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Limpias Kamiya KJ, Hosoe N, Hayashi Y, Kawaguchi T, Takabayashi K, Ogata H, Kanai T. Video capsule endoscopy in inflammatory bowel disease. DEN OPEN 2022; 2:e26. [PMID: 35310695 PMCID: PMC8828198 DOI: 10.1002/deo2.26] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 04/19/2021] [Accepted: 04/30/2021] [Indexed: 12/22/2022]
Affiliation(s)
- Kenji J.L. Limpias Kamiya
- Division of Gastroenterology and Hepatology Department of Internal Medicine Keio University School of Medicine Tokyo Japan
| | - Naoki Hosoe
- Center for Diagnostic and Therapeutic Endoscopy Keio University School of Medicine Tokyo Japan
| | - Yukie Hayashi
- Division of Gastroenterology and Hepatology Department of Internal Medicine Keio University School of Medicine Tokyo Japan
| | - Takaaki Kawaguchi
- Division of Gastroenterology and Hepatology Department of Internal Medicine Keio University School of Medicine Tokyo Japan
| | - Kaoru Takabayashi
- Center for Diagnostic and Therapeutic Endoscopy Keio University School of Medicine Tokyo Japan
| | - Haruhiko Ogata
- Center for Diagnostic and Therapeutic Endoscopy Keio University School of Medicine Tokyo Japan
| | - Takanori Kanai
- Division of Gastroenterology and Hepatology Department of Internal Medicine Keio University School of Medicine Tokyo Japan
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Pan J, Fu D, Li Y, Wang Y, Lian G, Liu X. Body weight, serum albumin and food intolerance were linked to upper gastrointestinal Crohn's disease: a 7-year retrospective analysis. ANNALS OF TRANSLATIONAL MEDICINE 2020; 8:1370. [PMID: 33313115 PMCID: PMC7723648 DOI: 10.21037/atm-20-2212] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
Background The clinical features of upper gastrointestinal (L4) Crohn’s disease (CD) and its subtypes, along with the associated and nutritional status, remain poorly described. Our aim was to evaluate the clinical characteristics of L4 CD phenotype and its subtypes at diagnosis, and their relationship with the nutritional status. Methods A retrospective study was conducted on 869 CD patients diagnosed between 2013 and 2019, and the association between the clinical characteristics and nutritional status of L4 patients was determined using Random forest importance ranking and logistic regression. Results The majority of the patients (59.72%) presented L4 lesions, of which 335, 158 and 26 had proximal ileal, jejunal and esophago-gastroduodenal (EGD) lesions respectively. L4 patients were predominantly male (OR 2.07), smoker (OR 1.80), and had higher body weight and BMI, longer disease course, and stricturing disease (OR 1.88). Furthermore, the serum albumin level, body weight and disease course showed higher MDG in the random forest importance ranking test for L4 CD and L4-proximal ileal types. According to logistic regression, body weight (OR 1.054), disease course (OR 1.010), stricturing behavior (OR 4.998) and tomato intolerance (OR 1.313) were the independent risk factors for L4. In addition, body weight (OR 1.042) and stricturing behavior (OR 3.152) were the relevant factors for proximal ileal subtype, and stricturing behavior (OR 4.206) and perianal disease (OR 0.339) for jejunal subtype. Conclusions L4 disease has a higher incidence rate compared to the non-L4 CD, and mainly affects males, and those with prolonged disease course, stricturing behavior, higher weight, BMI, albumin levels and food intolerance (FI).
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Affiliation(s)
- Jianfeng Pan
- Department of Gastroenterology, Xiangya Hospital, Central South University, Changsha, China
| | - Dongni Fu
- Department of Gastroenterology, Xiangya Hospital, Central South University, Changsha, China
| | - Yong Li
- Department of Gastroenterology, Xiangya Hospital, Central South University, Changsha, China
| | - Yifan Wang
- Department of Gastroenterology, Xiangya Hospital, Central South University, Changsha, China
| | - Guanghui Lian
- Department of Gastroenterology, Xiangya Hospital, Central South University, Changsha, China
| | - Xiaowei Liu
- Department of Gastroenterology, Xiangya Hospital, Central South University, Changsha, China
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Ramos López L, Hernández Camba A, Rodríguez-Lago I, Carrillo Palau M, Cejas Dorta L, Elorza A, Alonso Abreu I, Vela M, Hidalgo A, Hernández Álvarez-Builla N, Rodríguez GE, Rodríguez Y, Tardillo C, Díaz-Flórez L, Eiroa D, Aduna M, Garrido MS, Larena JA, Cabriada JL, Quintero Carrion E. Usefulness of magnetic resonance enterography in the clinical decision-making process for patients with inflammatory bowel disease. GASTROENTEROLOGIA Y HEPATOLOGIA 2020; 43:439-445. [PMID: 32349904 DOI: 10.1016/j.gastrohep.2020.03.007] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/09/2020] [Accepted: 03/04/2020] [Indexed: 02/07/2023]
Abstract
OBJECTIVE To evaluate the impact of magnetic resonance enterography (MRE) diagnosis on clinical decision-making regarding treatment choice and maintenance of treatment over time in patients with inflammatory bowel disease (IBD). METHODS A cohort of patients who underwent MRE for IBD assessment between 2011 and 2014 was analyzed. From clinical records, we retrospectively retrieved their demographic data and clinical data on their IBD at the time of MRE, the results of MRE and the patient's clinical course. Medical management decisions made during the three months following MRE and at the 15-month follow-up were assessed. RESULTS In total, 474 MREs were reviewed. In the first three-month period, MRE results led to changes in the medical management of 266 patients (56.1%). Of those, maintenance therapy was altered in 140 patients (68.3%) (90.7% step-up and 9.3% top-down strategy), 65 (24.4%) were prescribed a course of steroids and 61 (22.9%) underwent surgery. MRE confirmed a CD diagnosis in 14/41 patients (34.1%) previously diagnosed with indeterminate colitis or ulcerative colitis and in 4/18 patients (22.2%) with suspected IBD. At the 15-month follow-up, treatment remained unchanged in 289 patients (65.8%). CONCLUSIONS These results suggest that MRE is a diagnostic tool that provides valid information for the clinical-decision making process for patients with CD.
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Affiliation(s)
- Laura Ramos López
- Servicio de Aparato Digestivo, Hospital Universitario de Canarias, Tenerife, Spain
| | - Alejandro Hernández Camba
- Servicio de Aparato Digestivo, Hospital Universitario Nuestra Señora de Candelaria, Santa Cruz De Tenerife, Spain.
| | | | - Marta Carrillo Palau
- Servicio de Aparato Digestivo, Hospital Universitario de Canarias, Tenerife, Spain
| | - Luis Cejas Dorta
- Servicio de Aparato Digestivo, Hospital Universitario Nuestra Señora de Candelaria, Santa Cruz De Tenerife, Spain
| | - Ainara Elorza
- Servicio de Aparato Digestivo, Hospital de Galdakao, Galdakao, Spain
| | | | - Milagros Vela
- Servicio de Aparato Digestivo, Hospital Universitario Nuestra Señora de Candelaria, Santa Cruz De Tenerife, Spain
| | - Alba Hidalgo
- Servicio de Aparato Digestivo, Hospital de Galdakao, Galdakao, Spain
| | | | - G Esther Rodríguez
- Servicio de Aparato Digestivo, Hospital Universitario Nuestra Señora de Candelaria, Santa Cruz De Tenerife, Spain
| | - Yolanda Rodríguez
- Servicio de Aparato Digestivo, Hospital Universitario Nuestra Señora de Candelaria, Santa Cruz De Tenerife, Spain
| | - Carlos Tardillo
- Servicio de Aparato Digestivo, Hospital Universitario Nuestra Señora de Candelaria, Santa Cruz De Tenerife, Spain
| | - Lucio Díaz-Flórez
- Servicio de Radiología, Hospital Universitario de Canarias, Tenerife, Spain
| | - Daniel Eiroa
- Servicio de Radiología, Hospital Universitario Nuestra Señora de Candelaria, Santa Cruz De Tenerife, Spain
| | - Marta Aduna
- Osatek, Hospital de Galdakao, Galdakao, Spain
| | - María S Garrido
- Servicio de Radiología, Hospital Universitario Nuestra Señora de Candelaria, Santa Cruz De Tenerife, Spain
| | | | - José L Cabriada
- Servicio de Aparato Digestivo, Hospital de Galdakao, Galdakao, Spain
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Tanabe H, Ando K, Ohdaira H, Suzuki Y, Konuma I, Ueno N, Fujiya M, Okumura T. Successful medical treatment for a Crohn's disease patient with a perforation by a second-generation patency capsule. Endosc Int Open 2018; 6:E1436-E1438. [PMID: 30539066 PMCID: PMC6288758 DOI: 10.1055/a-0752-9903] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/18/2018] [Accepted: 08/09/2018] [Indexed: 11/02/2022] Open
Abstract
Background and study aims Symptomatic capsule retention is a very rare adverse event following patency capsule, and the vast majority of cases are resolved without either surgical or endoscopic intervention. We herein describe a rare case of small bowel perforation after swallowing a patency capsule in a 37-year-old man suspected of having Crohn's disease.
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Affiliation(s)
- Hiroki Tanabe
- Department of Gastroenterology, International University of Health and Welfare Hospital, Nasushiobara, Japan,Corresponding author Hiroki Tanabe Division of Gastroenterology and Hematology/OncologyDepartment of MedicineAsahikawa Medical UniversityMidorigaoka-Higashi 2-1-1-1Asahikawa Hokkaido 078-8510Japan+81-166-68-2469
| | - Katsuyoshi Ando
- Department of Gastroenterology, International University of Health and Welfare Hospital, Nasushiobara, Japan
| | - Hironori Ohdaira
- Department of Surgery, International University of Health and Welfare Hospital, Nasushiobara, Japan
| | - Yutaka Suzuki
- Department of Surgery, International University of Health and Welfare Hospital, Nasushiobara, Japan
| | | | - Nobuhiro Ueno
- Division of Gastroenterology and Hematology/Oncology Department of Medicine, Asahikawa Medical University, Asahikawa, Japan
| | - Mikihiro Fujiya
- Division of Gastroenterology and Hematology/Oncology Department of Medicine, Asahikawa Medical University, Asahikawa, Japan
| | - Toshikatsu Okumura
- Division of Gastroenterology and Hematology/Oncology Department of Medicine, Asahikawa Medical University, Asahikawa, Japan
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Goran L, Negreanu AM, Stemate A, Negreanu L. Capsule endoscopy: Current status and role in Crohn’s disease. World J Gastrointest Endosc 2018; 10:184-192. [PMID: 30283601 PMCID: PMC6162247 DOI: 10.4253/wjge.v10.i9.184] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/07/2018] [Revised: 07/01/2018] [Accepted: 08/05/2018] [Indexed: 02/06/2023] Open
Abstract
Capsule endoscopy (CE) has proved to be an important non-invasive tool for diagnosis and monitoring Crohn’s disease patients. It has the advantage of excellent visualization of digestive tract mucosa, a good tolerability and safety in well-selected patients. The risk of retention can be diminished by good selection of patients using imaging techniques and by the use of patency capsule. The aim of a capsule examination is not only an early diagnosis but also a very good stratification of prognosis, thus directing the treatment strategy for either a step up or top-down approach and also permitting the optimization of the treatment depending on the findings. When symptoms and biomarkers point to a change in the disease’s activity we can either adjust the treatment directly as recommended in CALM study or choose in selected patients to visualize the digestive mucosa through a CE and take a decision afterwards. The appearance of the new capsule from Medtronic-the Pillcam Crohn’s might be an important step forward in diagnosis, evaluating disease extent, the severity of the disease, prognosis, management in a treat to target approach, with treatment modifications according to the data from CE examination. Serial examinations in the same patient can be compared and a more objective evaluation of the lesions modification from one exam to another can be performed. We present the latest developments and current status and evidence that in selected patients capsule can be a tool in a treat to target approach.
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Affiliation(s)
- Loredana Goran
- Internal Medicine 2-Gastroenterology Department, University Hospital, Carol Davila University, Bucharest 050098, Romania
| | - Ana Maria Negreanu
- Internal Medicine 2-Gastroenterology Department, University Hospital, Carol Davila University, Bucharest 050098, Romania
| | - Ana Stemate
- Internal Medicine 2-Gastroenterology Department, University Hospital, Carol Davila University, Bucharest 050098, Romania
| | - Lucian Negreanu
- Internal Medicine 2-Gastroenterology Department, University Hospital, Carol Davila University, Bucharest 050098, Romania
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Mao R, Tang RH, Qiu Y, Chen BL, Guo J, Zhang SH, Li XH, Feng R, He Y, Li ZP, Zeng ZR, Eliakim R, Ben-Horin S, Chen MH. Different clinical outcomes in Crohn's disease patients with esophagogastroduodenal, jejunal, and proximal ileal disease involvement: is L4 truly a single phenotype? Therap Adv Gastroenterol 2018; 11:1756284818777938. [PMID: 29899757 PMCID: PMC5990878 DOI: 10.1177/1756284818777938] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/08/2017] [Accepted: 04/24/2018] [Indexed: 02/04/2023] Open
Abstract
BACKGROUND The Montreal classification defines L4 Crohn's disease (CD) as any disease location proximal to the terminal ileum, which anatomically includes L4-esophagogastroduodenal (EGD), L4-jejunal, and L4-proximal ileal involvement. L4-jejunal disease was established to be associated with poor prognosis. However, the outcome of patients with L4-proximal ileal disease or L4-EGD remains to be clarified. Our study aimed to investigate whether the outcome differs among CD patients with L4-EGD, L4-jejunal, and L4-proximal ileal disease. METHODS In our retrospective cohort study, 483 patients with confirmed CD were included. The primary outcome was intestinal surgery. Demographic features and outcomes were compared among L4-EGD, L4-jejunal, and L4-proximal ileal disease. RESULTS Thirty-nine (8.1%) patients had isolated L4 disease, whereas 146 patients had L4 as well as concomitant L1, L2, or L3 disease. During a median follow up of 5.8 years, L4 patients were more likely to have intestinal surgeries compared to non-L4 patients (31% versus 16%, p < 0.001). The percentage of L4-jejunal patients who underwent surgery was higher than that of L4-proximal ileal (66% versus 28%, p < 0.001), and both of these subtypes of L4 were at higher risk for intestinal resection compared to L4-EGD patients (66% and 28% versus 9%, respectively, p < 0.001 and p < 0.05). On multi-variable analysis, L4-jejunal (HR 3.08; 95% CI 1.30-7.31) and L4-proximal ileal disease (HR 1.83; 95% CI 1.07-3.15) were independent predictors for intestinal resection. CONCLUSIONS L4 disease had worse prognosis compared to non-L4 disease. Within L4 disease, phenotype of L4-jejunal and L4-proximal ileal disease indicated higher risk for intestinal surgery. It might be justified to further characterize the L4 phenotype of the Montreal classification into three specific subgroups including L4-EGD, L4-jejunal, and L4-proximal ileal disease, similar to the Paris classification of pediatric patients.
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Affiliation(s)
| | | | | | - Bai-Li Chen
- Department of Gastroenterology, The First Affiliated
Hospital, Sun Yat-sen University, Guangzhou, People’s Republic of China
| | - Jing Guo
- Department of Gastroenterology, The First Affiliated
Hospital, Sun Yat-sen University, Guangzhou, People’s Republic of China
| | - Sheng-Hong Zhang
- Department of Gastroenterology, The First Affiliated
Hospital, Sun Yat-sen University, Guangzhou, People’s Republic of China
| | - Xue-Hua Li
- Department of Radiology, The First Affiliated Hospital,
Sun Yat-sen University, Guangzhou, People’s Republic of China
| | - Rui Feng
- Department of Gastroenterology, The First Affiliated
Hospital, Sun Yat-sen University, Guangzhou, People’s Republic of China
| | - Yao He
- Department of Gastroenterology, The First Affiliated
Hospital, Sun Yat-sen University, Guangzhou, People’s Republic of China
| | - Zi-Ping Li
- Department of Radiology, The First Affiliated Hospital,
Sun Yat-sen University, Guangzhou, People’s Republic of China
| | - Zhi-Rong Zeng
- Department of Gastroenterology, The First Affiliated
Hospital, Sun Yat-sen University, Guangzhou, People’s Republic of China
| | - Rami Eliakim
- Department of Gastroenterology, Sheba Medical Center
& Sackler School of Medicine, Tel-Aviv University, Israel
| | - Shomron Ben-Horin
- Department of Gastroenterology, Sheba Medical Center
& Sackler School of Medicine, Tel-Aviv University, IsraelDepartment of
Gastroenterology, The First Affiliated Hospital, Sun Yat-sen University, Guangzhou,
China
| | - Min-Hu Chen
- Department of Gastroenterology, The First Affiliated
Hospital, Sun Yat-sen University, Guangzhou, People’s Republic of China
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Pilot study of endoscopic retrograde 3-dimensional - computed tomography enteroclysis for the assessment of Crohn's disease. Eur J Radiol Open 2017; 4:58-62. [PMID: 28508024 PMCID: PMC5423330 DOI: 10.1016/j.ejro.2017.04.003] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2017] [Revised: 04/17/2017] [Accepted: 04/18/2017] [Indexed: 12/22/2022] Open
Abstract
Purpose Endoscopic retrograde ileography (ERIG) is developed in our institute and applied clinically for the diagnosis and assessment of the Crohn’s disease activity. We have further improved the technique using 3-dimensional – computed tomography enteroclysis (3D-CTE) and conducted a retrospective study to determine the feasibility and the diagnostic value of endoscopic retrograde 3D-CTE (ER 3D-CTE) in Crohn’s disease patients in a state of remission. Methods Thirteen Crohn’s patients were included in this pilot study. CTE was performed after the infusion of air or CO2 through the balloon tube following conventional colonoscopy. The primary endpoint of this study was to assess the safety of this method. Secondarily, the specific findings of Crohn’s disease and length of the visualized small intestine were assessed. Results The procedures were completed without any adverse events. Gas passed through the small intestine and enterographic images were obtained in 10 out of 13 cases, but, in the remaining patients, insertion of the balloon tubes into the terminal ileum failed. Various features specific to Crohn’s disease were visualized using ER 3D-CTE. A cobble stone appearance or hammock-like malformation was specific and effective for diagnosing Crohn’s disease and the features of anastomosis after the surgical operations were also well described. Therefore, this technique may be useful after surgery. Conclusion In this study, ER 3D-CTE was performed safely in Crohn’s disease patients and may be used for the diagnosis and follow-up of this disease.
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Sconfienza LM, Cavallaro F, Colombi V, Pastorelli L, Tontini G, Pescatori L, Esseridou A, Savarino E, Messina C, Casale R, Di Leo G, Sardanelli F, Vecchi M. In-vivo Axial-strain Sonoelastography Helps Distinguish Acutely-inflamed from Fibrotic Terminal Ileum Strictures in Patients with Crohn's Disease: Preliminary Results. ULTRASOUND IN MEDICINE & BIOLOGY 2016; 42:855-863. [PMID: 26742896 DOI: 10.1016/j.ultrasmedbio.2015.11.023] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/21/2015] [Revised: 11/19/2015] [Accepted: 11/23/2015] [Indexed: 06/05/2023]
Abstract
We tested real-time sonoelastography (RTS) in-vivo to differentiate fibrotic from inflammatory terminal ileum strictures in patients with Crohn's disease (CD), using magnetic resonance enterography (MRE) as a reference standard. Sixteen patients (13 male, 3 female; median [interquartile interval] age = 41 [31-48.5] y; median C-reactive protein (CRP) = 0.95 [0-2.23] mg/dL; median disease duration = 108.5 [35-213.75] mo; median Harvey-Bradshaw Index (HBI) = 3 [3-5.25]) with terminal ileum CD were prospectively included. Short-axis scans were performed; each cross-section was ideally sub-divided into eight circular sectors. Color map provided by RTS was translated into semi-quantitative scale (1 = red; 2 = green; 3 = blue). At MRE, inflammation was seen in nine patients and fibrosis in seven. Total median RTS score was significantly lower in patients with inflammatory stricture (16 [16-18]) than in patients with fibrosis (20 [17.5-22]; p = 0.003). The same happened when the four most superficial quadrants of the loop were considered (8 [7-9] vs. 10 [9-11.5]; p = 0.003). No significant correlation was seen between RTS and HBI (r = 0.467; p = 0.686), RTS and CRP (r = -0.750; p = 0.567) or RTS and disease duration (r = 0.238; p = 0.483). RTS of the terminal ileum in patients with CD is feasible in-vivo, potentially differentiating between fibrotic and inflammatory strictures.
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Affiliation(s)
- Luca Maria Sconfienza
- Servizio di Radiologia, IRCCS Policlinico San Donato, San Donato Milanese, Italy; Dipartimento di Scienze Biomediche per la Salute, Università degli Studi di Milano, San Donato Milanese, Italy.
| | - Flaminia Cavallaro
- Unità Operativa di Gastroenterologia ed Endoscopia Digestiva, IRCCS Policlinico San Donato, San Donato Milanese, Italy
| | - Valentino Colombi
- Unità Operativa di Gastroenterologia ed Endoscopia Digestiva, IRCCS Policlinico San Donato, San Donato Milanese, Italy
| | - Luca Pastorelli
- Dipartimento di Scienze Biomediche per la Salute, Università degli Studi di Milano, San Donato Milanese, Italy; Unità Operativa di Gastroenterologia ed Endoscopia Digestiva, IRCCS Policlinico San Donato, San Donato Milanese, Italy
| | - Gianeugenio Tontini
- Unità Operativa di Gastroenterologia ed Endoscopia Digestiva, IRCCS Policlinico San Donato, San Donato Milanese, Italy
| | - Lorenzo Pescatori
- Scuola di Specializzazione in Radiodiagnostica, Università degli Studi di Milano, Milano, Italy
| | - Anastassia Esseridou
- Servizio di Radiologia, IRCCS Policlinico San Donato, San Donato Milanese, Italy
| | - Edoardo Savarino
- Divisione di Gastroenterologia, Dipartimenti di Scienze Chirurgiche, Oncologiche e Gastroenterologiche, Università degli Studi di Padova, Padova, Italy
| | - Carmelo Messina
- Scuola di Specializzazione in Radiodiagnostica, Università degli Studi di Milano, Milano, Italy
| | - Roberto Casale
- Area Vasta 3 Marche, Servizio di Radiodiagnostica, Civitanova Marche, Italy
| | - Giovanni Di Leo
- Servizio di Radiologia, IRCCS Policlinico San Donato, San Donato Milanese, Italy
| | - Francesco Sardanelli
- Servizio di Radiologia, IRCCS Policlinico San Donato, San Donato Milanese, Italy; Dipartimento di Scienze Biomediche per la Salute, Università degli Studi di Milano, San Donato Milanese, Italy
| | - Maurizio Vecchi
- Dipartimento di Scienze Biomediche per la Salute, Università degli Studi di Milano, San Donato Milanese, Italy; Unità Operativa di Gastroenterologia ed Endoscopia Digestiva, IRCCS Policlinico San Donato, San Donato Milanese, Italy
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Egnatios J, Kaushal K, Kalmaz D, Zarrinpar A. Video Capsule Endoscopy in Patients with Chronic Abdominal Pain with or without Associated Symptoms: A Retrospective Study. PLoS One 2015; 10:e0126509. [PMID: 25893440 PMCID: PMC4404061 DOI: 10.1371/journal.pone.0126509] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2014] [Accepted: 04/02/2015] [Indexed: 12/21/2022] Open
Abstract
BACKGROUND Chronic abdominal pain (CAP) is a common indication for gastroenterology referrals. More insidious causes of CAP isolated to the small bowel, such as malignancies and Crohn's disease, are rising in incidence and causing more gastroenterologists to evaluate their patients with video capsule endoscopy (VCE). However, the role of VCE in patients with CAP is still unclear. AIMS We assessed the efficacy of VCE in patients with CAP and whether it led to findings that contributed to disease management and meaningful interventions. METHODS This retrospective study evaluated 607 capsule endoscopy studies at an open referral endoscopy unit. Ninety of the studies were for CAP. These studies were compared to those performed for other indications to compare diagnostic yield. In addition, we investigated whether VCE led to an intervention that improved clinical outcomes. RESULTS Overall, the number of abnormal findings in CAP patients was significantly lower than VCE performed for other indications (24.4% vs 39.0%, respectively p = 0.009). When patients with CAP presented with other pertinent clinical findings (e.g. nausea, weight loss, anemia, history of in inflammatory bowel disease, etc.), the likelihood of an abnormal finding increased to a level that was not different from those who received VCE for other indications (27.1%, p = 0.10). The findings from VCE lead to changed management and improved outcomes in 16.2% of CAP patients with associated symptoms. However, the subgroup that benefited the most were those who had a prior history of Crohn's disease. Patients with CAP who did not have any associated symptoms continued to have a significantly lower abnormal finding rate compared to those who received VCE for other indications (19.4%, p = 0.03) and VCE rarely led to a change in management that would improve outcomes (5.6%). CONCLUSIONS VCE for CAP has a lower rate of abnormal findings than other indications. However, VCE is a useful diagnostic tool that can help provide a possible etiology of CAP in patients with associated symptoms. However, a change in management from VCE is likely to be limited to those with a history of Crohn's disease.
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Affiliation(s)
- Jeremy Egnatios
- School of Medicine, University of California San Diego, La Jolla, California, United States of America
| | - Khushboo Kaushal
- School of Medicine, University of California San Diego, La Jolla, California, United States of America
- Department of Medicine, University of California San Diego, La Jolla, California, United States of America
| | - Denise Kalmaz
- School of Medicine, University of California San Diego, La Jolla, California, United States of America
- Department of Medicine, University of California San Diego, La Jolla, California, United States of America
- Division of Gastroenterology, University of California, San Diego, La Jolla, California, United States of America
| | - Amir Zarrinpar
- School of Medicine, University of California San Diego, La Jolla, California, United States of America
- Department of Medicine, University of California San Diego, La Jolla, California, United States of America
- Division of Gastroenterology, University of California, San Diego, La Jolla, California, United States of America
- * E-mail:
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