scholarly journals The accuracy of intestinal ultrasound compared with small bowel capsule endoscopy in assessment of suspected Crohn’s disease in patients with negative ileocolonoscopy

2018 ◽  
Vol 11 ◽  
pp. 175628481876590 ◽  
Author(s):  
Dan Carter ◽  
Lior H. Katz ◽  
Eytan Bardan ◽  
Eti Salomon ◽  
Shulamit Goldstein ◽  
...  
Keyword(s):  
Crohn’S Disease ◽  
Small Bowel ◽  
Capsule Endoscopy ◽  
Diagnostic Yield ◽  
Inflammatory Biomarkers ◽  
Cross Sectional ◽  
Imaging Results ◽  
Cross Sectional Imaging ◽  
Sectional Imaging

Background: Small bowel involvement in Crohn’s disease (CD) is frequently proximal to the ileocecal valve and inaccessible by conventional ileocolonoscopy (IC). Small bowel capsule endoscopy (SBCE) is among the prime modalities for assessment of small bowel disease in these patients. Intestinal ultrasound (IUS) is an accurate bedside fast and low-cost diagnostic modality utilized in CD for both diagnosis and monitoring. The aim of this study was to examine the accuracy of IUS in patients with suspected CD after a negative IC, and to evaluate the correlation of IUS with SBCE, inflammatory biomarkers and other cross-sectional imaging techniques. Methods: Prospective single center study in which patients with suspected CD underwent IUS and SBCE examinations within 3 days. IUS results were blindly compared with SBCE that served as the gold standard. A post hoc comparison was performed of IUS and SBCE results and available cross-sectional imaging results (computed tomography or magnetic resonance enterography) as well as inflammatory biomarkers if measured. The study cohort was followed for 1 year. In case of discordance between the IUS and SBCE results, the diagnosis at 1 year was reported. Results: Fifty patients were included in the study. The diagnostic yield of both IUS and SBCE for the diagnosis of small bowel CD was 38%. The IUS findings significantly correlated to small bowel inflammation detected by SBCE ( r = 0.532, p < 0.001), with fair sensitivity and specificity (72% and 84%). Cross-sectional imaging results significantly correlated to IUS as well ( r = 0.46, p = 0.018). Follow up was available in 8 of the 10 cases of discordance between IUS and SBCE. In all of these cases, diagnosis of CD was not fully established at the end of the follow up. Conclusions: The diagnostic yield of CE and IUS for detection of CD in patients with negative ileocolonoscopy was similar. IUS can be a useful diagnostic tool in suspected CD when IC is negative.

scholarly journals Performance of Capsule Endoscopy and Cross-Sectional Techniques in Detecting Small Bowel Lesions in Patients with Crohn’s Disease

2020 ◽  
Vol 2 (2) ◽  
Author(s):  
Carlo Calabrese ◽  
Margherita Diegoli ◽  
Nikolas Dussias ◽  
Marco Salice ◽  
Fernando Rizzello ◽  
...  
Keyword(s):  
Crohn’S Disease ◽  
Small Bowel ◽  
Crohn's Disease ◽  
Capsule Endoscopy ◽  
Imaging Techniques ◽  
Cross Sectional ◽  
Imaging Characteristics ◽  
Cross Sectional Imaging ◽  
Sectional Imaging

Abstract Background Crohn’s disease (CD) can be classified according to endoscopic and cross-sectional imaging characteristics. Information regarding disease extent and phenotype may be provided by advanced endoscopic and imaging techniques. In this study, we compare the ability of capsule endoscopy (CE) and cross-sectional imaging techniques (CST) (MRE/Computer Tomography Enteroscopy [CTE]) in detecting small bowel (SB) lesions. Methods We retrospectively analyzed 102 patients with a diagnosis of CD who underwent both CE and CST. Only patients with at least a 12-month follow-up after CE were included. Results Sensitivity and specificity for the detection of SB lesions were, respectively, 100% and 83.3% for CE, 55.1% and 80% for CTE, and 60% and 82.3% for MRE. CE detected proximal CD lesions in 73% of patients, whereas MRE and CTE detected proximal lesions in 41% and 16% of patients, respectively (P &lt; 0.001). Positive findings on CE led to management changes in all patients, in a median follow-up period of 58.7 months. During the follow-up period, 26.5% of patients underwent surgery. Multivariate analysis revealed that moderate-to-severe disease at CE was independently correlated with surgery (P = 0.03). Conclusions CE has a superior sensitivity for detecting CD lesions in the proximal and medium SB compared with CST. In the terminal ileum, MRE and CTE displayed similar performance to CE.

scholarly journals Endoscopic Evaluation and Therapeutic Considerations of Small Bowel Crohn’s Disease

2021 ◽  
Vol 12 (2) ◽  
pp. 238-258
Author(s):  
Rupa Banerjee ◽  
Partha Pal
Keyword(s):  
Crohn’S Disease ◽  
Small Bowel ◽  
Crohn's Disease ◽  
Capsule Endoscopy ◽  
Balloon Dilation ◽  
Endoscopic Evaluation ◽  
Double Balloon Enteroscopy ◽  
Cross Sectional ◽  
Cross Sectional Imaging ◽  
Sectional Imaging

Small bowel evaluation is warranted in all newly diagnosed cases of Crohn’s disease (CD) as small bowel is involved in two-thirds of CD patients at diagnosis and the involvement can be discontinuous. Endoscopic evaluation of the small bowel in suspected or established CD can be done by video capsule endoscopy (VCE), device assisted enteroscopy (DAE) (which includes single and double balloon enteroscopy, novel motorized spiral enteroscopy (NMSE) and balloon guided endoscopy (BGE)) and intra-operative enteroscopy (IOE). In suspected CD with a negative ileo-colonoscopy, VCE is the preferred initial diagnostic modality in the absence of obstructive symptoms or known stenosis. VCE should be preceded by cross-sectional imaging or patency capsule testing if obstruction is suspected given with high retention risk. In established cases, small bowel cross-sectional imaging (magnetic resonance or computed tomography enterography) is preferred over VCE as it can assess transmural and extra-luminal involvement. VCE is indicated subsequently if necessary to assess disease extent, unexplained symptoms (e.g., anemia, malnutrition) or mucosal healing. Pan-enteric capsule endoscopy (PCE) and the use of artificial intelligence are the recent developments with VCE. DAE with small bowel biopsy can provide definitive evidence of CD including the extent and severity. A final diagnosis of CD is based on the constellation of clinical, radiologic, histologic and endoscopic features. Newer technologies like NMSE and BGE can help with deeper and faster small bowel evaluation. DAE has also allowed endoscopic treatment of small bowel strictures, small bowel bleeding and retrieval of retained capsule or foreign bodies. Endoscopic balloon dilation (EBD), endoscopic electro-incision, strictureplasty and stenting have shown promising results in CD related small bowel strictures. In conclusion, endoscopic evaluation of the small bowel is rapidly evolving field that has a major role in diagnosis and management of small bowel CD and can alter treatment outcomes in properly selected patients.

Cross-Sectional Imaging of Small Bowel Malignancies

2012 ◽  
Vol 63 (3) ◽  
pp. 215-221 ◽  
Author(s):  
Dellano D. Fernandes ◽  
Ram Prakash Galwa ◽  
Najla Fasih ◽  
Margaret Fraser-Hill
Keyword(s):  
Small Bowel ◽  
Accurate Diagnosis ◽  
Imaging Features ◽  
Cross Sectional ◽  
Conventional Endoscopy ◽  
Cross Sectional Imaging ◽  
Pretreatment Staging ◽  
Sectional Imaging ◽  
Histologic Subtypes

Small bowel malignancies are rare neoplasms, usually inaccessible to conventional endoscopy but detectable in many cases by cross-sectional imaging. Modern multidetector computed tomographies permit accurate diagnosis, complete pretreatment staging, and follow-up of these lesions. In this review, we describe the cross-sectional imaging features of the most frequent histologic subtypes of the small bowel malignancies.

Luminal narrowing alone allows an accurate diagnosis of Crohn’s disease small bowel strictures at cross-sectional imaging

2020 ◽  
Author(s):  
Daniel Stocker ◽  
Michael J King ◽  
Maria El Homsi ◽  
Guillermo Carbonell ◽  
Octavia Bane ◽  
...  
Keyword(s):  
Crohn’S Disease ◽  
Small Bowel ◽  
Crohn's Disease ◽  
Diagnostic Performance ◽  
Mr Enterography ◽  
Cross Sectional ◽  
Luminal Narrowing ◽  
Cross Sectional Imaging ◽  
Sectional Imaging ◽  
Sensitivity Specificity

Abstract Background and Aims Current consensus recommendations define small bowel strictures (SBS) in Crohn’s disease (CD) on imaging as luminal narrowing with unequivocal upstream bowel dilation. The aim of this study was to 1) evaluate the performance of cross-sectional imaging for SBS diagnosis in CD using luminal narrowing with upstream SB dilation and luminal narrowing with or without upstream dilation, and 2) compare the diagnostic performance of CT and MR enterography (MRE) for SBS diagnosis. Methods One hundred and eleven CD patients (81 with pathologically confirmed SBS, 30 controls) who underwent CT and/or MRE were assessed. Two radiologists (R1, R2) blinded to pathology findings independently assessed the presence of luminal narrowing and upstream SB dilation. Statistical analysis was performed for a) luminal narrowing with or without SB upstream dilation (“possible SBS”), b) luminal narrowing with upstream SB dilation ≥3cm (“definite SBS”). Results Sensitivity for detecting SBS was significantly higher using “possible SBS” (R1, 82.1%; R2, 77.9%) compared to “definite SBS” (R1, 62.1%; R2, 65.3%; p&lt;0.0001) with equivalent specificity (R1, 96.7%; R2, 93.3%; p&gt;0.9). Using criterion “possible SBS”, sensitivity/specificity were equivalent between CT (R1, 87.3%/93.3%; R2, 83.6%/86.7%) and MRE (R1, 75.0%/100%; R2: 70.0%/100%). Using criterion “definite SBS”, CT showed significantly higher sensitivity (78.2%) compared to MRE (40.0%) for R1 but not R2 with similar specificities (CT, 86.7%-93.3%; MRE, 100%). Conclusion SBS can be diagnosed using luminal narrowing alone without the need for upstream dilation. CT and MRE show similar diagnostic performance for SBS diagnosis using luminal narrowing with or without upstream dilation.

State-of-the-art aortic imaging: Part II - applications in transcatheter aortic valve replacement and endovascular aortic aneurysm repair

VASA ◽  
2014 ◽  
Vol 43 (1) ◽  
pp. 6-26 ◽  
Author(s):  
Fabian Rengier ◽  
Philipp Geisbüsch ◽  
Paul Schoenhagen ◽  
Matthias Müller-Eschner ◽  
Rolf Vosshenrich ◽  
...  
Keyword(s):  
Aortic Valve ◽  
Transcatheter Aortic Valve Replacement ◽  
Surgical Repair ◽  
Imaging Modality ◽  
Open Surgical Repair ◽  
Cross Sectional ◽  
Transcatheter Aortic Valve ◽  
Cross Sectional Imaging ◽  
Sectional Imaging

Transcatheter aortic valve replacement (TAVR) as well as thoracic and abdominal endovascular aortic repair (TEVAR and EVAR) rely on accurate pre- and postprocedural imaging. This review article discusses the application of imaging, including preprocedural assessment and measurements as well as postprocedural imaging of complications. Furthermore, the exciting perspective of computational fluid dynamics (CFD) based on cross-sectional imaging is presented. TAVR is a minimally invasive alternative for treatment of aortic valve stenosis in patients with high age and multiple comorbidities who cannot undergo traditional open surgical repair. Given the lack of direct visualization during the procedure, pre- and peri-procedural imaging forms an essential part of the intervention. Computed tomography angiography (CTA) is the imaging modality of choice for preprocedural planning. Routine postprocedural follow-up is performed by echocardiography to confirm treatment success and detect complications. EVAR and TEVAR are minimally invasive alternatives to open surgical repair of aortic pathologies. CTA constitutes the preferred imaging modality for both preoperative planning and postoperative follow-up including detection of endoleaks. Magnetic resonance imaging is an excellent alternative to CT for postoperative follow-up, and is especially beneficial for younger patients given the lack of radiation. Ultrasound is applied in screening and postoperative follow-up of abdominal aortic aneurysms, but cross-sectional imaging is required once abnormalities are detected. Contrast-enhanced ultrasound may be as sensitive as CTA in detecting endoleaks.

scholarly journals Role of endoscopy, cross-sectional imaging and biomarkers in Crohn's disease monitoring

Gut ◽  
2013 ◽  
Vol 62 (12) ◽  
pp. 1806-1816 ◽  
Author(s):  
Jose-Manuel Benitez ◽  
Marie-Alice Meuwis ◽  
Catherine Reenaers ◽  
Catherine Van Kemseke ◽  
Paul Meunier ◽  
...  
Keyword(s):  
Crohn’S Disease ◽  
Crohn's Disease ◽  
Disease Monitoring ◽  
Cross Sectional ◽  
Cross Sectional Imaging ◽  
Sectional Imaging

Case 9.28

2014 ◽  
pp. 476-477
Author(s):  
Christine U. Lee ◽  
James F. Glockner
Keyword(s):  
Small Bowel ◽  
Cross Sectional ◽  
New Era ◽  
True Incidence ◽  
Live Births ◽  
Cross Sectional Imaging ◽  
Sectional Imaging ◽  
The Right ◽  
Left Abdomen

11-year-old boy with suspected IBD Coronal SSFSE images (Figure 9.28.1) demonstrate abnormal orientation of large and small bowel, with small bowel in the right abdomen and colon in the left abdomen. Malrotation Classic thinking regarding malrotation holds that most cases are detected within the first few months of life. However, in the new era of cross-sectional imaging for everyone, more and more adults with asymptomatic malrotations are noted and the true incidence is not entirely certain. Estimates in the literature range from 1 in 6,000 to 1 in 200 live births. Autopsy studies suggest that some form of malrotation exists in 0.5% to 1% of the population....

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