scholarly journals Unsuspected Small-Bowel Crohn’s Disease in Elderly Patients Diagnosed by Video Capsule Endoscopy

2018 ◽  
Vol 2018 ◽  
pp. 1-7 ◽  
Author(s):  
Che-Yung Chao ◽  
Carl Frederic Duchatellier ◽  
Ernest G. Seidman
Keyword(s):  
Crohn’S Disease ◽  
Small Bowel ◽  
Crohn's Disease ◽  
Elderly Patients ◽  
Capsule Endoscopy ◽  
The Elderly ◽  
Fecal Calprotectin ◽  
Tertiary Hospital ◽  
Video Capsule Endoscopy ◽  
Deficiency Anemia

Background. Video capsule endoscopy (VCE) is increasingly performed among the elderly for obscure bleeding. Our aim was to report on the utility of VCE to uncover unsuspected Crohn’s disease (CD) in elderly patients. Methods. Retrospective review of VCE performed in elderly patients (≥70 y) at a tertiary hospital (2010–2015). All underwent prior negative bidirectional endoscopies. CD diagnosis was based on consistent endoscopic findings, exclusion of other causes, and a Lewis endoscopic score (LS) > 790 (moderate-to-severe inflammation). Those with lower LS (350–790) required histological confirmation. Known IBD cases were excluded. Results. 197 VCE were performed (mean age 78; range 70–93). Main indications were iron deficiency anemia (IDA), occult GI bleeding (OGIB), chronic abdominal pain, or diarrhea. Eight (4.1%) were diagnosed as CD based on the aforementioned criteria. Fecal calprotectin (FCP) was elevated in 7/8 (mean 580 μg/g). Mean LS was 1824. Small-bowel CD detected by VCE led to a change in management in 4/8. One patient had capsule retention secondary to NSAID induced stricture, requiring surgical retrieval. Conclusions. VCE can be safely performed in the elderly. A proportion of cases may have unsuspected small-bowel CD despite negative endoscopies. FCP was the best screening test. Diagnosis frequently changed management.

scholarly journals Diagnostic efficacy of double-balloon enteroscopy in patients with suspected isolated small bowel Crohn’s disease

2019 ◽  
Author(s):  
Zihan Huang ◽  
Xiang Liu ◽  
Fei Yang ◽  
Guoxin Wang ◽  
Nan Ge ◽  
...  
Keyword(s):  
Crohn’S Disease ◽  
Small Bowel ◽  
Crohn's Disease ◽  
Capsule Endoscopy ◽  
Abdominal Mass ◽  
Video Capsule Endoscopy ◽  
Small Intestinal Mucosa ◽  
Double Balloon Enteroscopy ◽  
Balloon Enteroscopy ◽  
Double Balloon

Abstract Background Due to the development of double-balloon enteroscopy and video capsule endoscopy, direct visualization of the entire small intestinal mucosa has been achieved. Compared with video capsule endoscopy, double-balloon enteroscopy has the advantages of biopsy samples and endoscopic treatment. The aim of this research was to explore the value of double-balloon enteroscopy for isolated small bowel Crohn’s disease. Methods This study included patients with suspected isolated small bowel Crohn’s disease who were hospitalized in Shengjing Hospital from April 2014 to June 2018. We included patients with symptoms of 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 Crohn’s disease were excluded from this cohort. Patients with suspected isolated small bowel Crohn’s disease underwent double-balloon enteroscopy. Results With clear endoscopic images and histological support, 14 patients were diagnosed with isolated small bowel Crohn’s disease. Three patients who were diagnosed with small bowel Crohn’s disease by double-balloon enteroscopy showed improved morphological features of the small bowel when the double-balloon enteroscopy was reviewed after medical treatment. Conclusions The diagnosis of Crohn’s disease is usually based on the patient’s clinical history and related examinations. Double-balloon enteroscopy provides imaging support and histological support for the definitive diagnosis of Crohn’s disease and can be considered as a useful tool to evaluate the therapeutic efficacy in the future.

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