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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.
Small Intestine Cancer
Published in Dongyou Liu, Tumors and Cancers, 2017
Andreas V. Hadjinicolaou, Christopher Hadjittofi
As esophagogastroduodenoscopy is limited to the proximal duodenum, and colonoscopy allows assessment up to the terminal ileum, leaving the small intestine largely out of reach, wireless video capsule endoscopy (VCE) is becoming the investigation of choice for suspected small intestine pathology. Double-balloon enteroscopy, although invasive, complements VCE as it achieves tissue biopsy for histological examination as well as dilatation of strictures, stent placements, or other therapeutic procedures.
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.
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
Nonspecific clinical symptoms coupled with the limited sensitivity of radiographic enteroclysis and conventional computed tomography for the detection of small bowel neoplasms led to the marked delay of the diagnosis. Multiphasic dynamic studies may have the potential to improve the diagnostic accuracy of multidetector computed tomography for small bowel neoplasms [30]. Only tumors in the proximal duodenum and the very distal ileum can be approached by conventional endoscopy. Newer investigation tools, such as computed tomography enteroclysis, magnetic resonance enteroclysis, wireless capsule endoscopy and double balloon enteroscopy now allow for an extensive exploration of the small bowel and should thus make early diagnosis possible [31–37]. Capsule endoscopy allows carrying out a complete small bowel exploration as an outpatient procedure. However, it should not be performed in the context of sub-occlusion. Double balloon enteroscopy can be used for the investigation of a wide range of small bowel pathologies [37]. Nevertheless, this procedure is less convenient than capsule endoscopy and should be used only if a biopsy or preoperative tattoo is required.
Outcome of patients receiving a continuous flow left ventricular assist device – a retrospective single center study
Published in Scandinavian Cardiovascular Journal, 2020
Jan Kiss, Christoffer Stark, Antti Nykänen, Karl Lemström
Aspirin medication was stopped in patients with recurrent gastrointestinal bleeding. The INR target was lowered to 1.8–2.5. In bleeders, endoscopy of the gastrointestinal tract was performed at least once, including esophagogastroduodenoscopy and colonoscopy. Capsule-endoscopy or double-balloon enteroscopy was used when necessary. Propranolol therapy was started in patients with angiodysplastic bowel lesions. Proton pump inhibitors were routinely used by all LVAD patients. Ocreotide therapy with daily subcutaneous injections was used in some cases and bevasitsumab therapy in an extremely challenging bleeder. Patients were also screened for iron-deficiency and received intravenous iron when necessary.