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Diagnosis of IBD
Published in Peter Sagar, Andrew G. Hill, Charles H. Knowles, Stefan Post, Willem A. Bemelman, Patricia L. Roberts, Susan Galandiuk, John R.T. Monson, Michael R.B. Keighley, Norman S. Williams, Keighley & Williams’ Surgery of the Anus, Rectum and Colon, 2019
Gregor Novak, Geert D’Haens, Najib Haboubi, John B. Schofield
Single- and double-balloon enteroscopy is being used to for detection of lesions in jejunal and proximal ileal CD. The procedure should be restricted to patients in which definitive verification of CD would have therapeutic implications. The advantages compared with capsule endoscopy include the ability to obtain biopsies for histopathology and the potential for therapeutic intervention (e.g. dilatation of strictures).108 Once the diagnosis of CD has been established, further endoscopic procedures are needed in patient management (to assess therapeutic response, disease severity, for therapeutic interventions [e.g. stricture dilatation], colorectal cancer surveillance, etc.).
Gastrointestinal Endoscopy
Published in Professor Sir Norman Williams, Professor P. Ronan O’Connell, Professor Andrew W. McCaskie, Bailey & Love's Short Practice of Surgery, 2018
Professor Sir Norman Williams, Professor P. Ronan O’Connell, Professor Andrew W. McCaskie
This technique allows the direct visualisation of and therapeutic intervention for the entire small bowel and may be attempted via either the oral or rectal route. Double-balloon enteroscopy was developed in 2001 in Japan; it involves the use of a thin enteroscope and an overtube, which are both fitted with a balloon. The procedure is usually carried out under general anaesthesia, but may be undertaken with the use of conscious sedation. The enteroscope and overtube are inserted through either the mouth or anus and steered to the proximal duodenum/terminal ileum in the conventional manner. Following this the endoscope is advanced a small distance in front of the overtube and the balloon at the end is inflated. Using the assistance of friction at the interface between the enteroscope and intestinal wall, the small bowel is accordioned back to the overtube. The overtube balloon is then deployed and the enteroscope balloon is deflated.
Stents in the Gastrointestinal Tract in Palliative Care
Published in Victor R. Preedy, Handbook of Nutrition and Diet in Palliative Care, 2019
Small bowel obstruction can occur due to various malignancies: primary, metastasis, or peritoneal carcinomatosis. This is an untapped area for SEMS insertion because complete assessment of stenosis status (e.g., location, severity, and length) is difficult to perform and the lesion is quite difficult to reach from the mouth or the anus, making SEMS insertion extremely challenging or impossible. Currently, three types of device-assisted enteroscopy, namely, double-balloon enteroscopy, single-balloon enteroscopy, and spiral enteroscopy, are available. These enteroscopy systems can reach the deep small bowel. However, they have a 2.8 mm working channel that cannot accommodate a 10-Fr delivery system of the conventional TTS stent. Therefore, SEMS insertion in the small bowel requires a complicated process as follows. First, a guidewire is traversed through the stricture using an enteroscope. Second, the enteroscope is withdrawn while leaving the guidewire in place. Third, a stent delivery system is fluoroscopically advanced through the overtube for enteroscopy (Ross et al. 2006), or through the conventional endoscope (Lee et al. 2012). Finally, SEMS is deployed at the proper position. However, a new-generation double-balloon enteroscopy with a 3.2 mm working channel and a new enteral stent with 9-Fr delivery system have been recently launched. The combination of these devices allows small bowel stenting using the TTS technique to be performed. However, many patients with small bowel obstruction, particularly due to metastasis or peritoneal carcinomatosis, are likely to have multiple sites of obstruction and/or significant decrease in bowel movement, in which SEMS placement may be of little or no help to relieve obstructive symptoms. Thus, careful evaluation using computed tomography and/or small bowel series using water-soluble contrast agent should be carried out before considering small bowel stenting.
Endoscopic characteristics of Meckel’s diverticulum in adults: a retrospective case-series from two tertiary general hospitals in China
Published in Scandinavian Journal of Gastroenterology, 2023
Jing Yang, Zhitao Chen, Yan Fan, Lei Zhou, Qingqing Tian, Xin Yin, Xiaowei Jin, Heng Zhang, Shoubin Ning
Double-balloon enteroscopy (Fujinon EN-450T5, Fujinon Inc., Japan) was used in 24 patients while 42 patients underwent the BAE examination taking the single-balloon enteroscopy (Olympus SIF-Q260, Olympus Inc., Japan). Considering that DBE and SBE had comparable diagnostic performance for small bowel diseases [10,11], the choice of BAE type depended on the facilities of the two hospitals and the preference of endoscopists. Endoscopic detection of double-lumen sign in the ileum (Figure 1) and/or intraluminal contemporaneous ulcerative lesions [4–6] were used to diagnose MD. On diagnosing MD, we scrutinized two lumens to distinguish between the diverticulum and the ileum. Moreover, we used biopsy forceps to measure the long diameter of the MD orifice and the depth of the whole diverticulum (Figure 2). The location of MD is denoted by the distance to the ileocecal valve. The small bowel upstream of the diverticulum was observed as much as possible.
Risk factors for surgery in patients with retention of endoscopic capsule
Published in Scandinavian Journal of Gastroenterology, 2018
Zemin Han, Weiguang Qiao, Xiuyun Ai, Aimin Li, Zhenyu Chen, Jie Zhang, Tianmo Wan, Xicheng Feng, Side Liu, Fachao Zhi
Previous studies reported that although some of the retained capsules may spontaneously pass after a certain period of time, surgery was still the main means for removing them [13]. Recent studies recommended double-balloon enteroscopy (DBE) as the primary method for treatment of capsule retention [14–16]. However, data on medical or endoscopic intervention in dealing with capsule retention have only been described in articles with a small sample size. Furthermore, studies analyzing the long-term follow-up of patients with capsule retention are lacking. It is largely unknown whether medical or endoscopic intervention can effectively prevent unnecessary surgery in patients with benign diseases. The risk factors associated with progress to surgery have not been explored.
The evolving management of small bowel adenocarcinoma
Published in Acta Oncologica, 2018
Eelco de Bree, Koen P. Rovers, Dimitris Stamatiou, John Souglakos, Dimosthenis Michelakis, Ignace H. de Hingh
SBA is a rare and unique malignancy, which is often diagnosed at an advanced stage due to atypical and late symptoms, its low index of suspicion, difficult endoscopic access and poor detection by radiological imaging. Its diagnostic approach and treatment are evolving. Double balloon enteroscopy and capsule endoscopy are novel techniques which may result in earlier diagnosis and consequently the improvement of the generally poor prognosis. Adequate lymph node dissection with an assessment of at least 8–10 lymph nodes correlates with improved prognosis. Adjuvant chemotherapy is increasingly being used to reduce the recurrence rate. The exact role of adjuvant chemotherapy and (neo) adjuvant radiotherapy has not been determined yet, but it seems that adjuvant chemotherapy is associated with significantly better outcome in stage III disease and probably not in stage I and II disease. The latter underlines once again the need for adequate staging with appropriate lymph node dissection. The combination of a fluoropyrimidine and oxaliplatin (FOLFOX or CAPOX) seems to be the most appropriate front-line systemic chemotherapy for disseminated disease. Genomic profiling can identify potentially targetable genomic alterations in the majority of patients with SBA, whereas the incidence of microsatellite instability and the higher tumor mutational burden suggest a potential role for immunotherapy. The role of administration of targeted agents or immune checkpoint inhibitors is still unknown and subject of various ongoing clinical trials. In the common case of peritoneal metastases, cytoreductive surgery and HIPEC may be an attractive alternative treatment option for selected patients.