Benign Neoplasms of the Colon and Rectum
Philip H. Gordon, Santhat Nivatvongs, Lee E. Smith, Scott Thorn Barrows, Carla Gunn, Gregory Blew, David Ehlert, Craig Kiefer, Kim Martens in Neoplasms of the Colon, Rectum, and Anus, 2007
In order to achieve more complete polyp clearance, Edwards et al. (111) analyzed their experience of using intraoperative enteroscopy in conjunction with explore celiotomy. The enteroscope was introduced through an enterotomy at the site of polypectomy for the largest polyps. Depending on the size of the polyps, snare polypectomy, electrocoagulation, or biopsies were performed. In their experience of 25 patients, enteroscopy identified 350 polyps not detected by palpation or transillumination of the bowel by an operating light. All the polyps were removed. There was one early complication of a delayed small bowel perforation at the site of a snare polypectomy that resulted in an urgent reoperation but no long-term sequelae. No patient in this group had required operative polypectomy within four years of polyp clearance by intraoperative enteroscopy, compared with registry data of 4 of 23 patients who had more than one exploratory celiotomy within a year. It appears that intraoperative enteroscopy for PJS improves polyp clearance without the need for additional enterotomies and may help to reduce the frequency of exploratory celiotomy (112).
Intestinal Transplantation for Necrotizing Enterocolitis
David J. Hackam in Necrotizing Enterocolitis, 2021
Once the vascular anastomoses are completed, the bowel is reperfused. Initial assessment of bowel reperfusion is performed and hemostasis secured. The enteric anastomoses can then be performed. The upper anastomosis is commonly performed in a side-to-side fashion (functional end-to-end anastomosis), mostly hand sewn two layer, although stapled joins have been done with inferior results. Except in the circumstance of ultra-short proximal duodenum, as discussed earlier, enough proximal native bowel is left so that if there is a graft failure and need for allograft enterectomy, there is sufficient native bowel for reconstruction. However, it is kept short enough so that at enteroscopy the anastomosis and proximal allograft bowel can be reached for biopsy purposes. The lower anastomosis is to the remaining distal native small bowel or, more commonly, the native colon. If there is a good length of native colon, no allograft colon is transplanted, and the ileocolic (or ileoileal) anastomosis is performed with a Bishop Koop ileostomy, or end to end with a loop ileostomy proximal to the anastomosis. Both these options allow for the ileal allograft to be scoped and biopsied for intestinal surveillance. Some programs have gone away from stomas and surveillance biopsies, but this is a programmatic decision and not routine. If there is only a small amount of native colon, allograft colon can be included with the transplant and a colocolic anastomosis done with a distal allograft loop colostomy performed for surveillance purposes.
Tropical Colorectal Surgery
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 in Keighley & Williams’ Surgery of the Anus, Rectum and Colon, 2019
Currently, for intra-abdominal and extraintestinal TB, contrast enhanced computerised tomography of the abdomen with multiplanar imaging and 3-D reconstruction is the imaging modality of choice.8 It is helpful in the delineation of mucosal pathology, stricture and fistula. Upper and lower intestinal endoscopy and enteroscopy will provide a comprehensive view of the entire intestinal tract and allows for biopsy of tissue. Capsule endoscopy is an alternative to enteroscopy, but biopsy of tissue is not possible, only images. Before capsule endoscopy is undertaken, it is essential to exclude intestinal stricture by prior water-soluble contrast study or MRI enteroclysis, lest the capsule becomes impacted at the site of luminal narrowing.
Does urgent balloon-assisted enteroscopy impact rebleeding and short-term mortality in overt obscure gastrointestinal bleeding?
Published in Scandinavian Journal of Gastroenterology, 2020
João Carlos Silva, Rolando Pinho, Ana Ponte, Adélia Rodrigues, Jaime Rodrigues, Ana Catarina Gomes, Edgar Afecto, João Carvalho
All procedures were performed with a single-balloon enteroscopy (Olympus® SIF-Q180), using the standard push-and-pull technique [20]. The procedures were performed by three endoscopists experienced in deep enteroscopy (RP, AR, AP). Antegrade (oral) or retrograde (anal) insertion, was chosen according to SBCE findings, using the small bowel transit time cut-off of 0.6, as previously described [21]. When the bleeding source was identified through imaging methods, the route of insertion was chosen according to the topography of the findings. If the selected route of insertion leads to negative findings, the opposite route was used and tattooing was made at the furthest depth of the initial route. Antegrade procedures were performed after an overnight fast, whereas retrograde BAE required bowel preparation with 4 L of polyethylene-glycol solution.
Assessment of small intestinal bacterial overgrowth in chronic pancreatitis patients using jejunal aspirate culture and glucose hydrogen breath test
Published in Scandinavian Journal of Gastroenterology, 2021
Rajesh Sanjeevi, Kapil Dev Jamwal, Sudipta Dhar Chowdhury, Balamurugan Ramadass, R. Gayathri, Amit Kumar Dutta, Anjilivelil Joseph Joseph, Balakrishnan S. Ramakrishna, Ashok Chacko
The jejunal aspirate was obtained using a modified double lumen catheter [18]. The catheter was constructed using principles as described by Ghoshal et al. [19]. Briefly, a double lumen catheter was created by refashioning an endoscopic injection needle. A rubber stopper was placed at the tip of the outer catheter to prevent the contamination of the inner catheter. The entire assembly was then gas sterilized. All patients recruited to the study underwent push enteroscopy using a single balloon enteroscope with minimal air insufflation after 12 h of fasting. Once the enteroscope was positioned 10 cm beyond the DJ flexure (position confirmed using fluoroscopy), the modified double lumen catheter was introduced into the small bowel lumen. The rubber stopper was dislodged by pushing out the inner catheter and small bowel content was aspirated using a sterile vacuum pressure syringe. A portion of the aspirate was then immediately transferred to an anaerobic transport medium and the remaining content was transferred to a sterile tube. No flushing of the biopsy channel/lens was done during the procedure.
Gastrointestinal bleeding in von Willebrand patients: special diagnostic and management considerations
Published in Expert Review of Hematology, 2023
Edwin Ocran, Nicholas L.J. Chornenki, Mackenzie Bowman, Michelle Sholzberg, Paula James
VWD is overrepresented in clinical presentations of angiodysplasia-related GI bleeding, and angiodysplasia is a significant cause of bleeding in VWD. The diagnosis of angiodysplasia-related GI bleeding is challenging. Lesions are located commonly in the small intestine which is not visualized by conventional endoscopy [20]. Angiodysplastic lesions may also have a slow rate of bleeding preventing identification by angiography or red cell scan. Ultimately, diagnosis typically involves multiple GI investigations using conventional or video capsule endoscopy (VCE) [20]. The main advantage of VCE over conventional upper and lower GI endoscopy is that it allows for safe small bowel examination which is the commonest location of angiodysplasia [22,26]. VCE, however, does not permit therapeutic interventions at the time of diagnosis, and is not interpreted in real time. Thus, more invasive small bowel enteroscopy techniques such as push enteroscopy are required for endoscopic treatments of lesions [22,24].
Related Knowledge Centers
- Capsule Endoscopy
- Colonoscopy
- Esophagogastroduodenoscopy
- Ileum
- Small Intestine
- Jejunum
- Endoscope
- Double-Balloon Enteroscopy
- Duodenum
- Gastroenterology