreciated endoscopically as well as histopathologically. Lesions can be observed in the entire gastrointestinal tract (GIT) including stomach, duodenum, jejunum and colon. The histological changes are appreciated mainly in the mucosal and submucosal blood vessels. A knowledge of these lesions as well as the changes helps in separating them from other close differentials with specific treatment to be instituted. The pathogenesis of the hemodynamic changes is not well-understood. The underlying factor is increased portal pressure. Studies indicate, that besides increased portal pressure other factors in combination led to the observed changes. Portal hypertensive gastropathy (PHG) is seen in the gastric body and fundus, while varices are noted in the cardia and fundus. Changes may be seen in the small intestine and throughout the colon with anorectal varices. Histopathological changes include dilated, congested and ectatic capillaries and edema in the lamina propria besides a large spectrum of other histopathological changes. Mucosal capillaries with thick irregular wall show absence of red blood cells in the lumen. Thickening of the vessel wall serves as a better marker than the vascular diameter when portal hypertension (PHT) is considered. Long standing cases may show fibrosis in lamina propria. At times, these changes may lead to occult gastrointestinal bleeding. Important differentials need to be ruled out in all the cases as the treatment and the outcome of all differs. Endoscopically or histopathologically if the mucosal changes are observed they should not be overlooked and a detailed work-up must be carried out.
Collapse
Affiliation(s)
- Vatsala Misra
- Department of Pathology and Gastroenterology, MLN Medical College, Prayagraj, Uttar Pradesh, India
| | - Ranjan Agrawal
- Department of Pathology, Rohilkhand Medical College and Hospital, Bareilly, Uttar Pradesh, India
| | - Sri Praksh Misra
- Department of Pathology and Gastroenterology, MLN Medical College, Prayagraj, Uttar Pradesh, India
| |
Collapse
|
4
|
Saad ZM, El-Dahrouty AH, El-Sayed AM, Keryakos HKH, Fanous NN, Mostafa I. Small-bowel mucosal changes in Egyptian cirrhotic patients with portal hypertension using capsule endoscopy versus single-balloon enteroscopy. EGYPTIAN LIVER JOURNAL 2020. [DOI: 10.1186/s43066-020-00025-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
Abstract
Background
Small-bowel mucosal abnormalities that may occur secondary to portal hypertension in patients with liver cirrhosis have an impact on health and quality of life. In spite of the importance of these changes, little is known about the frequency and features of small-bowel changes in cirrhotic patients with portal hypertension. Eighty cirrhotic patients with or without esophageal or gastric varices were recruited in this study as well as 60 age- and sex-matched controls. All study participants underwent capsule endoscopy. In addition, half of the patients and controls were randomized to receive single-balloon enteroscopy.
Results
The prevalence of small-bowel mucosal changes was statistically significantly higher in cirrhotic patients than in controls; 57% versus 6.7%, respectively (p < 0.05). Cirrhotic patients with portal hypertensive gastropathy showed a significant increase in the small-bowel changes (p < 0.001). Small-bowel changes were significantly higher in patients with higher MELD and Child-Pugh scores (p < 0.001). Moreover, capsule endoscopy was more effective in the detection of small-bowel changes than single-balloon enteroscopy.
Conclusions
Mucosal changes associated with portal hypertensive enteropathy are more prevalent in cirrhotic patients, regardless of the presence or absence of gastric varices. Small-bowel mucosal changes in patients with portal hypertensive enteropathy were more common in patients who suffered from portal hypertensive gastropathy and were positively correlated with advanced chronic liver disease.
Collapse
|
5
|
Nam SJ, Kim JH, Park SC. The Usefulness of New-Generation Capsule Endoscopy in Patients with Portal Hypertensive Enteropathy. Clin Endosc 2018; 51:505-507. [PMID: 30449077 PMCID: PMC6283760 DOI: 10.5946/ce.2018.165] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/03/2018] [Accepted: 10/31/2018] [Indexed: 11/14/2022] Open
Affiliation(s)
- Seung-Joo Nam
- Division of Gastroenterology and Hepatology, Department of Internal Medicine, Kangwon National University School of Medicine, Chuncheon, Korea
| | - Ji Hyun Kim
- Division of Gastroenterology and Hepatology, Department of Internal Medicine, Kangwon National University School of Medicine, Chuncheon, Korea
| | - Sung Chul Park
- Division of Gastroenterology and Hepatology, Department of Internal Medicine, Kangwon National University School of Medicine, Chuncheon, Korea
| |
Collapse
|
6
|
Video Capsule Endoscopy in the Assessment of Portal Hypertensive Enteropathy. Int J Hepatol 2018; 2018:5109689. [PMID: 30515332 PMCID: PMC6236554 DOI: 10.1155/2018/5109689] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/27/2018] [Revised: 09/02/2018] [Accepted: 09/17/2018] [Indexed: 02/07/2023] Open
Abstract
BACKGROUND The features of the portal hypertension enteropathy (PHE) vary from mild mucosal changes to varices with or without bleeding. The prevalence and the development are not fully understood. AIM Our aim is to examine the prevalence and the different manifestations of PHE using video capsule endoscopy (VCE). METHODS It is a single center retrospective study of patients with cirrhosis, who had VCE. Based on the published literature, we divided the PHE lesions into vascular lesions and mucosal lesions. RESULTS Of the 100 patients with cirrhosis that had a VCE study, the mean age was 62.82 years. Male gender was predominant (64%), while Caucasians represented 82% of the cohort. The most common etiology of cirrhosis was chronic alcohol abuse followed by chronic hepatitis C virus and nonalcoholic steatohepatitis. VCE detected small bowel lesions in 71% of the patients while the features of PHE were found in 65% from the total cohort. AVMs and inflammatory changes were the most common findings, followed by bleeding. More than 50% of the lesions were vascular in nature. The risk of finding PHE in decompensated cirrhosis is twice that in compensated cirrhosis. Forty-five patients had negative EGD exam for any active bleeding, esophageal varices, portal hypertensive gastropathy, or gastric varices. Of these, 69% had features of PHE in their VCE. CONCLUSIONS VCE detected small bowel lesions in 71% of our cohort. There is a high prevalence of PHE in decompensated cirrhosis. Vascular lesions are the most common finding in the small bowel of this population.
Collapse
|
7
|
Goenka MK, Shah BB, Rai VK, Jajodia S, Goenka U. Mucosal Changes in the Small Intestines in Portal Hypertension: First Study Using the Pillcam SB3 Capsule Endoscopy System. Clin Endosc 2018; 51:563-569. [PMID: 30300988 PMCID: PMC6283757 DOI: 10.5946/ce.2018.041] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/21/2018] [Accepted: 07/18/2018] [Indexed: 12/11/2022] Open
Abstract
BACKGROUND/AIMS To evaluate patients with portal hypertension (PH) of varied etiologies for portal hypertensive enteropathy (PHE) using the PillCam SB3 capsule endoscopy (CE) system. METHODS Consecutive patients with PH presenting with unexplained anemia and/or occult gastrointestinal bleeding were evaluated using the PillCam SB3 CE system. Abnormal findings were categorized as vascular or non-vascular. The patients with ongoing bleeding caused by PHE were treated. The correlation of the CE scores of PHE with the clinical, laboratory, and endoscopic features was determined. RESULTS Of the 43 patients included in the study, 41 (95.3%) showed PHE findings. These included varices (67.4%), red spots (60.5%), erythema (44.2%), villous edema (46.5%), telangiectasia (16.3%), and polyps (16.3%). The CE scores varied from 0 to 8 (mean±standard deviation, 4.09±1.8). Five patients (11.6%) showed evidence of ongoing or recent bleeding due to PHE. Three of these five patients underwent endotherapy, and one patient underwent radiological coil placement. CONCLUSION The PillCam SB3 CE system revealed a high prevalence of PHE in the patients with PH. Using this system, evidence of bleeding due to PHE was found in a small but definite proportion of the patients.
Collapse
Affiliation(s)
| | - Bhavik Bharat Shah
- Institute of Gastro-Sciences, Apollo Gleneagles Hospitals, Kolkata, India
| | - Vijay Kumar Rai
- Institute of Gastro-Sciences, Apollo Gleneagles Hospitals, Kolkata, India
| | - Surabhi Jajodia
- Department of Clinical Imaging and Interventional Radiology, Apollo Gleneagles Hospitals, Kolkata, India
| | - Usha Goenka
- Department of Clinical Imaging and Interventional Radiology, Apollo Gleneagles Hospitals, Kolkata, India
| |
Collapse
|
8
|
Egea Valenzuela J, Fernández Llamas T, García Marín AV, Alberca de Las Parras F, Carballo Álvarez F. Diagnostic and therapeutic features of small bowel involvement in portal hypertension. REVISTA ESPANOLA DE ENFERMEDADES DIGESTIVAS 2017; 109:856-862. [PMID: 28747052 DOI: 10.17235/reed.2017.4596/2016] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
Enteropathy is a lesser known complication of portal hypertension and consists of different changes in the mucosal layer of the small bowel which lead to the appearance of vascular and inflammatory lesions. It can be an important co-factor in the development of anemia in the cirrhotic population, and nowadays an easy and non-invasive diagnosis can be made thanks to capsule endoscopy. However, it is rarely considered in the management of patients with portal hypertension. Some aspects such as pathogenesis or incidence remain unclear and no specific recommendations are included in the guidelines regarding diagnosis or treatment. A review of the available literature was performed with regards to the most relevant aspects of this entity.
Collapse
Affiliation(s)
- Juan Egea Valenzuela
- Unidad de Gestión Clínica de Digestivo, Hospital Clínico Universitario Virgen de la Arrixa, España
| | | | | | - Fernando Alberca de Las Parras
- Servicio de Medicina de Aparato Digestivo., Hospital Clínico Universitario Virgen de la Arrixaca. IMIB-Arrixaca., España
| | | |
Collapse
|
9
|
|
10
|
Seiji K, Akinobu T, Iwamuro M, Tetsuya Y, Yoshiyasu K, Kou M, Toshihiro I, Yoshiro K, Yuzo U, Takahito Y, Hiroyuki O. Safety and Efficacy of Small Bowel Examination by Capsule Endoscopy for Patients before Liver Transplantation. BIOMED RESEARCH INTERNATIONAL 2017; 2017:8193821. [PMID: 28168199 PMCID: PMC5266832 DOI: 10.1155/2017/8193821] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/28/2016] [Accepted: 12/14/2016] [Indexed: 12/27/2022]
Abstract
Background and Aims. Gastrointestinal surveillance is a requirement prior to liver transplantation (LT), but small intestine examination is not generally undertaken. The aim of the present study was to evaluate the safety and efficacy of capsule endoscopy (CE) for patients with end-stage liver disease. Methods. 31 patients who needed LT were enrolled, and 139 patients who underwent CE over the same period of time acted as controls. Results. Frequency of successful achievement of evaluation of the full length of the small bowel, the mean gastric transit time, and the mean small bowel transit time were not significantly different between the two groups. Abnormalities in the small bowel were found in 26 patients. Comparative analysis revealed that history of EV rupture, history of EV treatment, red color sign of EV, and presence of PHG or HCC were significantly associated with patients with >2 two such findings (high score group). Conclusions. Small bowel examination by CE in patients before liver transplantation could be performed safely and is justified by the high rate of abnormal lesions detected particularly in patients with history of EV therapy or bleeding, red color sign, and presence of PHG or HCC. This study was registered in the UMIN Clinical Trial Registry (UMIN 000008672).
Collapse
|
11
|
Dabos KJ, Yung DE, Bartzis L, Hayes PC, Plevris JN, Koulaouzidis A. Small bowel capsule endoscopy and portal hypertensive enteropathy in cirrhotic patients: results from a tertiary referral centre. Ann Hepatol 2017; 15:394-401. [PMID: 27049493 DOI: 10.5604/16652681.1198815] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
BACKGROUND AND RATIONALE Portal hypertensive enteropathy (PHE) remains difficult to diagnose in patients with cirrhosis and portal hypertension. Limited test choices exist for the inspection of the small bowel in these patients. Small bowel capsule endoscopy (SBCE) is ideal in this situation but rarely performed. We aimed to determine the prevalence of PHE using SBCE in a cirrhotic patient population and correlate its presence with clinical and CT imaging findings. MATERIAL AND METHODS We retrospectively analysed data from cirrhotic patients who underwent SBCE at our unit. Studies were evaluated for the presence of cirrhosis-related findings in the oesophagus, stomach and small-bowel. The relationships between PHE and patients' clinical characteristics were evaluated. RESULTS 53 patients with cirrhosis underwent SCBE. We used PillCam®SB on 36 patients and MiroCam® capsule on 17. Thirty patients were referred for iron deficiency anaemia, 15 for obscure gastrointestinal bleeding, and 4 for other indications. Four data sets were not available for review, leaving 49 patients. Mean age was 61.19 ± 14.54 years (M/F = 27/22). Six SBCE examinations were incomplete. Thirty three patients had evidence of portal hypertensive gastropathy (PHG) and 17 had evidence of oesophageal varices. In total, 29 patients had SCBE evidence of PHE (57%). 28/29 (96.5%) patients with PHE had also evidence of PHG. 13/17 (76.4%) patients with oesophageal varices had also evidence of PHE. CONCLUSIONS The prevalence of PHE in our study was 57%. SBCE is a useful tool in evaluating PHE in cirrhotic patients irrespective of aetiology.
Collapse
Affiliation(s)
- Konstantinos J Dabos
- Centre of Liver and Digestive Disorders, Royal Infirmary of Edinburgh. Edinburgh, United Kingdom
| | - Diana E Yung
- Centre of Liver and Digestive Disorders, Royal Infirmary of Edinburgh. Edinburgh, United Kingdom
| | - Leonidas Bartzis
- Centre of Liver and Digestive Disorders, Royal Infirmary of Edinburgh. Edinburgh, United Kingdom
| | - Peter C Hayes
- Centre of Liver and Digestive Disorders, Royal Infirmary of Edinburgh. Edinburgh, United Kingdom
| | - John N Plevris
- Centre of Liver and Digestive Disorders, Royal Infirmary of Edinburgh. Edinburgh, United Kingdom
| | - Anastasios Koulaouzidis
- Centre of Liver and Digestive Disorders, Royal Infirmary of Edinburgh. Edinburgh, United Kingdom
| |
Collapse
|
12
|
Chandrasekar TS, Janakan GB, Chandrasekar VT, Kalamegam RY, Suriyanarayanan S, Sanjeevaraya PM. Spectrum of small-bowel mucosal abnormalities identified by capsule endoscopy in patients with portal hypertension of varied etiology. Indian J Gastroenterol 2017; 36:32-37. [PMID: 28066855 DOI: 10.1007/s12664-016-0721-5] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/06/2016] [Accepted: 11/26/2016] [Indexed: 02/04/2023]
Abstract
BACKGROUND Bleeding from small intestinal ectopic varices and persistent anemia caused by portal hypertensive enteropathy (PHE) can be very challenging. Capsule endoscopy (CE) is one of the best noninvasive modalities in identifying such lesions. AIM The aims of this study are to study the prevalence of small-bowel changes related to portal hypertension (PHT) and to correlate them with the observations related to the effects of portal hypertension in the esophagus, stomach, and colon. METHODS Thirty-two patients with various etiologies of PHT with either anemia or gastrointestinal bleed were included along with age- and sex-matched controls without PHT. All patients underwent blood tests, gastroscopy, colonoscopy, and CE. The small-bowel findings by CE were categorized as inflammatory-like and vascular lesions. The small-bowel changes were analyzed to find out any association with various demographic, clinical, and endoscopic variables. RESULTS Thirty-one out of 32 patients with PHT (96.8%) had PHE identified by CE. Of them, 31 (96.8%) had inflammatory-like appearance, 11 (34.4%) had vascular lesions, and 2 (6.2%) had small-bowel varices. Inflammatory-like appearance was noted in eight (25%) and angiodysplastic lesions in two (6.2%) controls. Findings compatible with PHE were detected in 96.8% of the patients and 25% of the controls (X 2 =34.72, p=0.000).The presence of PHE was not associated with any of the above-mentioned variables. CONCLUSIONS Small-bowel mucosal changes were seen in significantly higher number of patients with PHT with anemia.
Collapse
Affiliation(s)
- T S Chandrasekar
- Medindia Institute of Medical Specialities, 83, Valluvar Kottam High Road, Nungambakkam, Chennai, 600 034, India.
| | - Gokul Bollu Janakan
- Medindia Institute of Medical Specialities, 83, Valluvar Kottam High Road, Nungambakkam, Chennai, 600 034, India
| | | | - Raja Yogesh Kalamegam
- Medindia Institute of Medical Specialities, 83, Valluvar Kottam High Road, Nungambakkam, Chennai, 600 034, India
| | | | - Prasad Menta Sanjeevaraya
- Medindia Institute of Medical Specialities, 83, Valluvar Kottam High Road, Nungambakkam, Chennai, 600 034, India
| |
Collapse
|
13
|
Capsule Endoscopy for Portal Hypertensive Enteropathy. Gastroenterol Res Pract 2015; 2016:8501394. [PMID: 26819613 PMCID: PMC4706926 DOI: 10.1155/2016/8501394] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/28/2015] [Accepted: 07/15/2015] [Indexed: 02/08/2023] Open
Abstract
Portal hypertensive enteropathy (PHE) is a mucosal abnormality of the small bowel that is observed in patients with portal hypertension (PH) and can lead to gastrointestinal bleeding and anemia. The pathogenesis is still not completely understood. The introduction of new endoscopic methods, including capsule endoscopy (CE) or balloon-assisted enteroscopy, has increased the detection of these abnormalities. CE can also serve as a road map for deciding subsequent interventions and evaluating the treatment effect. The prevalence of PHE is reportedly 40-70% in patients with PH. Endoscopic findings can be roughly divided into vascular and nonvascular lesions such as inflammatory-like lesions. Traditionally, PHE-associated factors include large esophageal varices, portal hypertensive gastropathy or colopathy, Child-Turcotte-Pugh class B or C, a history of variceal treatment, and acute gastrointestinal bleeding. More recently, on using scoring systems, a high computed tomography or transient elastography score was reportedly PHE-related factors. However, the prevalence of PHE and its related associated factors remain controversial. The management of PHE has not yet been standardized. It should be individualized according to each patient's situation, the availability of therapy, and each institutional expertise.
Collapse
|
14
|
Aoyama T, Oka S, Aikata H, Igawa A, Nakano M, Naeshiro N, Yoshida S, Tanaka S, Chayama K. Major predictors of portal hypertensive enteropathy in patients with liver cirrhosis. J Gastroenterol Hepatol 2015; 30:124-30. [PMID: 24988903 DOI: 10.1111/jgh.12658] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 05/19/2014] [Indexed: 12/28/2022]
Abstract
BACKGROUND AND AIM Portal hypertensive enteropathy (PHE) is acknowledged as a source of bleeding, and predicting its presence has become more important. We assessed PHE using capsule endoscopy (CE) and investigated factors that may predict its presence, including portosystemic shunts (PSs). METHODS We analyzed data from 134 consecutive patients with liver cirrhosis, from February 2009 to September 2013. All patients had undergone dynamic computed tomography and esophagogastroduodenoscopy before CE examination. The frequencies and types of PHE lesions, and the relationships between the presence of PHE and patients' clinical characteristics were evaluated. The distribution of the lesions was also determined. RESULTS PHE was found in 91 (68%), erythema in 70 (52%), erosions in 25 (19%), angioectasia in 24 (18%), villous edema in 18 (13%), and varices in 10 (7%) patients. Most lesions were located in the jejunum. The clinical characteristics associated with the presence of PHE were a Child-Pugh grade of B or C (P = 0.0058), and the presence of PSs (P < 0.0001), ascites (P = 0.0017), portal thrombosis (P = 0.016), esophageal varices (P = 0.0017), and portal hypertensive gastropathy (P = 0.0029). The presence of PSs was an independent predictor of PHE (odds ratio [OR]: 3.15; 95% confidence interval [CI]: 1.27-7.95). Among the shunt types, left gastric vein (OR: 5.31; 95% CI: 1.97-17.0) and splenorenal shunts (OR: 4.26; 95% CI: 1.29-19.4) were independent predictors of PHE. CONCLUSION PSs, especially left gastric vein and splenorenal shunts, appear to reliably predict the presence of PHE.
Collapse
Affiliation(s)
- Taiki Aoyama
- Department of Gastroenterology and Metabolism, Graduate School of Biomedical Sciences, Hiroshima University, Hiroshima, Japan
| | | | | | | | | | | | | | | | | |
Collapse
|
15
|
Portal hypertensive enteropathy diagnosed by capsule endoscopy in cirrhotic patients: a nationwide multicenter study. Dig Dis Sci 2014; 59:1036-41. [PMID: 24493093 DOI: 10.1007/s10620-014-3036-3] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/27/2013] [Accepted: 01/08/2014] [Indexed: 02/08/2023]
Abstract
BACKGROUND AND AIM Due to the limited data on portal hypertensive enteropathy (PHE), the prevalence of and clinical factors related to PHE remain unclear. This study determined the prevalence of PHE using capsule endoscopy (CE) and PHE-related clinical factors. METHODS This was a retrospective multicenter study using the Capsule Endoscopy Nationwide Database Registry. From 2,879 cases that underwent CE, 45 cirrhosis patients with portal hypertension (PH) were enrolled and divided into PHE (n = 18) and non-PHE (n = 27) groups. From computed tomography (CT) images, six secondary changes due to PH were scored to give a total CT score of 0-6. The main outcome variable was the prevalence of PHE and PHE-related clinical factors. RESULTS The prevalence of PHE was 40 %. Comparing the PHE and non-PHE groups, the most common findings were angiodysplasias in 55.7 % (vs. 7.4 %, p = 0.001) and varices in 38.9 % (vs. 0 %, p = 0.001). Active bleeding was observed in 16.6 and 3.7 %, respectively, but this difference was not significant. In the univariate analysis, Child-Turcotte-Pugh class C (p = 0.002) and a high CT score (≥3 vs. <3, p = 0.004) were significantly associated with PHE. However, only a high CT score was significant in the multivariate analysis (odds ratio 11.19; 95 % confidence interval, 1.59-infinity; p = 0.040). CONCLUSIONS The prevalence of PHE was 40 %, and it might be more prevalent in cirrhosis patients with PH who have a high CT score. CE is a useful diagnostic tool for evaluating PHE in cirrhosis patients with PH.
Collapse
|
16
|
Gastrointestinal Bleeding in Cirrhotic Patients with Portal Hypertension. ISRN HEPATOLOGY 2013; 2013:541836. [PMID: 27335828 PMCID: PMC4890899 DOI: 10.1155/2013/541836] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/30/2013] [Accepted: 06/29/2013] [Indexed: 02/06/2023]
Abstract
Gastrointestinal bleeding related to portal hypertension is a serious complication in patients with liver cirrhosis. Most patients bleed from esophageal or gastric varices, but bleeding from ectopic varices or portal hypertensive gastropathy is also possible. The management of acute bleeding has changed over the last years. Patients are managed with a combination of endoscopic and pharmacologic treatment. The endoscopic treatment of choice for esophageal variceal bleeding is variceal band ligation. Bleeding from gastric varices is treated by injection with cyanoacrylate. Treatment with vasoactive drugs as well as antibiotic treatment is started before or at the time point of endoscopy. The first-line treatment for primary prophylaxis of esophageal variceal bleeding is nonselective beta blockers. Pharmacologic therapy is recommended for most patients; band ligation is an alternative in patients with contraindications for or intolerability of beta blockers. Treatment options for secondary prophylaxis include variceal band ligation, beta blockers, a combination of nitrates and beta blockers, and combination of band ligation and pharmacologic treatment. A clear superiority of one treatment over the other has not been shown. Bleeding from portal hypertensive gastropathy or ectopic varices is less common. Treatment options include beta blocker therapy, injection therapy, and interventional radiology.
Collapse
|
17
|
Abstract
Cirrhosis is the leading cause of portal hypertension worldwide, with the development of bleeding gastroesophageal varices being one of the most life-threatening consequences. Endoscopy plays an indispensible role in the diagnosis, staging, and prophylactic or active management of varices. With the expected future refinements in endoscopic technology, capsule endoscopy may one day replace traditional gastroscopy as a diagnostic modality, whereas endoscopic ultrasound may more precisely guide interventional therapy for gastric varices.
Collapse
|
18
|
Liu K, Kaffes AJ. Review article: the diagnosis and investigation of obscure gastrointestinal bleeding. Aliment Pharmacol Ther 2011; 34:416-23. [PMID: 21692820 DOI: 10.1111/j.1365-2036.2011.04744.x] [Citation(s) in RCA: 53] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
BACKGROUND Obscure gastrointestinal bleeding (OGIB) is a commonly encountered clinical problem in gastroenterology and is associated with significant morbidity and mortality. The investigation and management of OGIB has changed dramatically over the past decade with the advent of newer gastroenterological and radiological technologies. AIM To review the current evidence on the diagnosis and investigation of OGIB. METHODS We searched the PubMed database (1985-2010) for full original articles in English-language journals relevant to the investigation of OGIB. The search terms we used were 'gastrointestinal bleeding' or 'gastrointestinal hemorrhage' or 'small bowel bleeding' each in combination with 'obscure', or 'capsule endoscopy', or 'enteroscopy' or 'enterography' or 'enteroclysis'. RESULTS Capsule endoscopy (CE) or double balloon enteroscopy (DBE) should be first line investigations. They are complimentary procedures with comparable high diagnostic yields. DBE is also able to provide therapeutic intervention. Newer technologies such as single balloon and spiral enteroscopy are currently being evaluated. Radiological and nuclear medicine investigations, such as CT enterography and CT enteroclysis, are alternative diagnostic tools when CE or DBE are contraindicated. Repeating the gastroscopy and/or colonoscopy may be considered in selective situations. An algorithm for investigation of obscure bleeding is proposed. CONCLUSIONS The development of capsule endoscopy and double balloon enteroscopy has transformed the approach to the evaluation and management of obscure gastrointestinal bleeding over the past decade. Older diagnostic modalities still play a complementary, but increasingly selective role.
Collapse
Affiliation(s)
- K Liu
- Faculty of Medicine, University of Sydney, Sydney, NSW, Australia.
| | | |
Collapse
|
19
|
Almadi MA, Almessabi A, Wong P, Ghali PM, Barkun A. Ectopic varices. Gastrointest Endosc 2011; 74:380-8. [PMID: 21612777 DOI: 10.1016/j.gie.2011.03.1177] [Citation(s) in RCA: 35] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/28/2010] [Accepted: 03/14/2011] [Indexed: 12/13/2022]
Affiliation(s)
- Majid Abdulrahman Almadi
- Division of Gastroenterology, McGill University and the McGill University Health Centre, Montreal, Quebec, Canada
| | | | | | | | | |
Collapse
|
20
|
Ripoll C, Garcia-Tsao G. The management of portal hypertensive gastropathy and gastric antral vascular ectasia. Dig Liver Dis 2011; 43:345-51. [PMID: 21095166 DOI: 10.1016/j.dld.2010.10.006] [Citation(s) in RCA: 57] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/31/2010] [Accepted: 10/11/2010] [Indexed: 02/08/2023]
Abstract
Portal hypertensive gastropathy and gastric antral vascular ectasia are gastric mucosal lesions that can cause chronic gastrointestinal haemorrhage and, consequently, chronic anaemia, in patients with cirrhosis. Although chronic anaemia is the most common clinical manifestation, these entities may also lead to acute gastrointestinal bleeding. Despite similar clinical manifestations, their pathophysiology and management are entirely different. Their diagnosis is endoscopic and although generally each of them has a characteristic endoscopic appearance and distribution, there are cases in which the differential is difficult and must rely on histology. This review focuses on the management of both entities. The mainstay of management of portal hypertensive gastropathy is based on portal-hypotensive pharmacological treatment whilst gastric antral vascular ectasia benefits from endoscopic therapy. More invasive options should be reserved for refractory cases.
Collapse
Affiliation(s)
- Cristina Ripoll
- Servicio de Aparato Digestivo, Hospital General Universitario Gregorio Marañón and Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (CIBERehd), Spain
| | | |
Collapse
|
21
|
Yamada A, Watabe H, Obi S, Sugimoto T, Kondo S, Ohta M, Togo G, Ogura K, Yamaji Y, Okamoto M, Yoshida H, Kawabe T, Koike K, Omata M. Surveillance of small intestinal abnormalities in patients with hepatocellular carcinoma: a prospective capsule endoscopy study. Dig Endosc 2011; 23:124-9. [PMID: 21429016 DOI: 10.1111/j.1443-1661.2010.01050.x] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
BACKGROUND Patients with hepatocellular carcinoma (HCC) sometimes suffer from obscure gastrointestinal bleeding. Portal hypertension (PH), common in cirrhosis, induces esophagogastric varices. Because of the location, PH also may influence mucosal abnormalities in the small intestine. The objective of this study is to estimate the prevalence of small intestinal mucosal abnormalities in HCC patients using capsule endoscopy (CE). PATIENTS AND METHODS We prospectively conducted CE in HCC patients, and analyzed the findings in relation to hepatic function, the number and size of HCC tumor and findings obtained by conventional endoscopy. RESULTS Thirty-six patients (aged 66.7 ± 7.5 years, 29 men) underwent CE. Abnormal findings in the small bowel were found in 16 patients (44%), angioectasias in eight patients (22%), erosions in five (14%), varices in four (11%), polyps in four (11%), and submucosal tumor in one (3%). The patients with angioectasia had a larger spleen index than the no abnormal lesions group (85.4 ± 15.8 vs 59.0 ± 24.4, P = 0.02). The former group had been more frequently treated for esophageal varices endoscopically (62% vs 15%, P = 0.02). Large HCC nodules seemed more common in the patients with angioectasia than subjects without abnormal lesions (38% vs 5%, P = 0.06). Small intestinal varices also seemed to have a positive association with large HCC. During the follow up after CE, one patient with small intestinal polyps suffered from obscure gastrointestinal bleeding. CONCLUSIONS CE revealed that HCC patients frequently have small intestinal mucosal lesions. In particular, small intestinal angioectasia, which may cause obscure gastrointestinal bleeding, seems to be associated with portal hypertension.
Collapse
Affiliation(s)
- Atsuo Yamada
- Department of Gastroenterology, Graduate School of Medicine, University of Tokyo, Tokyo, Japan.
| | | | | | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
22
|
Ectopic ileal varices associated with recurrent bleeding: Report of a case. Surg Today 2011; 41:448-52. [DOI: 10.1007/s00595-009-4285-1] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2009] [Accepted: 10/27/2009] [Indexed: 01/13/2023]
|
23
|
Pezzoli A, Fusetti N, Simone L, Zelante A, Cifalà V, Carella A, Gullini S. Portal hypertensive enteropathy diagnosed by capsule endoscopy and demonstration of the ileal changes after transjugular intrahepatic portosystemic shunt placement: a case report. J Med Case Rep 2011; 5:90. [PMID: 21371340 PMCID: PMC3068106 DOI: 10.1186/1752-1947-5-90] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2010] [Accepted: 03/04/2011] [Indexed: 12/24/2022] Open
Abstract
Introduction Recent data suggest that mucosal abnormalities can occur even in the duodenum, jejunum, and distal ileum of cirrhosis patients. We present a case of portal hypertensive enteropathy in a cirrhosis patient shown by capsule endoscopy and the effect of transjugular intrahepatic portosystemic shunt on the ileal pictures. Case presentation An 83-year-old Caucasian woman was admitted to our hospital for anemia and a positive fecal occult blood test. An upper gastrointestinal endoscopy revealed small varices without bleeding signs and hypertensive gastropathy. Colonoscopy was negative. To rule out any other cause of bleeding, capsule endoscopy was performed; capsule endoscopy revealed severe hyperemia of the jejunum-ileal mucosa with active bleeding. Because of the persistence of anemia and the frequent blood transfusions, not responding to β-blocker drugs or octreotide infusion, a transjugular intrahepatic portosystemic shunt was performed. Anemia improved quickly after the transjugular intrahepatic portosystemic shunt, and no further blood transfusion was necessary in the follow-up. The patient developed portal encephalopathy two months later and was readmitted to our department. We repeated the capsule endoscopy that showed a significant improvement of the gastric and ileal mucosa without any signs of bleeding. Conclusion Hypertensive enteropathy is a rare condition, but it seems more common with the introduction of capsule endoscopy in clinical practice. This case shows that the jejunum can be a source of bleeding in cirrhosis patients, and this is the first demonstration of its resolution after transjugular intrahepatic portosystemic shunt placement.
Collapse
Affiliation(s)
- Alessandro Pezzoli
- Department of Gastroenterology and GI Endoscopy, Arcispedale S,Anna, Corso Giovecca 203, 44100 Ferrara, Italy.
| | | | | | | | | | | | | |
Collapse
|
24
|
Esaki M, Matsumoto T, Yada S, Yanaru-Fujisawa R, Kudo T, Yanai S, Nakamura S, Iida M. Factors associated with the clinical impact of capsule endoscopy in patients with overt obscure gastrointestinal bleeding. Dig Dis Sci 2010; 55:2294-301. [PMID: 19957038 DOI: 10.1007/s10620-009-1036-5] [Citation(s) in RCA: 46] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/05/2009] [Accepted: 10/26/2009] [Indexed: 12/12/2022]
Abstract
BACKGROUND AND STUDY AIMS Capsule endoscopy (CE) does not necessarily identify positive findings in patients with overt obscure gastrointestinal bleeding (OGIB). We aimed to identify factors predictive of positive CE findings and those of re-bleeding after negative CE in overt OGIB. PATIENTS AND METHODS We retrospectively analyzed 68 patients who underwent CE for overt OGIB. CE findings, therapeutic interventions, and clinical course after CE were reviewed. Clinical variables associated with positive CE findings and those associated with re-bleeding after negative CE findings were investigated. RESULTS Positive CE finding was found in 36 (53%) patients. Marked decrease in hemoglobin value [OR; 18.8, 95% CI; 3.4-152.0] and earlier CE examination within a week after the last episode of bleeding [OR; 8.0, 95% CI; 2.2-35.9] were factors associated with positive CE findings. Nine (28%) of 32 patients with negative CE findings re-bled. Marked decrease in hemoglobin value was more frequent in patients with re-bleeding than those without (P = 0.07). CONCLUSION Patients with massive and overt OGIB are the best candidates for CE. Earlier CE, virtually within a week, contributes to the better diagnostic yield of the procedure. Careful follow-up seems necessary for patients with massive bleeding even in cases of negative CE findings.
Collapse
Affiliation(s)
- Motohiro Esaki
- Department of Medicine and Clinical Science, Graduate Schools of Medical Sciences, Kyushu University, Higashi-ku, Fukuoka, Japan.
| | | | | | | | | | | | | | | |
Collapse
|
25
|
Transabdominal color Doppler ultrasonography for the diagnosis of small intestinal and vesical varices in a patient successfully treated with percutaneous transhepatic obliteration. Clin J Gastroenterol 2010; 3:214-8. [DOI: 10.1007/s12328-010-0164-y] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/08/2010] [Accepted: 06/30/2010] [Indexed: 02/06/2023]
|
26
|
Ripoll C, Garcia-Tsao G. Management of gastropathy and gastric vascular ectasia in portal hypertension. Clin Liver Dis 2010; 14:281-95. [PMID: 20682235 PMCID: PMC2916868 DOI: 10.1016/j.cld.2010.03.013] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
Portal hypertensive gastropathy and gastric antral vascular ectasia may cause gastrointestinal hemorrhage in patients with portal hypertension. Whereas the former presents exclusively in patients with portal hypertension, gastric antral vascular ectasia can also be observed in patients with other conditions. Diagnosis is established with upper gastrointestinal endoscopy, although some cases may require a biopsy to confirm the diagnosis. The most frequent manifestation is ferropenic anemia, which may become transfusion dependent. Treatment in portal hypertensive gastropathy is focused on portal pressure reducing drugs, mainly nonselective beta-blockers, whereas in gastric antral vascular ectasia treatment is based on endoscopic ablation. More invasive options can be used if first-line therapies fail, although these should be evaluated on a case-by-case basis.
Collapse
Affiliation(s)
| | - Guadalupe Garcia-Tsao
- Corresponding author: Guadalupe Garcia-Tsao, M.D., Digestive Diseases Section, Yale University School of Medicine, 333 Cedar Street – 1080 LMP, New Haven, CT 06510, , Tph: 203 737 6063, Fax: 203 785-7273
| |
Collapse
|
27
|
Rondonotti E, Villa F, Dell' Era A, Tontini GE, de Franchis R. Capsule endoscopy in portal hypertension. Clin Liver Dis 2010; 14:209-20. [PMID: 20682230 DOI: 10.1016/j.cld.2010.03.004] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Abstract
Since the introduction of small bowel capsule endoscopy, and more recently of esophageal capsule endoscopy, these diagnostic tools have become available for the evaluation of the consequences of portal hypertension in the esophagus, stomach, and small intestine. The main advantage of the esophageal and the small bowel capsule is the relatively less invasiveness that could potentially increase patients' adherence to endoscopic screening/surveillance programs. When esophageal capsule endoscopy was compared with traditional gastroscopy, it showed good sensitivity and specificity in recognizing the presence and the size of esophageal varices. However, the results are not consistent among studies, and more data are needed.
Collapse
Affiliation(s)
- Emanuele Rondonotti
- Università degli Studi di Milano, IRCCS Ca' Granda Ospedale Policlinico Foundation, Italy
| | | | | | | | | |
Collapse
|
28
|
Abdelaal UM, Morita E, Nouda S, Kuramoto T, Miyaji K, Fukui H, Tsuda Y, Fukuda A, Murano M, Tokioka S, Arafa UA, Kassem AM, Umegaki E, Higuchi K. Evaluation of portal hypertensive enteropathy by scoring with capsule endoscopy: is transient elastography of clinical impact? J Clin Biochem Nutr 2010; 47:37-44. [PMID: 20664729 PMCID: PMC2901762 DOI: 10.3164/jcbn.10-14] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2010] [Accepted: 02/11/2010] [Indexed: 12/17/2022] Open
Abstract
There is limited data about the mucosal lesions of portal hypertensive enteropathy (PHE) detected by capsule endoscopy, and there is no scoring system to evaluate their severity. Our aim is to create a reliable scoring system for PHE, and to explore the possible usefulness of using transient elastograhy (TE) in that field. We compared the medical records of 31 patients with liver cirrhosis and portal hypertension with 29 control patients. We found that the mucosal lesions compatible with PHE were significantly more common in cirrhotic patients than in control patients (67.7% vs 6.9%, p<0.001). Cirrhotic patients with high TE score (p = 0.018), high Child-Pugh grade, large esophageal varices (EV), portal hypertensive gastropathy, and history of endoscopic variceal injection sclerotherapy or ligation (EIS/EVL) were significantly associated with PHE. Using our scoring system, we found that patients with higher TE score (p = 0.004), high Child-Pugh score (p = 0.011), larger EV (p = 0.006), and prior EIS/EVL (p = 0.006) were significantly associated with higher PHE score. We concluded that using our scoring system might be helpful in grading PHE severity, and TE might be a new non-invasive method for detecting the presence and severity of PHE in cirrhotic patients.
Collapse
Affiliation(s)
- Usama M Abdelaal
- Second Department of Internal Medicine, Osaka Medical College, 2-7 Daigaku-machi, Takatsuki-shi, Osaka 569-8686, Japan
| | | | | | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
29
|
Díaz-Sánchez A, Núñez-Martínez O, González-Asanza C, Matilla A, Merino B, Beceiro I, Ponferrada A, Bañares R, Clemente G, Menchén PL. [Results of colonoscopic examination in the evaluation of cirrhotic candidates for liver transplantation]. GASTROENTEROLOGIA Y HEPATOLOGIA 2009; 32:327-33. [PMID: 19457593 DOI: 10.1016/j.gastrohep.2009.01.172] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Subscribe] [Scholar Register] [Received: 10/15/2008] [Accepted: 01/22/2009] [Indexed: 02/07/2023]
Abstract
AIM To assess the presence of preneoplastic and neoplastic colonic lesions, as well as those related to portal hypertensive vasculopathy, and their association with liver disease in cirrhotic patients who are candidates for orthotopic liver transplantation (LT). METHODS Between October 2004 and December 2005, colonoscopy was performed in 92 patients who were LT candidates, aged >50 years old or aged <50 years old but with clinical indications. RESULTS Eighty-eight percent of the patients were > 50 years old, the mean age was 55.3 years (29-69) and 81.5% were males. The main etiology of cirrhosis was alcoholic (46.7%), and 21% were Child-Pugh class A. No abnormalities were detected in 20.7%. Polyps were discovered in 38% (35/92) of patients (adenomatous 65.2%; tubular type 86.7%). Six patients with adenomatous polyps had mild dysplasia, and one asymptomatic patient had a well-differentiated adenocarcinoma. An association was found between polyps and male sex (44% males vs 17.6% females; p=0.044) and Child-Pugh grade (63.2% Child A vs 32.9% Child B/C, p=0.016) but not with serum levels of carcinoembryonic antigen (CEA), age or etiology of liver disease. Portal hypertensive colopathy was found in 23.9%, rectal varices in 7.6% and internal or mixed hemorrhoids in 52.3%. CONCLUSION The prevalence of preneoplastic and neoplastic colonic lesions may support the use of colonoscopy in LT candidates aged >50 years-old or with a history suggesting lower gastrointestinal bleeding or other abnormalities.
Collapse
Affiliation(s)
- Antonio Díaz-Sánchez
- Servicio de Aparato Digestivo, Hospital General Universitario Gregorio Marañón, Madrid, España.
| | | | | | | | | | | | | | | | | | | |
Collapse
|