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deep enteroscopy

Emanuele Rondonotti, Cristiano Spada, Samuel Adler, Andrea May, Edward J Despott, Anastasios Koulaouzidis, Simon Panter, Dirk Domagk, Ignacio Fernandez-Urien, Gabriel Rahmi, Maria Elena Riccioni, Jeanin E van Hooft, Cesare Hassan, Marco Pennazio
SMALL-BOWEL CAPSULE ENDOSCOPY (SBCE): 1: ESGE recommends that prior to SBCE patients ingest a purgative (2 L of polyethylene glycol [PEG]) for better visualization.Strong recommendation, high quality evidence.However, the optimal timing for taking purgatives is yet to be established. 2: ESGE recommends that SBCE should be performed as an outpatient procedure if possible, since completion rates are higher in outpatients than in inpatients.Strong recommendation, moderate quality evidence...
March 14, 2018: Endoscopy
Cindy Ningfu Zhu, Joshua Friedland, Brian Yan, Aze Wilson, Jamie Gregor, Vipul Jairath, Michael Sey
BACKGROUND AND AIMS: Melena is a symptom of upper gastrointestinal bleeding and usually indicates bleeding proximal to the ligament of Treitz. However, whether melena predicts bleeding in the proximal small intestine in patients with obscure gastrointestinal bleeding (OGIB) is unknown and the objective of this study. METHODS: A retrospective cohort study of consecutive patients undergoing capsule endoscopy for OGIB between July 2009 and May 2016 was conducted. Subjects were categorized based on the presence of melena, and the primary outcome was identification of a bleeding source within the proximal 2/3 of the small intestine...
March 8, 2018: Digestive Diseases and Sciences
Leopoldo López Rosés, Beatriz Álvarez, Abel González Ramírez, Alina López Baz, Alexia Fernández López, Sara Alonso, Andrés Dacal, Eva Martí, Gino Albines, Julieta Fernández Molina, Ángel Lancho
INTRODUCTION: there is a lot of controversy with regard to who should be responsible for sedation during digestive endoscopy, particularly in advanced procedures that require deep sedation such as enteroscopy. The aim of this study was to evaluate the endoscopist-directed sedation viability during single balloon enteroscopy. MATERIAL AND METHOD: this was a prospective, observational study of a series of consecutive enteroscopies. The clinical staff included an endoscopist, scrub nurse and a nurse in charge of monitoring and sedative administration...
February 21, 2018: Revista Española de Enfermedades Digestivas
Robert A Moran, Sindhu Barola, Joanna K Law, Stuart K Amateau, Daniil Rolshud, Erin Corless, Vandhana Kiswani, Vikesh K Singh, Anthony N Kalloo, Mouen A Khashab, Anne Marie Lennon, Patrick I Okolo, Vivek Kumbhari
Background: Three device-assisted deep endoscopic platforms presently exist and are available for clinical use: double-balloon enteroscopy, single-balloon enteroscopy (SBE), and spiral enteroscopy (SE). In a retrospective study, SE was associated with a greater depth of maximal insertion (DMI) with similar diagnostic yields and procedure time as compared with SBE. Aims: This was a prospective, randomized comparison of SE and SBE with respect to DMI, diagnostic yield, procedure time, and rate of adverse events...
2018: Clinical Medicine Insights. Gastroenterology
Chen-Shuan Chung, Kuan-Chih Chen, Yueh-Hung Chou, Kuo-Hsin Chen
A 28-year-old man presented with anemia symptoms and intermittent tarry stool passage for three days. No stigmata of hemorrhage were identified using esophagogastroduodenoscopy, ileocolonoscopy, and contrast-enhanced computed tomography. He then developed massive tarry stool passage with profound hypovolemic shock and hypoxic respiratory failure. Emergent angiography revealed active bleeder, probably from the jejunal branches of the superior mesenteric artery, but embolization was not performed due to possible subsequent extensive bowel ischemia...
January 7, 2018: World Journal of Gastroenterology: WJG
Michael G Noujaim, Jonathan Green, May Min, Christopher R Schlieve, Krunal Patel, Mitchell Cahan, David Cave
Background: Neuroendocine tumors (NETs) or carcinoids arise at many different sites of the gastrointestinal tract. The small intestine is the most common site for NETs. Diagnosing small bowel carcinoids remains challenging given their non-specific presentations and the overall low incidence of small bowel tumors. Video capsule endoscopy (VCE) has significanly improved our ability to detect small bowel malignancies. We explore the value of VCE in the initial workup and management of a series of small bowel carcinoid patients...
December 2017: Gastroenterology Research
Mohammad F Ali, Rani Modayil, Krishna C Gurram, Collin Brathwaite, David Friedel, Stavros Stavropoulos
BACKGROUND: Deep enteroscopy-assisted ERCP (DEA-ERCP) in post-bariatric Roux-en-Y (RY) anatomy is challenging. Laparoscopy-assisted ERCP (LA-ERCP) or EUS-directed transgastric ERCP (EDGE) are technically easier and faster, but are more invasive and morbid procedures. Therefore, we have used DEA-ERCP as our first-line approach, reserving EDGE and LA-ERCP for cases in which adjunctive techniques that cannot be performed through an enteroscope are required (eg, EUS-FNA, SO manometry), or DEA-ERCP failures...
January 6, 2018: Gastrointestinal Endoscopy
Tsung-Chun Lee, Yi-Chen Huang, Yen-Zhen Lu, Yu-Chang Yeh, Linda Chia-Hui Yu
KEY POINTS: Balloon-assisted enteroscopy (BAE) is an emerging standard procedure by utilizing distensible balloons to facilitate deep endoscopy in the small and large intestine. Sporadic cases of bacteraemia were found after BAE. Balloon distension by BAE caused gut tissue hypoxia. The impact of balloon distension-induced hypoxia on intestinal barriers remains unclear. Murine models of BAE by colonic balloon distension showed that short- and long-term hypoxia evoked opposite effects on epithelial tight junctions (TJs)...
November 27, 2017: Journal of Physiology
Weiguang Qiao, Zemin Han, Yutang Ren, Tongyin Xing, Wenxin Tan, Side Liu, Fachao Zhi
OBJECTIVE: Esophagogastroduodenoscopy (EGD) is the standard instrument to detect diseases of the upper digestive tract. However, the deep areas of the duodenum are often missed. This study aimed to clarify the diagnostic role of EGD in the distal duodenum. METHODS: This retrospective study enrolled 63 patients with distal duodenal lesions between January 2004 and July 2016. Rate of missed diagnosis on EGD examination was calculated. Logistic regression analysis was performed to identify factors associated with missed diagnosis...
October 12, 2017: Journal of Digestive Diseases
Klaus Mönkemüller, Carolina Olano, Steffen Rickes
Direct percutaneous endoscopic jejunostomy (DPEJ) is a useful technique to access the jejunum in order to: a) provide enteral nutrition to individuals when the gastric route is absent or contraindicated; and b) to decompress the jejunum in patients with malignant small bowel obstruction. Traditionally, DPEJ is performed using a colonoscope or enteroscope, which is advanced as deep as possible into the jejunum. The insertion technique of the feeding tube is identical to the one used for a gastrostomy tube (Ponsky-Gauderer method)...
October 2017: Revista Española de Enfermedades Digestivas
Jinsu Kim
The balloon-assisted enteroscope has been regarded as the standard device for direct visualization of deep small bowels and allows for the diagnosis and treatment of small bowel disease. At the beginning, its application was focused on the diagnosis of obscure gastrointestinal bleeding, inflammatory bowel disease, and small bowel tumor. However, the indications are being expanded to various therapeutic procedures, not only confined to bleeding control. With the expansion of the indications, the need to perform enteroscopy effectively and safely is increasing...
July 2017: Clinical Endoscopy
Naoki Ohmiya, Noriyuki Horiguchi, Tomomitsu Tahara, Mitsuo Nagasaka, Yoshihito Nakagawa, Tomoyuki Shibata, Tetsuya Tsukamoto, Makoto Kuroda
BACKGROUND AND STUDY AIMS:  Probe-based confocal laser endomicroscopy (pCLE) enables real-time optical biopsy. Little is known about pCLE imaging deep inside the small bowel, therefore the aim of this study was to determine its usefulness. PATIENTS AND METHODS:  Between April 2014 and January 2016, we performed 38 pCLE examinations during double-balloon enteroscopy with intravenous fluorescein in 37 patients with: tumors (n = 10), vascular disorders (n = 6), inflammatory diseases and drug injuries (n = 13), other disorders (n = 4), and normal findings (n = 4)...
July 2017: Endoscopy International Open
Wuttiporn Manatsathit, Usah Khrucharoen, Dennis M Jensen, O Joe Hines, Thomas Kovacs, Gordon Ohning, Rome Jutabha, Kevin Ghassemi, Gareth S Dulai, Gustavo Machicado
BACKGROUND: To evaluate roles of intraoperative endoscopy (IOE) in management of severe obscure GI bleeding (OGIB) before vs. after introduction of video capsule endoscopy (VCE) and deep enteroscopy (DE). METHODS: We retrospectively reviewed prospectively collected data of patients undergoing IOE for severe OGIB in a tertiary referral center. RESULTS: 52 patients had laparotomy/IOE for OGIB, 11 pre and 41 post VCE/DE eras. In the pre VCE/DE era, 36...
June 16, 2017: American Journal of Surgery
Takeshi Tsujino, Hiroyuki Isayama, Hirofumi Kogure, Tatsuya Sato, Yousuke Nakai, Kazuhiko Koike
Living donor liver transplantation (LDLT) is an effective alternative to deceased liver transplantation (DDLT) for end-stage liver disease. Although advances in surgical techniques, immunosuppressive management, and post-transplant care have improved the overall outcomes of LDLT, biliary strictures remain the major unsolved problem. Endoscopic retrograde cholangiopancreatography (ERCP) is currently considered the first-line therapy for biliary strictures following LDLT with duct-to-duct reconstruction, with percutaneous and surgical interventions reserved for patients with unsuccessful management via ERCP...
August 2017: Clinical Journal of Gastroenterology
J J E García-Correa, J J Ramírez-García, L F García-Contreras, C Fuentes-Orozco, L Irusteta-Jiménez, L R Michel-Espinoza, A S Carballo Uribe, J A Torres Chávez, A González-Ojeda
INTRODUCTION AND AIMS: Double-balloon enteroscopy has been improving the visualization of the entire intestine for more than a decade. It is a complementary method in the study of intestinal diseases that enables biopsies to be taken and treatments to be administered. Our aim was to describe its main indications, insertion routes, diagnostic/therapeutic efficacy, and complications. MATERIALS AND METHODS: All patients referred to our unit with suspected small bowel pathology were included...
May 12, 2017: Revista de Gastroenterología de México
Shabana F Pasha, Jonathan A Leighton
Capsule endoscopy is the diagnostic test of choice for the evaluation of overt and occult small bowel bleeding. Its yield is higher in patients presenting with overt bleeding. The yield is also improved if the capsule is performed soon after the presentation of bleeding. Capsule endoscopy has a complementary role with cross-sectional imaging to triage patients for appropriate management, including deep enteroscopy, surgery, or, if negative, conservative management. Although capsule endoscopy is useful to detect vascular and inflammatory lesions, it appears to have a significant miss rate for solitary small bowel lesions, including tumors...
February 2017: Gastroenterology & Hepatology
Abhinav Koul, Donald M Pham, Arjun Nanda, Kevin E Woods, Steven D Keilin
Background and study aims Left ventricular assist devices (LVADs) are currently the standard of care in treatment of patients with end-stage heart failure waiting for heart transplant as well as destination therapy for non-transplant candidates. However, patients with LVADs are at increased risk of gastrointestinal bleeding due to the device's unique effects on hemodynamics. A major source of gastrointestinal bleeding in these patients are gastrointestinal angioectasias located within the small bowel that can only be reached with deep enteroscopy...
March 2017: Endoscopy International Open
Chao-Ming Tseng, I-Chang Lin, Chi-Yang Chang, Hsiu-Po Wang, Chih-Cheng Chen, Lein-Ray Mo, Jaw-Town Lin, Chi-Ming Tai
BACKGROUND AND AIM: The role of computed tomography angiography (CTA) on the management of acute overt obscure gastrointestinal bleeding (OGIB) remains unclear. We designed a study to evaluate the impact of CTA before enteroscopy for acute overt OGIB. METHODS: All patients undergoing CTA followed by enteroscopy for acute overt OGIB were enrolled in this retrospective study. Clinical characteristics and diagnosis were compared between patients with positive and negative CTA findings...
2017: PloS One
Najib Nassani, Elie El-Charabaty, Patricia Nasr, Iskandar Barakat, Sherif Andrawes
Foreign body ingestion is common, although perforation after ingestion is rare. We report a case of an ingested sharp wooden stick that perforated the proximal jejunum toward the renal vasculature, causing segmental renal artery thrombosis and renal infarct. The patient presented with severe abdominal pain and vomiting. A computed tomography scan revealed a linear opacity corresponding to the foreign body. The wooden stick was removed endoscopically through deep-push enteroscopy with a rat-tooth forceps. We report this unique case of perforation by a foreign body through the proximal jejunum to the left kidney, which was managed endoscopically...
2017: ACG Case Reports Journal
Jennifer X Cai, David L Diehl, Ralf Kiesslich, Andrew C Storm, Mohamad H El Zein, Alan H Tieu, Arthur Hoffman, Vikesh K Singh, Mouen A Khashab, Patrick I Okolo, Vivek Kumbhari
BACKGROUND: Surgically altered gastrointestinal anatomy poses challenges for deep enteroscopy. Current overtube-assisted methods have long procedure times and utilize endoscopes with smaller working channels that preclude use of standard accessories. A through-the-scope balloon-assisted enteroscopy (TTS-BAE) device uses standard endoscopes with a large working channel to allow metallic and plastic stent insertion. We aim to determine the efficacy and safety of TTS-BAE in patients with altered surgical anatomy...
July 2017: Surgical Endoscopy
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