Small Bowel Endoscopy Diagnostic Yield and Reasons of Obscure GI Bleeding in Chinese Patients

Aim. To investigate the diagnostic yield and etiologies of patients with obscure gastrointestinal bleeding (OGIB) using capsule endoscopy (CE) or double-balloon enteroscopy (DBE).Method. We studied the data of 532 consecutive patients with OGIB that were referred to Xinqiao Hospital in Chongqing from December 2005 to January 2012. A lesion that was believed to be the source of the bleeding (ulceration, mass lesion, vascular lesion, visible blood, inflammation, or others) was considered to be a positive finding. We analyzed the diagnostic yield of CE and SBE and the etiologies of OGIB.Result. CE and SBE have similar diagnostic yields, at 71.9% (196/231) and 71.8% (251/304), respectively. The most common etiology was erosions/ulceration (27.1%) followed by mass lesion (19.4%) and angiodysplastic/vascular lesions (13.9%). By stratified analysis, we found that erosions/ulceration (27.1%) was the most common etiology for the 21–40-year age group. Mass lesion was the most common etiology in the 41–60-year age group. However, in the >60 years age group, angiodysplastic/vascular lesions were significantly increased compared with the other groups, even though erosions/ulceration was most common.Conclusion. In this study, we found that CE and SBE have similar diagnostic yields and erosions/ulceration was the most common reason for OGIB, followed by mass lesion and angiodysplasias.

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Causes and Clinical Characteristics of Small Bowel Bleeding in Northern Vietnam

Canadian Journal of Gastroenterology and Hepatology ◽

10.1155/2020/8884092 ◽

2020 ◽

Vol 2020 ◽

pp. 1-7

Author(s):

Cong Long Nguyen ◽

Khac Khiem Pham ◽

Canh Hiep Nguyen ◽

Hoang Nam Nguyen ◽

Tran Tien Dao ◽

...

Keyword(s):

Small Bowel ◽

Diagnostic Yield ◽

Vascular Lesions ◽

High Detection Rate ◽

Double Balloon Enteroscopy ◽

Balloon Enteroscopy ◽

Computed Tomographic ◽

Double Balloon ◽

Common Causes ◽

Vietnamese Population

Aim. Causes, clinical features, and diagnostic approaches for small bowel (SB) bleeding were analyzed to derive recommendations in dealing with this clinical condition. Methods. We included 54 patients undergoing surgical treatment for SB bleeding, from January 2009 to December 2019. Detailed clinical data, diagnosis procedures, and causes of bleeding were collected. Results. Among 54 cases with SB bleeding, the most common causes were tumors (64.8%), followed by angiopathy (14.8%), ulcers (9.3%), diverticula (5.6%), tuberculosis (3.7%), and enteritis (1.9%). Most tumors (32/35 cases, 91.4%) and vascular lesions (8/8 cases, 100%) were located in the jejunum. The incidence of tumors was higher in the older (30/41 cases, 73.1%) than that in patients younger than 40 years of age (5/13 cases, 38.5%, P < 0.01 ). Common initial findings were melena (68.5%) and hematochezia (31.5%). The overall diagnostic yield of computed tomographic enterography (CTE) was 57.4% (31/54 cases), with the figures for tumors, vascular lesions, and inflammatory lesions being 71.4% (25/35 cases), 62.5% (5/8 cases), and 12.5% (1/8 cases), respectively. Double-balloon enteroscopy (DBE) definitively identified SB bleeding sources in 16/22 (72.7%) patients. Conclusion. Tumors, angiopathy, ulcers, and diverticula were the most common causes of SB bleeding in Northern Vietnamese population. CTE has a high detection rate for tumors in patients with SB bleeding. CTE as a triage tool may identify patients before double-balloon enteroscopy because of the high prevalence of SB tumors.

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IMPACT OF SMALL BOWEL CAPSULE ENDOSCOPY IN IRON DEFICIENCY ANEMIA: INFLUENCE OF PATIENT’SAGE ON DIAGNOSTIC YIELD

Arquivos de Gastroenterologia ◽

10.1590/s0004-2803.201800000-61 ◽

2018 ◽

Vol 55 (3) ◽

pp. 242-246 ◽

Cited By ~ 2

Author(s):

Sofia XAVIER ◽

Joana MAGALHÃES ◽

Bruno ROSA ◽

Maria João MOREIRA ◽

José COTTER

Keyword(s):

Small Bowel ◽

Iron Deficiency ◽

Iron Deficiency Anemia ◽

Capsule Endoscopy ◽

Diagnostic Yield ◽

Vascular Lesions ◽

Deficiency Anemia ◽

Age Group ◽

Single Center Study ◽

Significant Pathology

ABSTRACT BACKGROUND: Iron deficiency anemia remains one of the main indications to perform small bowel capsule endoscopy. Literature suggests that diagnostic yield is influenced by patient’s age but with conflicting results regarding age cutoff. OBJECTIVE: We aimed to clarify the differences in diagnostic yield and incidence of specific findings according to age. METHODS: Retrospective single-center study including 118 patients performing small bowel capsule endoscopy in the study of iron deficiency anemia. Videos were reviewed and small bowel findings that may account for anemia were reported. Incomplete examinations were excluded. Findings were compared between patients ≤60 and >60 years. RESULTS: Patients had a mean age of 58 years old (SD ±17.9) with 69.5% females (n=82). The overall diagnostic yield was 49% (58/118), being higher among patients >60 years (36/60, diagnostic yield 60%) than those ≤60 years (20/58, diagnostic yield 34%), (P<0.01). Angioectasias were more frequent in patients >60 years (45% vs 9%, P<0.01). Patients ≤60 years presented more frequently significant inflammation (Lewis score >135 in 10.3% vs 1.7%, P<0.05) and other non-vascular lesions (24% vs 10%, P=0.04). CONCLUSION: In our cohort small bowel capsule endoscopy diagnosed clinically relevant findings in the setting of iron deficiency anemia in almost half the patients. Diagnostic yield was higher in patients older than 60 years (60%), with vascular lesions being more frequent in this age group. Despite the lower diagnostic yield in patients ≤60 years, significant pathology was also found in this age group, mainly of inflammatory type.

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Deep Learning and Device-Assisted Enteroscopy: Automatic Detection of Gastrointestinal Angioectasia

Medicina ◽

10.3390/medicina57121378 ◽

2021 ◽

Vol 57 (12) ◽

pp. 1378

Author(s):

Miguel Mascarenhas Saraiva ◽

Tiago Ribeiro ◽

João Afonso ◽

Patrícia Andrade ◽

Pedro Cardoso ◽

...

Keyword(s):

Deep Learning ◽

Gastrointestinal Bleeding ◽

Processing Speed ◽

Diagnostic Yield ◽

Automatic Detection ◽

Normal Mucosa ◽

Vascular Lesions ◽

Image Dataset ◽

Common Etiology ◽

Deep Exploration

Background and Objectives: Device-assisted enteroscopy (DAE) allows deep exploration of the small bowel and combines diagnostic and therapeutic capacities. Suspected mid-gastrointestinal bleeding is the most frequent indication for DAE, and vascular lesions, particularly angioectasia, are the most common etiology. Nevertheless, the diagnostic yield of DAE for the detection of these lesions is suboptimal. Deep learning algorithms have shown great potential for automatic detection of lesions in endoscopy. We aimed to develop an artificial intelligence (AI) model for the automatic detection of angioectasia DAE images. Materials and Methods: A convolutional neural network (CNN) was developed using DAE images. Each frame was labeled as normal/mucosa or angioectasia. The image dataset was split for the constitution of training and validation datasets. The latter was used for assessing the performance of the CNN. Results: A total of 72 DAE exams were included, and 6740 images were extracted (5345 of normal mucosa and 1395 of angioectasia). The model had a sensitivity of 88.5%, a specificity of 97.1% and an AUC of 0.988. The image processing speed was 6.4 ms/frame. Conclusions: The application of AI to DAE may have a significant impact on the management of patients with suspected mid-gastrointestinal bleeding.

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Digital subtraction cerebral angiography after negative computed tomography angiography findings in non-traumatic subarachnoid hemorrhage

Journal of NeuroInterventional Surgery ◽

10.1136/neurintsurg-2019-015375 ◽

2019 ◽

Vol 12 (5) ◽

pp. 526-530

Author(s):

Joshua S Catapano ◽

Michael J Lang ◽

Stefan W Koester ◽

Derrick J Wang ◽

Joseph D DiDomenico ◽

...

Keyword(s):

Subarachnoid Hemorrhage ◽

Diagnostic Yield ◽

Vascular Lesion ◽

Vascular Lesions ◽

Superior Cerebellar Artery ◽

Digital Subtraction ◽

Single Institution ◽

Dorsal Wall ◽

Cerebellar Artery ◽

Traumatic Subarachnoid Hemorrhage

BackgroundCT angiography (CTA) is widely used for the detection of vascular lesions in patients with non-traumatic subarachnoid hemorrhage (ntSAH); however, digital subtraction angiography (DSA) remains the gold standard for diagnosis. Our aim was to analyze the diagnostic yield of DSA after negative high-resolution CTA findings.MethodsRecords of patients with a CTA-negative ntSAH at a single institution from 2014 to 2018 were retrospectively analyzed. ntSAH patterns were categorized as cortical, perimesencephalic, or diffuse. Subsequent DSA findings were compared across the three cohorts.ResultsA total of 186 patients had CTA-negative ntSAH. The ntSAH pattern was identified as cortical (n=77, 41.4%), diffuse (n=60, 32.3%), or perimesencephalic (n=49, 26.3%). In eight patients (4%), DSA revealed a vascular lesion (one cervical arteriovenous fistula and seven atypical aneurysms) after negative CTA findings. All eight patients with positive DSA findings had diffuse SAH (13% of patients with a diffuse pattern). The seven aneurysms included four blister or dissecting (two basilar artery, one superior cerebellar artery, and one dorsal wall internal carotid artery), two fusiform (one posterior communicating artery and one anterior spinal artery), and one saccular aneurysm (middle cerebral artery).ConclusionDSA identified a causative lesion in 4% of patients with CTA-negative ntSAH, but only in patients with diffuse ntSAH. Most of the lesions detected were atypical aneurysms and were found on delayed angiograms. These results suggest that DSA can help to diagnose CTA-negative ntSAH caused by unusual aneurysms, and repeat DSA may be needed only for patients with diffuse ntSAH.

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Analysis of Cerebral Vascular Lesion Pools in Ischemic Stroke Based on the Analysis and the Prognostic Assessment of Risk Factors in Patients with Primary and Recurrent Ischemic Stroke

Family Medicine ◽

10.30841/2307-5112.5.2016.248736 ◽

2016 ◽

pp. 65-68

Author(s):

Oksana Mikitey

Keyword(s):

Risk Factors ◽

Risk Assessment ◽

Ischemic Stroke ◽

Recurrent Stroke ◽

Significant Risk ◽

Vascular Lesion ◽

Assessment Tools ◽

Vascular Lesions ◽

Global Risk ◽

Risk Assessment Tools

Stroke is an important medical and social problem, and stroke risk assessment tools have difficulty on the interaction of risk factors and the effects of certain risk factors with analysis by age, gender, race, because this information fully available to global risk assessment tools. In addition, these tools tend to be focused and usually do not include the entire range of possible factors contributing. The aim of the study was to conduct a comparison of brain vascular lesions pool with ischemic stroke (II) based predictive analysis and assessment of the main risk factors in patients with primary and recurrent ischemic stroke. Prognostically significant risk factors for recurrent ischemic stroke is not effective antihypertensive therapy, multiple stenoses any one pool vascular brain, duration of hypertension (AH) over 5 years and regular smoking patients (p<0.001). In the initial localization in the second vertebrobasilar recurrent stroke was significantly (p<0.05) more developed in the same pool in women than in men; and the localization of the primary carotid AI in the pool, re-developed stroke often unreliable in the same pool in women than in men.

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Abstract P249: Effects of Lifestyle Changes on Metabolism and Early Vascular Lesion in Healthy People

Hypertension ◽

10.1161/hyp.70.suppl_1.p249 ◽

2017 ◽

Vol 70 (suppl_1) ◽

Author(s):

Xu Fengcheng ◽

Yu Chaoping ◽

Liu Tianhu

Keyword(s):

Healthy Lifestyle ◽

Low Density Lipoprotein ◽

Fasting Blood Glucose ◽

Ankle Brachial Index ◽

Density Lipoprotein ◽

Vascular Lesion ◽

Lifestyle Changes ◽

Healthy People ◽

Vascular Lesions ◽

Before And After

Objective: Through propaganda and education on lifestyle change, we study the effects on metabolism and vascular lesions in healthy people. Methods: the healthy subjects that conform to the requirements, through propaganda and education on vascular health, through moderate exercise, proper control of starchy foods, low salt, low fat diet, reduce smoking and other lifestyle changes, compare changes in weight, renal function, fasting blood glucose, blood lipids and ankle brachial index (ABI), cardio ankle vascular index(CAVI) before and after lifestyle changes. Results: After lifestyle changed, the subjects’ body mass index [(23.13±3.18)kg/m 2 vs (22.67±3.36)kg/m 2 ], ABI[1.11±0.08 vs 1.09±0.09], CAVI[(7.14±1.13 ) vs (7. 01±1.18) ], serum creatinine[(84.31±22.41)umol/L vs (79.92±23.64)umol/L], blood uric acid[(337.79±102.17 )umol/L vs (328.12±88.33)umol/L], low density lipoprotein cholesterol[(2.49±0.65) mmol/L vs (2.37±0.69) mmol/L],all have good changes. Conclusion: Healthy lifestyle is good for metabolism and early vascular lesions, can improve metabolic disorder and slow the occurrence of arteriosclerosis.

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Abstract 3734: Presurgical fMRI and Morbidity Outcomes in Patients with Vascular Lesions

Stroke ◽

10.1161/str.43.suppl_1.a3734 ◽

2012 ◽

Vol 43 (suppl_1) ◽

Author(s):

Andrew C Radtke ◽

Joshua Pankratz ◽

Ryan Holdsworth ◽

Dovile Baniulis ◽

Nicole Kornder ◽

...

Keyword(s):

Logistic Regression ◽

Preoperative Planning ◽

Binary Logistic Regression ◽

Vascular Lesion ◽

Vascular Lesions ◽

Motor Deficits ◽

Binary Logistic Regression Analysis ◽

Language Mapping ◽

Motor Mapping ◽

The Relationship

Background fMRI is being increasingly used as an adjunct imaging technique for preoperative planning for patients with various brain lesions. The proximity of the lesion to eloquent cortex is a major factor in guiding surgical planning. Our group has previously reported significant association between the distance between brain tumor periphery and area of fMRI activation (Lesion-Activation Distance; LAD) and morbidity and mortality outcomes. This study investigated the relationship between vascular lesion LAD and morbidity. Methods This study was a retrospective analysis of data from patients with vascular lesions [arteriovenous malformations (AVMs) (n=49), and cavernomas (n=57)], who had received fMRI as part of their preoperative planning. The preoperative fMRI included motor mapping (n=87) and/or language mapping (n=102). The fMRI paradigms were chosen based on observed preoperative weakness (aphasia, paresis) and anticipated functional areas of the brain that may be affected by treatment. Results Multiple logistic regression analyses showed that a model that combines Age and Language LAD was a significant predictor of postoperative deficits (p= 0.04). Broca’s LAD(1-2 cm) X Age was a significant predictor of postoperative deficits (change in odds ratio (OR) =0.82, CI:0.68-0.98). The relationship between Brocas’s LAD and postoperative aphasia and Broca’s LAD and pre and postoperative aphasia trended towards significance (p = .08 and p =.07 respectively). Wernicke’s LAD, independently or combined with Age, was not a significant predictor of postoperative deficits. Binary logistic regression analysis for SMC LAD and postop deficits did not reach significance (p =.10). There were no significant differences in postoperative language or motor deficits as a function of gender or handedness. Conclusions These results suggest that both age and the proximity of a vascular lesion to language LAD are factors that can help predict postoperative outcomes, especially for Broca’s LAD. The lack of similar results when investigating the relationship between Wernicke’s LAD and postoperative deficits suggests potential brain reorganization and/or robustness of this brain region. These results have implications for the potential use of fMRI as a presurgical tool for language mapping in patients with vascular lesions.

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Vascular dementia and the cholinergic pathways

Dementia & Neuropsychologia ◽

10.1590/s1980-57642008dn10100002 ◽

2007 ◽

Vol 1 (1) ◽

pp. 2-9 ◽

Cited By ~ 6

Author(s):

Eliasz Engelhardt ◽

Denise Madeira Moreira ◽

Jerson Laks

Keyword(s):

Vascular Dementia ◽

Therapeutic Potential ◽

Clinical Manifestations ◽

Vascular Cognitive Impairment ◽

Vascular Lesion ◽

Vascular Lesions ◽

Behavioral Integration ◽

Cholinergic Pathways ◽

High Prevalence ◽

Cholinergic Hypofunction

Abstract Vascular cognitive impairment/vascular dementia have been the subject of a large number of studies, due to their high prevalence and broad preventive and compensatory therapeutic potential. The knowledge of the cerebral anatomy correlated to the vascular territories of irrigation enables understanding of clinical manifestations, as well as classification into the several types of syndromic presentations. The central cholinergic system exercises important neuromodulatory functions on cerebral circuits related to cognitive and behavioral integration, as well as on vasomotor control related to cerebral blood flow adjustments. The acquisition of data on the anatomy of the cholinergic pathways, including the localization of the nuclei of the basal prosencephalon and the routes of their projections, established an important milestone. The knowledge of the vascular distribution and of the trajectories of the cholinergic pathways allows identification of the strategic points where a vascular lesion can cause interruption. The ensuing denervation leads to cholinergic hypofunction in the involved territories. This information proves important to better evaluate the sites of vascular lesions, emphasizing their strategic localizations in relation to the cholinergic pathways, and offering more robust foundations for treatment aiming at enhancing cholinergic activity.

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PROFIL PALATOSKISIS DI BAGIAN ILMU BEDAH PLASTIK BLU RSUP PROF. DR. R.D. KANDOU MANADO PERIODE JANUARI-DESEMBER 2011

JURNAL BIOMEDIK (JBM) ◽

10.35790/jbm.5.1.2013.2632 ◽

2013 ◽

Vol 5 (1) ◽

Author(s):

Kalsum Taufiq ◽

Jan T. Ngantung ◽

Maximillian C. H. Oley

Keyword(s):

Retrospective Study ◽

Environmental Factors ◽

Plastic Surgery ◽

Genetic Factor ◽

Congenital Disorder ◽

Age Group ◽

The World ◽

Common Etiology

Abstract: After labioschizis, palatoschizis is the most frequently encountered congenital disorder with multifactorial causes, and is a disorder that can be found in every nation in the world. Among the factors, the genetic factor was agreed upon to be a major factor. This was a descriptive retrospective study. This study aimed to find out palatoschizis cases in the Division of Plastic Surgery, Prof. Dr. R.D. Kandou Hospital, Manado, from January to December 2011. The results showed that there were 40 cases of both disordersd in the Division of Plastic Surgery Prof Dr. R.D. Kandou Manado Hospital from January 2011 through December 2011, showing 55% with palatoschizis and 45% with labiopalatoschizis. From the total cases, 53% were females in contrast to 47% males. Fifty-seven percent represented the most frequently treated age group of 1-4 years with 72.5% requiring palatoplasty. From the total number of palatoschizis cases, as many as 58% were caused by environmental factors. Fifty-two percent were unilateral palatoschizis, in comparison to 2.5% bilateral. Conclusion: In the Division of Plastic Surgery, Prof. Dr. R.D. Kandou Hospital, Manado, from January to December 2011 most of the palatoschizis and labiopalatoschizis cases were unilateral. Environmental factors were the mot common etiology for most of the women who suffered from this disease. Palatoplasty procedures were most widely used among the largest age group of 1-4 years. Keywords: palatoschizis, labiopalatoschizis. Abstrak: Palatoskisis merupakan kelainan kongenital yang paling sering dijumpai setelah labioskisis dengan penyebab multifaktorial, dan dijumpai pada setiap bangsa di dunia. Diantara faktor-faktor penyebabnya, faktor genetika disepakati menjadi faktor utama. Palatoskisis lebih banyak ditemukan pada perempuan. Palatoskisis unilateral kiri lebih sering dari pada yang kanan. Penelitian ini bersifat retrospektif deskriptif untuk mengetahui tentang kejadian palatoskisis di Bagian Ilmu Bedah Plastik RSUP Prof. Dr. R.D. Kandou Manado periode Januari-Desember 2011. Hasil penelitian memperlihatkan jumlah kasus di Bagian Bedah Plastik RSUP Prof. Dr. R.D. Kandou Manado periode Januari-Desember 2011 sebanyak 40 kasus dengan palatoskisis (55%) dan labiopalatoskisis (45%), lebih sering pada perempuan (53%) dibandingkan laki-laki (47%). Kelompok usia yang tersering ditangani 1-4 tahun (57%) dan jenis operasi yang digunakan yaitu palatoplasty (72,5%). Faktor penyebab yang tersering ialah faktor lingkungan (58%). Kasus palatoskisis unilateral sebanyak 52,5% sedangkan yang bilateral 2,5%. Simpulan: Di Bagian Ilmu Bedah Plastik RSUP Prof. Dr. R.D. Kandou Manado periode Januari-Desember 2011 sebagian besar kasus palatoskisis dan labiopalatoskisis ditemukan unilateral dengan lokasi defek terbanyak di bagian kiri. Jenis kelamin perempuan lebih sering ditemukan dan etiologi tersering yaitu faktor lingkungan. Kelompok usia yang tersering ditangani yaitu 1-4 tahun dan tindakan yang tersering digunakan ialah palatoplasty. Kata kunci: palatoskisis, labiopalatoskisis.

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Response of Vascular Lesions of the Head and Neck to Argon Laser Radiation

Otolaryngology ◽

10.1177/019459988309100217 ◽

1983 ◽

Vol 91 (2) ◽

pp. 203-208 ◽

Cited By ~ 4

Author(s):

Joseph R. DiBartolomeo

Keyword(s):

Laser Radiation ◽

Surgical Technique ◽

Head And Neck ◽

Excellent Result ◽

Argon Laser ◽

Vascular Lesion ◽

Vascular Lesions ◽

Hypertrophic Scars ◽

Argon Ion

Argon laser radiation is used to treat congenital and acquired vascular lesions of the head and neck. Thirteen patients requiring a total of 36 treatments were followed up for a minimum of 1 year to assess the response of the vascular lesion to argon ion radiation. Of the 13 patients, 10 had an excellent result, with the lesion no longer being identifiable. Three of the patients had residual but minimal color remaining in the lesion. There were no complications or hypertrophic scars after 1 year of follow-up. The laser parameters used and the surgical technique followed are outlined.

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