1
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Mota J, Almeida MJ, Mendes F, Martins M, Ribeiro T, Afonso J, Cardoso P, Cardoso H, Andrade P, Ferreira J, Mascarenhas M, Macedo G. From Data to Insights: How Is AI Revolutionizing Small-Bowel Endoscopy? Diagnostics (Basel) 2024; 14:291. [PMID: 38337807 PMCID: PMC10855436 DOI: 10.3390/diagnostics14030291] [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: 11/13/2023] [Revised: 01/09/2024] [Accepted: 01/16/2024] [Indexed: 02/12/2024] Open
Abstract
The role of capsule endoscopy and enteroscopy in managing various small-bowel pathologies is well-established. However, their broader application has been hampered mainly by their lengthy reading times. As a result, there is a growing interest in employing artificial intelligence (AI) in these diagnostic and therapeutic procedures, driven by the prospect of overcoming some major limitations and enhancing healthcare efficiency, while maintaining high accuracy levels. In the past two decades, the applicability of AI to gastroenterology has been increasing, mainly because of the strong imaging component. Nowadays, there are a multitude of studies using AI, specifically using convolutional neural networks, that prove the potential applications of AI to these endoscopic techniques, achieving remarkable results. These findings suggest that there is ample opportunity for AI to expand its presence in the management of gastroenterology diseases and, in the future, catalyze a game-changing transformation in clinical activities. This review provides an overview of the current state-of-the-art of AI in the scope of small-bowel study, with a particular focus on capsule endoscopy and enteroscopy.
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Affiliation(s)
- Joana Mota
- Precision Medicine Unit, Department of Gastroenterology, São João University Hospital, Alameda Professor Hernâni Monteiro, 4200-427 Porto, Portugal (G.M.)
- WGO Gastroenterology and Hepatology Training Center, Alameda Professor Hernâni Monteiro, 4200-427 Porto, Portugal
| | - Maria João Almeida
- Precision Medicine Unit, Department of Gastroenterology, São João University Hospital, Alameda Professor Hernâni Monteiro, 4200-427 Porto, Portugal (G.M.)
- WGO Gastroenterology and Hepatology Training Center, Alameda Professor Hernâni Monteiro, 4200-427 Porto, Portugal
| | - Francisco Mendes
- Precision Medicine Unit, Department of Gastroenterology, São João University Hospital, Alameda Professor Hernâni Monteiro, 4200-427 Porto, Portugal (G.M.)
- WGO Gastroenterology and Hepatology Training Center, Alameda Professor Hernâni Monteiro, 4200-427 Porto, Portugal
| | - Miguel Martins
- Precision Medicine Unit, Department of Gastroenterology, São João University Hospital, Alameda Professor Hernâni Monteiro, 4200-427 Porto, Portugal (G.M.)
- WGO Gastroenterology and Hepatology Training Center, Alameda Professor Hernâni Monteiro, 4200-427 Porto, Portugal
| | - Tiago Ribeiro
- Precision Medicine Unit, Department of Gastroenterology, São João University Hospital, Alameda Professor Hernâni Monteiro, 4200-427 Porto, Portugal (G.M.)
- WGO Gastroenterology and Hepatology Training Center, Alameda Professor Hernâni Monteiro, 4200-427 Porto, Portugal
| | - João Afonso
- Precision Medicine Unit, Department of Gastroenterology, São João University Hospital, Alameda Professor Hernâni Monteiro, 4200-427 Porto, Portugal (G.M.)
- WGO Gastroenterology and Hepatology Training Center, Alameda Professor Hernâni Monteiro, 4200-427 Porto, Portugal
| | - Pedro Cardoso
- Precision Medicine Unit, Department of Gastroenterology, São João University Hospital, Alameda Professor Hernâni Monteiro, 4200-427 Porto, Portugal (G.M.)
- WGO Gastroenterology and Hepatology Training Center, Alameda Professor Hernâni Monteiro, 4200-427 Porto, Portugal
| | - Helder Cardoso
- Precision Medicine Unit, Department of Gastroenterology, São João University Hospital, Alameda Professor Hernâni Monteiro, 4200-427 Porto, Portugal (G.M.)
- WGO Gastroenterology and Hepatology Training Center, Alameda Professor Hernâni Monteiro, 4200-427 Porto, Portugal
- Faculty of Medicine, University of Porto, Alameda Professor Hernâni Monteiro, 4200-427 Porto, Portugal
| | - Patrícia Andrade
- Precision Medicine Unit, Department of Gastroenterology, São João University Hospital, Alameda Professor Hernâni Monteiro, 4200-427 Porto, Portugal (G.M.)
- WGO Gastroenterology and Hepatology Training Center, Alameda Professor Hernâni Monteiro, 4200-427 Porto, Portugal
- Faculty of Medicine, University of Porto, Alameda Professor Hernâni Monteiro, 4200-427 Porto, Portugal
| | - João Ferreira
- Department of Mechanical Engineering, Faculty of Engineering, University of Porto, R. Dr. Roberto Frias, 4200-465 Porto, Portugal;
- Digestive Artificial Intelligence Development, R. Alfredo Allen 455-461, 4200-135 Porto, Portugal
| | - Miguel Mascarenhas
- Precision Medicine Unit, Department of Gastroenterology, São João University Hospital, Alameda Professor Hernâni Monteiro, 4200-427 Porto, Portugal (G.M.)
- WGO Gastroenterology and Hepatology Training Center, Alameda Professor Hernâni Monteiro, 4200-427 Porto, Portugal
- Faculty of Medicine, University of Porto, Alameda Professor Hernâni Monteiro, 4200-427 Porto, Portugal
- ManopH Gastroenterology Clinic, R. de Sá da Bandeira 752, 4000-432 Porto, Portugal
| | - Guilherme Macedo
- Precision Medicine Unit, Department of Gastroenterology, São João University Hospital, Alameda Professor Hernâni Monteiro, 4200-427 Porto, Portugal (G.M.)
- WGO Gastroenterology and Hepatology Training Center, Alameda Professor Hernâni Monteiro, 4200-427 Porto, Portugal
- Faculty of Medicine, University of Porto, Alameda Professor Hernâni Monteiro, 4200-427 Porto, Portugal
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2
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Yen H, Hsu Y, Kuo C, Hsu T, Chen Y. Real‐world
experience of adalimumab therapy for patients with ulcerative colitis: A single tertiary medical center experience in Central Taiwan. ADVANCES IN DIGESTIVE MEDICINE 2022. [DOI: 10.1002/aid2.13300] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Affiliation(s)
- Hsu‐Heng Yen
- Division of Gastroenterology, Department of Internal Medicine Changhua Christian Hospital Changhua Taiwan
- General Education Center Chienkuo Technology University Changhua Taiwan
- Department of Electrical Engineering Chung Yuan Christian University Taoyuan Taiwan
| | - Yu‐Chun Hsu
- Division of Gastroenterology, Department of Internal Medicine Changhua Christian Hospital Changhua Taiwan
| | - Chu‐Hsuan Kuo
- Division of Gastroenterology, Department of Internal Medicine Changhua Christian Hospital Changhua Taiwan
- Grigore T. Popa University of Medicine and Pharmacy Iasi Romania
| | - Tsui‐Chun Hsu
- Division of Gastroenterology, Department of Internal Medicine Changhua Christian Hospital Changhua Taiwan
| | - Yang‐Yuan Chen
- Division of Gastroenterology, Department of Internal Medicine Changhua Christian Hospital Changhua Taiwan
- Department of Hospitality Management MingDao University Changhua Taiwan
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3
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New‐onset Crohn's disease after interleukin‐
17A
inhibitor therapy with secukinumab: A report of an unusual case. ADVANCES IN DIGESTIVE MEDICINE 2021. [DOI: 10.1002/aid2.13292] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
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4
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Pérez-Cuadrado Robles E, Pinho R, González-Suárez B, Mão-de-Ferro S, Chagas C, Esteban Delgado P, Carretero C, Figueiredo P, Rosa B, García-Lledó J, Nogales Ó, Ponte A, Andrade P, Juanmartiñena-Fernández JF, San-Juan-Acosta M, Lopes S, Prieto-Frías C, Egea Valenzuela J, Caballero N, Valdivieso-Cortázar E, Cardoso H, Gálvez C, Almeida N, Borque Barrera P, Gómez Rodríguez BJ, Sánchez Ceballos FL, Bernardes C, Alonso-Aguirre PA, Argüelles Arias F, Mascarenhas Saraiva M, Pérez-Cuadrado Martínez E. Small bowel enteroscopy - A joint clinical guideline by the Spanish and Portuguese small-bowel study groups. REVISTA ESPANOLA DE ENFERMEDADES DIGESTIVAS 2021; 112:309-318. [PMID: 32188259 DOI: 10.17235/reed.2020.7020/2020] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
The present evidence-based guidelines are focused on the use of device-assisted enteroscopy in the management of small-bowel diseases. A panel of experts selected by the Spanish and Portuguese small-bowel study groups reviewed the available evidence focusing on the main indications of this technique, its role in the management algorithm of each indication, and its diagnostic and therapeutic yield. A set of recommendations was issued accordingly.
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Affiliation(s)
| | - Rolando Pinho
- Gastroenterología, Centro Hospitalar de Vila Nova de Gaia e Espinho, Portugal
| | | | - Susana Mão-de-Ferro
- Gastroenterology Department, Instituto Português de Oncologia de Lisboa. E.P.E., Portugal
| | | | | | | | - Pedro Figueiredo
- Gastroenterology , Centro Hospitalar e Universitário de Coimbra, Portugal
| | - Bruno Rosa
- Gastroenterology, Hospital Senhora da Oliveira, Portugal
| | | | - Óscar Nogales
- Aparato Digestivo, Hospital General Universitario Gregorio Marañón, España
| | - Ana Ponte
- Centro Hospitalar Vila Nova de GaiaEspinho, Portugal
| | | | | | | | - Sandra Lopes
- Gastroenterology, Centro Hospitalar e Universitário de Coimbra, Portugal
| | | | | | - Noemí Caballero
- Gastrointestinal Endoscopy, Hospital Universitario Germans Trias i Pujol, Spain
| | | | | | - Consuelo Gálvez
- Gastroenterología, Hospital Clínico Universitario de Valencia, Spain
| | - Nuno Almeida
- Gastroenterology , Centro Hospitalar e Universitário de Coimbra, Portugal
| | - Pilar Borque Barrera
- Aparato Digestivo. Unidad de Endoscopia, Hospital Universitario Nuestra Sra. de Candelaria, España
| | | | | | - Carlos Bernardes
- Gastroenterology, Hospital de Santo António dos Capuchos, Centro Hospitalar Universitário de Lisboa Central, Portugal
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5
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Yoo AY, Lee BJ, Kim WS, Kim SM, Kim SH, Joo MK, Kim HJ, Park JJ. Clinicopathological Features of Small Bowel Tumors Diagnosed by Video Capsule Endoscopy and Balloon-Assisted Enteroscopy: A Single Center Experience. Clin Endosc 2020; 54:85-91. [PMID: 32892518 PMCID: PMC7939772 DOI: 10.5946/ce.2020.047] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/12/2020] [Accepted: 06/20/2020] [Indexed: 02/06/2023] Open
Abstract
Background/Aims Small bowel malignancies often present a diagnostic challenge due to their relative rarity and nonspecific clinical symptoms. However, technical developments in endoscopic instruments, including video capsule endoscopy (VCE) and enteroscopy, have allowed for the visualization of the entire small bowel. This study aimed to investigate the clinicopathological features of small bowel malignant tumors diagnosed by VCE and double-balloon enteroscopy (DBE) in a single tertiary center.
Methods We retrospectively analyzed VCE and DBE findings from Korea University Guro Hospital from January 2010 through September 2018.
Results A total of 510 VCE and 126 DBE examinations were performed in 438 patients. Small bowel malignancies were diagnosed in 28 patients (15 males; mean age, 61.0 years; range, 42 to 81 years). Among them, 8 had lymphoma, 8 had primary adenocarcinoma, 7 had gastrointestinal stromal tumor (GIST) and 5 had metastatic cancer. Abdominal pain and obstructive symptoms were the most common findings in metastatic cancers (4/5, 80%). On the other hand, obscure gastrointestinal bleeding was the most common symptom of GIST (6/7, 85.7%) and adenocarcinoma (3/8, 37.5%).
Conclusions Approximately 6% of the patients who underwent either VCE or DBE were diagnosed with small bowel malignancy. These findings demonstrated the different clinical characteristics among small bowel malignancies and merit further study.
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Affiliation(s)
- Ah Young Yoo
- Division of Gastroenterology, Department of Internal Medicine, Korea University Guro Hospital, Korea University, College of Medicine, Seoul, Korea
| | - Beom Jae Lee
- Division of Gastroenterology, Department of Internal Medicine, Korea University Guro Hospital, Korea University, College of Medicine, Seoul, Korea
| | - Won Shik Kim
- Division of Gastroenterology, Department of Internal Medicine, Korea University Guro Hospital, Korea University, College of Medicine, Seoul, Korea
| | - Seong Min Kim
- Division of Gastroenterology, Department of Internal Medicine, Korea University Guro Hospital, Korea University, College of Medicine, Seoul, Korea
| | - Seung Han Kim
- Division of Gastroenterology, Department of Internal Medicine, Korea University Guro Hospital, Korea University, College of Medicine, Seoul, Korea
| | - Moon Kyung Joo
- Division of Gastroenterology, Department of Internal Medicine, Korea University Guro Hospital, Korea University, College of Medicine, Seoul, Korea
| | - Hyo Jung Kim
- Division of Gastroenterology, Department of Internal Medicine, Korea University Guro Hospital, Korea University, College of Medicine, Seoul, Korea
| | - Jong-Jae Park
- Division of Gastroenterology, Department of Internal Medicine, Korea University Guro Hospital, Korea University, College of Medicine, Seoul, Korea
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6
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Yen HH, Chen MW, Chang YY, Huang HY, Hsu TC, Chen YY. Predictive values of stool-based tests for mucosal healing among Taiwanese patients with ulcerative colitis: a retrospective cohort analysis. PeerJ 2020; 8:e9537. [PMID: 32742803 PMCID: PMC7367046 DOI: 10.7717/peerj.9537] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2020] [Accepted: 06/23/2020] [Indexed: 12/17/2022] Open
Abstract
Background/Purpose Over the past two decades, ulcerative colitis (UC) has emerged in the Asia Pacific area, and its treatment goal has shifted from symptom relief to endoscopic remission. Endoscopy is the gold standard for the assessment of mucosal healing; however, it is an invasive method. Fecal calprotectin (FC) is a non-invasive stool-based inflammatory marker which has been used to monitor mucosal healing status, but it is expensive. By contrast, the immune fecal occult blood test (iFOBT) is a widely utilized stool-based screening tool for colorectal cancer. In this study, we compared the predictive values of iFOBT and FC for mucosal healing in Taiwanese patients with UC. Methods A total of 50 patients with UC identified via the electronic clinical database of Changhua Christian Hospital, Taiwan, were retrospectively enrolled from January 2018 to July 2019. Results of iFOBT, FC level, and blood tests as well as Mayo scores were reviewed and analyzed. Colonic mucosa was evaluated using the endoscopic Mayo subscore. Results The average age of the patients was 46 years, and 62% of the patients were men. Disease distribution was as follows: E1 (26%), E2 (40%), and E3 (34%). Complete mucosal healing (Mayo score = 0) was observed in 30% of patients. Endoscopic mucosal healing with a Mayo score of 0 or 1 was observed in 62% of the patients. Results of FC and iFOBT were compared among patients with and without mucosal healing. Predictive cutoff values were analyzed using receiver operating characteristics curves. iFOBT and FC had similar area under the curve for both complete mucosal healing (0.813 vs. 0.769, respectively, p = 0.5581) and endoscopic mucosal healing (0.906 vs. 0.812, respectively, p = 0.1207). Conclusion In daily clinical practice, FC and iFOBT do not differ in terms of predictive values for mucosal healing among Taiwanese patients with UC.
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Affiliation(s)
- Hsu-Heng Yen
- Division of Gastroenterology, Department of Internal Medicine, Changhua christian Hospital, Changhua, Taiwan.,Institute of Medicine, Chung Shan Medical and Dental College, Taichung, Taiwan.,General Education Center, Chienkuo Technology University, Changhua, Taiwan
| | - Mei-Wen Chen
- Department of Tumor Center, Changhua Christian Hospital, Changhua, Taiwan.,Information Management, Chienkuo Technology University, Changhua, Taiwan
| | - Yu-Yao Chang
- Department of Colorectal Surgery, Changhua Christian Hospital, Changhua, Taiwan
| | - Hsuan-Yuan Huang
- Department of Colorectal Surgery, Changhua Christian Hospital, Changhua, Taiwan
| | - Tsui-Chun Hsu
- Division of Gastroenterology, Department of Internal Medicine, Changhua christian Hospital, Changhua, Taiwan
| | - Yang-Yuan Chen
- Division of Gastroenterology, Department of Internal Medicine, Changhua christian Hospital, Changhua, Taiwan
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7
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Pérez-Cuadrado-Robles E, Pinho R, Gonzalez B, Mão de Ferro S, Chagas C, Esteban Delgado P, Carretero C, Figueiredo P, Rosa B, García Lledó J, Nogales Ó, Ponte A, Andrade P, Juanmartiñena-Fernández JF, San-Juan-Acosta M, Lopes S, Prieto-Frías C, Egea-Valenzuela J, Caballero N, Valdivieso-Cortazar E, Cardoso H, Gálvez C, Almeida N, Borque Barrera P, Gómez-Rodríguez BJ, Sánchez Ceballos F, Bernardes C, Alonso P, Argüelles-Arias F, Mascarenhas Saraiva M, Pérez-Cuadrado-Martínez E. Small Bowel Enteroscopy - A Joint Clinical Guideline from the Spanish and Portuguese Small Bowel Study Groups. GE-PORTUGUESE JOURNAL OF GASTROENTEROLOGY 2020; 27:324-335. [PMID: 32999905 DOI: 10.1159/000507375] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/01/2020] [Accepted: 03/19/2020] [Indexed: 12/13/2022]
Abstract
The present evidence-based guidelines are focused on the use of device-assisted enteroscopy in the management of small-bowel diseases. A panel of experts selected by the Spanish and Portuguese small bowel study groups reviewed the available evidence focusing on the main indications of this technique, its role in the management algorithm of each indication and on its diagnostic and therapeutic yields. A set of recommendations were issued accordingly.
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Affiliation(s)
| | - Rolando Pinho
- Department of Gastroenterology, Centro Hospitalar de Vila Nova de Gaia e Espinho, Vila Nova de Gaia, Portugal
| | - Begoña Gonzalez
- Department of Gastroenterology. Endoscopy Unit, ICMDiM, Hospital Clínic, Barcelona, Spain
| | - Susana Mão de Ferro
- Department of Gastroenterology, Instituto Português de Oncologia de Lisboa Francisco Gentil EPE, Lisbon, Portugal
| | - Cristina Chagas
- Department of Gastroenterology, Hospital de Egas Moniz, Centro Hospitalar de Lisboa Ocidental, Lisbon, Portugal
| | | | - Cristina Carretero
- Department of Gastroenterology, University of Navarra Clinic, Pamplona, Spain
| | - Pedro Figueiredo
- Gastroenterology Unit, Centro Hospitalar e Universitário de Coimbra, Coimbra, Portugal.,Faculty of Medicine, University of Coimbra, Coimbra, Portugal
| | - Bruno Rosa
- Department of Gastroenterology, Hospital da Senhora da Oliveira, Guimarães, Portugal.,Life and Health Sciences Research Institute, School of Medicine, University of Minho, ICVS/3B's, PT Government Associate Laboratory, Braga/Guimarães, Portugal
| | - Javier García Lledó
- Department of Gastroenterology, Endoscopy Unit, Hospital General Universitario Gregorio Marañón, Madrid, Spain
| | - Óscar Nogales
- Department of Gastroenterology, Endoscopy Unit, Hospital General Universitario Gregorio Marañón, Madrid, Spain
| | - Ana Ponte
- Department of Gastroenterology, Centro Hospitalar de Vila Nova de Gaia e Espinho, Vila Nova de Gaia, Portugal
| | - Patrícia Andrade
- Department of Gastroenterology, Centro Hospitalar São João, Porto, Portugal
| | | | - Mileidis San-Juan-Acosta
- Department of Gastroenterology, Gastrointestinal Endoscopy Unit, Hospital Universitario Nuestra Señora de Candelaria, Candelaria, Tenerife, Spain
| | - Sandra Lopes
- Gastroenterology Unit, Centro Hospitalar e Universitário de Coimbra, Coimbra, Portugal.,Faculty of Medicine, University of Coimbra, Coimbra, Portugal
| | - César Prieto-Frías
- Department of Gastroenterology, University of Navarra Clinic, Pamplona, Spain
| | - Juan Egea-Valenzuela
- Unit of Gastrointestinal Endoscopy, Department of Digestive Disease, Hospital Clínico Universitario Virgen de la Arrixaca, Murcia, Spain
| | - Noemí Caballero
- Department of Gastrointestinal Endoscopy, Hospital Universitario Germans Trias i Pujol, Badalona, Spain
| | | | - Hélder Cardoso
- Department of Gastroenterology, Centro Hospitalar São João, Porto, Portugal
| | - Consuelo Gálvez
- Department of Gastroenterology. Hospital Clínico Universitario de Valencia, Valencia, Spain
| | - Nuno Almeida
- Gastroenterology Unit, Centro Hospitalar e Universitário de Coimbra, Coimbra, Portugal.,Faculty of Medicine, University of Coimbra, Coimbra, Portugal
| | - Pilar Borque Barrera
- Department of Gastroenterology, Gastrointestinal Endoscopy Unit, Hospital Universitario Nuestra Señora de Candelaria, Candelaria, Tenerife, Spain
| | - Blas José Gómez-Rodríguez
- Department of Gastroenterology, Hospital Universitario Virgen Macarena, Universidad de Sevilla, Sevilla, Spain
| | | | - Carlos Bernardes
- Department of Gastroenterology, Hospital de Santo António dos Capuchos, Centro Hospitalar Universitário de Lisboa Central, Lisbon, Portugal
| | - Pedro Alonso
- Department of Gastroenterology, Complejo Hospitalario Universitario de A Coruña, A Coruña, Spain
| | - Federico Argüelles-Arias
- Department of Gastroenterology, Hospital Universitario Virgen Macarena, Universidad de Sevilla, Sevilla, Spain
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8
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Huang Z, Liu X, Yang F, Wang G, Ge N, Wang S, Guo J, Sun S. Diagnostic efficacy of double-balloon enteroscopy in patients with suspected isolated small bowel Crohn's disease. BMC Gastroenterol 2020; 20:42. [PMID: 32101148 PMCID: PMC7045397 DOI: 10.1186/s12876-020-01188-0] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/22/2019] [Accepted: 02/11/2020] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Owing to the development of double-balloon enteroscopy (DBE) and video capsule endoscopy (VCE) in recent years, direct visualization of the entire small intestinal mucosa has become possible. Because of the nonspecific symptoms and the anatomic location of the small bowel, diagnosis of isolated small bowel Crohn's disease (CD) remains a challenge. The aim of this research was to explore the value of DBE for isolated small bowel CD in situations where routine tests cannot confirm the diagnosis. METHODS This study included patients with suspected isolated small bowel CD who were hospitalized in Shengjing Hospital from April 2014 to June 2018. We included patients presenting with chronic diarrhea, abdominal pain, abdominal mass, perianal lesions, and systemic symptoms including weight loss, fever, and anemia after excluding infection factors. Patients with purely colonic CD were excluded from this cohort. Patients with suspected isolated small bowel CD underwent DBE. RESULTS In 16/18 patients, pathological findings were detected by DBE. In 12 of the cases, small bowel CD was confirmed. The remaining four patients were diagnosed with small bowel inflammation, duodenal carcinoma, ileum inflammation and small bowel ulcers. However, the diagnosis of CD was confirmed in 14/18 (78%) patients by taking into account the clinical presentation, endoscopic and histological results as well as the experimental treatment. DBE assisted in the diagnosis in 86% (12/14) of the patients. CONCLUSIONS In the diagnosis of small bowel CD, DBE is a helpful tool. Before assessment with DBE, clinical features, colonoscopy, and CT were used to initially assess the intestine. According to the lesions indicated by CT, we chose the most appropriate endoscope insertion route, and combined the endoscopic characteristics and pathological results of DBE to confirm the diagnosis.
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Affiliation(s)
- Zihan Huang
- The Department of Gastroenterology, Shengjing Hospital, China Medical University, No.36, Sanhao Street, Shenyang, 110004, Liaoning Province, China
| | - Xiang Liu
- The Department of Gastroenterology, Shengjing Hospital, China Medical University, No.36, Sanhao Street, Shenyang, 110004, Liaoning Province, China.
| | - Fei Yang
- The Department of Gastroenterology, Shengjing Hospital, China Medical University, No.36, Sanhao Street, Shenyang, 110004, Liaoning Province, China
| | - Guoxin Wang
- The Department of Gastroenterology, Shengjing Hospital, China Medical University, No.36, Sanhao Street, Shenyang, 110004, Liaoning Province, China
| | - Nan Ge
- The Department of Gastroenterology, Shengjing Hospital, China Medical University, No.36, Sanhao Street, Shenyang, 110004, Liaoning Province, China
| | - Sheng Wang
- The Department of Gastroenterology, Shengjing Hospital, China Medical University, No.36, Sanhao Street, Shenyang, 110004, Liaoning Province, China
| | - Jintao Guo
- The Department of Gastroenterology, Shengjing Hospital, China Medical University, No.36, Sanhao Street, Shenyang, 110004, Liaoning Province, China
| | - Siyu Sun
- The Department of Gastroenterology, Shengjing Hospital, China Medical University, No.36, Sanhao Street, Shenyang, 110004, Liaoning Province, China
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9
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Abstract
PURPOSE OF REVIEW Strictures of the small bowel are an underdiagnosed entity with significant morbidity because of obstruction and risk of perforation and penetrating disease. RECENT FINDINGS Recent advances in imaging, enteroscopy, and therapeutic advances particularly in Crohn's disease have enabled gastroenterologists to target and individualize management of small bowel strictures, preventing untimely surgery and complications. SUMMARY All patients with obstructive symptoms, suspected small bowel disease, and negative panendoscopy should be evaluated for small intestinal strictures with cross-sectional imaging and considered for capsule endoscopy. Furthermore, the role of device-assisted enteroscopy, initially employed as a diagnostic tool, has evolved into triaging and delivering further medical and interventional treatments.
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Affiliation(s)
- Deniz Durmush
- Prince of Wales Clinical School, UNSW Medicine, Gastrointestinal and Liver Unit, Prince of Wales Hospital, Randwick
| | - Arthur J Kaffes
- AW Morrow Gastroenterology and Liver Centre, Royal Prince Alfred Hospital, RPA Medical Centre, Camperdown, Sydney, New South Wales, Australia
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10
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Kang HS, Lee JS, Hyun CR, Jung IH, Kang KS. Meckel's Diverticulum Diagnosed in a Child with Suspected Small Bowel Crohn's Disease. Pediatr Gastroenterol Hepatol Nutr 2019; 22:98-104. [PMID: 30671380 PMCID: PMC6333590 DOI: 10.5223/pghn.2019.22.1.98] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/29/2018] [Revised: 11/27/2018] [Accepted: 12/14/2018] [Indexed: 12/22/2022] Open
Abstract
We report a rare case of Meckel's diverticulum in a boy who initially presented with chronic iron deficiency anemia (IDA) without any history of gastrointestinal (GI) bleeding at 8 years-old. Isolated small bowel Crohn's disease was suspected based on findings of small bowel ulcers on capsule endoscopy. At four years from initial presentation, he developed massive GI bleeding. Abdominal computed tomographic angiography and small bowel series revealed findings suggestive of Meckel's diverticulum. Meckel's diverticulum should be suspected in children with unexplained chronic IDA even in the absence of prominent GI bleeding and negative findings on repetitive Meckel's scans. Moreover, Meckel's diverticulum should be included in the differential diagnosis of isolated small bowel Crohn's disease when the disease is limited to a short segment of the distal small bowel, as ulcers and inflammation may result as a consequence of acid secreted from adjacent heterotopic gastric mucosa constituting the Meckel's diverticulum.
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Affiliation(s)
- Hyun Sik Kang
- Department of Pediatrics, Jeju National University School of Medicine, Jeju, Korea
| | - Jeong Sub Lee
- Department of Radiology, Jeju National University School of Medicine, Jeju, Korea
| | - Chang Rim Hyun
- Department of Pathology, Jeju National University School of Medicine, Jeju, Korea
| | - In-Ho Jung
- Department of Surgery, Jeju National University School of Medicine, Jeju, Korea
| | - Ki Soo Kang
- Department of Pediatrics, Jeju National University School of Medicine, Jeju, Korea
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Yen HH, Weng MT, Tung CC, Wang YT, Chang YT, Chang CH, Shieh MJ, Wong JM, Wei SC. Epidemiological trend in inflammatory bowel disease in Taiwan from 2001 to 2015: a nationwide populationbased study. Intest Res 2018; 17:54-62. [PMID: 30449079 PMCID: PMC6361021 DOI: 10.5217/ir.2018.00096] [Citation(s) in RCA: 94] [Impact Index Per Article: 15.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/27/2018] [Accepted: 10/06/2018] [Indexed: 12/22/2022] Open
Abstract
BACKGROUND/AIMS Incidences of inflammatory bowel diseases (IBDs), ulcerative colitis (UC), and Crohn's disease (CD), have been increasing in Asia. In this study, we report the relevant clinical characteristics and determined the epidemiological trend of IBD in Taiwan from 2001 to 2015. METHODS A retrospective study was conducted to analyze data recorded from January 2001 through December 2015 in the registered database compiled by the National Health Insurance and provided by the Ministry of Health and Welfare, Taiwan. RESULTS A total of 3,806 patients with catastrophic IBD illness were registered from 2001 to 2015 in Taiwan (CD, 919; UC, 2,887). The crude incidence of CD increased from 0.17/100,000 in 2001 to 0.47/100,000 in 2015, whereas that of UC increased from 0.54/100,000 in 2001 to 0.95/100,000 in 2015. The prevalence of CD increased from 0.6/100,000 in 2001 to 3.9/100,000 in 2015, whereas that of UC increased from 2.1/100,000 in 2001 to 12.8/100,000 in 2015. The male-to-female ratio in the study sample was 2.19 for CD and 1.62 for UC. The median age of those registered with CD was lower than that of those registered for UC: 38.86 and 44.86 years, respectively. A significantly greater increase in CD incidence rate was identified among 20 to 39-year-old compared with other age groups. CONCLUSIONS Using Taiwan's nationwide insurance database, we determined that the number of patients with CD increased more rapidly during the study period than the number of patients with UC, especially among age 20 to 39-year-old, resulting in a decreased UC-to-CD ratio.
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Affiliation(s)
- Hsu-Heng Yen
- Department of Internal Medicine, Changhua Christian Hospital, Changhua, Taiwan.,Department of Endoscopy Center, Changhua Christian Hospital, Changhua, Taiwan
| | - Meng-Tzu Weng
- Department of Internal Medicine, Far Eastern Memorial Hospital, New Taipei, Taiwan
| | - Chien-Chih Tung
- Department of Integrated Diagnostics & Therapeutics, National Taiwan University Hospital, Taipei, Taiwan
| | - Yu-Ting Wang
- Department of Medical Research, National Taiwan University Hospital, Taipei, Taiwan
| | - Yuan Ting Chang
- Department of Public Health, National Taiwan University, Taipei, Taiwan
| | - Chin-Hao Chang
- Department of Medical Research, National Taiwan University Hospital, Taipei, Taiwan.,Department of Public Health, National Taiwan University, Taipei, Taiwan
| | - Ming-Jium Shieh
- Department of Oncology, National Taiwan University Hospital, Taipei, Taiwan, Taiwan
| | - Jau-Min Wong
- Department of Internal Medicine, National Taiwan University Hospital, Taipei, Taiwan, Taiwan
| | - Shu-Chen Wei
- Department of Internal Medicine, Changhua Christian Hospital, Changhua, Taiwan.,Department of Inflammatory Bowel Disease Clinical and Study Integrated Center, National Taiwan University Hospital, Taipei, Taiwan
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