Sample records for four-lumen double-balloon 4l-db

  1. Double balloon enteroscopy examinations in general anesthesia

    Institute of Scientific and Technical Information of China (English)

    Laszlo; Zubek; Lena; Szabo; Peter; Laszlo; Lakatos; Janos; Papp; Janos; Gal; Gabor; Elo


    AIM:To demonstrate that the double balloon enteroscopy(DBE) can be safely performed in general anesthesia with intubation.METHODS:We performed a retrospective examination between August 2005 and November 2008 amongpatients receiving intubation narcosis due to DBE examination.The patients were grouped based on sex,age and physical status.Anesthesia records includedduration of anesthesia,quantity of medication usedand anesthesia-related complications.We determinedthe frequency of complications in the differen...

  2. Double-balloon endoscopy: Who needs it?

    DEFF Research Database (Denmark)

    Hendel, J.W.; Vilmann, P.; Jensen, T.


    Objective. Double-balloon endoscopy (DBE) made the small bowel accessible to inspection and therapy in its entirety. However, DBE is a time-consuming procedure that requires a highly skilled endoscopist, several nurses and - more often than not - anesthesiological support. This makes the selectio...... within the next 12 months. Conclusions. CE can be applied as a screening procedure for DBE and allows for an approximately two-thirds reduction in the need for DBE as well as enabling a choice to be made between the oral and anal route Udgivelsesdato: 2008...

  3. Investigating obscure gastrointestinal bleeding : capsule endoscopy or double balloon enteroscopy?

    NARCIS (Netherlands)

    Westerhof, J.; Weersma, R. K.; Koornstra, J. J.


    The possibility to visualise the small bowel has dramatically improved with the introduction of capsule endoscopy (CE) and double balloon enteroscopy (DBE). CE and DBE have become standard practice in investigating suspected diseases of the small bowel. An important reason to perform small bowel inv

  4. Investigating obscure gastrointestinal bleeding : capsule endoscopy or double balloon enteroscopy?

    NARCIS (Netherlands)

    Westerhof, J.; Weersma, R. K.; Koornstra, J. J.


    The possibility to visualise the small bowel has dramatically improved with the introduction of capsule endoscopy (CE) and double balloon enteroscopy (DBE). CE and DBE have become standard practice in investigating suspected diseases of the small bowel. An important reason to perform small bowel

  5. Double-balloon enteroscopy in detecting small intestinal bleeding

    Institute of Scientific and Technical Information of China (English)

    ZHI Fa-chao; PAN De-shou; ZHOU Dian-yuan; XIAO Bing; JIANG Bo; WAN Tian-mo; GUO Yu; ZHOU Dan; WANG Li-hui; CHEN Jin-feng; XIE Lu


    @@ Digestive tract hemorrhage is a common disease of the digestive system, but about 0.4%-5% intestinal bleeding can not be detected with gastroscope or colonscope.1 Since the intestine is long, tortuous, far away from both ends of the digestive tract and unfixed in position, clinical diagnosis of the bleeding is relatively difficult. Yamamoto and Sugano2 reported the clinical application of double-balloon enteroscope at American DDW in 2003.

  6. Malignant lymphoma in the ileum diagnosed by double-balloon enteroscopy

    Institute of Scientific and Technical Information of China (English)

    Kazuko Beppu; Nobuhiro Sato; Toshiki Kamano; Yasuo Hayashida; Sumio Watanabe; Taro Osada; Akihito Nagahara; Naoto Sakamoto; Tomoyoshi Shibuya; Masato Kawabe; Takeshi Terai; Toshifumi Ohkusa; Tatsuo Ogihara


    A 73-year old man presented with abdominal pain. A tumor with central ulceration was observed in the ileum using double-balloon enteroscopy. Histological findings of the biopsy specimens were consistent with malignant lymphoma. Double-balloon enteroscopy confirmed the diagnosis of a malignant lymphoma tumor which was surgically resected. The patient is still in complete remission now.

  7. Double balloon enteroscopy in the old: Experience from China

    Institute of Scientific and Technical Information of China (English)

    Qiong He; Bing Xiao; Ya-Li Zhang; Bo Jiang; Yang Bai; Fa-Chao Zhi; Qiang Zhang; Jian-Dong Li; Ya-Dong Wang; Tian-Mo Wan; Zhen-Yu Chen; De-Shou Pan; Jian-Qun Cai; Si-De Liu


    AIM:To evaluate the safety,efficacy and management of double balloon enteroscopy (DBE) carried out in those aged individuals with suspicious small intestine diseases.METHODS:DBE is a wonderful invention of the past decade and is widely used as an examination tool for the gastrointestinal tract.From January 2003 to July 2011,data from patients who were ≥ 65 years old and underwent DBE examination in the Nanfang Hospital were included in a retrospective analysis.RESULTS:Fifty-nine individuals were found and subsequently analyzed.The mean age was 69.63 ± 3.89 years (range 65-84),34 were males.Indications for DBE were melena/hematochezia (36 cases),abdominal pain (15 cases),diarrhea (3 cases),stool change (1 case),weight loss (1 case),vomiting (2 cases),and de bilitation (1 case).The average duration of symptoms was 33.34 ± 64.24 mo.Twenty-seven patients suffered from age-related diseases.Severe complications were not found during and after DBE.Comparison between systolic and diastolic blood pressure before and after DBE was statistically significant (mean ± SD,P < 0.01,P < 0.05,respectively).Small bowel pathologies were found by DBE in 35 patients,definite diagnoses were made in 31 cases,and detection rate and diagnostic yield for DBE were 68.6% and 60.8%,respectively.CONCLUSION:DBE is a safe and effective method for gastrointestinal examination in the aged population.Aging alone is not a risk factor for elderly patients with suspicious gastrointestinal diseases and thorough preparation prior to the DBE procedure should be made for individuals with multiple diseases especially cardiopulmonary disorders.

  8. Single-balloon versus double-balloon bipedicular kyphoplasty for osteoporotic vertebral compression fractures. (United States)

    Wang, Heng; Sun, Zhenzhong; Wang, Zhiwen; Jiang, Weimin


    Twenty-eight patients with osteoporotic vertebral compression fractures (OVCF) were treated with single-balloon bipedicular kyphoplasty (Group A), and 40 patients were treated with double-balloon bipedicular kyphoplasty (Group B). Visual Analogue Scale (VAS) score, vertebral height, and kyphotic angle (KA) were evaluated pre-operatively, post-operatively (3 days after surgery) and at final follow-up. Operative time, X-ray exposure frequency and costs were recorded. The mean operative time and X-ray exposure frequency in Group A were greater than in Group B (pkyphoplasty is a safe and cost-effective surgical method for the treatment of OVCF. It can achieve pain relief comparable with double-balloon bipedicular kyphoplasty. However, double-balloon bipedicular kyphoplasty is more efficacious in terms of the restoration of vertebral height and reduction of KA, and the operative time and X-ray exposure frequency are lower.

  9. Transcervical double-balloon catheter as an alternative and salvage method for medical termination of pregnancy in midtrimester

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    Yi-An Tu


    Conclusion: There was no significant additional benefit of using a double-balloon catheter in midtrimester termination of pregnancy, although the technique was considered simple and generally well-tolerated. Placing a transcervical double-balloon catheter could be the primary method, or one of the alternative medical methods if the patient and/or obstetrician prefers no operation.

  10. Double-balloon enteroscopy reliably directs surgical intervention for patients with small intestinal bleeding

    Institute of Scientific and Technical Information of China (English)

    Mou-Bin Lin; Lu Yin; Jian-Wen Li; Wei-Guo Hu; Qian-Jian Qian


    AIM: To evaluate preoperative double-balloon enteroscopy for determining bleeding lesions of small intestine, thus directing selective surgical intervention.METHODS: We retrospectively reviewed 56 patients who underwent double-balloon enteroscopy to localize intestinal bleeding prior to surgical intervention, and compared enteroscopic findings with those of intraoperation to determine the accuracy of enteroscopy in identifying and localizing the sites of small intestinal bleeding.RESULTS: Double-balloon enteroscopy was performed in all 56 patients in a 30-mo period. A possible site of blood loss was identified in 54 (96%) patients. Enteroscopy provided accurate localization of the bleeding in 53 (95%) of 56 patients, but failed to disclose the cause of bleeding in 4 (7%). There was one case with negative intraoperative finding (2%). Resection of the affected bowel was carried out except one patient who experienced rebleeding after operation. Gastrointestinal stromal tumor (GIST) was most frequently diagnosed (55%).CONCLUSION: Double-balloon enteroscopy is a safe, reliable modality for determining bleeding lesion of small intestine. This technique can be used to direct selective surgical intervention.

  11. Double Balloon Cervical Ripening Catheter for Control of Massive Hemorrhage in a Cervical Ectopic Pregnancy (United States)

    Zambrano, Nabila; Reilly, James; Moretti, Michael


    Cervical pregnancy can be complicated by perfuse vaginal bleeding. Mechanical compression directed at tamponing the cervical vessels can control hemostasis. There are several types of balloon catheters that have been described for cervical compression. However use of a double balloon catheter is a novel approach for cervical tamponade, as one balloon is positioned below the external cervical os and the second balloon is situated above in the internal cervical os. This compresses the cervix from internal os to external os between the two balloons, forming a “cervical sandwich.” We describe this method of cervical tamponade using a silicone double balloon cervical ripening catheter that rapidly controlled hemorrhage in a patient that failed conservative management with methotrexate. PMID:28261511

  12. Non-small-bowel lesions encountered during double-balloon enteroscopy performed for obscure gastrointestinal bleeding

    Institute of Scientific and Technical Information of China (English)

    Hoi-Poh; Tee; Arthur; J; Kaffes


    AIM:To report the incidence of non-small-bowel bleeding pathologies encountered during double-balloon enteroscopy (DBE) procedures and to analyse their significance.METHODS: A retrospective study of a prospective DBE database conducted in a tertiary-referral center was conducted. A total of 179 patients with obscure gastrointestinal bleeding (OGIB) referred for DBE from June 2004 to November 2008 were analysed looking for the incidence of non-small-bowel lesions (NSBLs; all and newly diagnosed) encountered ...

  13. Examining the whole bowel, double balloon enteroscopy:Indications, diagnostic yield and complications

    Institute of Scientific and Technical Information of China (English)

    Fatih Saygili; Saba Mukaddes Saygili; Erkin Oztas


    Double balloon enteroscopy (DBE) is an advanced typeof endoscopic procedure which brings the advantage ofreaching the whole small bowel using anterograde orthe retrograde route. This procedure is both diagnosticand interventional for a variety of small intestinaldiseases, such as vascular lesions, tumors, polypsand involvement of inflammatory bowel diseases.Main indication is the diagnosis and treatment ofmid-gastrointestinal bleeding according to the recentpublished data all over the world. The complicationrates seem to be higher than conventional proceduresbut growing experience is lowering them and improvingthe procedure to be safe and well tolerated. Thisreview is about the technique, indications, diagnosticimportance and complications of DBE according to theliterature growing since 2001.

  14. The value of double balloon enteroscopy in diagnosing blue rubber bleb naevus syndrome: a case report.

    LENUS (Irish Health Repository)

    O'Kelly, Fardod


    Blue rubber bleb naevus syndrome is a rare vascular disorder associated with multiple gastrointestinal haemangiomas that have the potential for life-threatening haemorrhage. These may be difficult to diagnose, and have classically been described using computed tomographic studies and\\/or mesenteric angiography. Resected surgical specimens of these lesions, especially in the small bowel, have often been extensive and poorly localized. The recent advent and progressive development of double balloon enteroscopy has allowed the direct visualization and marking of these enteric lesions and serves as a valuable adjunct not only in diagnosis but also planning prior to surgery to allow accurate estimate of the extent of resection.

  15. Duplication cyst of the small intestine found by double-balloon endoscopy: A case report

    Institute of Scientific and Technical Information of China (English)

    Haruei Ogino; Kazuhiko Nakamura; Toshiaki Ochiai; Norimoto Nakamura; Daisuke Yoshimura; Teppei Kabemura; Tetsuya Kusumoto; Hiroshi Matsuura; Akihiko Nakashima; Kuniomi Honda


    A 35-year-old man was admitted due to bloody stool and anemia.The bleeding source could not be detected by esophagogastroduodenoscopy or colonoscopy.Double balloon endoscopy (DBE)revealed a diverticulum-like hole in which coagula stuck in the ileum at 1 meter on the oral side from the ileocecal valve.The adjacent mucosa just to the oral side of the hole was elevated like a submucosal tumor.The lesion was considered the source of bleeding and removed surgically.It was determined to be a cyst with an ileal structure on the mesenteric aspect accompanying gastric mucosa.The diagnosis was a duplication cyst of the ileum,which is a rare entity that can cause gastrointestinal bleeding.In the present case,DBE was used to find the hemorrhagic duplication cyst in the ileum.

  16. Double-Balloon Enteroscopy following Capsule Endoscopy in the Management of Obscure Gastrointestinal Bleeding: Outcome of a Combined Approach

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    Patarapong Kamalaporn


    Full Text Available BACKGROUND: There is no consensus on the relative accuracy of capsule endoscopy (CE versus double-balloon enteroscopy (DBE to investigate obscure gastrointestinal bleeding (GIB. CE is less invasive, but DBE more directly examines the small bowel, and allows tissue sampling plus therapeutic intervention.

  17. Coordination and nursing care of pediatric patients undergoing double balloon enteroscopy

    Institute of Scientific and Technical Information of China (English)

    Jie Wu; Cui-Fang Zheng; Ying Huang; Cai-Hong Shao; Ying-Kit Leung


    AIM: To review safety, efficacy, and proper nursing care of double-balloon enteroscopy (DBE) in pediatric patients with small intestinal disease. METHODS: Our study included 37 patients with abdominal pain, diarrhea, passage of blood in the stools, and other symptoms, who underwent DBE from December 2006 to July 2010. DBE was retrograde in 36 procedures, antegrade in six, and from both ends in five. The diagnostic significance and salient points in nursing care are discussed in this article. RESULTS: At least one lesion was discovered in 28 out of 37 patients, which yielded a positive diagnosis in 75.7% of cases. Good bowel preparation and skilled nursing care not only shortened the procedure time, but could also alleviate patient discomfort and enhance the quality of examination. No serious procedure-related complications were observed in any cases. CONCLUSION: DBE is a new modality of endoscopic procedure that improves the standard of diagnosis and treatment of small bowel diseases in children. Good nursing care is essential to the successful execution of the procedure.

  18. Usefulness of Double-Balloon Endoscopy in the Postoperative Gastrointestinal Tract

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    Masaki Endo


    Full Text Available Background. The small intestine has been considered to be a highly difficult organ to visualize in imaging examinations due to its anatomical location compared with the stomach and the colon. In recent years, many imaging modalities have become available, such as CT enterography, MR enterography, capsule endoscopy (CE, and double-balloon endoscopy (DBE. Patients and Methods. DBE was performed in the postoperative intestines of 91 patients (128 DBE examinations at Iwate Medical University between 2004 and 2010. There were 61 male and 30 female patients, and their mean age was 69.7 years (range: 30–80 years. Results. A total of 124 DBE examinations were performed with endoscope insertion into the reconstructed intestines. The endoscope reached the blind end in 115 of 124 examinations, (92.7%. There were 17 patients with obscure gastrointestinal bleeding in whom 30 DBE examinations were performed. The bleeding site was identified in 12 patients (70.6%. Nine patients underwent endoscopic treatment. Hemostasis was achieved in all patients. Conclusion. DBE is very useful modality for the assessment and application of endotherapy to areas of the small bowel which have been altered by surgery.

  19. Acute pancreatitis associated with peroral double-balloon enteroscopy: A case report

    Institute of Scientific and Technical Information of China (English)

    Kuniomi Honda; Ken Kawabe; Yoshiyuki Arita; Tetsuhide Ito; Takahiro Mizutani; Kazuhiko Nakamura; Naomi Higuchi; Kenji Kanayama; Yorinobu Sumida; Shigetaka Yoshinaga; Soichi Itaba; Hirotada Akiho


    A 58-year-old Japanese man had tarry stool and severe anemia. Neither upper nor lower gastrointestinal (GI) endoscopy showed any localized lesions. Thus, the source of his GI bleeding was suspected to be in the small intestine, and he underwent peroral double-balloon enteroscopy (DBE) using EN-450T5 (Fujinon-Toshiba ES System Co., Tokyo, Japan). There were no lesions considered to be the source of GI bleeding. After the procedure, the patient began to experience abdominal pain. Laboratory tests revealed hyperamylasemia and abdominal computed tomography revealed an inflammation of the pancreas and the peripancreas. He was thus diagnosed to have acute pancreatitis. Conservative treatments resulted in both clinical and laboratory amelioration. He had no history of alcohol ingestion, gallstone disease or pancreatitis. Magnetic resonance cholangiopancreatography demonstrated no structural alterations and no stones in the pancreatobiliary ductal system. As his abdominal pain started after the procedure, his acute pancreatitis was thus thought to have been related to the peroral DBE. This is the first reported case of acute pancreatitis probably associated with peroral DBE.

  20. Percutaneous management of acutely thrombosed hemodialysis grafts: the double balloon occlusion technique. (United States)

    Lai, Chi-Cheng; Kang, Pei-Leun; Tsai, Han-Lin; Mar, Guang-Yuan; Liu, Chun-Peng


    The aim of this article is to introduce a new technique, named the "double balloon occlusion technique" (DBOT), for the salvage of acutely thrombosed grafts and to demonstrate its safety and efficacy. Acute thrombosis is recognized as the most common factor of acute graft failures. A suitably percutaneous technique should be devised to remove thrombi safely and effectively. Care should also be taken to prevent possible thromboembolic complications during procedures. Mainly composed of two balloons, the percutaneous DBOT has been developed to meet the clinical needs. Thirty-two patients with graft failures undergoing the DBOT were recruited between May 2007 and May 2008. The DBOT is itemized in the text and a practical case undergoing successful DBOT is also demonstrated. Of the 32 DBOT treatments, the procedural success rate was 100% (32/32). The clinical success rate was 94% (30/32). One complicated case with severe hematoma resulting from a balloon-induced graft rupture received surgery, although the graft outflow restored. The mean procedure time was 92 minutes. Three patients died and two patients were lost within the 3-month follow-up. The 3-month graft patency rate was 70% (19/27). The DBOT has the potential to be operated safely and effectively. Preliminary results had high success rates and patency rates. With basic devices, it may serve as an option to rescue thrombosed grafts. More data are needed to identify its clinical role. (c) 2008 Wiley-Liss, Inc.

  1. Ileal polypoid lymphangiectasia bleeding diagnosed and treated by double balloon enteroscopy. (United States)

    Park, Min Seon; Lee, Beom Jae; Gu, Dae Hoe; Pyo, Jeung-Hui; Kim, Kyeong Jin; Lee, Yun Ho; Joo, Moon Kyung; Park, Jong-Jae; Kim, Jae Seon; Bak, Young-Tae


    Intestinal lymphangiectasia is a rare disease characterized by focal or diffuse dilated enteric lymphatics with impaired lymph drainage. It causes protein-losing enteropathy and may lead to gastrointestinal bleeding. Commonly, lymphangiectasia presents as whitish spots or specks. To our knowledge, small bowel bleeding resulting from polypoid intestinal lymphangiectasia has not been reported. Here, we report a rare case of active bleeding from the small bowel caused by polypoid lymphangiectasia with a review of the relevant literature. An 80-year-old woman was hospitalized for melena. Esophagogastroduodenoscopy could not identify the source of bleeding. Subsequent colonoscopy showed fresh bloody material gushing from the small bowel. An abdominal-pelvic contrast-enhanced computed tomography scan did not reveal any abnormal findings. Video capsule endoscopy showed evidence of active and recent bleeding in the ileum. To localize the bleeding site, we performed double balloon enteroscopy by the anal approach. A small, bleeding, polypoid lesion was found in the distal ileum and was successfully removed using endoscopic snare electrocautery.

  2. Endoscopic ultrasound with double-balloon endoscopy for the diagnosis of inverted Meckel’s diverticulum: a case report

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    Araki Akihiro


    Full Text Available Abstract Introduction Inverted Meckel’s diverticulum has usually been misdiagnosed in the cases based on computed tomography images presented in the literature. The final diagnosis was made intra-operatively or by pathology reports after surgery. Despite this, preoperative diagnosis could be made successfully by using endoscopic ultrasound with double-balloon endoscopy prior to surgery. Case presentation A 60-year-old Japanese woman with severe anemia complained of several episodes of black stool over the preceding 2 years. Abdominal computed tomography showed a 3.0-cm low-density tumor in the ileum, suggesting a diagnosis of intestinal lipoma. Examination of the tumor by endoscopic ultrasound with double-balloon endoscopy revealed a hypo-echoic layer corresponding to the muscularis propria, and a hyper-echoic layer corresponding to the fat tissue. These findings, which suggested that the tumor included areas outside the intestinal serosa, are not typical for a lipoma, despite the existence of a hyper-echoic layer corresponding to fatty tissue. We then considered a diagnosis of inverted Meckel’s diverticulum. Conclusion Lipoma and inverted Meckel’s diverticulum are difficult to differentially diagnose by computed tomography. Polypectomy is the preferred therapeutic approach when a lipoma is present; however, polypectomy in a patient with Meckel’s diverticulum requires full-thickness resection. Situations where polypectomy is performed without preparing for full-thickness resection can be avoided by first making a precise diagnosis using double-balloon endoscopy and endoscopic ultrasound.

  3. Double balloon endoscopy associated pancreatitis:A description of six cases

    Institute of Scientific and Technical Information of China (English)

    Soeresh VA Jarbandhan; Stijn JB van Weyenberg; Willem M van der Veer; Dimitri GN Heine; Chris JJ Mulder; Maarten AJM Jacobs


    AIM:To perform a single-center analysis of all double balloon endoscopy (DBE) related cases of pancreatitis identified prospectively from a recorded DBE-complication database.METHODS:From November 2003 until January 2007,603 DBE procedures were performed on 412 patients,with data on complications recorded in a database.The setting was a tertiary care center offering DBE.DBE was performed from the antegrade or retrograde route.Out come measurements included age,gender,medication,indication,DBE-endoscope type,insertion depth,proce dure duration,findings,interventions,post-procedural abdominal pain,and post-procedural hospitalization.RESULTS:This is the largest single-center study report ing on post-DBE pancreatitis prospectively.Six patients (1.0%) developed post-DBE pancreatitis,all after antegrade DBE.There was no association with gender,duration of the procedure or type of endoscope.The mean age was 51.9 years (range 25-78).Four patients had severe pancreatitis.Of these,two had inflammatory signs in the body-tail region,one had pancreatitis in the tail region,and the total pancreas was involved in one.CONCLUSION:The incidence of post-DBE pancreatitis in our series is higher than previously reported.We found no relation with DBE-endoscope type.The inflammatory changes occurred in the body-tail region of the pancreas,suggesting that post-DBE pancreatitis is caused by repetitive mechanical strain on the pancreas.

  4. Double-balloon enteroscopy: Indications, approaches, diagnostic and therapeutic yield, and safety. Early experience at a single center. (United States)

    García-Correa, J J E; Ramírez-García, J J; García-Contreras, L F; Fuentes-Orozco, C; Irusteta-Jiménez, L; Michel-Espinoza, L R; Carballo Uribe, A S; Torres Chávez, J A; González-Ojeda, A


    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 yield, and complications. All patients referred to our unit with suspected small bowel pathology were included. The insertion route (oral/anal) was determined through diagnostic suspicion. The variables measured were: insertion route, small bowel examination extent, endoscopic diagnosis/treatment, biopsy/histopathology report, complications, and surgical findings. The study included 28 double-balloon enteroscopies performed on 23 patients, of which 10 were women and 13 were men (mean age of 52.95 years). The oral approach was the most widely used (n=21), the main indication was overt small bowel bleeding (n=16), and the general diagnostic yield was 65.21%. The therapeutic intervention rate was 39.1% and the procedure was effective in all the cases. The most widely used treatment was argon plasma therapy (n=7). The complication rate was 8.6%; one patient presented with low blood pressure due to active bleeding and another had deep mucosal laceration caused by the argon plasma. Double-balloon enteroscopy is a safe and efficacious method for the study and management of small bowel diseases, with an elevated diagnostic and therapeutic yield. Copyright © 2017 Asociación Mexicana de Gastroenterología. Publicado por Masson Doyma México S.A. All rights reserved.

  5. Hemosuccus Pancreaticus in the Era of Capsule Endoscopy and Double Balloon Enteroscopy Complicated by Multifocal Mycobacterium chelonae/abscessus Infection

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    Shabana F. Pasha


    Full Text Available Hemosuccus pancreaticus is a rare etiology of obscure gastrointestinal bleeding characterized by bleeding into the pancreatic duct. The diagnosis may be delayed for months to years, due to the episodic nature of bleeding and failure to consider the diagnosis. Patients often undergo multiple endoscopies and radiologic evaluations prior to diagnosis. Incidental gastrointestinal findings may lead to unnecessary endoscopic and surgical interventions. This report describes a patient with hemosuccus pancreaticus diagnosed in the era of video capsule endoscopy and double balloon enteroscopy, whose management was complicated by multifocal Mycobacteria chelonae/abscessus infection.

  6. The use of double-balloon enteroscopy in retrieving mucosal biopsies from the entire human gastrointestinal tract

    DEFF Research Database (Denmark)

    Rhee, Nicolai Alexander; Vilmann, Peter; Hassan, Hazem


    OBJECTIVE: The aim of this explorative study was to evaluate double-balloon enteroscopy (DBE) as a new tool for collecting mucosal biopsies from well-defined parts of the entire small and large bowel in patients with type 2 diabetes and in matched healthy subjects. MATERIAL AND METHODS: Twelve su...... possibility to access hitherto unexplored human anatomy and physiology....... subjects with type 2 diabetes and 12 body mass index and age-matched healthy subjects underwent anterograde and retrograde DBE under nurse-administered propofol sedation on two separate days. We attempted to collect two mucosal biopsies from every 30 cm from pylorus to rectum. RESULTS: A mean of 21 biopsy...

  7. A Case of Blind Loop Syndrome Caused by Infection with Giardia duodenalis Diagnosed with Double Balloon Enteroscopy. (United States)

    Nakagawa, Tomoo; Katsuno, Tatsuro; Mandai, Yasushi; Saito, Masaya; Yoshihama, Sayuri; Saito, Keiko; Minemura, Shoko; Maruoka, Daisuke; Matsumura, Tomoaki; Arai, Makoto; Yokosuka, Osamu


    A 75-year-old man who had undergone partial gastrectomy was referred to our hospital due to worsening leg edema, loose stools and malnutrition. Double balloon enteroscopy followed by insertion of an indwelling ileus tube was performed to investigate the microbial flora and for washing inside the blind loop. Trophozoites of Giardia were detected in the sampled fluid from the blind loop and DNA analysis disclosed an assemblage of genotype A-II of Giardia duodenalis. Treatment with oral metronidazole was effective. This case emphasizes the importance of a correct diagnosis when treating patients with blind loop syndrome in the digestive tract.

  8. A Case of Blind Loop Syndrome Caused by Infection with Giardia duodenalis Diagnosed with Double Balloon Enteroscopy

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    Tomoo Nakagawa


    Full Text Available A 75-year-old man who had undergone partial gastrectomy was referred to our hospital due to worsening leg edema, loose stools and malnutrition. Double balloon enteroscopy followed by insertion of an indwelling ileus tube was performed to investigate the microbial flora and for washing inside the blind loop. Trophozoites of Giardia were detected in the sampled fluid from the blind loop and DNA analysis disclosed an assemblage of genotype A-II of Giardia duodenalis. Treatment with oral metronidazole was effective. This case emphasizes the importance of a correct diagnosis when treating patients with blind loop syndrome in the digestive tract.

  9. Effect of double-balloon enteroscopy on pancreas: An experimental porcine model

    Institute of Scientific and Technical Information of China (English)

    Rafael Latorre; Federico Soria; Octavio López-Albors; Ricardo Sarriá; Francisco Sánchez-Margallo; Pilar Esteban; Fernando Carballo; Enrique Pérez-Cuadrado


    AIM:To evaluate the effect of double-balloon enteroscopy (DBE) on pancreas histology and levels of pancreatic enzymes.METHODS:Conventional upper gastrointestinal endoscopy was performed on five control pigs.Oral DBE was performed with an EN-450T5 enteroscope on 20 pigs.Two experimental groups (10 pigs each) were defined according to DBE duration:90 min for Group 1 and 140 min for Group 2.During oral insertion,the balloons were not inflated in the descending part of the duodenum to avoid the minor duodenal papilla.Serum amylase,lipase and C-reactive protein (CRP) levels were monitored before the procedure and repeated every 30 min until the exploration was finished,as well as 24 h and 7 d after.After the procedure and for a total of 7 d,the pigs were observed twice a day for signs of decreased activity,irritability,vomiting or anorexia.Gross and microscopic examination of the pancreas was performed on day 7.RESULTS:All animals tolerated DBE without clinical manifestations of acute pancreatitis.Experimental groups had higher levels of enzymes than the control group at 24 h.Throughout the exploration,the amylase levels increased significantly above the baseline 24 h after DBE,although the increase was not statistically significant and did not reach 20% of the baseline.An increase in lipase and CRP was observed at 24 h after the procedure,although by day 7,all enzymatic levels had returned to baseline.No differences between Groups 1 and 2 were found for any enzyme and sampiing site during and after the procedure.Similarly,no correlation between insertion depth and enzyme levels was observed.Direct in situ and post-removal inspection of the pancreas did not show any evidence of fluid collection,abscesses or hemorrhage.Histological examination of the pancreas from Groups 1 and 2 revealed the existence of focal areas (0.14-0.26 mm2) of ischemic necrosis in 47.4% of the animals.In the pigs with damaged pancreas,the left lobe (tail) was always affected.However,this only

  10. Partial stent-in-stent placement of biliary metallic stents using a short double-balloon enteroscopy

    Institute of Scientific and Technical Information of China (English)

    Koichiro Tsutsumi; Hironari Kato; Takeshi Tomoda; Kazuyuki Matsumoto; Ichiro Sakakihara; Naoki Yamamoto; Yasuhiro Noma


    Endoscopic intervention is less invasive than percutaneous or surgical approaches and should be considered the primary drainage procedure in most cases with obstructive jaundice.Recently,therapeutic endoscopic retrograde cholangiopancreatography (ERCP) using double-balloon enteroscopy (DBE) has been shown to be feasible and effective,even in patients with surgically altered anatomies.On the other hand,endoscopic partial stent-in-stent (PSIS) placement of selfexpandable metallic stents (SEMSs) for malignant hilar biliary obstruction in conventional ERCP has also been shown to be feasible,safe and effective.We performed PSIS placement of SEMSs for malignant hilar biliary obstruction due to liver metastasis using a short DBE in a patient with Roux-en-Y anastomosis and achieved technical and clinical success.This procedure can result in quick relief from obstructive jaundice in a single session and with short-term hospitalization,even in patients with surgically altered anatomies.

  11. Diagnosis agreement between capsule endoscopy and double-balloon enteroscopy in obscure gastrointestinal bleeding at a referral center

    Directory of Open Access Journals (Sweden)

    Enrique Pérez-Cuadrado-Robles


    Full Text Available Background and aim: Capsule endoscopy and double-balloon enteroscopy are well-recognized procedures in obscure gastrointestinal bleeding, with many factors that may influence their diagnosis yield. The aim of the present study was to characterize the degree of agreement between both techniques with focus on the type of lesion in a large cohort of patients at a referral center. Material and method: One thousand two hundred and nine capsules were administered in 1,078 patients and 381 enteroscopies were performed in 361 patients with obscure-gastrointestinal bleeding from 2004 to 2014. Results: Both procedures were carried out in 332 patients (mean age: 65.22 ± 15.41, 183 men and they have a similar diagnosis yield (70.5% vs. 69.6%, p = 0.9. Overall enteroscopy diagnosis yield was higher within patients with a previous positive capsule endoscopy (79.3% vs. 27.9%, p < 0.001. The degree of agreement was very good for polyps (0.89 [95% CI: 0.78-0.99], good for vascular lesions (0.66 [95% CI: 0.55-0.77] and tumors (0.66 [95% CI: 0.55-0.76] and moderate for ulcers (0.56 [95% CI: 0.46-0.67]. Diverticula (0.39 [95% CI: 0.29-0.5] achieved a fair agreement. The results of CE and DBE differed in 73 patients (22%. Conclusions: The present study confirms that although overall diagnostic yield by capsule endoscopy and double-balloon enteroscopy is similar, there are many factors which can modify these values, mainly the type of lesion.

  12. A pedunculated polyp-shaped small-bowel lymphangioma causing gastrointestinal bleeding and treated by double-balloon enteroscopy

    Institute of Scientific and Technical Information of China (English)

    Akihiko Kida; Koichiro Matsuda; Satoshi Hirai; Akiyoshi Shimatani; Yousuke Horita; Katsushi Hiramatsu; Mitsuru Matsuda


    We report a rare case of a small-bowel lymphangioma causing massive gastrointestinal (GI) bleeding that we successfully diagnosed and treated using double-balloon enteroscopy (DBE).An 81-year-old woman suffering from repeated GI bleeding of unknown origin underwent a capsule endoscopy at a previous hospital.She was suspected of having bleeding from the jejunum,and was referred to our department for diagnosis and treatment.An oral DBE revealed a 20 mmx 10 mm,regularly surfaced,white to yellowish,elongated,pedunculated jejunal polyp with small erosions at 10 cm distal to the ligament of Treiz.Since no other source of bleeding was identified by endoscopy in the deep jejunum,an endoscopic polypectomy (EP) was performed for this lesion.A subsequent histopathological examination of the resected polyp showed clusters of lymphatic vessels with marked cystic dilatation in the submucosa and the deep layer of the lamina propria mucosae.These characteristics are consistent with the typical features of small-bowel lymphangioma with erosions.Although clipping hemostasis was performed during EP,re-bleeding occurred.Finally,a complete hemostasis was achieved by performing an additional argon plasma coagulation.

  13. Multidetector CT Enterography versus Double-Balloon Enteroscopy: Comparison of the Diagnostic Value for Patients with Suspected Small Bowel Diseases

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    Jingjing Wang


    Full Text Available Aim. To compare the diagnostic value of multidetector CT enterography (MDCTE and double-balloon enteroscopy (DBE for patients with suspected small bowel diseases. Methods. From January 2009 to January 2014, 190 patients with suspected small bowel diseases were examined with MDCTE and DBE. The characteristics of the patients, detection rates, diagnostic yields, sensitivity, specificity, positive predictive value, and negative predictive value were described and analyzed. Results. The overall detection rates of DBE and MDCTE were 92.6% and 55.8%, respectively (P<0.05, while the overall diagnostic yields were 83.2% and 33.7%, respectively (P<0.05. The sensitivity, specificity, positive predictive value, and negative predictive value of DBE were all higher than those of MDCTE. DBE had a higher diagnostic yield for OGIB (87.3% versus 20.9%, P<0.05. The diagnostic yields of DBE were higher than those of MDCTE for inflammatory diseases, angioma/angiodysplasia, and diverticulums, while being not for gastrointestinal tumors/polyps. Conclusions. The diagnostic value of DBE for small bowel diseases is better than that of MDCTE as a whole, but if gastrointestinal tumors are suspected, MDCTE is also needed to gain a comprehensive and accurate diagnosis.

  14. A Retrospective Evaluation of the Utility of Capsule Endoscopy and Double-Balloon Endoscopy in Crohn’s Disease

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    Masanao Nakamura


    Full Text Available Background. Although the usefulness of capsule endoscopy (CE and double-balloon endoscopy (DBE for the evaluation of Crohn’s disease (CD is established, their capabilities in the differential diagnosis of small bowel stenosis have not been sufficiently addressed. The present study therefore aimed to retrospectively determine the types of patients for whom CE and DBE would confer the most benefit. Patients and Methods. We retrospectively reviewed data from 185 patients with established CD. A change of treatment based on CE or DBE results or successful DBE balloon dilation was defined as clinically useful indication. We then analyzed the factors significantly related to useful and poor indications. Results. CE results were assessed as useful indications in 28 (45% of 62 patients. Multivariate analysis demonstrated that positive CRP and low IOIBD score are factors significantly related to a useful indication. DBE results were recognized as useful indications in 118 (77% of 153 patients. Multivariate analysis indicated small bowel stenosis and abdominal pain as factors significantly associated with useful indications. All patients with a poor indication on CE had small bowel stenosis. Conclusions. CE was most useful for patients in clinical remission with positive CRP and without stenosis, whereas DBE was useful for patients with symptoms of stenosis.

  15. A case of a ruptured submucosal aneurysm of the small intestine identified using double-balloon enteroscopy. (United States)

    Chiba, Hirofumi; Endo, Katsuya; Fujishima, Fumiyoshi; Ohtsuka, Hideo; Naitoh, Takeshi; Kuroha, Masatake; Kimura, Tomoya; Shiga, Hisashi; Kakuta, Yoichi; Kinouchi, Yoshitaka; Unno, Michiaki; Shimosegawa, Tooru


    A 47-year-old woman was admitted to our hospital urgently with sudden-onset hematochezia. She was temporarily in a state of hemorrhagic shock. As we strongly suspected bleeding from the small intestine, peroral double-balloon enteroscopy was performed, and indicated a 2.0-cm diameter hemispheric elevated lesion in the jejunum. Moreover, a blood clot was observed at the top of the protrusion. The site was marked by injecting India ink, without taking a biopsy specimen, to avoid further hemorrhaging. Subsequently, laparoscopic partial small bowel resection was performed. On histopathological examination, the lesion was found to be a sac-like submucosal arterial aneurysm, with a diameter of 3.5 mm, comprising several small abnormal arteries. The final diagnosis was a ruptured submucosal aneurysm of the small intestine. Ruptured submucosal aneurysms are very rarely observed in the small intestine. Only a few reports have described their endoscopic findings. Our experience indicates that small bowel enteroscopy may be useful for managing ruptured submucosal aneurysms of the small intestine.

  16. Complimentary Imaging Modalities for Investigating Obscure Gastrointestinal Bleeding: Capsule Endoscopy, Double-Balloon Enteroscopy, and Computed Tomographic Enterography

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    Ye Chu


    Full Text Available Objectives. The complimentary value of computed tomographic enterography (CTE and double-balloon enteroscopy (DBE combined with capsule endoscopy (CE was evaluated in the diagnosis of obscure gastrointestinal bleeding (OGIB. Methods. Patients who received CE examinations at Ruijin Hospital between July 2007 and July 2014 with the indication of OGIB were identified, and those who also underwent DBE and/or CTE were included. Their clinical information was retrieved, and results from each test were compared with findings from the other two examinations. Results. The overall diagnostic yield of CE was comparable with DBE (73.9% versus 60.9% but was significantly higher than the yield of CTE (87% versus 25%, p<0.001. The diagnostic yield of angiodysplasia at CE was significantly higher than CTE (73% versus 8%, p<0.001 and DBE (39.1% versus 17.4%, p=0.013, while no significant difference was found between the three approaches for small bowel tumors. DBE and CTE identified small bowel diseases undetected or undetermined by CE. Conversely, CE improved diagnosis in the cases with negative CTE and DBE, and findings at initial CE directed further diagnosis made by DBE. Conclusions. Combination of the three diagnostic platforms provides complementary value in the diagnosis of OGIB.

  17. Thromboembolic events associated with single balloon-, double balloon-, and stent-assisted coil embolization of asymptomatic unruptured cerebral aneurysms: evaluation with diffusion-weighted MR imaging

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    Takigawa, Tomoji; Suzuki, Kensuke; Sugiura, Yoshiki; Suzuki, Ryotaro; Takano, Issei; Shimizu, Nobuyuki; Tanaka, Yoshihiro; Hyodo, Akio [Dokkyo Medical University Koshigaya Hospital, Department of Neurosurgery, Koshigaya, Saitama (Japan)


    The introduction of the balloon remodeling and stent-assisted technique has revolutionized the approach to coil embolization for wide-neck aneurysms. The purpose of this study was to determine the frequency of thromboembolic events associated with single balloon-assisted, double balloon-assisted, and stent-assisted coil embolization for asymptomatic unruptured aneurysms. A retrospective review was undertaken by 119 patients undergoing coiling with an adjunctive technique for unruptured saccular aneurysms (64 single balloon, 12 double balloon, 43 stent assisted). All underwent diffusion-weighted imaging (DWI) within 24 h after the procedure. DWI showed hyperintense lesions in 48 (40 %) patients, and ten (21 %) of these patients incurred neurological deterioration (permanent, two; transient, eight). Hyperintense lesions were detected significantly more often in procedures with the double balloon-assisted technique (7/12, 58 %) than with the single balloon-assisted technique (16/64, 25 %, p = 0.05). Occurrence of new lesions was significantly higher with the use of stent-assisted technique (25/43, 58 %) than with the single balloon-assisted technique (p = 0.001). Symptomatic ischemic rates were similar between the three groups. The increased number of microcatheters was significantly related to the DWI abnormalities (two microcatheters, 15/63 (23.8 %); three microcatheters, 20/41 (48.8 %) (p = 0.008); four microcatheters, 12/15 (80 %) (p = 0.001)). Thromboembolic events detected on DWI related to coil embolization for unruptured aneurysms are relatively common, especially in association with the double balloon-assisted and stent-assisted techniques. Furthermore, the number of microcatheters is highly correlated with DWI abnormalities. The high rate of thromboembolic events suggests the need for evaluation of platelet reactivity and the addition or change of antiplatelet agents. (orig.)

  18. Double-balloon catheter and sequential vaginal prostaglandin E2 versus vaginal prostaglandin E2 alone for induction of labor after previous cesarean section. (United States)

    Kehl, Sven; Weiss, Christel; Wamsler, Michael; Beyer, Jana; Dammer, Ulf; Heimrich, Jutta; Faschingbauer, Florian; Sütterlin, Marc; Beckmann, Matthias W; Schleussner, Ekkehard


    To evaluate the efficacy of inducing labor using a double-balloon catheter and vaginal prostaglandin E2 (PGE2) sequentially, in comparison with vaginal PGE2 alone after previous cesarean section. A total of 264 pregnant women with previous cesarean section undergoing labor induction at term were included in this prospective multicentre cohort study. Induction of labor was performed either by vaginal PGE2 gel or double-balloon catheter followed by vaginal PGE2. The primary outcome measure was the cesarean section rate. The cesarean section rate was 37 % without any statistically significant difference between the two groups (PGE2: n = 41, 37 % vs. balloon catheter/PGE2: n = 41, 42 %; P = 0.438). The median (range) number of applications of PGE2 [2 (1-10) versus 1 (0-8), P cesarean section were "no previous vaginal delivery" (OR 5.391; CI 2.671-10.882) and "no oxytocin augmentation during childbirth" (OR 2.119; CI 1.215-3.695). The sequential application of double-balloon catheter and vaginal PGE2 is as effective as the sole use of vaginal PGE2 with less applications and total amount of PGE2.

  19. [Double-balloon enteroscopy: experience in the Hospital de Especialidades del Centro Médico Nacional Siglo XXI IMSS, Mexico City]. (United States)

    Blancas Valencia, Juan Manuel; Paz Flores, Víctor Manuel; Yokota, Alejo Miyamoto; Huerta Fosado, Blanca Rosa; Meneses, Luis Fernando; Piccini Larco, Julio Roberto; Mejía Cuan, Luis Alvaro


    The methods used for the study of the small bowel are not ideal. Double-balloon enteroscopy is a new alternative with therapeutic potential. Evaluate the utility, efficacy and safety of double-balloon enteroscopy in Mexico. Adult patients seen in the Hospital de Especialidades Centro Médico Nacional Siglo XXI, Mexico City who were being studied for: chronic diarrhea, obscure gastrointestinal hemorrhage, weight-loss and chronic anemia were included in the study. Anterograde (oral) and retrograde (anal) approaches were used and study time, findings and complications were evaluated. Thirty-one enteroscopies were performed, 15 were anterograde, 8 retrograde and 8 were performed via both routes, in 23 patients studied between February and October, 2004; 10 of them were women and 13 men with ages ranging from 25 to 80 years. Fourteen patients were sedated and 9 patients were anesthetized. Study time varied form 55 to 90 minutes. With the anterograde route the ileum was reached in 56.6% of cases, 39.1% the jejunum and only in one patient (4.3%) the whole intestine was explored. With the retrograde route in 62.5% of cases the jejunum was explored and 37.5% the ileum. Four patients with obscure gastrointestinal bleeding and 1 patient with chronic anemia had vascular ecstasies, and in 40% of patients there was no identifiable cause. In 2 patients with intestinal stenosis biopsies revealed intestinal lymphoma in one and ischemic injury in another one. The adverse effects were mild and transitoru. Double-balloon enteroscopy is a safe diagnostic and therapeutic method that is useful in cases of obscure hemorrhage, chronic anemia; small bowel pathology was found in 64.7% of cases.

  20. Double-balloon catheter for induction of labour in women with a previous cesarean section, could it be the best choice? (United States)

    De Bonrostro Torralba, Carlos; Tejero Cabrejas, Eva Lucía; Marti Gamboa, Sabina; Lapresta Moros, María; Campillos Maza, Jose Manuel; Castán Mateo, Sergio


    We analysed the efficacy and safety of double-balloon catheter for cervical ripening in women with a previous cesarean section and which were the most important variables associated with an increased risk of repeated cesarean delivery. We designed an observational retrospective study of 418 women with unfavourable cervices (Bishop Score cesarean delivery, and induction of labour with a double-balloon catheter. Baseline maternal data and perinatal outcomes were recorded for a descriptive, bivariate, and multivariate analysis. A p value cesarean section were dystocia in the previous pregnancy (OR 1.744; CI 95% 1.066-2.846), the absence of previous vaginal delivery (OR 2.590; CI 95% 1.066-6.290), suspected fetal macrosomia (OR 2.410; CI 95% 0.959-6.054), and duration of oxytocin induction period (OR 1.005; CI 95% 1.004-1.006). The area under the curve was 0.789 (p cesarean delivery and unfavourable cervix. In our study, most women could have a vaginal delivery in spite of their risk factors for cesarean delivery. A multivariate model based on some clinical variables has moderate predictive value for intrapartum cesarean section.

  1. The role of capsule endoscopy combined with double-balloon enteroscopy in diagnosis of small bowel diseases

    Institute of Scientific and Technical Information of China (English)

    LI Xiao-bo; GE Zhi-zheng; DAI Jun; GAO Yun-jie; LIU Wen-zhong; HU Yun-biao; XIAO Shu-dong


    Background The diagnosis of small bowel diseases remains relatively inefficient using traditional imaging techniques.Capsule endoscopy (CE) and double-balloon enteroscopy (DBE) are two novel methods of enteroscopy for examining the entire small bowel. The aim of this study was to evaluate the detection rate and diagnostic accuracy of CE and DBE in patients with suspected small bowel diseases and to investigate the clinical significance of combined use of these two novel modalities.Methods Two hundred and eighteen patients were evaluated for suspected small bowel disease, including 116 with obscure gastrointestinal bleeding and 102 with obscure abdominal pain or chronic diarrhea. One hundred and sixty-five out of these patients underwent CE first and 53 patients underwent DBE (under anesthesia with propofol) first. DBE was recommended after negative or equivocal evaluation on CE and vise versa. Introduction of the endoscope during DBE was either orally or anally and the patients were referred for a second procedure using the opposite route several days later when no abnormalities were found on the first procedure. The detection rates, diagnostic accuracy, tolerance and frequency of adverse events of these two modalities were then analyzed.Results Failure of the procedure was seen in one patient with CE and in two patients with DBE. Sixty-four DBE procedures were carried out in 51 patients; by the oral route in 34 cases, the anal route in 4 and both routes in 13 cases.The overall detection rate of small bowel diseases using CE (72.0%, 118/164) was superior to that with DBE (41.2%,21/51); χ2=16.1218, P<0.0001. The diagnostic rate (51.8%, 85/164) was also higher than that with the latter procedure (39.2%, 20/51), but was not significantly different (χ2=2.4771, P>0.05). Furthermore, the detection rate of small bowel diseases in patients with obscure gastrointestinal bleeding using CE (88.0%, 88/100) was superior to that of DBE (60.0%,9/15); χ2=7.7457, P=0

  2. Pancreatic and Gastric Heterotopia with Associated Submucosal Lipoma Presenting as a 7-cm Obstructive Tumor of the Ileum: Resection with Double Balloon Enteroscopy

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    Kun Jiang


    Full Text Available Pancreatic and gastric heterotopias are rare clinical entities which have been identified throughout the entire length of the gastrointestinal tract. Combined gastric and pancreatic heterotopias, although unusual, have been described in the duodenum and jejunum, and in other structures, including Meckel's diverticulum and the ampulla of Vater. We report a novel case of pancreatic and gastric heterotopia with an associated submucosal lipoma in a 38-year-old female with a recent history of rectal cancer and chronic crampy abdominal pain. On computed tomography, a 7-cm luminal polypoid mass extending into the distal ileum was discovered. The mass was successfully resected using retrograde double balloon enteroscopy. We believe this is the first report of all three histological entities co-existing in an obstructive ileal lesion in an adult. It highlights endoscopic resection trough double enteroscopy as a safe alternative to more invasive surgical approaches for this type of lesion.

  3. A meta-analysis of the yield of capsule endoscopy compared to double-balloon enteroscopy in patients with small bowel diseases

    Institute of Scientific and Technical Information of China (English)


    AIM: To compare the diagnostic yield of capsule endoscopy(CE) with that of double-balloon enteroscopy (DBE).METHODS: Pubmed, Embase, Elsevier ScienceDirect,the China Academic Journals Full-text Database, and Cochrane Controlled Trials Register were searched for the trials comparing the yield of CE with that of DBE.Outcome measure was odds ratio (OR) of the yield. Fixed or random model method was used for data analysis.RESULTS: Eight studies (n = 277) which prospectively compared the yield of CE and DBE were collected. The results of meta-analysis indicated that there was no difference between the yield of CE and DBE [170/277 vs 156/277, OR 1.21 (95% CI: 0.64-2.29)]. Based on sub analysis, the yield of CE was significantly higher than that of double-balloon enteroscopy without combination of oral and anal insertion approaches [137/219 vs 110/219, OR 1.67 (95% CI: 1.14-2.44), P < 0.01), but not superior to the yield of DBE with combination of the two insertion approaches [26/48 vs 37/48, OR 0.33 (95% CI: 0.05-2.21), P > 0.05)]. A focused meta-analysis of the fully published articles concerning obscure GI bleeding was also performed and showed similar results wherein the yield of CE was significantly higher than that of DBE without combination of oral and anal insertion approaches [118/191 vs 96/191, fixed model: OR 1.61(95% CI: 1.07-2.43), P <0.05)] and the yield of CE was significantly lower than that of DBE by oral and anal combinatory approaches [11/24 vs 21/24, fixed model:OR 0.12 (95% CI: 0.03-0.52), P < 0.01)].CONCLUSION: With combination of oral and anal approaches, the yield of DBE might be at least as high as that of CE. Decisions made regarding the initial approach should depend on patient's physical status, technology availability, patient's preferences, and potential for therapeutic endoscopy.

  4. 245例双气囊电子小肠镜检查应用分析%Applied analysis of double-balloon enteroscopy in 245cases

    Institute of Scientific and Technical Information of China (English)

    李邦库; 谢惠君; 胡乃中; 许建明; 杨桂芳; 方加旭


    目的 评价双气囊电子小肠镜对小肠疾病患者的诊断价值及其安全性.方法 对2007年2月至2010年7月间245例有消化道症状,经胃镜、结肠镜等检查为阴性者,采用双气囊电子小肠镜检查,根据病情选择进镜方式.结果 244例完成预定检查,1例患者因回盲瓣严重变形,检查失败,小肠镜未能进入回肠.在244例完成双气囊电子小肠镜检查患者中,有阳性发现206例,病变检出率84.4%(206/244),病因诊断率77.8%(190/244).检出的疾病有:小肠非特异性炎症36例,小肠血管畸形24例,小肠息肉21例,小肠克罗恩病18例,小肠恶性肿瘤17例,小肠憩室22例,小肠间质瘤21例,糜烂出血性回肠炎1例,十二指肠溃疡2例,回肠吻合口溃疡1例,空肠柿石1例,出血坏死性小肠炎2例,过敏性紫癜1例,腭裂溃疡伴出血1例,肠钩虫感染13例等.双气囊电子小肠镜对不明原因消化道出血的诊断率为79.6%(115/142),对不明原因小肠梗阻的病因诊断率为77.6%(66/85).所有患者检查过程中未发生严重并发症,只有咽喉部不适、轻度疼痛感,腹痛、腹胀、肛门不适等,患者均能忍受完成检查.结论 双气囊电子小肠镜能安全、快速地检查全小肠,对小肠疾病诊断有较高价值,并且很安全.%Objective To evaluate clinical efficacy and safety of double-balloon enteroscopy for small bowel diseases. Methods 245 cases of small bowel diseases with negative findings of various routine diagnostic modalities were performed with double-balloon enteroscopy .From February2007 to May2010.Starting insertion route( oral or anal ) of double-balloon enteroscopy was chosen according to the estimated location of the suspected lesions basing on the clinical presentation and on the fingings. Results The lesion was detected in 206 of 244 cases, the total positive rate of double-balloon enteroscopy was 84.4%(206/244), the diagnostic yield was 77.8%( 190/244 ).the findings were non

  5. Double-Balloon Endoscopy in Overt and Occult Small Bowel Bleeding: Results, Complications, and Correlation with Prior Videocapsule Endoscopy in a Tertiary Referral Center (United States)

    Hermans, Carlijn; Stronkhorst, Arnold; Tjhie-Wensing, Annemarie; Kamphuis, Jan; van Balkom, Bas; Dahlmans, Rob; Gilissen, Lennard


    Background/Aims Videocapsule endoscopy (VCE) and double-balloon endoscopy (DBE) allow deep exploration in patients with suspected small bowel pathology. VCE is often performed as an initial small bowel examination to explore whether an intervention by DBE is indicated and to determine insertion route. The study aim was to evaluate the correlation between DBE and VCE in patients with obscure or overt bleeding or anemia, as well as intervention frequency, and complications. Methods Retrospective observational study. Results DBE procedures (n=205) showed small bowel lesions in 64% cases. Antegrade DBE showed positive results in 79% cases, mostly angiodysplasias (63%). Retrograde DBE showed positive results in 22% cases. An intervention was performed in 64% of DBE procedures. The major complication rate was 0.5%, which was one case of perforation. Pancreatitis did not occur. The overall diagnostic agreement was 66% among the 134 DBEs with preceded VCE. Conclusions In cases of overt or occult bleeding or anemia, DBE was positive in 64%, with only a few complications. Positive correlation was 66% among initially performed VCEs and DBEs. Owing to the time-consuming and invasive character of DBE, performing VCE before DBE might still be clinically relevant. PMID:28076941

  6. Double-balloon enteroscopy: a descriptive study of 50 explorations Enteroscopia de doble balón: estudio descriptivo de 50 exploraciones

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    E. Pérez-Cuadrado


    Full Text Available Aim: to evaluate the utility of double-balloon enteroscopy for small-bowel disease. Design: a prospective study of 50 consecutive enteroscopies performed from December 2004 to July 2005 to analyze diagnoses and treatments. Patients: 44 patients (33 had undergone a previous capsule endoscopy with indications for obscure digestive hemorrhage, angiodysplasia, Peutz-Jeghers syndrome, ulcer, suspected Crohn's disease, tumors, and refractory celiac disease. Results: we carried out enteroscopy studies in 44 patients by the oral route and, in 6 additional patients, by both the oral and anal routes. We reached the ileon with the oral route in all cases but one (jejunal stenosis, and in 4 cases out of 7 with the anal route, with an average duration of 73 minutes. We found angiodysplasia in 19 cases, as well as NSAID-related enteropathy, Crohn's disease, diverticulosis, and Waldenström's disease. We performed biopsies in 31% of cases with diagnoses of adenocarcinoma, lymphangiectasia secondary to tumor in celiac disease, and Whipple's disease. We treated 19 patients with angiodysplasia (1 to 20 synchronous lesions with argon, and 4 patients with polyps using polipectomy (sporadic polyps or Peutz-Jeghers syndrome. A retained capsule in one patient with stenosis was removed. Conclusions: double-balloon enteroscopy is a useful and effective technique in the diagnosis and treatment of small intestine diseases, thus complementing capsule endoscopy. More studies are needed to analyze its impact on the management of this condition.Objetivo: valorar la utilidad de la enteroscopia de doble balón en enfermedades de intestino delgado. Diseño: estudio prospectivo descriptivo de 50 enteroscopias consecutivas (diciembre 2004 a julio 2005, analizando diagnóstico y terapéutica. Pacientes: cuarenta y cuatro pacientes (33 con cápsula endoscópica previa con hemorragia digestiva oculta o lesiones detectadas mediante cápsula (angiodisplasias, pólipos, úlceras

  7. Indications, detectability, positive findings, total enteroscopy, and complications of diagnostic double-balloon endoscopy: a systematic review of data over the first decade of use. (United States)

    Xin, Lei; Liao, Zhuan; Jiang, Yue-Ping; Li, Zhao-Shen


    Double-balloon endoscopy (DBE) has been used in clinical practice for nearly 10 years. To systematically collect and produce pooled data on indications, detection rate, total enteroscopy, complications, and the composition of positive findings in diagnostic DBE. A systematic review. We searched PubMed between January 1, 2001 and March 31, 2010 for original articles about DBE evaluation of small-bowel diseases. Data on total number of procedures, distribution of indications, pooled detection rate, pooled total enteroscopy rate, and composition of positive findings were extracted and/or calculated. In addition, the data involving DBE-associated complications were analyzed. A total of 66 English-language original articles involving 12,823 procedures were included. Suspected mid-GI bleeding (MGIB) was the most common indication (62.5%), followed by symptoms/signs only (7.9%), small-bowel obstruction (5.8%), and Crohn's disease (5.8%). The pooled detection rates were 68.1%, 68.0%, 53.6%, 63.4%, and 85.8% for overall, suspected MGIB, symptoms/signs only, Crohn's disease, and small-bowel obstruction, respectively. Inflammatory lesions (37.6%) and vascular lesions (65.9%) were the most common findings, respectively, in suspected MGIB patients of Eastern and Western countries. The pooled total enteroscopy rate was 44.0% by combined or antegrade-only approach. The pooled minor and major complication rates were 9.1% and 0.72%, respectively. Inclusion and exclusion criteria were loosely defined. The detectability and complication risk of diagnostic DBE are acceptable. Suspected MGIB is the most common indication, with a relatively high detection rate, but there was a difference in its causes between Western and Eastern countries. Copyright © 2011 American Society for Gastrointestinal Endoscopy. Published by Mosby, Inc. All rights reserved.

  8. 双气囊內镜在小肠疾病诊断中的应用价值%Diagnostic value of double balloon enteroscopy for intestinal diseases

    Institute of Scientific and Technical Information of China (English)

    李易; 李良平; 韩盛玺; 张初民; 陈琼; 阳运超; 周丽华


    目的 评价双气囊內镜对小肠疾病的诊断价值.方法 2008年12月~2010年6月对37例拟诊或需排除小肠疾病的患者进行小肠镜检查,18例单纯经口进镜,13例单纯经肛门进镜,6例经口和肛门二次进镜.结果 37例患者中发现小肠疾病28例,检出率75.7%.其中小肠血管病变16例,小肠息肉3例,小肠肿瘤2例,小肠寄生虫2例,小肠憩室2例,小肠克罗恩病2例,小肠结核1例.结论 双气囊內镜能安全快速地检查小肠,具有直视、可控性好、能活检及进行镜下治疗等优点,为小肠疾病患者提供了全新的检查手段.%[ Objective ] To assess the diagnostic value of double balloon enteroscopy(DBE)for suspected intestinal disease. [Methods] From December 2008 to June 2010, 37 patients with suspected intestinal disease underwent DBE. Oral and anal routes DBE were performed in 18 and 13 patients, respectively, while 6 patients underwent a combination of both approaches. [Results] The overall diagnostic yield of DBE was 75.7% (28/37), with vascular lesions in 16, polyp in 3, tumor in 2, parasitic infections in 2, diverticulosis in 2, Crohn,s disease in 2, intestinal tuberculosis in 1. [Conclusions] DBE has the advantage of allowing direct visualization, taking biopsy specimens easily and treating lesions directly, and it is a new diagnostic method for small intestinal disease.

  9. 双气囊小肠镜在小肠克罗恩病中的诊断价值研究%Diagnostic value of double-balloon enteroscopy for small bowel Crohn disease

    Institute of Scientific and Technical Information of China (English)

    王小璇; 杜奕奇; 陈洁; 徐灿; 廖专; 生晶; 吴仁培; 席惠君; 李兆申


    Objective To investigate the value of double-balloon endoscopy for the diagnosis of small bowel Crohn disease(CD).Methods Data of 141 patients with suspected CD undergoing double-balloon endoscopy were reviewed.Diagnosis was made based on pathological,endoscopic findings and clinic follow-up results.Detection rates and diagnosis rates of small bowel CD were compared by double-balloon enteroscopy,CT enterography and capsule endoscopy.Results The detection and diagnosis rates of small bowel CD by double-balloon endoscopy were 90.8% ( 128/141 ) and 98.4% ( 126/128),respectively.These two variables by CT enterography were 76.0% (19/25) and 89.5% (17/19),and those by capsule endoscopy were 60.0% (15/25) and 93.3% (14/15).Conclusion Double balloon enteroscopy has high application value for the diagnosis of small bowel CD.For those contraindicated with endoscopy,CT enterography can be considered as a preferred auxiliary diagnostic modality.%目的 探讨双气囊小肠镜在小肠克罗恩病(CD)诊断中的价值.方法 回顾性总结141例临床怀疑小肠CD行双气囊小肠镜检查患者的临床资料,以病理诊断结合内镜表现和临床随访结果为最终诊断结果,对比分析小肠CD双气囊小肠镜、CT小肠成像以及胶囊内镜的检出率和确诊率.结果 双气囊小肠镜检出小肠CD 128例,检出率为90.8%( 128/141),最终经病理及临床随访确诊126例,确诊率为98.4% (126/128);CT小肠成像检出小肠CD 19例,检出率为76.0%( 19/25),最终经病理及临床随访确诊17例,确诊率为89.5% (17/19);胶囊内镜镜检出小肠CD 15例,检出率为60.0%( 15/25),最终经病理及临床随访确诊14例,确诊率为93.3% (14/15).双气囊小肠镜组小肠CD检出率和确诊率均高于胶囊内镜和CT小肠成像.结论 双气囊小肠镜在小肠CD诊断中具有较好的应用价值,对存在内镜检查禁忌证者CT小肠成像可作为首选辅助检查手段.

  10. Clinical analysis of double-balloon catheter for cervical ripening in 66 cases%促子宫颈成熟球囊改善子宫颈条件66例临床观察

    Institute of Scientific and Technical Information of China (English)

    赫英东; 胡君; 章小维; 黄禾; 陈倩


    Objective To evaluate the efficacy and safety for cervical ripening by double-balloon catheter among full-term pregnancy women underwent labor induction.Methods It was a prospective nonrandomly controlled research.Totally 128 singleton-pregnancy women in full-term who had to undergo labor induction because of pregnancy complications or comorbidities from August 2011 to April 2013 in Peking University First Hospital were selected as study subjects.Participants were allocated to preinduction cervical ripening with either a double-balloon catheter (66 participants,study group) or prostaglandin vaginal insert (62 participants,control group).Compare the efficacy for cervical ripening and adverse reactions between the two groups.Results The efficacy for cervical ripening (Bishop scores improved by ≥ 2) had no significant differences between study and control groups [82% (54/66) compared with 81% (50/ 62),P>0.05].The time interval between intervention and parturiency was significantly higher in the doubleballoon catheter group than in the prostaglandin vaginal insert group [(24.2±8.5) compared with (14.5±8.0) hours,P<0.05].The proportion of women who achieved parturiency within 12 hours was significantly lower in the double-balloon catheter group than that in the control group [9% (6/66) compared with 21% (13/62),P<0.05].The cesarean section rate showed no significant differences [41% (27/66) compared with 43%(27/62),P>0.05].The prevalence of intrauterine infection demonstrated by clinical diagnosis was significantly higher in the double-balloon catheter group [11% (7/66) compared with 6% (4/62),P<O.05].The double-balloon catheter group had significantly lower rates of contraction overfrequency [0(0/66) compared with 42% (26/62),P<0.05],hyperthermia [3% (2/66) compared with 19% (12/62),P<0.05],fetal heart rate abnormalities before removing the device or drug [5% (3/66) compared with 19% (12/62),P<0.05],as well as precipitate

  11. Enteroscopia de doble balón para el diagnóstico de las enfermedades del intestino delgado en los niños Double-balloon enteroscope for the diagnosis of small intestine diseases in children

    Directory of Open Access Journals (Sweden)

    Héctor Rubén Hernández Garcés


    Full Text Available INTRODUCCIÓN. La enteroscopia de doble balón (EDB es un nuevo método que permite la visualización completa de la luz del intestino delgado. La presente investigación se realizó con el objetivo de evaluar la experiencia en la realización de esta técnica en niños atendidos en el Servicio de Endoscopia Pediátrica del Instituto Cubano de Gastroenterología. MÉTODOS. Se realizó un estudio descriptivo retrospectivo para evaluar la seguridad, eficacia y extensión de exploración de la enteroscopia de doble balón en el diagnóstico de las enfermedades del intestino delgado en niños. Para ello fueron estudiados 8 pacientes con examen físico y complementarios negativos de enfermedad del intestino delgado, atendidos entre noviembre de 2008 y octubre de 2009. En 3 de los 8 pacientes existía la sospecha clínica y radiológica de enfermedad de Crohn; en otros 3, la sospecha de tumor de intestino delgado y los restantes fueron atendidos por presentar sangramiento oculto de origen intestinal. RESULTADOS. Se practicaron 7 procedimientos por vía retrógrada y 2 por vía anterógrada; a un paciente se le realizó enteroscopia total empleando ambas vías. La duración media de la EDB por vía oral fue de 62,5 min, con un intervalo de 60 a 65 min y por la vía anal fue de 50,7 min, con intervalo de 45 a 60 min. En todos los casos se logró identificar alguna lesión que explicara los síntomas. CONCLUSIÓN. La enteroscopia de doble balón es un método seguro para el diagnóstico de enfermedades del intestino delgado en los niños.INTRODUCTION. The double balloon enteroscope (DBE is a new method allows the whole visualization of the small intestine lumen. The objective of present research was to assess the experience in the carrying out of this technique in children seen in the Pediatric Endoscopy Service of the Cuban Institute of Gastroenterology. METHODS. A retrospective and descriptive study was conducted to assess the accuracy, effectiveness

  12. A four lumen screwing device for multiparametric brain monitoring. (United States)

    Feuerstein, T H; Langemann, H; Gratzl, O; Mendelowitsch, A


    We describe multiparametric monitoring in severe head trauma using a new screwing device. Our aim was to create a screw which would make the implantation of the probes and thus multiparametric monitoring easier. The new screw allows us to implant 3 probes (microdialysis, Paratrend and an intracranial pressure device) through one burr hole. The screw has four channels, the fourth being for ventricular drainage. We monitored 13 patients with severe head trauma (GCS = 3-8) for up to 7 days. Brain tissue pO2, pCO2, pH, and temperature were measured on-line with the Paratrend 7 machine. The microdialytic parameters glucose, lactate, pyruvate and glutamate were determined semi on-line with a CMA 600 enzymatic analyser. There were no complications in any of the patients that could be ascribed to the screw.

  13. 术前全腹CT检查对双气囊小肠镜诊断消化道出血的意义%Abdominal Computed Tomography for Double Balloon Enteroscopy Diagnosing Gastrointestinal Bleeding

    Institute of Scientific and Technical Information of China (English)

    邵晓冬; 赵佳钧; 任丽楠; 梁振东; 郭道光; 郭晓钟


    目的 探讨消化道出血患者在接受双气囊小肠镜(double balloon enteroscopy,DBE)检查前进行全腹电子计算机断层扫描(computed tomography,CT)检查的临床意义.方法 回顾分析2009-08/2014-08月在作者科室因消化道出血而接受DBE检查的患者资料.评估DBE检查前行全腹CT检查对最终诊断结果的影响.结果 203例患者因消化道出血在作者科室接受了DBE检查,其中94例患者在DBE检查前进行了全腹CT检查.对于消化道出血DBE诊断阳性率90.40%,而全腹CT的诊断阳性率为43.60%.与非肿瘤性消化道出血相比,全腹CT在肿瘤性消化道出血中的诊断阳性率明显增高,组间比较差异具有统计学意义(P=0.000).与CT检查结果阴性的患者相比,DBE术前CT检查结果阳性可以明显提高首次DBE检查路径选择的正确性(P=0.000).结论 全腹CT检查可有助于判断哪些患者会从DBE检查受益,也有利于选择正确的DBE检查人路.

  14. Diagnostic value of double balloon enteroscopy for intestinal diseases%双气囊内镜在小肠疾病诊断中的应用价值研究

    Institute of Scientific and Technical Information of China (English)

    付雪琼; 晏霞; 丁一娟; 赵炳超; 于皆平; 于红刚


    目的 评价双气囊内镜对小肠疾病的诊断价值.方法 2007年7月至2009年11月,对141例拟诊或需排除小肠疾病的患者在静脉麻醉下进行小肠镜检查,59例单纯经口进镜,46例单纯经肛门进镜,36例经口和肛门两次进镜.结果 141例患者中发现小肠疾病105例,检出率为74.5%.其中良恶性肿瘤32例,克罗恩病14例,小肠非特异性炎症17例,小肠息肉15例,小肠憩室16例,小肠血管病变9例,肠结核3例,小肠钩虫病1例.检查过程中有1例并发胰腺炎,余未发生明显并发症.结论 双气囊内镜能安全快速地检查全小肠,并能准确地诊断各种小肠疾病.%Objective To assess the diagnostic value of double balloon enteroscopy (DBE) for sus-pected intestinal diseases. Methods The data of 141 patients with suspected intestinal diseases, who un-derwent DBE with intravenous sedation from July 2007 to November 2009, were retrospectively analyzed. Oral and anal routes DBE were performed in 59 and 46 patients, respectively, while 36 patients underwent a com-bination of both approaches. Results The overall diagnostic yield of DBE was 74.5% (105/141), with benign and malignant tumors in 32, Crohn's disease in 14, non-specific enteric inflammation in 17, polyp in 15, diverticulosis in 16, vascular lesions in 9, intestinal tuberculosis in 3 and intestinal ancylostomiasis in 1. Acute pancreatitis was complicated in 1 patient. Conclusion DBE is a safe and effective method in di-agnosis of suspected intestinal diseases.

  15. 双气囊内镜在中消化道疾病诊断中的应用价值研究%Diagnostic value of double balloon endoscopy for gastrointestinal disease

    Institute of Scientific and Technical Information of China (English)

    赵云峰; 张丽瑶; 高峰; 杨卓; 麻树人; 张宁; 宫照杰


    Objective To study the diagnostic value of double balloon endoscopy (DBE) for gastrointestinal disease.Methods Clinical data of 53 patients with suspected intermediate gastrointestinal diseases who underwent DBE procedures were retrospectively analyzed for detection rate,complications and the incidence of adverse reactions.Results All of 53 patients underwent successful DBE,Procedures were performed via mouth ( n =26),anus ( n =9 ) and the combined routes ( n =18 ).And definite diagnosis was made in 46 cases (86.79%),including upper gastrointestinal (above ligament of Treitz) disease in 3 cases (5.66%),intermediate gastrointestinal disease in 41 cases (77.36% ) and lower gastrointestinal disease in 2 cases (3.77%).All 53 patients were tolerant to the operation and anesthesia.No severe complications like bleeding,perforation,intestinal torsion,mesenteric tear,pancreatitis or anesthetic accident occured.Several patients showed abdominal flatulence,transient abdominal pain.Some patients in oral route reported slight throat discomfort or slight nasal bleeding.Incarceration occurred in 1 case due to friction of endotracheal intubation and the silicone tube,which was released after deflation and removed out.2 patients showed mild diarrhea with low fever,and the symptoms were self-healing without special treatment in 48 h.Conclusion DBE is of high diagnostic value for gastrointestinal diseases with a high safety.%目的 探讨双气囊内镜(DBE)在中消化道疾病诊断中的应用价值.方法 对53例行DBE检查的疑似中消化道疾病患者的临床资料进行回顾性分析,总结病变检出情况以及并发症、不良反应发生情况.结果 53例均顺利完成DBE检查,其中单纯经口进镜者26例、单纯经肛进镜者9例、经口+经肛进镜者18例,共46例(86.79%)发现病变,包括上消化道病变3例(5.66%)、中消化道病变41例(77.36%)和下消化道病变2例(3.77%).53例患者均能耐受麻醉及内镜检查,无

  16. Double balloon endoscopy in diagnosis of ulcerative lesions in small intestine%双气囊内镜检查对小肠溃疡病变的诊断研究

    Institute of Scientific and Technical Information of China (English)

    智发朝; 白杨; 徐智民; 肖冰; 姜泊; 岳辉


    Objective To evaluate the use of double balloon endoscopy(DBE) in diagnosis of ulcerative lesions in small intestine.Methods Data of patients diagnosed as small intestinal ulcer under DBE during September 2003 and December 2007 at Nanfang Hospital were analyzed retrospectively.Results Ulcer in small intestine was detected by DBE in a total of 62 patients,including 48 males and 14 females,aging from 10 to 71 years old( mean 43.9 yr).The main clinical manifestations consisted of small intestinal hemorrhage(38/62,61.3%),abdominal pain(16/62,25.8%),abdominal distention(5/62,8.1%),loss of weight(2/62,3.2%),and diarrhea(1/62,1.6%).The ulcers were diagnosed endoscopically as Crohn's disease(CD) in 53 cases(85.5%),drug induced lesions in 4(6.5%),nonspecific chronic inflammation in 2(3.2%),lymphoma in 2(3.2%) and tuberculosis in 1(1.6%).They were all microscopically diagnosed as chronic inflammation.Of the 62 patients,32(51.6%) underwent surgery.In 30 cases of CD diagnosed by DBE,22 were confirmed by post-surgery pathology(malignant cells were found in 3),while in the other 8 cases,4 were diagnosed as lymphoma,3 as Behcet's disease and 1 as tuberculosis.Meanwhile,the 1 case of tuberculosis and 1 lymphoma diagnosed by DBE were confirmed as CD after operation.The overall accurate diagnosis rate of small intestinal ulcerative lesions by DBE was 68.8%(22/32).Conclusion DBE is valuable in diagnosis of ulcerative lesions in small intestine,but surgery should be included into consideration to confirm the diagnosis when necessary.%目的 研究双气囊内镜(DBE)检查对小肠溃疡病变的诊断价值.方法 统计2003年9月到2007年12月广州南方医院DBE检查发现的小肠单纯溃疡而内镜活检显示为"小肠溃疡"或"慢性炎症"者的资料.结果 符合以上条件者62例,其中男48例,女14例,年龄10~71岁,平均43.9岁.临床主诉为消化道出血38例(61.3%)、腹痛16例(25.8%)、腹胀5例(8.1%)、消瘦2例(3.2%)、腹泻1例(1.6%).DBE

  17. Double-balloon endoscopy and capsule endoscopy for small intestinal bleeding%双气囊内镜和胶囊内镜诊断小肠出血的临床评价

    Institute of Scientific and Technical Information of China (English)

    张以洋; 韩树堂; 周晓白; 肖君; 史伟


    目的 评价双气囊内镜和胶囊内镜对小肠出血的临床诊断价值.方法 比较双气囊内镜、胶囊内镜及全消化道造影对小肠出血病灶的总体检出率;通过自身对照,比较双气囊内镜和胶囊内镜对小肠出血诊断率;分析胶囊内镜对1次双气囊内镜检查明确诊断率的影响.结果 105例小肠出血患者中,双气囊内镜检出克罗恩病24例,腺癌15例,慢性非特异性炎症12例,不明原因小肠溃疡10例,小肠间质肿瘤8例,小肠息肉8例,小肠血管畸形出血6例,钩虫病5例,麦克尔憩室及多发憩室5例,小肠淋巴瘤3例,无明显异常9例,阳性率91.4%(96/105).其中40例进行胶囊内镜检查,病变检出率75.0%(30/40);75例患者全消化道造影检查,病变检出率33.3%(25/75).根据胶囊内镜结果1次双气囊内镜检查明确诊断率90.0%(36/40),而根据临床特征及消化道造影结果1次双气囊内镜检查明确诊断率69.2%(45/65).结论 小肠疾病的主要病因是小肠良性溃疡(包括克罗恩病)、肿瘤、慢性炎症,其次是息肉、血管畸形、寄生虫感染、麦克尔憩室及淋巴瘤等.双气囊内镜对小肠出血诊断率高于胶囊内镜,胶囊内镜能提高1次双气囊内镜明确诊断率.%Objective To study the diagnostic value of double-balloon endoscopy (DBE) and capsule endoscopy (CE) for small intestinal bleeding. Methods Overall detection rates of small intestinal bleeding with DBE, CE and the whole alimentary tract barium meal were compared. Positive rates of bleeding detection with DBE and CE were compared within the same patients. Influence of CE on one-procedure rate of DBE was analyzed. Results In 105 cases of small intestine bleeding, DBE detected 24 cases of Crohn's disease, 15 adenocarcinoma, 12 chronic nonspecific inflammation, 10 small intestinal ulcer of unknown reason, 8 entero-mesenchymoma, 8 polypus, 6 vascular deformation hemorrhage, 5 ancylostomiasis, 5 Mechel's diverticula ( including

  18. 缩宫素与 COOK双球囊在促进宫颈成熟合并引产的临床对比研究%Clinical comparative study of oxytocin and COOK double balloon in promoting cervical mature combining induced labor

    Institute of Scientific and Technical Information of China (English)

    孙娟娟; 易明芳


    目的:探究静点小剂量缩宫素与采用库克子宫颈扩张球囊( COOK)双球囊在促进宫颈成熟合并引产的临床效果。方法选取武汉市商业职工医院自2014年5月至2015年5月产科收治的90例孕妇作为研究对象,采用随机数字表法分为两组,使用缩宫素促进宫颈成熟并引产为对照组,使用COOK双球囊促进宫颈成熟并引产为试验组,对两组受检者的宫颈成熟率、引产方式、引产后母婴的相关并发症及产妇产后6个月时性生活质量进行比较分析。结果试验组孕妇引产中宫颈成熟度、阴道分娩率均显著高于对照组(χ2值分别为6.06、5.54,均P<0.05),剖宫产率显著低于对照组(χ2=5.32,P<0.05),而两组产后出血量比较无显著性差异(t=1.48,P>0.05),宫颈裂伤和阴道血肿发生率比较均无显著性差异(t值分别为2.96、3.04,均P>0.05)。两组新生儿体重、出生后5min Apgar评分比较均无显著性差异(t值分别为1.56、3.16,均P>0.05),新生儿窒息率比较无显著性差异(χ2=0.00,P>0.05)。两组产妇产后6个月时性生活满意率、性欲下降率、性交疼痛率比较均无显著性差异(χ2值分别为2.46、2.54、2.32,均P>0.05)。结论 COOK双球囊可以明显促进宫颈成熟并引产,并且效果明显优于缩宫素,未增加母婴引产后的并相关发症,且对性生活质量无明显影响。%Objective To explore and analyze the clinical effect of static point of small dose of oxytocin and COOK double balloon in promoting cervical mature combining induced labor.Methods From May 2014 to May 2015 90 pregnant women admitted in Business Worker’ s Hospital of Wuhan City were selected as research objects, and they were divided into two groups using random number table method.Control group used oxytocin to promote cervical maturity and induced labor, while

  19. The value of multi-slice spiral CT enterography and double-balloon enteroscopy in the diagnosis of unexplained abdominal pains%多层螺旋CT小肠造影与双气囊小肠镜在不明原因腹痛诊断中的价值

    Institute of Scientific and Technical Information of China (English)

    周建伟; 潘杰; 侯俊良


    Objective To assess the value of multi-slice spiral CT enterography (MSCTE) and double-balloon enteroscopy (DBE) in the diagnosis of unexplained abdominal pains. Methods 41 patients with unexplained abdominal pains were selected and received MSCTE and DBE examination. With combining the results of endoscopy and/or surgical pathology, clinical follow-ups, the differences in pathological detection rate and diagnostic accuracy between these two measures were compared. Results The detection rates of MSCTE and DBE were 63.41% (26/41) and 87.80% (36/41), and the diagnostic accuracies were 70.73% (29/41) and 92.68% (38/41), respectively. Conclusion The detection rate and diagnostic accuracy of DBE were both higher than those of MSCTE. MSCTE could facilitate the diagnosis of small bowel tumor and Crohn's disease, with positioning and qualitative value. MSCTE could be a pre-test to help decide the appropriate way of DBE insertion.%目的:评价多层螺旋CT小肠造影(MSCTE)与双气囊小肠镜(DBE)在不明原因腹痛患者诊断中的价值.方法:41例不明原因腹痛患者,同时行MSCTE和DBE检查,结合内镜和(或)手术病理、临床随访等,比较两者对不明原因腹痛病因的检出率、诊断准确率.结果:MSCTE和DBE的病变检出率分别为63.41%(26/41)和87.80%(36/41);诊断准确率分别为70.73%(29/41)和92.68%(38/41).结论:DBE对不明原因腹痛患者的病变检出率、诊断准确率均高于MSCTE; MSCTE对小肠肿瘤、克罗恩病有一定的定位、定性诊断价值;MSCTE可作为DBE检查前筛选性检查,对DBE进镜方式选择提供有效的帮助.

  20. Safety and Efficacy of Double Balloon Dilation in Induction of Labor during Second- and Third-trimester High Risk Pregnancy%双球囊在中晚期高危妊娠引产中应用的有效性及安全性

    Institute of Scientific and Technical Information of China (English)

    范翠芳; 孙艳梅; 陈建华


    目的 探讨双球囊在中晚期高危妊娠引产中应用的有效性和安全性.方法 收集2010年6月~2011年8月40例年龄在19~40岁的中晚期高危妊娠妇女.病例包括:早发型重度子痫前期合并肝肾损害10例,子痫3例,糖尿病合并重度子痫前期小于28周3例,死胎8例,妊娠合并白血病1例,双胎输血综合征2例,肾功能不全伴胎儿生长受限(FGR)5例,妊娠合并血小板减少性紫癜(ITP)2例,重度子痫前期合并HELLP综合征3例,胎儿畸形合并羊水过少3例.放置方法;子宫球囊插入宫颈后置于宫颈内口并充生理盐水80 mL,宫颈-阴道球囊放置于宫颈外口并充生理盐水80 mL,12~24 h后无宫缩或宫缩不规律,阴道放置米索前列醇或静脉滴注小剂量催产素.结果 40例高危妊娠的孕妇顺利引产39例,引产成功率达97.5%,自放置球囊到胎儿娩出平均时间26.5 h.10例加用小剂量米索前列醇引产成功;7例加用小剂量催产索引产成功.结论 对于中晚期高危妊娠妇女中孕周尚早,胎儿存活率低下或已发生死胎及有肝肾严重损害者,双球囊引产安全有效,避免了药物对肝肾的损害,避免了不必要的剖宫产,降低以后再生育的风险.%Objective To explore the safety and efficacy of double balloon dilation in induction of labor during second- and third-trimester pregnancy. Methods Forty women(age rang 19 - 40) .diagnosed as having a high-risk pregnancy, were recruited at the point of admission to our hospital during June 2010 to August 2011, and clinic data were analyzed. Out of 40 cases, 10 women had early-onset severe pre-eclampsia with liver and kidney injury,3 had eclampsia,and 3 had diabetes with severe pre-ec-lampsia in less than 28 weeks pregnancy. There were also 8 cases of stillbirth,one case of leukemia,2 cases of twin-twin transfusion syndrome,5 cases of fetal growth restriction(FGR)accompanied by renal insufficiency,2 cases of idiopathic thrombocytope

  1. Value of double-balloon enteroscopy for diagnosis and management of suspected small intestinal bleeding%双气囊内镜用于可疑小肠出血性疾病诊断和治疗的临床价值研究

    Institute of Scientific and Technical Information of China (English)

    岳辉; 周殿元


    Objective To evaluate the value of DBE in the diagnosis and selective treatment for suspected small intestinal bleeding and to study possible etiology of small intestinal bleeding. Methods Enteroscopy, using the double-balloon method,were performed in 212 patients with suspected intestinal diseases and 126 patients with suspected small intestinal bleeding from June 2003 and August 2007 at Guangdong No.2 Provincial People's Hospital and Nanfangmedical University Hospital. Results The bleeding lesions of small intestine were found in 101 out of 126 patients with suspected intestinal diseases(80.2%), including 42 cases of small intestinal ulcers(including Crohn's diseases),25 cases of diverticulum (including Micheal's diverticulosis), 19 cases of intestinal neoplasms, IO cases of vascular deformity,2 cases of stero-pronematodiasis and 3 cases of ancylostomiasis; the bleeding lesions of Non-small intestine (includingbleeding lesions from stomach,esophagus and large intestine) in 16 out of 176 patients with suspected intestinal diseases(12.7%);9 cases of essentially normality. There were no serious adverse reactions and complications in all patients received enteroscopy. Conclusion DBE has higher diagnosis rate for small intestinal bleeding,and can be regarded as the first choice for suspected intestinal bleeding patients. The main reason of small intestinal bleeding are benign ulcers including Crohn's disease, intestine diverticulum and intestinal neoplasms as well as vascular deformity and Parasitosis infection are the rare cause.%目的 探讨双气囊内镜(DBE)对小肠出血性疾病病因诊断和治疗选择的作用.方法 2003年6月至2007年8月在广东省第二人民医院和广州南方医院将临床可疑小肠疾病212例,其中疑有小肠出血患者126例,进行DBE检查,发现出血病灶或相关病变进行标记或活检,并与部分手术结果对照.结果 可疑小肠出血患者中DBE检查发现小肠出血病变,检出阳性率为80

  2. Effect analysis of cervix dilatation with double balloon, prostaglandin E2 suppository and for cervical ripening and labor induction in full-term pregnancy%宫颈扩张双球囊、前列腺素E2栓剂用于促宫颈成熟及足月妊娠引产的效果分析

    Institute of Scientific and Technical Information of China (English)

    罗雪芹; 廖宇媛; 朱圣玉; 吴海兰


    目的:探讨宫颈扩张双球囊(COOK球囊)、前列腺素E2栓剂用于促宫颈成熟及足月妊娠引产的有效性和安全性。方法采取回顾对照研究方法,选取2013年3月~2014年3月在本院住院有引产指征的初产妇共240例,随机分为A组(COOK球囊组)80例、B组(前列腺素E2栓剂组)80例、C组(缩宫素组)80例。观察3组产妇的用药后促宫颈成熟及引产效果、用药后至临产时间、阴道分娩率、产后出血量、新生儿1 min Apgar评分及母婴并发症情况。结果 A组的引产总有效率为100.00%,B组为91.25%,C组为46.25%,3组的引产总有效率比较,差异有统计学意义(P0.05)。 A、B组的用药后至临产时间明显短于C组,阴道分娩率明显高于C组,差异有统计学意义(P0.05)。结论 COOK球囊促宫颈成熟及引产效果与前列腺素制剂相当,且明显优于缩宫素,是一种更安全、有效、简单的促宫颈成熟及引产的方法,值得临床推广应用。%Objective To explore the effectiveness and safety of cervix dilatation with double balloon (COOK balloon) and prostaglandin E2 suppository for cervical ripening and labor induction in full-term pregnancy. Methods By the method of retrospective control study,240 primiparae meeting the indications of induced labor who were admitted into our hospital from March 2013 to March 2014 were selected and evenly divided into three groups:the group A (the COOK balloon group),the group B (the prostaglandin E2 suppository group),and the group C (the oxytocin group) in ran-dom.Effect of cervical ripening and labor induction,time from medication to give birth,rate of vaginal parturition,post-partum amount of bleeding,neonatal Apgar score of 1 min and complications in maternal and child were observed in the three groups. Results The total effective rate of labor induction in the group A was 100.00%,the group B was 91.25%, and the group C was 46.25%,and there was a statistical

  3. Prospective multi-centre randomised trial comparing induction of labour with a double-balloon catheter versus dinoprostone

    DEFF Research Database (Denmark)

    Løkkegaard, E; Lundstrøm, M; Kjær, Michael;


    group (difference not significant). After 24 h, 55.3% had given birth in the balloon group versus 54.3% in the dinoprostone group. Additional oxytocin stimulation was used more often in the balloon (46%) compared with that in the dinoprostone (34%) (relative risk: 1.34 (95%CI 1.16 -1.54) group....... Caesarean section rates and neonatal outcome were similar. Overall, the two methods for induction were comparable with regard to efficacy and safety....

  4. 双球囊导管在足月妊娠促宫颈成熟和引产中的应用%Efficacy of Double-balloon Catheter for Cervical Ripening and Labor Induction

    Institute of Scientific and Technical Information of China (English)

    张力; 刘兴会; 卫蔷; 边策; 彭冰; 姚强


    目的 探讨双球囊导管用于足月单胎孕妇促宫颈成熟和引产的应用指征、安全性、有效性及应用技巧.方法 搜集四川大学华西第二医院2011年5月至2012年10月586例应用双球囊导管孕妇的临床资料,按照放置球囊前的宫颈Bishop评分分为试验1组(Bishop评分≤3分,155例)、试验2组(Bishop评分4~5分,223例)和试验3组(Bishop评分≥6分,208例),并与同期宫颈Bishop评分≥6分而直接应用缩宫素静滴引产的112例孕妇(对照组)进行比较.结果 ①试验1、2、3组双球囊导管促宫颈成熟有效率、阴道分娩率逐渐递增,缩宫素使用率和使用时间逐渐递减,差异均有统计学意义.②与对照组相比,试验3组阴道分娩率明显增加、总产程明显缩短,差异均有统计学意义;两组母婴并发症的比较差异无统计学意义.结论 双球囊导管促宫颈成熟与引产的效果与宫颈Bishop评分密切相关,适合于宫颈Bishop评分较高孕妇的促宫颈成熟和计划分娩.

  5. Diagnostic value of double balloon enteroscopy combined with T-SPOT-TB, MIP-1α detection in Crohn disease%双气囊小肠镜联合T-SPOT-TB、MIP-1α检测对Crohn病的诊断价值

    Institute of Scientific and Technical Information of China (English)

    王晓玲; 李俊达; 侯灵红; 林赛穆; 郑昌京


    目的 分析Crohn病的小肠镜特点,探讨双气囊小肠镜联合T-SPOT-TB试验、趋化因子巨噬细胞炎症蛋白-1α(macrophage inflammatory protein-1α,MIP-1α)检测对Crohn病的诊断价值.方法 以资料完整的32例Crohn病、11例肠结核及29例其他小肠结肠溃疡患者为研究对象,行小肠镜或结肠镜检查,并以ELISA法检测MIP-1α水平,部分病例行T-SPOT-TB试验.结果 内镜下Crohn病患者溃疡数目≥4个、纵行溃疡、空肠或回肠受累、病变节段≥4段、肠腔狭窄均比肠结核组多见(P<0.05或P<0.01),而肠结核患者回盲瓣受累明显比Crohn病组多见(P <0.0001).其他病变组以多发的不规则溃疡、浅小溃疡多见.肠结核患者T-SPOT-TB阳性率高于Crohn病组及其他病变组.MIP-1α水平在Crohn病与其他病变组中差异有统计学意义(t=11.1,P<0.0001).结论 跳跃式分布的纵行溃疡是Crohn病特征性的内镜表现.空肠或回肠受累、病变节段多、肠腔狭窄对Crohn病较具诊断价值.小肠镜联合T-SPOT-TB试验、MIP-1α检测能提高Crohn病的诊断水平.

  6. Updates and Future of Enteroscopy

    Institute of Scientific and Technical Information of China (English)

    Hidemi Goto


    @@ Video capsule emdoscopy (VCE) and double balloon endoscopy (DBE) have allowed endoscopic observation of the entire small bowel. With introduction of these modalities, we have identified new diseases of the small bowel.

  7. Femoral artery recanalisation with percutaneous angioplasty and segmentally enclosed plasminogen activator

    DEFF Research Database (Denmark)

    Jørgensen, B; Tønnesen, K H; Bülow, J;


    To establish whether re-occlusion of the femoral artery could be prevented, in 6 consecutive patients undergoing percutaneous transluminal angioplasty (PTA) for superficial femoral artery occlusion the recanalised segment was isolated, with a 7-French double-balloon catheter. 5 mg recombined human...

  8. Femoro-popliteal artery occlusions treated by percutaneous transluminal angioplasty and enclosed thrombolysis

    DEFF Research Database (Denmark)

    Tønnesen, K H; Holstein, P; Andersen, E


    Removal of fibrin from the site of a newly dilated femoro-popliteal occlusion may be an attractive way of preventing rethrombosis. A double balloon catheter with a dilating tip balloon and an occlusive balloon 10, 15 or 20 cm approximately were introduced percutaneously. Following successful dila...

  9. Segmentally enclosed thrombolysis in percutaneous transluminal angioplasty for femoropopliteal occlusions

    DEFF Research Database (Denmark)

    Jørgensen, B; Tønnesen, K H; Nielsen, J D;


    Segmentally enclosed thrombolysis (SET) was performed immediately following 34 percutaneous transluminal angioplasties (PTAs) for femoropopliteal occlusions. The dilated segment was sealed off with a double balloon catheter, and recombinant tissue plasminogen activator (rt-PA) 1 mg/ml and heparin...

  10. Imaging the small bowel.

    LENUS (Irish Health Repository)

    Murphy, Kevin P


    Radiologic investigations continue to play a pivotal role in the diagnosis of pathologic conditions of the small intestine despite enhancement of capsule endoscopy and double-balloon endoscopy. Imaging techniques continue to evolve and new techniques in MRI in particular, are being developed.

  11. Obscure gastrointestinal bleeding: preoperative CT-guided percutaneous needle localization of the bleeding small bowel segment. (United States)

    Heiss, Peter; Feuerbach, Stefan; Iesalnieks, Igors; Rockmann, Felix; Wrede, Christian E; Zorger, Niels; Schlitt, Hans J; Schölmerich, Jürgen; Hamer, Okka W


    A 57-year-old woman presented with obscure gastrointestinal bleeding. Double balloon enteroscopy, angiography, and surgery including intraoperative enteroscopy failed to identify the bleeding site. Multidetector computed tomography (CT) depicted active bleeding of a small bowel segment. The bleeding segment was localized by CT-guided percutaneous needle insertion and subsequently removed surgically.

  12. Small Bowel Metastasis of Hepatocellular Carcinoma Detected by Capsule Endoscopy

    Directory of Open Access Journals (Sweden)

    A. Igawa


    Full Text Available We report a rare case of metastasis of hepatocellular carcinoma (HCC to the small bowel that presented as a pedunculated epithelial polyp. A 60-year-old man with liver cirrhosis type B was treated for HCC (stage IVb at our hospital. He had been admitted for melena and anemia. Capsule endoscopy was performed in this patient with obscure gastrointestinal bleeding. It showed a polypoid lesion with bleeding in the ileum. Double-balloon endoscopy was performed. The lesion was determined to be a pedunculated polyp in the ileum. Histological examination of biopsy specimens showed tumor cells resembling HCC. We performed endoscopic mucosal resection for the lesion by double-balloon endoscopy to prevent bleeding from the tumor. The patient had no melena or anemia and his condition improved after endoscopic mucosal resection. However, he died of liver failure 2 months later.

  13. New Endoscopic Techniques for Obscure Gastrointestinal Bleeding

    Directory of Open Access Journals (Sweden)

    Henk den Ouden


    Full Text Available The case of a postmenopausal woman with a congenital aortic stenosis is presented. She presented with severe iron deficiency anemia. After negative extensive gastrointestinal analysis, she was treated with octreotide for six months. After cessation of octreotide, anemia rapidly recurred. A second capsule endoscopy and a double balloon enteroscopy were performed, and an intestinal vascular malformation was found. After surgical segment resection, the patient had stable, normal levels of hemoglobin and no complaints after 14 months of follow-up.

  14. Gastrointestinal bleeding 30 years after a complicated cholecystectomy

    Institute of Scientific and Technical Information of China (English)

    Thorsten; Brechmann; Wolff; Schmiegel; Volkmar; Nicolas; Markus; Reiser


    Gastrointestinal bleeding from small-bowel varices is a rare and difficult to treat complication of portal hypertension. We describe the case of a 79-year-old female patient with recurrent severe hemorrhage from smallbowel varices 30 years after a complicated cholecystectomy. When double balloon enteroscopy was unsuccessful to reach the site of bleeding, a rendezvous approach was favored with intraoperative endoscopy. Active bleeding from varices within a biliodigestive anastomosis was found and controlled ...

  15. Triple-balloon pulmonary valvuloplasty: an advantageous technique for percutaneous repair of pulmonary valve stenosis in the large pediatric and adult patients. (United States)

    Escalera, Robert B; Chase, Thaddeus J; Owada, Carl Y


    This report describes a new valvuloplasty procedure for the treatment of pulmonary valve stenosis (PVS) and large pulmonary valve annulus (PVA) diameters using a triple-balloon valvuloplasty (TBV) technique. We sought to demonstrate the safety and efficacy of this new technique. Percutaneous balloon pulmonary valvuloplasty (BPV) is the preferred treatment for PVS. BPV in older patients with large PVA remains a challenge, even when the double-balloon valvuloplasty technique is performed. The technique was first attempted in a case where a large single balloon was unsuccessful and double-balloon valvuloplasty met with technical difficulties. Three subsequent patients underwent the procedure safely and successfully. An algorithm is presented to determine balloon size for TBV. The median PVA diameter was 23.9 mm. Balloon diameters ranged from 12 to 18 mm. The median peak right ventricular-to-pulmonary artery systolic pressure gradient was 43.5 mm Hg before valvuloplasty and was reduced to 12 mm Hg following intervention. No major complications were encountered. Percutaneous valvuloplasty using TBV can be performed safely and provides excellent clinical results. This technique offers advantages over single-balloon and double-balloon valvuloplasty techniques, especially in treatment of PVS in large pediatric or adult patients. Copyright 2005 Wiley-Liss, Inc.

  16. Meckel's diverticulum bleeding diagnosed with magnetic resonance enterography: a case report. (United States)

    Zhou, Fu-Run; Huang, Liu-Ye; Xie, Hai-Zhu


    Although the introduction of double-balloon enteroscopy has greatly improved the diagnostic rate, definite diagnosis of Meckel's diverticulum far from the ileocecal valve is still impossible in most cases. We explored the role of magnetic resonance (MR) enterography in detecting bleeding from Meckel's diverticulum that can not be confirmed via double-balloon enteroscopy. This study describes a case of male patient with bleeding from Meckel's diverticulum diagnosed with MR enterography of the small intestine. No bleeding lesion was found via colonoscopy, anal enteroscopy, or oral colonoscopy. MR enterography of the small intestine revealed an occupying lesion of 3.0 cm in the lower segment of the ileum. The patient was transferred to the Department of Abdominal Surgery of our hospital for surgical treatment. During surgery, a mass of 3 cm × 2 cm was found 150 cm from the ileocecal valve, in conjunction with congestion and edema of the corresponding mesangium. Intraoperative diagnosis was small bowel diverticulum with bleeding. The patient underwent partial resection of the small intestine. Postoperative pathology showed Meckel's diverticulum containing pancreatic tissues. He was cured and discharged 7 d after operation. We conclude that MR enterography of the small intestine has greatly improved the diagnosis rate of Meckel's diverticulum, particularly in those patients with the disease which can not be confirmed via double-balloon enteroscopy.

  17. CT enteroclysis in small bowel Crohn's disease

    Energy Technology Data Exchange (ETDEWEB)

    Kohli, Marc D. [Department of Radiology, Indiana University School of Medicine, Indianapolis, IN (United States); Maglinte, Dean D.T. [Department of Radiology, Indiana University School of Medicine, Indianapolis, IN (United States)], E-mail:


    The diagnostic evaluation of small bowel Crohn's disease has changed dramatically over the last decade. The introduction of wireless capsule endoscopy, double balloon endoscopy and the introduction of newer therapeutic agents have changed the role of imaging in the small bowel. Additionally, advances in multidetector CT technology have further changed how radiologic investigations are utilized in the diagnosis and management of small bowel Crohn's disease. This article describes how we perform CT enteroclysis in the investigation of small bowel Crohn's disease and discusses the role of CT enteroclysis in the current management of small bowel Crohn's disease.

  18. Review article: the diagnosis and investigation of obscure gastrointestinal bleeding. (United States)

    Liu, K; Kaffes, A J


    Obscure gastrointestinal bleeding (OGIB) is a commonly encountered clinical problem in gastroenterology and is associated with significant morbidity and mortality. The investigation and management of OGIB has changed dramatically over the past decade with the advent of newer gastroenterological and radiological technologies. To review the current evidence on the diagnosis and investigation of OGIB. We searched the PubMed database (1985-2010) for full original articles in English-language journals relevant to the investigation of OGIB. The search terms we used were 'gastrointestinal bleeding' or 'gastrointestinal hemorrhage' or 'small bowel bleeding' each in combination with 'obscure', or 'capsule endoscopy', or 'enteroscopy' or 'enterography' or 'enteroclysis'. Capsule endoscopy (CE) or double balloon enteroscopy (DBE) should be first line investigations. They are complimentary procedures with comparable high diagnostic yields. DBE is also able to provide therapeutic intervention. Newer technologies such as single balloon and spiral enteroscopy are currently being evaluated. Radiological and nuclear medicine investigations, such as CT enterography and CT enteroclysis, are alternative diagnostic tools when CE or DBE are contraindicated. Repeating the gastroscopy and/or colonoscopy may be considered in selective situations. An algorithm for investigation of obscure bleeding is proposed. The development of capsule endoscopy and double balloon enteroscopy has transformed the approach to the evaluation and management of obscure gastrointestinal bleeding over the past decade. Older diagnostic modalities still play a complementary, but increasingly selective role. © 2011 Blackwell Publishing Ltd.

  19. Recurrent Cholangitis by Biliary Stasis Due to Non-Obstructive Afferent Loop Syndrome After Pylorus-Preserving Pancreatoduodenectomy: Report of a Case (United States)

    Sanada, Yukihiro; Yamada, Naoya; Taguchi, Masanobu; Morishima, Kazue; Kasahara, Naoya; Kaneda, Yuji; Miki, Atsushi; Ishiguro, Yasunao; Kurogochi, Akira; Endo, Kazuhiro; Koizumi, Masaru; Sasanuma, Hideki; Fujiwara, Takehito; Sakuma, Yasunaru; Shimizu, Atsushi; Hyodo, Masanobu; Sata, Naohiro; Yasuda, Yoshikazu


    We report a 71-year-old man who had undergone pylorus-preserving pancreatoduodenectomy (PPPD) using PPPD-IV reconstruction for cholangiocarcinoma. For 6 years thereafter, he had suffered recurrent cholangitis, and also a right liver abscess (S5/8), which required percutaneous drainage at 9 years after PPPD. At 16 years after PPPD, he had been admitted to the other hospital because of acute purulent cholangitis. Although medical treatment resolved the cholangitis, the patient was referred to our hospital because of dilatation of the intrahepatic biliary duct (B2). Peroral double-balloon enteroscopy revealed that the diameter of the hepaticojejunostomy anastomosis was 12 mm, and cholangiography detected intrahepatic stones. Lithotripsy was performed using a basket catheter. At 1 year after lithotripsy procedure, the patient is doing well. Hepatobiliary scintigraphy at 60 minutes after intravenous injection demonstrated that deposit of the tracer still remained in the upper afferent loop jejunum. Therefore, we considered that the recurrent cholangitis, liver abscess, and intrahepatic lithiasis have been caused by biliary stasis due to nonobstructive afferent loop syndrome. Biliary retention due to nonobstructive afferent loop syndrome may cause recurrent cholangitis or liver abscess after hepaticojejunostomy, and double-balloon enteroscopy and hepatobiliary scintigraphy are useful for the diagnosis of nonobstructive afferent loop syndrome. PMID:25058778

  20. [Mid-gastrointestinal bleeding - endoscopy sheds light in the darkness]. (United States)

    May, A


    Mid-gastrointestinal bleeding is defined as a bleeding of the small bowel and is the most common indication for small bowel endoscopy. Intraoperative enteroscopy has been regarded as gold standard for a long time. With the introduction of different endoscopy techniques, they play now the central role, whereas intraoperative enteroscopy has become a reserve method for selected patients. Actually, there are, beside capsule endoscopy, five non-surgical, flexible enteroscopy techniques available. In Germany and Europe balloon-assisted enteroscopy (double balloon and single balloon enteroscopy) is mainly used. Double balloon enteroscopy (DBE) is the "oldest" flexible enteroscopy technique and has become established throughout the world for diagnostic and therapeutic examinations of the small bowel. The majority of the studies have been performed with DBE and it provides the highest rate of complete enteroscopy. Nevertheless, technical improvements to make enteroscopy easier and faster are still required. In patients with chronic MGI or problematic situations capsule endoscopy is an ideal screening option. In case of acute MGI the flexible enteroscopy techniques should be preferred because of the high diagnostic yield combined with the possibility of endoscopic therapeutic interventions. In difficult cases with unsuccessful enteroscopy, CT angiography and conventional angiography with the option of embolisation had proved their value.

  1. Arteriovenous Malformation Detected by Small Bowel Endoscopy

    Directory of Open Access Journals (Sweden)

    Takaaki Fujii


    Full Text Available Gastrointestinal bleeding that originates in the small intestine is often difficult to diagnose. When successful diagnosis reveals a lesion that can be localized preoperatively, the laparoscopic approach is an appropriate and beneficial treatment modality for small bowel resection. A 69-year-old man presented with a 6-month history of gastrointestinal bleeding and symptomatic transfusion-dependent anemia. Upper and lower endoscopy were normal. Double-balloon endoscopy established the source of the bleeding as a 0.5-cm polypoid mass appearing as a submucosal tumor with redness and pulsation in the lower ileum, suggesting a vascular lesion. Laparoscopic small bowel resection was successful in removing the mass in the ileum. Histological evaluation of the mass revealed an arteriovenous malformation. Preoperative small bowel endoscopy can be useful for diagnosing the cause and localization of arteriovenous malformation in the small intestine.

  2. Appropriate use of endoscopy in the diagnosis and treatment of gastrointestinal diseases: up-to-date indications for primary care providers

    Directory of Open Access Journals (Sweden)

    Vien X Nguyen


    Full Text Available Vien X Nguyen1, Vi Thuy Le Nguyen2, Cuong C Nguyen11Department of Gastroenterology, Mayo Clinic, Scottsdale, AZ, USA; 2Department of Pharmacy, Banner Baywood Medical Center, Mesa, AZ, USAAbstract: The field of endoscopy has revolutionized the diagnosis and treatment of ­gastrointestinal (GI diseases in recent years. Besides the ‘traditional’ endoscopic ­procedures (esophagogastroduodenoscopy, colonoscopy, flexible sigmoidoscopy, and endoscopic retrograde cholangiopancreatography, advances in imaging technology (endoscopic ultrasonography, ­wireless capsule endoscopy, and double balloon enteroscopy have allowed GI specialists to detect and manage disorders throughout the digestive system. This article reviews various ­endoscopic procedures and provides up-to-date endoscopic indications based on the ­recommendations of American Society for Gastrointestinal Endoscopy and American Cancer Society for primary care providers in order to achieve high-quality and cost-effective care.Keywords: endoscopy, endoscopic indications, endoscopic procedures, imaging, primary care, gastrointestinal disorders, appropriate use

  3. Usefulness of Small Intestinal Endoscopy in a Case of Adult-onset Familial Mediterranean Fever Associated with Jejunoileitis. (United States)

    Kitade, Takashi; Horiki, Noriyuki; Katsurahara, Masaki; Totoki, Toshiaki; Harada, Tetsuro; Tano, Shunsuke; Yamada, Reiko; Hamada, Yasuhiko; Inoue, Hiroyuki; Tanaka, Kyosuke; Gabazza, Esteban C; Hayashi, Hiroyuki; Tanaka, Masanori; Takei, Yoshiyuki


    A 66-year-old Japanese man consulted our institution due to paroxysmal and repetitive bouts of fever and abdominal pain that had persisted for more than one week. Capsule and double-balloon endoscopy (DBE) showed petal-shaped mucosal redness with white hemming in the jejunum and ileum, and histopathology of the biopsy specimens revealed villous atrophy and cryptitis with extensive severe neutrophil infiltration. A genetic examination disclosed compound heterozygous MEFV mutations (E84K, P369S), and familial Mediterranean fever was diagnosed. Treatment with colchicine and infliximab was very effective in inducing the complete disappearance of symptoms and normalization of the endoscopic findings. To the best of our knowledge, this is the first report to describe the findings of small intestinal endoscopic images obtained using capsule and DBE.

  4. Evaluation of the margins of differentiated early gastriccancer by using conventional endoscopy

    Institute of Scientific and Technical Information of China (English)


    Progress in double-balloon endoscopy (DBE) hasallowed for the diagnosis and treatment of disease inthe postoperative bowel. For example, a short DBE,which has a 2.8 mm working channel and 152 cmworking length, is useful for endoscopic retrogradecholangiopancreatography in bowel disease patients.However, afferent loop and Roux-limb obstruction,though rare, is caused by postoperative recurrence ofbiliary tract cancer with intractable complications. Mostof the clinical findings involving these complicationsare relatively nonspecific and include abdominal pain,nausea, vomiting, fever, and obstructive jaundice.Treatments by surgery, percutaneous transhepaticbiliary drainage, percutaneous enteral stent insertion,and endoscopic therapy have been reported. Thegeneral conditions of patients with these complicationsare poor due to cancer progression; therefore, a lessinvasive treatment is better. We report on the usefulnessof metallic stent insertion using an overtube for afferentloop and Roux-limb obstruction caused by postoperativerecurrence of biliary tract cancer under short DBE in twopatients with complexly reconstructed intestines.

  5. Bleeding Jejunal Diverticulosis in a Patient with Myasthenia Gravis

    Directory of Open Access Journals (Sweden)

    I. Zuber-Jerger


    Full Text Available A seventy-year-old male presented with severe myasthenia gravis and an episode of obscure bleeding. There was a history of gastric ulcer leading to Billroth II surgery twenty-five years ago. Upper endoscopy revealed no pathology. Colonoscopy showed a few solitary diverticula and traces of old blood in the terminal ileum. Capsule endoscopy pictured red smear in the upper jejunum. Diverticula were seen as well. Suspecting bleeding jejunal diverticulosis double balloon enteroscopy was performed. The complete jejunal ascending loop and about 100 cm of the jejunum through the descending jejunal loop could be inspected. Large diverticula with fecoliths were found in both loops. Bleeding had ceased. The patient was discharged to neurology for optimizing therapy for myasthenia gravis.

  6. Enteroendocrine K and L cells in healthy and type 2 diabetic individuals

    DEFF Research Database (Denmark)

    Jorsal, Tina; Rhee, Nicolai A; Pedersen, Jens


    AIMS/HYPOTHESIS: Enteroendocrine K and L cells are pivotal in regulating appetite and glucose homeostasis. Knowledge of their distribution in humans is sparse and it is unknown whether alterations occur in type 2 diabetes. We aimed to evaluate the distribution of enteroendocrine K and L cells...... and relevant prohormone-processing enzymes (using immunohistochemical staining), and to evaluate the mRNA expression of the corresponding genes along the entire intestinal tract in individuals with type 2 diabetes and healthy participants. METHODS: In this cross-sectional study, 12 individuals with type 2...... diabetes and 12 age- and BMI-matched healthy individuals underwent upper and lower double-balloon enteroscopy with mucosal biopsy retrieval from approximately every 30 cm of the small intestine and from seven specific anatomical locations in the large intestine. RESULTS: Significantly different densities...

  7. 正确掌握引产催产方法

    Institute of Scientific and Technical Information of China (English)

    张建平; 包琳


    This article includes an overview of various techniques to effect delivery; prostaglandins, foley catheter, double balloon catheter and oxytocin, and also includes an introduction of treatments for the prolonged pregnancy, nuchal cord encirclements, fatal distress, premature of membrane, pregnancy-induced hypertension and vaginal birth after cesarean section, which are unnecessary for cesarean sections.%文章介绍了常见的引产、催产的方法,如地诺前列酮、水囊、缩宫素,并针对无剖宫产指征者,如超期(过期)妊娠、脐带绕颈、胎儿窘迫、胎膜早破、妊娠期高血压疾病、剖宫产后再次阴道分娩的引产和催产方式做了介绍.

  8. Evaluation and outcomes of patients with obscure gastrointestinal bleeding

    Institute of Scientific and Technical Information of China (English)

    Cositha; Santhakumar; Ken; Liu


    Obscure gastrointestinal bleeding(OGIB) is defined as recurrent or persistent bleeding or presence of iron deficiency anaemia after evaluation with a negative bidirectional endoscopy. OGIB accounts for 5% of gastrointestinal bleeding and presents a diagnostic challenge. Current modalities available for the investigation of OGIB include capsule endoscopy, balloon assisted enteroscopy, spiral enteroscopy and computed tomography enterography. These modalities overcome the limitations of previous techniques. Following a negative bidirectional endoscopy, capsule endoscopy and double balloon enteroscopy remain the cornerstone of investigation in OGIB given their high diagnostic yield. Longterm outcome data in patients with OGIB is limited, but is most promising for capsule endoscopy. This article reviews the current literature and provides an overview of the clinical evaluation of patients with OGIB, available diagnostic and therapeutic modalities and longterm clinical outcomes.

  9. Iatrogenic Colonic Perforation due to Computed Tomographic Colonography

    Directory of Open Access Journals (Sweden)

    Takashi Kato


    Full Text Available Although the complications of computed tomographic colonography (CTC are very rare, CTC is associated with potential risk of colonic perforation. In the present report we describe two cases of colonic perforation secondary to CTC. In the first case with ascending colonic carcinoma, insertion of a rigid double-balloon catheter caused direct rectal wall perforation. In the second case with obstructive colonic carcinoma, pneumoperitoneum developed due to automated carbon dioxide insufflation. Both patients were asymptomatic after examination and recovered without any complications. Based on the findings of the current cases, we recommend that a soft-tip catheter be used for CTC, and suggest that colonic perforation can occur even with automatic insufflation, depending on patient characteristics.

  10. Clinical approach to obscure GI bleeding - Diagnostic testing and management

    Directory of Open Access Journals (Sweden)

    Prashanth Prabakaran


    Full Text Available Obscure gastrointestinal bleeding (OGIB can present as a diagnostic dilemma and management can be challenging. The search for causes of OGIB is usually centered on visualizing the small bowel, and in the past decade, the technology to visualize the entire small bowel has significantly advanced. Moreover, small bowel endoscopic imaging has replaced, in many instances, prior radiographic evaluation for obscure GI bleeding. These new modalities, such as small bowel capsule endoscopy (CE, balloon-assisted deep enteroscopy [double balloon enteroscopy (DBE and single balloon enteroscopy (SBE], and overtube-assisted deep enteroscopy (spiral enteroscopy, are paving the way toward more accurately identifying and treating patients with OGIB. We will review the diagnostic modalities available in evaluating a patient with OGIB and also propose the management based on clinical and endoscopic findings.

  11. A New Paradigm in Space Based Experiments Using Rubber Balloons

    CERN Document Server

    Chakrabarti, Sandip K; Palit, Sourav; Chakraborty, Subhankar; Mondal, Sushanta; Bhattacharyya, Arnab; Middya, Susanta; Chakrabarti, Sonali


    Indian Centre for Space Physics is engaged in long duration balloon borne experiments with typical payloads less than ~ 3kg. Low cost rubber balloons are used. In a double balloon system, the booster balloon lifts the orbiter balloon to its cruising altitude where data is taken for a long time. Here we present results of muon detections and recent solar activities, including the light curves and flare spectra in the 20-100keV range. We not only show that we have successfully obtained several flares and there spectra at different altitudes, we also found that the high energy X-ray flux of strong flares at altitudes of 10-13 km (the flight altitude of commercial planes) could be more than the contribution due to cosmic rays.

  12. Multifocal stenosing ulceration of the small intestine

    Institute of Scientific and Technical Information of China (English)

    Hugh James Freeman


    Several reports have described an apparently uncommon clinicopathological disorder that is characterized by multifocal stenosing small-intestinal ulceration. Compared to Crohn's disease, the ulcers are not transmural and typically remain shallow, and involve only the mucosa and submucosa. The disorder seems to be localized in the jejunum and proximal ileum only, and not the distal ileum or colon. Only nonspecific inflammatory changes are present without giant cells or other typical features of granulomatous inflammation. Most patients present clinically with recurrent obstructive events that usually respond to steroids, surgical resection, or both. With the development of newer imaging modalities to visualize the small-intestinal mucosa, such as double-balloon enteroscopy, improved understanding of the long-term natural history of this apparently distinctive disorder should emerge.

  13. Capsule endoscopy in non-steroidal anti-inflammatory drugs-enteropathy and miscellaneous, rare intestinal diseases

    Institute of Scientific and Technical Information of China (English)

    Gerard Gay; Michel Delvaux; Muriel Frederic


    Despite significant advances over the last decade,mucosal lesions of the small bowel are poorly detected by imaging studies such as CT scan,MRI-enteroclysis and contrast-enhanced abdominal ultrasound.Capsule endoscopy (CE) has dramatically changed the diagnostic approach to intestinal diseases.Moreover,the use of CE can be extended to include other conditions.However,it is difficult to assess the positive influence of CE on patient outcomes in conditions involving a small number of patients,or in critically ill and difficult to examine patients.CE has the advantage of diagnosing intestinal lesions and of directing the use of double balloon enteroscopy (DBE) in order to obtain biopsy specimens.Moreover,CE allows repeated assessment in chronic conditions,especially to detect relapse of an infectious disease.

  14. An update on pediatric endoscopy. (United States)

    Friedt, Michael; Welsch, Simon


    Advances in endoscopy and anesthesia have enabled gastrointestinal endoscopy for children since 1960. Over the past decades, the number of endoscopies has increased rapidly. As specialized teams of pediatric gastroenterologists, pediatric intensive care physicians and pediatric endoscopy nurses are available in many medical centers, safe and effective procedures have been established. Therefore, diagnostic endoscopies in children are routine clinical procedures. The most frequently performed endoscopies are esophagogastroduodenoscopy (EGD), colonoscopy and endoscopic retrograde cholangiopancreaticography (ERCP). Therapeutic interventions include variceal bleeding ligation, foreign body retrieval and percutaneous endoscopic gastrostomy. New advances in pediatric endoscopy have led to more sensitive diagnostics of common pediatric gastrointestinal disorders, such as Crohn's disease, ulcerative colitis and celiac disease; likewise, new diseases, such as eosinophilic esophagitis, have been brought to light.Upcoming modalities, such as capsule endoscopy, double balloon enteroscopy and narrow band imaging, are being established and may contribute to diagnostics in pediatric gastroenterology in the future.

  15. Endoscopic findings in the excluded stomach after Roux-en-Y gastric bypass surgery. (United States)

    Kuga, Rogerio; Safatle-Ribeiro, Adriana V; Faintuch, Joel; Ishida, Robson K; Furuya, Carlos K; Garrido, Arthur B; Cecconello, Ivan; Ishioka, Shinichi; Sakai, Paulo


    After gastric bypass surgery performed because of morbid obesity, the excluded stomach can rarely be endoscopically examined. With the advent of a new apparatus and technique, possible mucosal changes can be routinely accessed and monitored, thus preventing potential benign and malignant complications. Prospective observational study in a homogeneous population with nonspecific symptoms. Outpatient clinic of a large public academic hospital. Forty consecutive patients (mean +/- SD age, 44.5 +/- 10.0 y ears; 85.0% women) were seen at a mean +/- SD of 77.3 +/- 19.4 months after Roux-en-Y gastric bypass surgery. Elective double-balloon enteroscopy of the excluded stomach was performed. Rate of successful intubation, endoscopic findings, and complications. The excluded stomach was reached in 35 of 40 patients (87.5%). Mean +/- SD time to enter the organ was 24.9 +/- 14.3 minutes (range, 5-75 minutes). Endoscopic findings were normal in 9 patients (25.7%), whereas in 26 (74.3%), various types of gastritis (erythematous, erosive, hemorrhagic erosive, and atrophic) were identified, primarily in the gastric body and antrum. No cancer was documented in the present series. Tolerance was good, and no complications were recorded during or after the intervention. The double-balloon method is useful and practical for access to the excluded stomach. Although cancer was not noted, most of the studied population had gastritis, including moderate and severe forms. Surveillance of the excluded stomach is recommended after Roux-en-Y gastric bypass surgery performed because of morbid obesity.

  16. Special diaphragm-like strictures of small bowel unrelated to non-steroidal anti-inflammatory drugs

    Institute of Scientific and Technical Information of China (English)

    Ming-Liang Wang; Fei Miao; Yong-Hua Tang; Xue-Song Zhao; Jie Zhong; Fei Yuan


    AIM: To summarize clinical, endoscopic, radiologic and pathologic ffeatures off special diaphragm-like strictures ffound in small bowel, with no patient use off non-steroidal anti-inflammatory drugs (NSAIDs). METHODS: From January 2000 to Ddecember 2009, 5 cases (2 men and 3 women, with a mean age of 41.6 years) were diagnosed as having diaphragm-like strictures off small bowel on imaging,operationand, operationandoperation and pathology. All the patients denied the use of NSAIDs. The clinical, endoscopic, radiologic and pathologic findings in these 5 patients were retrospectively reviewed from the hospital database. Images of capsule endoscopy (CE) and small bowel follow-through (SBFT) obtained in 3 and 3 patients, respectively, and images off double-balloon enteroscopy and computed tomography enterography (CTE) obtained in all 5 patients were available for review. RESULTS: All patients presented with long-term (2-16 years) symptoms of gastrointestinal bleeding and varying degrees of anemia. There was only one stricture in ffour cases and three lesions in one case, and all the lesions were located in the middle or distal segment off ileum. Circumferential stricture was shown in the small bowel in three cases in the CE image, but the capsule was retained in the small bowel of 2 patients. Routine abdomen computed tomography scan showed no other abnormal results except gallstones in one patient. The lesions were shown as circumfferential strictures accompanied by dilated small bowel loops in the small bowel on the images of CTE (in all 5 cases), SBFT (in 2 cases) and double-balloon enteroscopy (in all cases). On microscopy, a chronic infflammatory inffiltrate and circumferential diaphragm were found in all lesions. CONCLUSION: Ddiaphragm-like strictures off small bowel might be a special consequence off unclear damaging insults to the intestine, having similar clinical, endoscopic, radiologic and pathologic features.

  17. Small bowel capsule endoscopy in 2007: Indications, risks and limitations

    Institute of Scientific and Technical Information of China (English)


    Capsule endoscopy has revoluzionized the study of the small bowel by providing a reliable method to evaluate,endoscopically, the entire small bowel. In the last six years several papers have been published exploring the possible role of this examination in different clinical conditions. At the present time capsule endoscopy is generally recommended as a third examination, after negative bidirectional endoscopy, in patients with obscure gastrointestinal bleeding. A growing body of evidence suggests also an important role for this examination in other clinical conditions such as Crohn's disease, celiac disease, small bowel polyposis syndromes or small bowel tumors. The main complication of this examination is the retention of the device at the site of a previously unknown small bowel stricture. However there are also some other open issues mainly due to technical limitations of this tool (which is not driven from remote control, is unable to take biopsies, to insufflate air, to suck fluids or debris and sometimes to correctly size and locate lesions).The recently developed double balloon enteroscope, owing to its capability to explore a large part of the small bowel and to take targeted biopsies, although being invasive and time consuming,can overcome some limitations of capsule endoscopy.At the present time, in the majority of clinical conditions (i.e. obscure GI bleeding), the winning strategy seems to be to couple these two techniques to explore the small bowel in a painless, safe and complete way (with capsule endoscopy) and to define and treat the lesions identified (with double balloon enteroscopy).


    Directory of Open Access Journals (Sweden)

    Mahesh Babu


    Full Text Available BACKGROUND: Maintaining the lumen patency of Central venous catheters (CVCsusing low dose Heparin is recommended in many guidelines of CVC maintenance. This study is to compare the efficacy of low - dose Heparin 3ml (10U/ml and 0.9% Sodium chloride (10ml flush solutions to maintain Centra l venous catheter (CVC lumen patency. METHODS: We s tudied 100 adult patients between March 2012 and August 2012 who required short - term CVC insertion to compare two flush solutions , Heparin and0.9% Sodium Chloride on catheter lumen patency . RESULTS : The crude catheter non patency was 4% ( two lumensin Heparin group and 8% (four lumens in the Sodium Chloride group . There was no incidence of thrombocytopenia in both the study groups. CONCLUSION : This study has demonstrated no significant difference bet ween Heparin and 0.9% Sodium Chloride flushes with regards to catheter patency in adult patients with short - term use of CVCs .

  19. Ischemic etiopathogenesis as the possible origin of post-double baloon enteroscopy pancreatitis: a porcine model study

    Directory of Open Access Journals (Sweden)

    Federico Soria


    Full Text Available The aim is to evaluate the pancreatic vascular-ischemic effects related to double balloon enteroscopy in the porcine model as a possible etiopathogenesis of post-enteroscopic pancreatitis. For this reason we carry out two independent experiments in a porcine animal model. In the first arm protocol (group I, 10 animals underwent 90 minutes of oral enteroscopy with 7 days follow-up. The levels of amylase, lipase and C-reactive protein were measured at T0 basal-T1 -90 min, T2-24, T3-7 days. Also we perform upper gastrointestinal endoscopy in a control group. At 7 days, the animals of experimental protocol-I had their pancreases removed for a pathological and immunohistochemical study to evaluate vascular epithelial growth factor (VEGF expression. The second experimental protocol in this study aims to evaluate possible changes in vascular topography due to the double balloon enteroscopy (DBE. Group-II (10 animals underwent oral enteroscopy and selective angiography of the cranial mesenteric artery and celiac trunk. None of the group I or control group animals presented pancreatitis, although the biochemical results for group-I showed increases in the levels of amylase, lipase and C reactive protein at 24 hours. The microscopic study for group-I showed pancreatic necrotic foci and positive VEGF expression, though these changes were not expressed in the control group. These foci were found in 50 % of the group I animals and in relation to the total of the parenchyma were quantified at 6 % of the pancreas. The results for group-II showed that the enteroscopy caused mobilization of the mesenteric vascular axis, with signs of both intestinal and pancreatic hypoperfusion. The conclusions of this study are that, after enteroscopy in the porcine model, pancreatic necrotic foci are produced, in addition to ischemic phenomena causing VEGF expression. This could be related to episodes of visceral hypoperfusion caused by vascular alterations on a topographic

  20. Mesenteric Air Embolism Following Enteroscopic Small Bowel Tattooing Procedure

    Directory of Open Access Journals (Sweden)

    Natalie Chen


    Full Text Available Double balloon enteroscopy (DBE is a revolutionary procedure in which the entire small bowel can be visualized endoscopically. DBE has the advantage of both diagnostic and therapeutic capabilities in the setting of small bowel neoplasms and vascular malformations. We present a unique case of a 76-year-old female who underwent small bowel DBE tattoo marking of a distal small bowel tumor complicated by development of severe abdominal pain postprocedure secondary to bowel air embolism into the mesenteric veins. Mesenteric air can be seen after other endoscopic procedures such as biopsy, mucosal clip placement and polypectomy, or following a colonoscopy. Mesenteric air embolism following small bowel tattooing procedure has not been previously reported in the literature. Mesenteric air when present may be attributed to mesenteric ischemia and can subject the patient to unnecessary surgical intervention if misdiagnosed. Thus, this report holds significance for the radiologist as computed tomography (CT findings of mesenteric air embolism must be evaluated in the context of appropriate clinical history before treatment decisions are made.

  1. Transabdominal Ultrasonography of the Small Bowel

    Directory of Open Access Journals (Sweden)

    Rudolf Kralik


    Full Text Available In the era of double balloon enteroscopy, capsule endoscopy, CT, and MRI enterography is transabdominal ultrasonography (TUS underestimated method for evaluation of small bowel pathology. As often initial imagine method in abdominal complaints, nowadays has TUS much better diagnostic potential than two decades ago. High-resolution ultrasound probes with harmonic imaging significantly improve resolution of bowel wall in real time, with possibility to asses bowel peristalsis. Color flow doppler enables evaluation of intramural bowel vascularisation, pulse wave doppler helps to quantificate flow in coeliac and superior mesenteric arteries. Small intestine contrast ultrasonography with oral contrast fluid, as well as contrast enhanced ultrasonography with intravenous microbubble contrast also improves small bowel imaging. We present a review of small intestine pathology that should be detected during ultrasound examinations, discuss technical requirements, advantages and limitations of TUS, typical ultrasound signs of Crohn's disease, ileus, celiac disease, intussusception, infectious enteritis, tumours, ischemic and haemorrhagic conditions of small bowel. In the hands of experienced investigator, despite some significant limitations(obesity, meteorism, is transabdominal ultrasonography reliable, noninvasive and inexpensive alternative method to computerised tomography (CT and magnetic resonance imaging (MRI in small bowel examination.

  2. Sonography of the small intestine

    Institute of Scientific and Technical Information of China (English)

    Kim Nylund; Svein (φ)degaard; Trygve Hausken; Geir Folvik; Gülen Arslan Lied; Ivan Viola; Helwig Hauser; Odd-Helge Gilja


    In the last two decades, there has been substantial development in the diagnostic possibilities for examining the small intestine. Compared with computerized tomography, magnetic resonance imaging, capsule endoscopy and double-balloon endoscopy, ultrasonography has the advantage of being cheap, portable, flexible and user- and patient-friendly, while at the same time providing the clinician with image data of high temporal and spatial resolution. The method has limitations with penetration in obesity and with intestinal air impairing image quality. The flexibility ultrasonography offers the examiner also implies that a systematic approach during scanning is needed. This paper reviews the basic scanning techniques and new modalities such as contrast-enhanced ultrasound, elastography, strain rate imaging, hydrosonography, allergosonography, endoscopic sonography and nutritional imaging, and the literature on disease-specific findings in the small intestine. Some of these methods have shown clinical benefit, while others are under research and development to establish their role in the diagnostic repertoire. However, along with improved overall image quality of new ultrasound scanners, these methods have enabled more anatomical and physiological changes in the small intestine to be observed. Accordingly, ultrasound of the small intestine is an attractive clinical tool to study patients with a range of diseases.

  3. Consensus of the Present and Prospects on Endoscopic Diagnosis and Treatment in East Asian Countries

    Directory of Open Access Journals (Sweden)

    Takeshi Kamiya


    Full Text Available Background and Aim. New diagnostic or therapeutic methods in endoscopy have been used. Current clinical application of these procedures is not well known. The aim of this study is to investigate the present situation on endoscopic diagnosis and treatment of gastrointestinal disorders in East Asian countries. Method. A representative member from the International Gastrointestinal Consensus Symposium Committee provided a questionnaire to physicians in China, Indonesia, Japan, Korea, the Philippines, and Thailand. Results. In total, 514 physicians including gastroenterologists, surgeons, and general practitioners enrolled. The most frequently occurring disorder as the origin of upper gastrointestinal bleeding is gastric ulcer. Capsule endoscopy is selected as the first choice for the diagnosis of small intestine bleeding. The second choice was double-balloon endoscopy or angiography. For patients with gastric adenoma, the number of physicians who choose endoscopic mucosal resection is larger than those selecting endoscopic submucosal dissection (ESD in China, Indonesia, the Philippines, and Thailand. ESD is chosen first in Japan and Korea. Conclusion. New instruments or techniques on endoscopy have not come into wide use yet, and there is diversity in the situation on it in Asian countries. We should unify the endoscopic diagnostic criteria or treated strategy in patients with GI disease.

  4. Restenosis following balloon dilation of benign esophageal stenosis

    Institute of Scientific and Technical Information of China (English)

    Ying-Sheng Cheng; Ming-Hua Li; Ren-Jie Yang; Hui-Zhen Zhang; Zai-Xian Ding; Qi-Xin Zhuang; Zhi-Ming Jiang; Ke-Zhong Shang


    AIM: To elucidate the mechanism of restenosis following balloon dilation of benign esophageal stenosis.METHODS: A total of 49 rats with esophageal stenosis were induced in 70 rats using 5 ml of 50 % sodium hydroxide solution and the double-balloon method, and an esophageal restenosis (RS) model was developed by esophageal stenosis using dilation of a percutaneous transluminal coronary angioplasty (PTCA) balloon catheter. These 49 rats were divided into two groups: rats with benign esophageal stricture caused by chemical burn only (control group, n=21) and rats with their esophageal stricture treated with balloon catheter dilation (experimental group, n=28). Imaging analysis and immunohistochemistry were used for both quantitative and qualitative analyses of esophageal stenosis and RS formation in the rats, respectively.RESULTS: Cross-sectional areas and perimeters of the esophageal mucosa layer, muscle layer, and the entire esophageal layers increased significantly in the experimental group compared with the control group. Proliferating cell nuclear antigen (PCNA) was expressed on the 5th day after dilation, and was still present at 1 month. Fibronectin (FN)was expressed on the 1st day after dilation, and was still present at 1 month.CONCLUSION: Expression of PCNA and FN plays an important role in RS after balloon dilation of benign esophageal stenosis.

  5. Balloon-assisted enteroscopy for suspected Meckel’s diverticulum and indefinite diagnostic imaging workup (United States)

    Gomes, Guilherme Francisco; Bonin, Eduardo Aimore; Noda, Rafael William; Cavazzola, Leandro Totti; Bartholomei, Thiago Ferreira


    Meckel’s diverticulum (MD) is estimated to affect 1%-2% of the general population, and it represents a clinically silent finding of a congenital anomaly in up to 85% of the cases. In adults, MD may cause symptoms, such as overt occult lower gastrointestinal bleeding. The diagnostic imaging workup includes computed tomography scan, magnetic resonance imaging enterography, technetium 99m scintigraphy (99mTc) using either labeled red blood cells or pertechnetate (known as the Meckel’s scan) and angiography. The preoperative detection rate of MD in adults is low, and many patients ultimately undergo exploratory laparoscopy. More recently, however, endoscopic identification of MD has been possible with the use of balloon-assisted enteroscopy via direct luminal access, which also provides visualization of the diverticular ostium. The aim of this study was to review the diagnosis by double-balloon enteroscopy of 4 adults with symptomatic MD but who had negative diagnostic imaging workups. These cases indicate that balloon-assisted enteroscopy is a valuable diagnostic method and should be considered in adult patients who have suspected MD and indefinite findings on diagnostic imaging workup, including negative Meckel’s scan. PMID:27803776

  6. A case report concerning the importance of the patients’ symptoms and clinical findings in the management of patients

    Directory of Open Access Journals (Sweden)

    Bodil Ohlsson


    Full Text Available The gastrointestinal tract has always been difficult to visualize in its entire length. New technology such as magnetic resonance imaging enterography, computed tomography ente­ro­­graphy, single- and double-balloon entero­scopy, and video capsule enteroscopy have improved the possibilities for visualizing mucosal changes and pathology in the small intestine. We describe here a case of a patient with gastrointestinal signs and symptoms suggesting recurrent intestinal obstruction over a period of several years, who had mostly normal morphology on endoscopic examination. Nonetheless, after some delay, the patient underwent explorative surgery because of his accelerating symptoms. Abdominal exploration revealed a Meckel’s diverticulum, which had led to inflammatory adhesions of the small intestine with a sharp bend and proximal intestinal dilation. After the operation the patient’s health was restored. We concluded that in certain situations the clinician should rely on the patients’ symptoms and clinical findings more than on technological examinations and the clinical picture should guide clin­icians’ interventions, even though we live in a high-technique era.

  7. Assessing the reproducibility of high definition urethral pressure profilometry and its correlation with an air-charged system. (United States)

    Klünder, Mario; Amend, Bastian; Sawodny, Oliver; Stenzl, Arnulf; Ederer, Michael; Kelp, Alexandra; Sievert, Karl-Dietrich; Feuer, Ronny


    Recently, a new urodynamic method for the assessment of stress urinary incontinence called high definition urethral pressure profilometry (HD-UPP) has been introduced. This method combines a novel microtip catheter with advanced signal processing to enable spatial data location and the reconstruction of a pressure image inside the urethra. In order to assess the reproducibility of HD-UPP data, we statistically evaluate HD-UPP datasets and compare them to data from a double balloon air-charged system. Both catheters are used on sedated female minipigs. Data from the microtip catheter are processed through a signal reconstruction algorithm, urodynamic features are extracted, and compared to the air-charged system. Reproducibility of HD-UPP data is assessed by statistically evaluating consecutive, intra-individual datasets. HD-UPP delivers results in agreement with previous comparisons of microtip and air-charged systems. The average deviation of two consecutive, intra-individual pressure images is very low at 7 cm H2 O. HD-UPP provides physicians with detailed information on the pressure distribution inside the urethra. Through comparison with an air-charged catheter, it is shown that HD-UPP delivers results in agreement with previous studies on the comparison of microtip and air-charged catheters. It provides excellent reproducibility, as the difference between sequentially measured profiles from the same minipig is significantly lower than the one between profiles from different minipigs. © 2016 Wiley Periodicals, Inc.

  8. Infection with fully mature Corynosoma cf. validum causes ulcers in the human small intestine. (United States)

    Takahashi, Keitaro; Ito, Takahiro; Sato, Tomonobu; Goto, Mitsuru; Kawamoto, Toru; Fujinaga, Akihiro; Yanagawa, Nobuyuki; Saito, Yoshinori; Nakao, Minoru; Hasegawa, Hideo; Fujiya, Mikihiro


    Corynosoma is a parasite that can normally be found in the intestinal tract of fish-eating mammals, particularly in seals and birds. The present case proposed that Corynosoma could attain full maturity in the human intestine. A 70-year-old female complained of abdominal pain. A computed tomography (CT) scan revealed a swelling of the intraperitoneal lymph nodes with no responsible lesion. Video capsule endoscopy and double-balloon endoscopy detected several ulcerations and one parasite in the ileum, which was tightly attached at the bottom of the ulcerations. The parasite was cylindrical and measured approximately 10 mm (long) x 3 mm (wide). Pathologically, the worm had a four-layered body wall and contained embryonated eggs. The sequences of the parasite-derived nuclear ribosomal DNA fragment and mitochondrial DNA fragment of cox1 were almost identical to those of Corynosoma validum. The patient's abdominal pain immediately improved after the administration of pyrantel pamoate (1,500 mg). Corynosoma was possibly the responsible disease in a patient who complained of abdominal pain and in whom no responsible lesion was detected by CT, gastroduodenoscopy or colonoscopy. Examinations of the small intestines should be aggressively performed in such cases.

  9. Considerable Risk of Restenosis After Endoscopic Treatment for Hepaticojejunostomy Stricture After Living-Donor Liver Transplantation. (United States)

    Kamei, H; Imai, H; Onishi, Y; Ishihara, M; Nakamura, M; Kawashima, H; Ishigami, M; Ito, A; Ohmiya, N; Hirooka, Y; Goto, H; Ogura, Y


    There are few reports on the short- and long-term follow-up of endoscopic retrograde cholangiography (ERC) in adult patients with hepaticojejunostomy (HJS) stricture after living-donor liver transplantation (LDLT). Nine LDLT recipients underwent ERC with the use of double-balloon endoscopy (DBE) for HJS stricture at Nagoya University Hospital. We assessed the rate of reaching biliary anastomosis, procedure success rate, procedure duration, complications, improvement in liver function test results, and biliary anastomosis patency. In total, 19 ERC procedures with the use of DBE were performed for 9 adult LDLT recipients with HJS stricture from June 2006 to September 2014. Balloon dilation with the use of DBE was successfully performed in 5 of the 9 patients during the 1st procedure. Of the 4 patients in whom DBE-ERC failed to be completed, 3 patients underwent 2nd procedures successfully. Liver function test results were significantly improved in the successful cases. Four patients underwent 2nd DBE-ERC for stricture recurrence at a mean time of 2.3 years after the 1st successful procedure. Of those, 2 patients required 3rd procedures for stricture recurrence after the 2nd procedure. DBE-ERC is promising as a treatment for HJS stricture in adult LDLT recipients in the short term. However, the DBE-ERC procedure may have a considerable risk of restenosis. Copyright © 2015 Elsevier Inc. All rights reserved.

  10. Ancylostoma ceylanicum hookworm infection in Japanese traveler who presented chronic diarrhea after return from Lao People's Democratic Republic. (United States)

    Kaya, Daisuke; Yoshikawa, Masahide; Nakatani, Toshiya; Tomo-Oka, Fumimasa; Fujimoto, Yuki; Ishida, Koji; Fujinaga, Yukihisa; Aihara, Yosuke; Nagamatsu, Shinsaku; Matsuo, Eijo; Tokoro, Masaharu; Ouji, Yukiteru; Kikuchi, Eiryo


    Ancylostoma (A.) ceylanicum, one of the most common species of hookworms infecting dogs and cats, also causes patent infections in humans and is now considered to be the second most common hookworm species infecting populations in southeast Asia. A Japanese patient who returned from a visit to Thailand and Lao People's Democratic Republic (PDR) was presented with intermittent watery diarrhea with eosinophilia. Hookworm eggs were found in feces samples, and adult worms were confirmed to be present in the jejunum with capsule endoscopy and double balloon enteroscopy. A diagnosis of A. ceylanicum infection was made based on the morphology of the adult worms along with findings of a PCR-based molecular study using larvae obtained from a fecal sample culture. The infection was considered likely to have been obtained during a 1-month stay in a Laotian village, where the patient had eaten local food, worn sandals on bare feet, and lived as a local native villager, though he had stayed in modern hotels during the visit to Thailand. Copyright © 2016 Elsevier Ireland Ltd. All rights reserved.

  11. 胶囊内镜在小肠疾病中的应用进展%Progress of Application of Capsule Endoscopy in Small Bowel Diseases

    Institute of Scientific and Technical Information of China (English)



    胶囊内镜(CE)技术发展迅速,已成为一线小肠无创检查技术之一,目前已广泛用于不明原因消化道出血(0GIB)、炎症性肠病、小肠肿瘤、乳糜泻和腹痛等的诊断,其与双气囊小肠镜(DBE)联合应用可提高小肠疾病的诊疗水平.本文就CE在小肠疾病中的应用进展作一综述.%Capsule endoscopy (CE) has evolved in recent years to be a first-line, noninvasive diagnostic technique for small bowel diseases, and has now been widely used in the diagnosis of obscure gastrointestinal bleeding (OGIB),inflammatory bowel disease, small bowel tumor, celiac disease and abdominal pain, etc. The combination of CE and double-balloon enteroscopy (DBE) could further enhance the diagnostic and therapeutic yield in small bowel diseases. This article reviewed the progress of application of CE in small bowel diseases.

  12. Adenocarcinoma arising from jejunal ectopic pancreas mimicking peritoneal metastasis from colon cancer: a case report and literature review. (United States)

    Yamaoka, Yusuke; Yamaguchi, Tomohiro; Kinugasa, Yusuke; Shiomi, Akio; Kagawa, Hiroyasu; Yamakawa, Yushi; Numata, Masakatsu; Sugimoto, Shinya; Imai, Kenichiro; Hotta, Kinichi; Sasaki, Keiko


    Adenocarcinoma arising from jejunal ectopic pancreas is very rare. We report a case of a 69-year-old female with adenocarcinoma arising from jejunal ectopic pancreas after resection of advanced colon cancer. She underwent right hemicolectomy for advanced ascending colon cancer (ypT3N0M0, stage IIA) after chemotherapy. Two and half years after colectomy, her tumor markers were elevated, and computed tomography revealed a mass measuring 20 × 20 mm in the small intestine, having an abnormal uptake of (18)F-fluorodeoxyglucose on (18)F-fluorodeoxyglucose-positron emission tomography ((18)FDG-PET). Double-balloon enteroscopy revealed a submucosal tumor in the jejunum, and histopathology of biopsy specimens from that lesion showed ectopic pancreas without malignancy. Therefore, peritoneal metastasis from colon cancer concomitant with ectopic pancreas or adenocarcinoma arising from ectopic pancreas was considered as a differential diagnosis. She underwent laparoscopic jejunectomy. Pathological examination revealed a moderately differentiated adenocarcinoma arising from jejunal ectopic pancreas, not peritoneal metastasis from colon cancer. Even if histopathology of the biopsy specimen shows ectopic pancreas without malignancy, adenocarcinoma arising from ectopic pancreas should be considered when the tumor markers are elevated or the lesion has an abnormal uptake of (18)FDG.

  13. Study of the properties of Cosmic rays and solar X-Ray Flares by balloon borne experiments

    CERN Document Server

    Chakrabarti, S K; Chakraborty, S; Palit, S; Mondal, S K; Bhattacharya, A; Midya, S; Chakrabarti, S


    Indian Centre for Space Physics is engaged in pioneering balloon borne experiments with typical payloads less than ~ 3.5kg. Low cost rubber balloons are used to fly them to a height of about 40km. In a double balloon system, the booster balloon lifts the orbiter balloon to its cruising altitude where data is taken for a longer period of time. In this Paper, we present our first scientific report on the variation of Cosmic Rays and muons with altitude and detection of several solar flares in X-rays between 20keV and 100keV. We found the altitude of the Pfotzer maximum at Tropic of Cancer for cosmic rays and muons and catch several solar flares in hard X-rays. We find that the hard X-ray (> 40keV) sky becomes very transparent above Pfotzer maximum. We find the flare spectrum to have a power-law distribution. From these studies, we infer that valuable scientific research could be carried out in near space using low cost balloon borne experiments. Published in Online version of Indian Journal of Physics.

  14. [Peutz-Jeghers syndrome manifested as massive melæna at CHU-JRA Madagascar hospital: a case report]. (United States)

    Martinetti, Andrianimaro Florelia; Andriantsoa, Rasoanaivo Mamy; Andriambelo, Rajaonera Tovohery; Nicole, Rakotoarison Ratsaraharimanana Cathérine; Enintsoa, Raveloson Nasolotsiry


    Peutz-Jeghers syndrome (SPJ) is characterized by intestinal hamartomatous polyps in association with mucocutaneous lentiginosis. Patients are exposed to mechanical and bleeding complications. It is a cancer predisposition syndrome. Our study highlights the diagnostic criteria for Peutz-Jeghers syndrome (SPJ), the complications and the therapeutic progresses in patient care. We report the case of a 32-year-old male presenting with a massive melaena. It was hospitalized in the surgical intensive care unit with hypovolemic shock difficult to control. This required surgical intervention to stop bleeding. We found a hamartomatous polyps in the small intestine which caused bleeding. Peutz Jeghers Syndrome was diagnosed on the basis of labial lentigines during childhood. Clinical and paraclinical explorations did not reveal the presence of cancer. In Madagascar, this disease is still poorly understood. In the literature, the diagnosis of Peutz Jeghers syndrome is based on clinical findings or on the presence of complications such as haemorrhage, invagination or bowel obstruction. In our case, the disease was complicated by gastrointestinal bleeding with hypovolemic shock. Endoscopic polypectomy using double-balloon enteroscopy can reduce emergency small bowel surgery. Peutz-Jeghers syndrome is a rare disease. Despite this, it is important for clinicians to know it and to take it into consideration in case of gastrointestinal bleeding.

  15. Obscure gastrointestinal bleeding: preliminary comparison of 64-section CT enteroclysis with video capsule endoscopy

    Energy Technology Data Exchange (ETDEWEB)

    Khalife, Samer; Vahedi, Kouroche; Dray, Xavier; Marteau, Philippe [Hopital Lariboisiere-AP-HP, Universite Diderot-Paris 7, Department of Digestive Diseases, Paris Cedex 10 (France); Soyer, Philippe; Hamzi, Lounis; Place, Vinciane; Boudiaf, Mourad [Hopital Lariboisiere-AP-HP, Universite Diderot-Paris 7, Department of Abdominal Imaging, Paris Cedex 10 (France); Alatawi, Abdullah [Hopital Lariboisiere-AP-HP, Universite Diderot-Paris 7, Department of Digestive Diseases, Paris Cedex 10 (France); Hopital Lariboisiere-AP-HP, Universite Diderot-Paris 7, Department of Abdominal Imaging, Paris Cedex 10 (France)


    To retrospectively compare the diagnostic capabilities of 64-section CT enteroclysis with those of video capsule endoscopy (VCE) to elucidate the cause of obscure gastrointestinal bleeding. Thirty-two patients who had 64-section CT enteroclysis and VCE because of obscure gastrointestinal bleeding were included. Imaging findings were compared with those obtained at double balloon endoscopy, surgery and histopathological analysis, which were used as a standard of reference. Concordant findings were found in 22 patients (22/32; 69%), including normal findings (n = 13), tumours (n = 7), lymphangiectasia (n = 1) and inflammation (n = 1), and discrepancies in 10 patients (10/32; 31%), including ulcers (n = 3), angioectasias (n = 2), tumours (n = 2) and normal findings (n = 3). No statistical difference in the proportions of abnormal findings between 64-section CT enteroclysis (11/32; 34%) and VCE (17/32, 53%) (P = 0.207) was found. However, 64-section CT enteroclysis helped identify tumours not detected at VCE (n = 2) and definitely excluded suspected tumours (n = 3) because of bulges at VCE. Conversely, VCE showed ulcers (n = 3) and angioectasias (n = 2) which were not visible at 64-section CT enteroclysis. Our results suggest that 64-section CT enteroclysis and VCE have similar overall diagnostic yields in patients with obscure gastrointestinal bleeding. However, the two techniques are complementary in this specific population. (orig.)

  16. [Primary gastrointestinal follicular lymphoma of the small intestine with massive hemorrhage: a report of three cases]. (United States)

    Sato, Akiyasu; Tsujimura, Hideki; Sugiyama, Takahiro; Maruyama, Satoshi; Yamada, Shuhei; Ono, Keiko; Wang, Xiaofei; Sugawara, Takeaki; Ise, Mikiko; Itami, Makiko; Kumagai, Kyouya


    Primary gastrointestinal follicular lymphoma (FL) has an indolent clinical presentation and many of cases are diagnosed incidentally during routine endoscopic examinations. Herein, we present 3 cases with FL of the small intestine developed massive intestinal hemorrhage that necessitated blood transfusion. In all three patients, upper and lower endoscopic examinations failed to detect the bleeding sites. Eventually, video capsule endoscopies identified ulcerative lesions in the jejunum and biopsies using single- or double-balloon endoscopy confirmed the FL diagnosis in our three cases. The respective clinical stages according to the Lugano system were I, II-1 and II-1. PET-CT did not play a significant role in identifying the gastrointestinal lesions. Two patients received rituximab monotherapy and achieved a complete response. The other remains under observation after termination of antiplatelet drug therapy. Generally, the macroscopic appearance of multiple whitish nodules and the absence of symptoms represent the typical clinical picture of gastrointestinal FL. However, this study demonstrates that patients with ulcerative lesions may be at risk for massive bleeding. Further discussion is required to determine the optimal indications for total endoscopic examination of the small intestine.

  17. Recurrent Lower Gastrointestinal Bleeding: Ileal GIST Diagnosed by Video Capsule Endoscopy—A Case Report and Literature Review

    Directory of Open Access Journals (Sweden)

    Jie Ling


    Full Text Available Introduction. Gastrointestinal stromal tumor (GIST in the ileum is an extremely rare cause of recurrent lower gastrointestinal bleeding (GIB. Case Report. An 89-year-old man was admitted with melana. He had extensive PMH of CAD post-CABG/AICD, AAA repair, chronic anemia, myelodysplastic syndrome, lung cancer after resection, and recurrent GIB. Prior EGDs, colonoscopies, and upper device-assisted enteroscopy showed duodenal ulcer, A-V malformation s/p cauterization, and angioectasia. On admission, Hb was 6.0 g/dL. An endoscopic capsule study showed an ulcerated tumor in the ileum. CT showed no distant metastasis. The lesion was resected successfully and confirmed as a high-grade GIST. The patient was discharged with no further bleeding. Discussion. Early diagnosis for patients with ileal GIST is often challenging. Video capsule endoscopy and double balloon enteroscopy could be useful diagnostic tools. Surgical removal is the first line for a resectable GIST. Imatinib has become the standard therapy. Conclusion. This is a unique case of an ileal GIST in a patient with recurrent GIB which was diagnosed by video capsule. Complicated medical comorbidities often lead to a significant delay in diagnosis. Therefore, we recommend that if GIB does not resolve after appropriate treatments for known causes, the alternative diagnosis for occult GIB must be considered, including malignancy such as GIST.

  18. The evaluation and management of obscure and occult gastrointestinal bleeding. (United States)

    Singh, Vijay; Alexander, Jeffrey A


    Gastrointestinal (GI) bleeding is a common clinical presentation increasing in an aging population, frequently requiring hospitalization and emergent intervention, with significant morbidity, mortality, and costs. It may manifest overtly as hematemesis, melena, or hematochezia, or as an asymptomatic occult bleed. Management typically involves an esophagogastroduodenoscopy or a colonoscopy; these in combination sometimes do not identify a source of bleeding, with the source remaining obscure. Further work up to identify an obscure source frequently requires radiologically detecting the leakage of an intravascular tracer (using tagged red blood cells or angiography) with brisk bleeding or in other cases CT enterography (CTE) to detect bowel wall changes consistent with a bleeding source. Recent advances including capsule endoscopy, CTE, and double-balloon endoscopy have helped to identify bleeding sources beyond the reach of conventional endoscopy. Clinical decision-making about their use is complex and evolving. Knowing their relative merits and weaknesses including yield, contraindications, complications, and cost is essential in coming up with an appropriate management plan. This review covers the rationale for clinical management of obscure sources of GI bleeding, mentioning the approach to and the yield of conventional methods, with an emphasis on the recent advances mentioned above.

  19. Radiation profiles measured through clouds using a return glider radiosonde (United States)

    Kräuchi, Andreas; Philipona, Rolf; Kivi, Rigel


    With new and improved radiation sensors in a small glider aircraft vertical flights through clouds have been conducted. This new Return Glider Radiosonde (RG-R) is lifted up with double balloon technique to keep the radiation instruments as horizontal as possible during ascent. The RG-R is equipped with a routine radiosonde to transmit the data to a ground station and an autopilot to fly the glider radiosonde back to the launch site, where it lands autonomous with a parachute. The RG-R was successfully tested and deployed for tropospheric and stratospheric radiation measurements up to 30 hPa (24 km altitude) at the GRUAN sites Payerne (Switzerland) and Sodankylä (Finland). Radiation profiles and the radiation budget through the atmosphere during different daytimes and under cloud-free and cloudy situations will be shown in relation to temperature and humidity at the surface and in the atmosphere. The RG-R flight characteristics and new measurement possibilities will also be discussed.

  20. Familial Mediterranean fever in which Crohn's disease was suspected: a case report. (United States)

    Matsumoto, Satohiro; Urayoshi, Shunsuke; Yoshida, Yukio


    Familial Mediterranean fever is a hereditary autoinflammatory disease, mainly characterized by periodic fever and serositis. The level of awareness about familial Mediterranean fever is far from sufficient, and it is assumed that there may be many patients with this disease who are under observation without an accurate diagnosis. A 30-year-old Japanese man presented to us with a few years' history of recurrent episodes of fever, abdominal pain and diarrhea. He often visited a hospital when the attacks occurred; however, acute enteritis was diagnosed each time, and the symptoms resolved spontaneously within a few days. When he noticed a shortening of the interval between the attacks, he visited the hospital again. Upper endoscopy and colonoscopy performed at this hospital revealed no significant abnormal findings. He was then referred to our hospital under the suspicion of a small intestinal disease. Abdominal computed tomography revealed wall thickening and increased density of the mesenteric adipose tissue in the jejunum, which led us to suspect Crohn's disease. Oral double-balloon enteroscopy was performed; because this revealed only mild mucosal edema in the jejunum, Crohn's disease was considered to be highly improbable. Based on the patient's clinical course, we suspected familial Mediterranean fever. As the Livneh criteria for familial Mediterranean fever were satisfied, the patient was started on oral colchicine for the purpose of diagnostic treatment. A definitive diagnosis of familial Mediterranean fever was then made based on the detection of a mutation of the Mediterranean fever gene. A marked reduction in the frequency of attacks was observed in response to colchicine treatment. Although Crohn's disease may be considered first in the differential diagnosis of young patients presenting with periodic fever, abdominal pain and diarrhea, the possibility of familial Mediterranean fever should also be borne in mind.

  1. The Renaissance of Transcervical Balloon Catheters for Cervical Ripening and Labour Induction. (United States)

    Rath, W; Kehl, S


    Due to rising rates of labour induction in industrialised countries, safe and effective methods of induction have once again become a focus of interest and research. Prostaglandins are effective for cervical ripening and induction of uterine contractions. They do, however, cause overstimulation of the uterus in up to 20 % of cases, sometimes causing changes in fetal heart rate. Transcervical balloon catheters provide an alternative to prostaglandins for labour induction and have been used for this purpose for almost 50 years. This induction method has experienced a recent renaissance in clinical practice that is reflected in an annually rising number of publications on its use. Balloon catheters allow gentle ripening of the cervix without causing uterine overstimulation. The two catheters available are the Foley catheter (off-label use) and the double balloon catheter, which is licensed for use in induction of labour. Both are as effective as prostaglandins, and do not increase the risk of infection to mother or child. Catheter induction also requires less monitoring compared to prostaglandins resulting in improved patient satisfaction. Balloon catheters provide a useful and promising option to achieve vaginal delivery despite failed prostaglandin induction. Intravenous oxytocin is nevertheless required in up to 85 % of cases for adequate induction/augmentation of contractions. Balloon catheters, vaginal PGE2 and misoprostol are equally effective in the context of an unripe/unfavourable cervix, the rate of uterine hyperstimulation being significantly lower, and the need for oxytocin significantly higher for catheters. Balloon catheters are increasingly being used in combination or sequentially with oral/vaginal misoprostol, although there is currently inadequate published data on the subject. International guidelines recommend the use of balloon catheters for labour induction with an unripe cervix (also following previous caesarean section) as an alternative to

  2. Assessment of multi-modality evaluations of obscure gastrointestinal bleeding (United States)

    Law, Ryan; Varayil, Jithinraj E; WongKeeSong, Louis M; Fidler, Jeff; Fletcher, Joel G; Barlow, John; Alexander, Jeffrey; Rajan, Elizabeth; Hansel, Stephanie; Becker, Brenda; Larson, Joseph J; Enders, Felicity T; Bruining, David H; Coelho-Prabhu, Nayantara


    AIM To determine the frequency of bleeding source detection in patients with obscure gastrointestinal bleeding (OGIB) who underwent double balloon enteroscopy (DBE) after pre-procedure imaging [multiphase computed tomography enterography (MPCTE), video capsule endoscopy (VCE), or both] and assess the impact of imaging on DBE diagnostic yield. METHODS Retrospective cohort study using a prospectively maintained database of all adult patients presenting with OGIB who underwent DBE from September 1st, 2002 to June 30th, 2013 at a single tertiary center. RESULTS Four hundred and ninety five patients (52% females; median age 68 years) underwent DBE for OGIB. AVCE and/or MPCTE performed within 1 year prior to DBE (in 441 patients) increased the diagnostic yield of DBE (67.1% with preceding imaging vs 59.5% without). Using DBE as the gold standard, VCE and MPCTE had a diagnostic yield of 72.7% and 32.5% respectively. There were no increased odds of finding a bleeding site at DBE compared to VCE (OR = 1.3, P = 0.150). There were increased odds of finding a bleeding site at DBE compared to MPCTE (OR = 5.9, P < 0.001). In inpatients with overt OGIB, diagnostic yield of DBE was not affected by preceding imaging. CONCLUSION DBE is a safe and well-tolerated procedure for the diagnosis and treatment of OGIB, with a diagnostic yield that may be increased after obtaining a preceding VCE or MPCTE. However, inpatients with active ongoing bleeding may benefit from proceeding directly to antegrade DBE. PMID:28216967

  3. Cost-effectiveness analysis of management strategies for obscure GI bleeding. (United States)

    Gerson, Lauren; Kamal, Ahmad


    Of patients who are seen with GI hemorrhage, approximately 5% will have a small-bowel source. Management of these patients entails considerable expense. We performed a decision analysis to explore the optimal management strategy for obscure GI hemorrhage. We used a cost-effectiveness analysis to compare no therapy (reference arm) to 5 competing modalities for a 50-year-old patient with obscure overt bleeding: (1) push enteroscopy, (2) intraoperative enteroscopy, (3) angiography, (4) initial anterograde double-balloon enteroscopy (DBE) followed by retrograde DBE if the patient had ongoing bleeding, and (5) small-bowel capsule endoscopy (CE) followed by DBE guided by the CE findings. The model included prevalence rates for small-bowel lesions, sensitivity for each intervention, and the probability of spontaneous bleeding cessation. We examined total costs and quality-adjusted life years (QALY) over a 1-year time period. An initial DBE was the most cost-effective approach. The no-therapy arm cost $532 and was associated with 0.870 QALYs compared with $2407 and 0.956 QALYs for the DBE approach, which resulted in an incremental cost-effectiveness ratio of $20,833 per QALY gained. Compared to the DBE approach, an initial CE was more costly and less effective. The initial DBE arm resulted in an 86% bleeding cessation rate compared to 76% for the CE arm and 59% for the no-therapy arm. The model results were robust to a wide range of sensitivity analyses. The short time horizon of the model, because of the lack of long-term data about the natural history of rebleeding from small-intestinal lesions. An initial DBE is a cost-effective approach for patients with obscure bleeding. However, capsule-directed DBE may be associated with better long-term outcomes because of the potential for fewer complications and decreased utilization of endoscopic resources.

  4. Inflammatory bowel disease unclassified

    Institute of Scientific and Technical Information of China (English)

    Ning ZHOU; Wei-xing CHEN; Shao-hua CHEN; Cheng-fu XU; You-ming LI


    Objective: Inflammatory bowel diseases (IBDs) are idiopathic, chronic, and inflammatory intestinal disorders. The two main types, ulcerative colitis (UC) and Crohn's disease (CD), sometimes mimic each other and are not readily distinguishable. The purpose of this study was to present a series of hospitalized cases, which could not initially be classified as a subtype of IBD, and to try to note roles of the terms indeterminate colitis (IC) and inflammatory bowel disease unclassified (IBDU) when such a dilemma arises. Methods: Medical records of 477 patients hospitalized due to IBD, during the period of January 2002 to April 2009, were retrospectively studied in the present paper. All available previous biopsies from endoscopies of these patients were reanalyzed. Results: Twenty-seven of 477 IBD patients (5.7%) had been initially diagnosed as having IBDU. Of them, 23 received colonoscopy and histological examinations in our hospital. A total of 90% (9/10) and 66.7% (4/6) of patients, respectively, had a positive finding via wireless capsule endoscopy (CE) and double-balloon enteroscopy (DBE). The barium-swallow or small bowel follow-through (SBFT) was performed on 11 patients. Positive changes were observed under computer tomographic (CT) scanning in 89.5% (17/19) of patients. Reasonable treatment strategies were employed for all patients. Conclusions: Our data indicate that IBDU accounts for 5.7% of initial diagnoses of IBD. The definition of IBDU is valuable in clinical practice. For those who had no clear clinical, endoscopic, histological, or other features affording a diagnosis of either UC or CD,IBDU could be used parenthetically.

  5. Human in vivo regional intestinal permeability: quantitation using site-specific drug absorption data. (United States)

    Sjögren, Erik; Dahlgren, David; Roos, Carl; Lennernäs, Hans


    Application of information on regional intestinal permeability has been identified as a key aspect of successful pharmaceutical product development. This study presents the results and evaluation of an approach for the indirect estimation of site-specific in vivo intestinal effective permeability (Peff) in humans. Plasma concentration-time profiles from 15 clinical studies that administered drug solutions to specific intestinal regions were collected and analyzed. The intestinal absorption rate for each drug was acquired by deconvolution, using historical intravenous data as reference, and used with the intestinal surface area and the dose remaining in the lumen to estimate the Peff. Forty-three new Peff values were estimated (15 from the proximal small intestine, 11 from the distal small intestine, and 17 from the large intestine) for 14 active pharmaceutical ingredients representing a wide range of biopharmaceutical properties. A good correlation (r(2) = 0.96, slope = 1.24, intercept = 0.030) was established between these indirect jejunal Peff estimates and jejunal Peff measurements determined directly using the single-pass perfusion double balloon technique. On average, Peff estimates from the distal small intestine and large intestine were 90% and 40%, respectively, of those from the proximal small intestine. These results support the use of the evaluated deconvolution method for indirectly estimating regional intestinal Peff in humans. This study presents the first comprehensive data set of estimated human regional intestinal permeability values for a range of drugs. These biopharmaceutical data can be used to improve the accuracy of gastrointestinal absorption predictions used in drug development decision-making.

  6. The role of capsule endoscopy after negative CT enterography in patients with obscure gastrointestinal bleeding

    Energy Technology Data Exchange (ETDEWEB)

    Heo, Hyun Mi; Park, Chan Hyuk; Lee, Jin Ha; Kim, Bo Kyung; Cheon, Jae Hee; Kim, Tae Il; Kim, Won Ho; Hong, Sung Pil [Yonsei University College of Medicine, Department of Internal Medicine and Institute of Gastroenterology, Seoul (Korea, Republic of); Lim, Joon Seok [Yonsei University College of Medicine, Department of Diagnostic Radiology, Seoul (Korea, Republic of)


    The aim of the present study was to evaluate the role of capsule endoscopy in patients with obscure gastrointestinal bleeding (OGIB) after negative computed tomographic (CT) enterography. We retrospectively included 30 patients with OGIB who received capsule endoscopy after negative CT enterography. The median age of the patients was 60 years, and 60% of patients were male. The median follow-up duration was 8 months. Overt bleeding was 60%, and occult bleeding was 40%. Based on capsule endoscopy results, a definitive diagnosis was made for 17 patients (57%): ulcer in nine patients (30%), active bleeding with no identifiable cause in five (17%), angiodysplasia in two (7%) and Dieulafoy's lesion in one (3%). Two patients with jejunal ulcers were diagnosed with Crohn's disease. Seven patients (41%) with positive capsule endoscopy received double balloon enteroscopy and two patients (12%) received steroid treatment for Crohn's disease. Patients with overt bleeding, a previous history of bleeding, or who received large amounts of blood transfusions were more likely to show positive capsule endoscopy. Capsule endoscopy showed high diagnostic yields in patients with OGIB after negative CT enterography and may help to provide further therapeutic plans for patients with OGIB and negative CT enterography. circle CT enterography has been widely used in evaluating obscure gastrointestinal bleeding (OGIB). circle Capsule endoscopy showed high diagnostic yield for OGIB after negative CT enterography. circle Negative CT enterography does not exclude important causes of small bowel bleeding. circle Most lesions missed at CT-enterography are flat and can be detected by capsule endoscopy. (orig.)

  7. In vivo characterization of abnormalities in small-bowel diseases using probe-based confocal laser endomicroscopy. (United States)

    Ohmiya, Naoki; Horiguchi, Noriyuki; Tahara, Tomomitsu; Nagasaka, Mitsuo; Nakagawa, Yoshihito; Shibata, Tomoyuki; Tsukamoto, Tetsuya; Kuroda, Makoto


     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.  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). We measured the calibers of capillary and lymphatic vessels at 15 different sites and compared the calibers between pCLE images and histopathology. We also compared pCLE findings with pathologic diagnosis.  The inner diameters of capillary vessels beneath the epithelium and in the middle of villi were 16.2 ± 3.0 µm and 14.5 ± 3.1 µm, respectively, in the pCLE images, but these were not consistent with formalin-fixed paraffin-embedded histology. In tumors, larger capillary vessels were observed in aggressive malignant lymphoma and metastasis, and a "soccer ball-like pattern" constituting homogenous dark cells packed with polygonal, narrower capillary vessels was characteristic in pCLE images of a malignant lymphoma follicle. Hereditary hemorrhagic telangiectasia and angiodysplasia contained anastomosis of capillary vessels of different calibers. In IgA vasculitis, segmental capillary strictures were observed. Intestinal lymphangiectasia with protein-losing enteropathy contained a reticular network of lymphatic vessels and dilated lymphatic ducts accompanied by numerous cell gaps. pCLE findings corresponded to pathologic diagnosis in 32 examinations (91 %).  pCLE is useful for in vivo analysis of abnormalities of the capillary and lymphatic vessels and epithelium, and for diagnosis in various small-bowel diseases.

  8. Is there still a role for intraoperative enteroscopy in patients with obscure gastrointestinal bleeding? ¿Tiene aún sentido la enteroscopia intraoperatoria en pacientes con hemorragia gastrointestinal de origen oscuro?

    Directory of Open Access Journals (Sweden)

    Pedro Monsanto


    Full Text Available Background: in 21st century, endoscopic study of the small intestine has undergone a revolution with capsule endoscopy and balloon-assisted enteroscopy. The difficulties and morbidity associated with intraoperative enteroscopy, the gold-standard in the 20th century, made this technique to be relegated to a second level. Aims: evaluate the actual role and assess the diagnostic and therapeutic value of intraoperative enteroscopy in patients with obscure gastrointestinal bleeding. Patients and methods: we conducted a retrospective study of 19 patients (11 males; mean age: 66.5 ± 15.3 years submitted to 21 IOE procedures for obscure GI bleeding. Capsule endoscopy and double balloon enteroscopy had been performed in 10 and 5 patients, respectively. Results: with intraoperative enteroscopy a small bowel bleeding lesion was identified in 79% of patients and a gastrointestinal bleed-ing lesion in 94%. Small bowel findings included: angiodysplasia (n = 6, ulcers (n = 4, small bowel Dieulafoy's lesion (n = 2, bleed-ing from anastomotic vessels (n = 1, multiple cavernous hemangiomas (n = 1 and bleeding ectopic jejunal varices (n = 1. Agreement between capsule endoscopy and intraoperative enteroscopy was 70%. Endoscopic and/or surgical treatment was used in 77.8% of the patients with a positive finding on intraoperative enteroscopy, with a rebleeding rate of 21.4% in a mean 21-month follow-up period. Procedure-related mortality and postoperative complications have been 5 and 21%, respectively. Conclusions: intraoperative enteroscopy remains a valuable tool in selected patients with obscure GI bleeding, achieving a high diagnostic yield and allowing an endoscopic and/or surgical treatment in most of them. However, as an invasive procedure with relevant mortality and morbidity, a precise indication for its use is indispensable.

  9. Is there still a role for intraoperative enteroscopy in patients with obscure gastrointestinal bleeding?

    Directory of Open Access Journals (Sweden)

    Pedro Monsanto

    Full Text Available Background: in 21st century, endoscopic study of the small intestine has undergone a revolution with capsule endoscopy and balloon-assisted enteroscopy. The difficulties and morbidity associated with intraoperative enteroscopy, the gold-standard in the 20th century, made this technique to be relegated to a second level. Aims: evaluate the actual role and assess the diagnostic and therapeutic value of intraoperative enteroscopy in patients with obscure gastrointestinal bleeding. Patients and methods: we conducted a retrospective study of 19 patients (11 males; mean age: 66.5 ± 15.3 years submitted to 21 IOE procedures for obscure GI bleeding. Capsule endoscopy and double balloon enteroscopy had been performed in 10 and 5 patients, respectively. Results: with intraoperative enteroscopy a small bowel bleeding lesion was identified in 79% of patients and a gastrointestinal bleed-ing lesion in 94%. Small bowel findings included: angiodysplasia (n = 6, ulcers (n = 4, small bowel Dieulafoy's lesion (n = 2, bleed-ing from anastomotic vessels (n = 1, multiple cavernous hemangiomas (n = 1 and bleeding ectopic jejunal varices (n = 1. Agreement between capsule endoscopy and intraoperative enteroscopy was 70%. Endoscopic and/or surgical treatment was used in 77.8% of the patients with a positive finding on intraoperative enteroscopy, with a rebleeding rate of 21.4% in a mean 21-month follow-up period. Procedure-related mortality and postoperative complications have been 5 and 21%, respectively. Conclusions: intraoperative enteroscopy remains a valuable tool in selected patients with obscure GI bleeding, achieving a high diagnostic yield and allowing an endoscopic and/or surgical treatment in most of them. However, as an invasive procedure with relevant mortality and morbidity, a precise indication for its use is indispensable.

  10. Balloon catheters for induction of labor at term after previous cesarean section: a systematic review. (United States)

    Kehl, Sven; Weiss, Christel; Rath, Werner


    To systematically review the application of balloon catheters for cervical ripening and labor induction at term after previous cesarean section. All pregnancies at term with previous cesarean section were included when cervical ripening or labor induction was conducted with balloon catheters. MEDLINE, Cochrane database and bibliography of identified articles were searched for English language studies. Reviews and meta-analysis, randomized and non-randomized controlled trials, prospective and retrospective cohort studies as well as case-control studies were considered. A total of 48 potentially relevant studies were identified. The title and abstract were screened for eligibility and 32 articles were excluded. The remaining 16 publications included 1447 women (single-balloon catheter: n=1329, double-balloon catheter: n=118). There were no randomized controlled trials. Most of the trials were retrospective studies (n=10). The rate of uterine rupture after labor induction was low (n=18, 1.2%). Meta-analysis of studies comparing the risk of uterine rupture between labor induction and spontaneous onset of labor found a higher risk after induction (OR 2.45, 95%CI 1.34-4.47, NNH 186). The average rate of oxytocin application was 68.4%, and vaginal birth was achieved in 56.4%. The risk for cesarean delivery was higher when labor was induced (OR 2.63, 95%CI 2.24-3.10). Data on balloon catheters for labor induction after previous cesarean section are limited by small sample size and retrospective analyses. The present data show a moderately increased risk for uterine rupture (OR=2.45) compared to spontaneous onset of labor. However, for evidence based recommendations much more well-conducted trials are needed.

  11. Gastrointestinal Transcriptomic Response of Metabolic Vitamin B12 Pathways in Roux-en-Y Gastric Bypass (United States)

    Sala, Priscila; Belarmino, Giliane; Torrinhas, Raquel S; Machado, Natasha M; Fonseca, Danielle C; Ravacci, Graziela R; Ishida, Robson K; Guarda, Ismael F M S; de Moura, Eduardo G; Sakai, Paulo; Santo, Marco A; da Silva, Ismael D C G; Pereira, Claudia C A; Logullo, Angela F; Heymsfield, Steven; Giannella-Neto, Daniel; Waitzberg, Dan L


    Objectives: Vitamin B12 (B12) deficiency after Roux-en-Y gastric bypass (RYGB) is highly prevalent and may contribute to postoperative complications. Decreased production of intrinsic factor owing to gastric fundus removal is thought to have a major role, but other components of B12 metabolism may also be affected. We evaluated changes in the expression levels of multiple B12 pathway-encoding genes in gastrointestinal (GI) tissues to evaluate the potential roles in contributing to post-RYGB B12 deficiency. Methods: During double-balloon enteroscopy, serial GI biopsies were collected from 20 obese women (age, 46.9±6.2 years; body mass index, 46.5±5.3 kg/m2) with adult-onset type 2 diabetes (fasting plasma glucose ≥126 mg/dl; hemoglobin A1c≥6.5%) before and, at the same site, 3 months after RYGB. Gene expression levels were assessed by the Affymetrix Human GeneChip 1.0 ST microarray. Findings were validated by real-time quantitative PCR (RT–qPCR). Results: Gene expression levels with significant changes (P≤0.05) included: transcobalamin I (TCN1) in remnant (−1.914-fold) and excluded (−1.985-fold) gastric regions; gastric intrinsic factor (GIF) in duodenum (−0.725-fold); and cubilin (CUBN) in duodenum (+0.982-fold), jejunum (+1.311-fold), and ileum (+0.685-fold). Validation by RT–qPCR confirmed (P≤0.05) observed changes for TCN1 in the remnant gastric region (−0.132-fold) and CUBN in jejunum (+2.833-fold). Conclusions: RYGB affects multiple pathway-encoding genes that may be associated with postoperative B12 deficiency. Decreased TCN1 levels seem to be the main contributing factor. Increased CUBN levels suggest an adaptive genetic reprogramming of intestinal tissue aiming to compensate for impaired intestinal B12 delivery. PMID:28055029

  12. Peutz-Jeghers syndrome: Diagnostic and therapeutic approach

    Institute of Scientific and Technical Information of China (English)

    Marcela Kopacova; Ilja Tacheci; Stanislav Rejchrt; Jan Bures


    Peutz-Jeghers syndrome (PJS) is an inherited, autosomal dominant disorder distinguished by hamartomatous polyps in the gastrointestinal tract and pigmented mucocutaneous lesions.Prevalence of PJS is estimated from 1 in 8300 to 1 in 280 000 individuals.PJS predisposes sufferers to various malignancies (gastrointestinal, pancreatic, lung, breast, uterine, ovarian and testicular tumors).Bleeding, obstruction and intussusception are common complications in patients with PJS.Double balloon enteroscopy (DBE) allows examination and treatment of the small bowel.Polypectomy using DBE may obviate the need for repeated urgent operations and small bowel resection that leads to short bowel syndrome.Prophylaxis and polypectomy of the entire small bowel is the gold standard in PJS patients.Intraoperative enteroscopy (IOE) was the only possibility for endoscopic treatment of patients with PJS before the DBE era.Both DBE and IOE facilitate exploration and treatment of the small intestine.DBE is less invasive and more convenient for the patient.Both procedures are generally safe and useful.An overall recommendation for PJS patients includes not only gastrointestinal multiple polyp resolution, but also regular lifelong cancer screening (colonoscopy, upper endoscopy, computed tomography, magnetic resonance imaging or ultrasound of the pancreas, chest X-ray, mammography and pelvic examination with ultrasound in women, and testicular examination in men).Although the incidence of PJS is low, it is important for clinicians to recognize these disorders to prevent morbidity and mortality in these patients, and to perform presymptomatic testing in the first-degree relatives of PJS patients.

  13. Perspectives of colorectal cancer screening in Germany 2009. (United States)

    Sieg, Andreas; Friedrich, Kilian


    Adequate screening methods can decrease colorectal cancer (CRC) mortality. The guaiac test for fecal occult-blood (FOBT) is part of the German CRC Screening Program since 1970 and has evidence level Ia. In randomized multicenter-studies FOBT has an average sensitivity of 24% and decreases CRC mortality up to 30%. Immunological tests for human haemoglobin (iFOBT) show better performance characteristics than guaiac FOBT, with augmented sensitivity and specificity. However, the single tests show wide differences in diagnostic performance and iFOBT is not yet covered by insurance companies although it should replace the guaiac test for CRC screening. Visual colonoscopy, which was introduced to the German National Cancer Screening Program in 2002, is the gold standard for the diagnosis of colorectal neoplasia. From 2003 to 2007 more than 2.8 million examinations have been documented in Germany. The prevalence of adenomas is around 20% and of CRC about 0.7% to 1.0% of the screenings. Seventy percent of the carcinomas detected during screening are in an early stage (UICC I and II). Furthermore, screening colonoscopy is a cost saving procedure with a low complication rate (0.25% overall). Insurance companies save 216€ for each screening colonoscopy mainly by prevention of neoplasia due to polypectomy. In Germany, virtual colonography by computed tomography (CT) or magnetic resonance imaging still lacks standardization of the hard and software. In experienced centres the sensitivity for CRC and large polyps of CT colonography is comparable to colonoscopy but in meta-analyses the ranking is lower. New technologies like computer-aided colonoscopies with sheath or double balloon techniques are coming up as well as capsule colonoscopy, which sensitivity for large polyps is about 70%. Advised by his physician, the patient can choose his most acceptable examination method from this whole set of screening tools.

  14. CT enterography in obscure gastrointestinal bleeding: a systematic review and meta-analysis. (United States)

    Wang, Zhen; Chen, Jun-qiang; Liu, Jin-lu; Qin, Xin-gan; Huang, Yuan


    The objective of this article is to provide a comprehensive and update overview of clinical application of CT enterography (CTE) in the evaluation of obscure gastrointestinal bleeding (OGIB). We performed a systematic review of relevant literatures in PubMed, EMBASE and The Cochrane Library and pooled the yield of CTE and the incremental yield (IY) of CTE over an alternate modality. A total of 18 studies (n = 660) reported the yield of CTE in evaluating OGIB and the pooled yield was 40% (95% confidence interval (CI): 33-49%). Seven studies (n = 279) compared the yield of CTE with capsule endoscopy (CE). The yield for CTE and CE for all findings was 34% and 53%, respectively (IY = -19%, 95% CI = -34% to -4%). When considering the types of identified lesions, the yield was significantly different for vascular and inflammatory lesions but not significantly different for neoplastic or other lesions. Two studies (n = 63) compared the yield of CTE with double-balloon enteroscopy (DBE). The yield for CTE and DBE was 38% and 78%, respectively (IY = -40%, 95% CI = -55% to -25%). Three studies (n = 49) compared the yield of CTE with digital subtraction angiography. The yield for CTE and digital subtraction angiography was 64% and 60%, respectively (IY = 4%, 95% CI = -40% to 47%). CTE is an excellent diagnostic tool in patients with OGIB. It may play a complementary role to CE and can be used as a triage tool prior to DBE in evaluating OGIB.

  15. Percutaneous Hepatic Perfusion (PHP) with Melphalan as a Treatment for Unresectable Metastases Confined to the Liver. (United States)

    de Leede, Eleonora M; Burgmans, Mark C; Martini, Christian H; Tijl, Fred G J; van Erkel, Arian R; Vuyk, Jaap; Kapiteijn, Ellen; Verhoef, Cornelis; van de Velde, Cornelis J H; Vahrmeijer, Alexander L


    Unresectable liver metastases of colorectal cancer can be treated with systemic chemotherapy, aiming to limit the disease, extend survival or turn unresectable metastases into resectable ones. Some patients however, suffer from side effects or progression under systemic treatment. For patients with metastasized uveal melanoma there are no standard systemic therapy options. For patients without extrahepatic disease, isolated liver perfusion (IHP) may enable local disease control with limited systemic side effects. Previously, this was performed during open surgery with satisfying results, but morbidity and mortality related to the open procedure, prohibited a widespread application. Therefore, percutaneous hepatic perfusion (PHP) with simultaneous chemofiltration was developed. Besides decreasing morbidity and mortality, this procedure can be repeated, hopefully leading to a higher response rate and improved survival (by local control of disease). During PHP, catheters are placed in the proper hepatic artery, to infuse the chemotherapeutic agent, and in the inferior caval vein to aspirate the chemosaturated blood returning through the hepatic veins. The caval vein catheter is a double balloon catheter that prohibits leakage into the systemic circulation. The blood returning from the hepatic veins is aspirated through the catheter fenestrations and then perfused through an extra-corporeal filtration system. After filtration, the blood is returned to the patient by a third catheter in the right internal jugular vein. During PHP a high dose of melphalan is infused into the liver, which is toxic and would lead to life threatening complications when administered systemically. Because of the significant hemodynamic instability resulting from the combination of caval vein occlusion and chemofiltration, hemodynamic monitoring and hemodynamic support is of paramount importance during this complex procedure.

  16. In the absence of nutrients, pancreatic-biliary secretions in the jejunum do not exert feedback control of human pancreatic or gastric function. (United States)

    Krawisz, B R; Miller, L J; DiMagno, E P; Go, V L


    Feedback inhibition of basal pancreatic enzyme secretion by luminal pancreatic enzymes appears to be an important regulator of pancreatic secretion in some laboratory animals. To determine whether pancreatic enzymes in the jejunum influence pancreatic or gastric functions in healthy man, we intubated six subjects with a gastric sump tube and a four-lumen duodenal tube which provided (1) a duodenal perfusion site, (2) a duodenal aspiration site, (3) an inflatable balloon immediately distal to the aspiration site, and (4) a jejunal perfusion site immediately beyond the balloon. In this way, the gastroduodenal segment could be functionally separated from the remainder of the intestine. The jejunum was exposed to normal saline, active pancreatic-biliary secretions, or pancreatic-biliary secretions in which the enzymes had been inactivated by heat. Ten minutes after initiation of each jejunal perfusion, normal saline was instilled into the stomach. No differences in trypsin secretion, gastric acid secretion, or gastric emptying occurred with the different jejunal perfusates. We therefore conclude that normal man, in the absence of intraluminal nutrients, does not exhibit a jejunal pancreatic enzyme-dependent feedback control mechanism for pancreatic enzyme or gastric secretion. However, our study does not exclude the possibility of a duodenal feedback regulatory mechanism.

  17. Acute Middle Gastrointestinal Bleeding Risk Associated with NSAIDs, Antithrombotic Drugs, and PPIs: A Multicenter Case-Control Study.

    Directory of Open Access Journals (Sweden)

    Naoyoshi Nagata

    Full Text Available Middle gastrointestinal bleeding (MGIB risk has not been fully investigated due to its extremely rare occurrence and the need for multiple endoscopies to exclude upper and lower gastrointestinal bleeding. This study investigated whether MGIB is associated with the use of non-steroidal anti-inflammatory drugs (NSAIDs, low-dose aspirin (LDA, thienopyridines, anticoagulants, and proton-pump inhibitors (PPIs, and whether PPI use affects the interactions between MGIB and antithrombotic drugs.In this multicenter, hospital-based, case-control study, 400 patients underwent upper and lower endoscopy, 80 had acute overt MGIB and 320 had no bleeding and were matched for age and sex as controls (1:4. MGIB was additionally evaluated by capsule and/or double-balloon endoscopy, after excluding upper and lower GI bleeding. Adjusted odds ratios (AOR for MGIB risk were calculated using conditional logistic regression. To estimate the propensity score, we employed a logistic regression model for PPI use.In patients with MGIB, mean hemoglobin level was 9.4 g/dL, and 28 patients (35% received blood transfusions. Factors significantly associated with MGIB were chronic kidney disease (p<0.001, liver cirrhosis (p = 0.034, NSAIDs (p<0.001, thienopyridines (p<0.001, anticoagulants (p = 0.002, and PPIs (p<0.001. After adjusting for these factors, NSAIDs (AOR, 2.5; p = 0.018, thienopyridines (AOR, 3.2; p = 0.015, anticoagulants (AOR, 4.3; p = 0.028, and PPIs (AOR; 2.0; p = 0.021 were independently associated with MGIB. After adjusting for propensity score, the use of PPIs remained an independent risk factors for MGIB (AOR, 1.94; p = 0.034. No significant interactions were observed between PPIs and NSAIDs (AOR, 0.7; p = 0.637, LDA (AOR, 0.3; p = 0.112, thienopyridine (AOR, 0.7, p = 0.671, or anticoagulants (AOR, 0.5; p = 0.545.One-third of patients with acute small intestinal bleeding required blood transfusion. NSAIDs, thienopyridines, anticoagulants, and PPIs increased

  18. Acute Middle Gastrointestinal Bleeding Risk Associated with NSAIDs, Antithrombotic Drugs, and PPIs: A Multicenter Case-Control Study. (United States)

    Nagata, Naoyoshi; Niikura, Ryota; Yamada, Atsuo; Sakurai, Toshiyuki; Shimbo, Takuro; Kobayashi, Yuka; Okamoto, Makoto; Mitsuno, Yuzo; Ogura, Keiji; Hirata, Yoshihiro; Fujimoto, Kazuma; Akiyama, Junichi; Uemura, Naomi; Koike, Kazuhiko


    Middle gastrointestinal bleeding (MGIB) risk has not been fully investigated due to its extremely rare occurrence and the need for multiple endoscopies to exclude upper and lower gastrointestinal bleeding. This study investigated whether MGIB is associated with the use of non-steroidal anti-inflammatory drugs (NSAIDs), low-dose aspirin (LDA), thienopyridines, anticoagulants, and proton-pump inhibitors (PPIs), and whether PPI use affects the interactions between MGIB and antithrombotic drugs. In this multicenter, hospital-based, case-control study, 400 patients underwent upper and lower endoscopy, 80 had acute overt MGIB and 320 had no bleeding and were matched for age and sex as controls (1:4). MGIB was additionally evaluated by capsule and/or double-balloon endoscopy, after excluding upper and lower GI bleeding. Adjusted odds ratios (AOR) for MGIB risk were calculated using conditional logistic regression. To estimate the propensity score, we employed a logistic regression model for PPI use. In patients with MGIB, mean hemoglobin level was 9.4 g/dL, and 28 patients (35%) received blood transfusions. Factors significantly associated with MGIB were chronic kidney disease (pfactors, NSAIDs (AOR, 2.5; p = 0.018), thienopyridines (AOR, 3.2; p = 0.015), anticoagulants (AOR, 4.3; p = 0.028), and PPIs (AOR; 2.0; p = 0.021) were independently associated with MGIB. After adjusting for propensity score, the use of PPIs remained an independent risk factors for MGIB (AOR, 1.94; p = 0.034). No significant interactions were observed between PPIs and NSAIDs (AOR, 0.7; p = 0.637), LDA (AOR, 0.3; p = 0.112), thienopyridine (AOR, 0.7, p = 0.671), or anticoagulants (AOR, 0.5; p = 0.545). One-third of patients with acute small intestinal bleeding required blood transfusion. NSAIDs, thienopyridines, anticoagulants, and PPIs increased the risk of acute small intestinal bleeding. However, there were no significant interactions found between antithrombotic drugs and PPI use for bleeding

  19. 原发性小肠肿瘤51例影像表现分析%Analysis of 51 cases of primary small intestinal tumor imaging findings

    Institute of Scientific and Technical Information of China (English)

    宋军伟; 李晓景; 银王力


    Objective To investigate image diagnostic methods and imaging demonstration of primary small intestine tumor. Methods A total of 51 cases of patients with primary small intestine tumors, who were confirmed by pathology from 2002 to 2014, were collected. Their inspection methods and imaging findings were reviewed retroactively. Results There were 15 cases (29.41%) of benign small intestinal tumor and 36 cases (70.59%) of malignant small intestine tu-mors. The positive ratio of CT enterography, upper gastrointestinal endoscopy, double-balloon enteroscopy, capsule en-doscopy, MRI enterography, full gastrointestinal contrast and low tension of small bowel enema were 68.89%(31/45), 71.43%(22/35), 80.00%(4/5), 66.67%(2/3), 60.00%(9/15), 25.00%(3/12), 60.00%(6/10) respectively. Conclusion In order to diagnose small intestinal tumor more effectively, imaging features of small intestinal tumor, advantages and disadvantages of various methods should be mastered, and it is necessary to combine all kinds of inspection methods.%目的:探讨小肠原发性肿瘤的影像诊断方法及影像表现。方法收集2002~2014年经病理证实的51例原发性小肠肿瘤患者,对其曾行过的检查方法及影像表现进行回顾性分析。结果良性小肠肿瘤15例(29.41%),恶性小肠肿瘤36例(70.59%),各项阳性检出比为:CT小肠造影68.89%(31/45),上消化道内镜71.43%(25/35),双气囊小肠镜80.00%(4/5),胶囊内镜66.67%(2/3),MRI小肠造影60.00%(9/15),全消化道造影25.00%(3/12),低张小肠灌肠造影60.00%(6/10)。结论掌握小肠原发性肿瘤影像学表现,熟悉各类检查方法的优缺点,各类检查方法相结合,更有效诊断小肠肿瘤。

  20. Small bowel imaging - still a radiologic approach? (United States)

    Markova, Ingrid; Kluchova, Katerina; Zboril, Radek; Mashlan, Miroslav; Herman, Miroslav


    In recent years, there has been renewed interest in small bowel imaging using a variety of radiologic or endoscopic techniques. This article gives an overview and comparison of old and new techniques used in small bowel imaging. New imaging methods as computed tomography (CT), CT enteroclysis (CTEc), CT enterography (CTEg), ultrasound (US), contrast-enhanced ultrasound (CEUS), US enteroclysis, US enterography, magnetic resonance imaging (MRI), MR enteroclysis (MREc) and MR enterography (MREg) are compared with the older techniques such as small- bowel follow- through (SBFT), conventional enteroclysis (CE) and endoscopic techniques including push enteroscopy, ezofagogastroduodenoscopy (EGD), sonde enteroscopy, ileocolonoscopy, double-balloon enteroscopy, intraoperative enteroscopy and wireless capsule enteroscopy (WCE). Systematic scan of Pubmed, Medline, Ovid, Elsevier search engines was used.. Additional information was found through the bibliographical review of relevant articles. SBFT has only secondary role in small bowel imaging. US is still the method of choice in imaging for pediatric populations. US and CEUS are also accepted as a method of choice especially in inflammatory cases. CE has been replaced by new cross - sectional imaging techniques (CTEc/CTEg or MREc/MREg). CTEc combines the advantages of CT and CE. MREc combines the advantages of MRI and CE. Some authors prefer CTEg or MREg with peroral bowel preparation and they strictly avoid nasojejunal intubation under fluoroscopic control. MREc has better soft tissue contrast, showing it to be more sensitive in detecting mucosal lesions than CTEc in inflammatory diseases. CTEg/MREg are techniques preferred for patients in follow-up of the inflammatory diseases. The radiologic community is not unanimous however about their role in the imaging process. CTEc/MREc as well as CTEg/MREg are superior to endoscopic methods in the investigation of small-bowel tumors. WCE gives unparalleled imaging of the mucosal

  1. Deficiência de ferro nas afecções gastrointestinais do adulto Iron deficiency related to gastrointestinal diseases in adults

    Directory of Open Access Journals (Sweden)

    Cyrla Zaltman


    Full Text Available A anemia por deficiência de ferro (ADF ou a deficiência de ferro (DF isolada são comuns em crianças e mulheres pré-menopausa. Entretanto, em adultos do sexo masculino e mulheres pós-menopausa, essa condição se associa frequentemente a perdas sanguíneas gastrointestinais ou mal absorção. A prevalência das lesões gastrointestinais torna essencial o exame do aparelho digestório superior e inferior através da endoscopia. Investigações complementares devem ser realizadas se os procedimentos endoscópicos não evidenciarem sangramento em situações clínicas, tais como a necessidade de múltiplas hemotransfusões, a ausência de sangramento visível à endoscopia digestiva alta e colonoscopia e a falta de resposta à reposição de ferro.Esses casos devem ser direcionados para investigação do intestino delgado com métodos radiológicos ou, mais recentemente, com a cápsula endoscópica e da enteroscopia com duplo balão. A cintigrafia com hemácias marcadas e a angiografia têm papel restrito, sendo utilizadas apenas no sangramento aberto. O tratamento varia de acordo com a etiologia, a intensidade da perda sanguínea e da deficiência de ferro.Iron deficiency anaemia and isolated iron deficiency are common in children and pre-menopausal women. However, in male adults and post-menopausal women this condition is most frequently caused by gastrointestinal blood loss or malabsorption. The prevalence of gastrointestinal lesions makes the examination by endoscopy of both upper and lower gastrointestinal tracts essential. Further investigations, when the initial exams are negative, are only warranted in cases of multiple transfusions, visible blood loss or lack of response to oral iron supplementation. In these cases examinations should be focused on the small bowel by radiological methods or more recently using capsule endoscopy and double balloon enteroscopy. Nuclear medicine and angiography have a limited role to play in this

  2. Avances en el tratamiento farmacológico de la hemorragia digestiva de origen oscuro Update on medical therapy for obscure gastrointestinal hemorrhage

    Directory of Open Access Journals (Sweden)

    J. Molina Infante


    Full Text Available El desarrollo de la cápsula endoscópica y la enteroscopia de doble balón ha aumentado las tasas de diagnóstico y tratamiento en la hemorragia digestiva de origen oscuro, en la que las angiodisplasias del intestino delgado son la causa más frecuente. Sin embargo, el 25-40% de los pacientes, no subsidiarios o no respondedores a la terapéutica endoscópica, angiográfica o quirúrgica, pueden tener alto riesgo de resangrado y carecen de tratamiento médico claramente eficaz. La utilidad de la terapia hormonal está cuestionada actualmente, sin olvidar los frecuentes y limitantes efectos secundarios. El octreótido suele ser eficaz en el control de la hemorragia pero no parece la terapia de mantenimiento más óptima. Los beta-bloqueantes no selectivos, de igual manera que en la profilaxis de la hemorragia por hipertensión portal, pueden ser útiles en combinación con otros fármacos. Recientemente, el octreotido LAR, una formulación de liberación retardada que se administra una vez al mes por vía intramuscular, y la talidomida oral, un potente inhibidor de la angiogénesis, han demostrado su eficacia y seguridad a largo plazo en casos graves aislados.The development of capsule endoscopy and double-balloon enteroscopy has increased diagnostic and therapeutic rates in obscure gastrointestinal hemorrhage, where angiodysplasia of the small bowel is the most frequent cause. Nevertheless, almost 25-40% of patients who are not candidates or do not respond to endoscopic, angiographic, or surgical management may be at high risk of rebleeding, and therefore lack a clearly effective medical therapy. The utility of hormonal therapy remains unclear and is burdened by adverse effects. Subcutaneous octreotide usually controls bleeding but does not seem adequate for mainteinance therapy. Non-selective beta-blockers alone or in combination with other treatments, as in the prophylaxis of portal hypertension variceal bleeding, may be helpful. Recently

  3. A case of civil pilot with small intestine diverticulosis complicated by ulcer bleeding and literature review%民航飞行员小肠憩室伴溃疡出血一例并文献复习

    Institute of Scientific and Technical Information of China (English)

    李银喜; 黄连顺; 岑跃进; 许燕; 王云


    Objective To explore the diagnosis,treatment and medical assessment of the pilot suffering from small intestine diverticulosis,and provide the reference to aeromedical assessment of military and civil pilots and physical examination of pilot recruitment.Methods A case of civil pilot suffering from small intestine diverticulosis with ulcer bleeding was analyzed.By referring to the literature review,the pathophysiologic features,clinical manifestations,diagnosis and treatments for intestine diverticulosis were summarized.Results The intestine diverticulosis with ulcer bleeding was diagnosed by the capsule endoscopy and double-balloon enteroscopy.With the treatments of hemostasis,anti-infection and the consolidation of dietary nutrition,the pilot was recovered and qualified for flying.18months follow up showed that he was in normal physical condition.Conclusion Pilots suffering from small intestine diverticulosis and obscure gastrointestinal bleeding can be diagnosed by capsule endoscopy and double balloon enteroscopy.If small intestine diverticulosis was in stable,it wouldn't affect flying and treatment wouldn't be required.If small intestine diverticulosis combined with ulcer bleeding and infection,the hemostatic and anti-infection treatments would be required.If small intestine diverticulosis was with ulcer bleeding and had been affected,treatment of hemostasis and anti-infective treatment should be taken.Military transporter pilot and civil pilot can be qualified for flying in case of blood loss stopped and fitness recovered.The surgery should be considered if conservative treatment failed,or recurrent diverticulosis complication appeared.The assessment should be individually issued according to pilot's postoperative recovery.Routine capsule endoscopy examination is recommended due to its effective diagnosis and reference value to the physical examination of pilot recruitment.%目的 探讨飞行员小肠憩室的诊断、治疗和医学鉴定,为军事及民航

  4. Resultados da valvoplastia por balão do grupo submetido a plastia mitral percutânea ou cirúrgica prévias com o tratado pela primeira vez: evolução do grupo com plastia prévia Balloon valvuloplasty outcome of a group previously submitted to mitral percutaneous or surgical valve repair versus first-time valvuloplasty patients: evolution of the group previously submitted to valve repair procedures

    Directory of Open Access Journals (Sweden)

    Edison Carvalho S. Peixoto


    Full Text Available OBJETIVO: Avaliar 501 procedimentos de valvoplastia mitral e as diferenças entre um grupo já submetido a plastia valvar prévia por balão ou cirúrgica, com 59 procedimentos e um grupo sem intervenção prévia, com 442 procedimentos. MÉTODOS: Foi utilizado balão único em 406 procedimentos, balão de Inoue em 89, e duplo balão em seis, não havendo diferença entre os balões utilizados nos dois grupos (p=0,6610. Estudou-se a evolução a longo prazo dos pacientes com plastia prévia. RESULTADOS: O grupo submetido a plastia valvar prévia era mais velho, com maior escore ecocardiográfico, maior porcentual de pacientes em fibrilação atrial, e dos seus 59 pacientes, 48 tinham sido submetidos à comissurotomia cirúrgica, oito a valvoplastia com balão e três à comissurotomia cirúrgica e à valvoplastia com balão. Os grupos da valvoplastia com plastia valvar prévia e da valvoplastia sem intervenção prévia apresentaram pré-valvoplastia: área valvar mitral ecocardiográfica de 0,99±0,21 e 0,94±0,21 cm² (p=0,0802 e área valvar mitral (Gorlin 0,94±0,18 e 0,91±0,21 cm² (p=0,2518 e área valvar mitral pós-valvoplastia mitral de 1,95±0,44 e 2,05±0,42 cm² (p=0,1059. CONCLUSÕES: O grupo com plastia valvar prévia apresentou o mesmo resultado imediato do grupo sem intervenção prévia. O subgrupo com plastia prévia seguido a longo prazo, apresentou evolução satisfatória.OBJECTIVE: To evaluate 501 procedures of mitral balloon valvuloplasty and the differences among the group already submitted the prior surgical or balloon valvuloplasty, with 59 procedures and the group without previous intervention, with 442 procedures. METHODS: It was used the single balloon in 403, Inoue balloon in 89 and a double balloon in six, with no difference between the 2 groups (p=0.6610. RESULTS: The prior surgical or balloon valvuloplasty group was older, with higher echo score and higher atrial fibrillation rate and of its 59 patients, 48 had

  5. Clinical Comprehensive Therapy of Peutz-Jeghers Syndrome ( Report of 71 Cases )%Peutz-Jeghers综合征临床综合治疗模式初探(附71例报道)

    Institute of Scientific and Technical Information of China (English)

    王石林; 顾国利; 魏学明; 毛高平; 宁守斌


    目的 探索将临床综合治疗模式应用于Peutz-Jeghers综合征(PJS)的临床治疗效果.方法 2000年1月至2010年12月期间我院收治的71例PJS患者先接受内镜下息肉灼除或圈套切除,对无法镜下切除或出现严重并发症者进行外科解救治疗;在内镜或手术治疗后对患者进行宣教,签署知情同意书者口服塞来昔布6~9个月进行预防性治疗.定期随访,对其治疗结果进行分析.结果 71例(男41例,女30例)中有家族史者29例(40.8%).62例共行94次手术,肠套叠为其最主要的手术原因(72.3%,68/94).65例行169次双气囊电子小肠镜下治疗,共摘除或灼除胃肠道息肉1714枚,最大者直径8 cm;3例发生小肠穿孔.口服塞来昔布者共8例,完成6个月疗程者共3例,息肉的数量减少、大小缩小.结论 包括局部治疗(内镜)、解救治疗(手术)、预防治疗(药物干预)的综合治疗模式用于PJS胃肠道息肉的临床治疗是积极、有效的.%To explore the clinical comprehensive therapy of Peutz-Jeghers syndrome. Methods From January 2000 to December 2010, 71 cases of Peutz-Jeghers syndrome underwent endoscopic polyp resection firstly, and those with unresectable lesions or with severe complications underwent rescue laparotomy. After endoscopic or surgical treatment, the patients took Celecoxib capsules voluntarily for 6 to 9 months under informed consents. All cases were followed up from 6 months to 8 years. Results Twenty-nine patients had familial history of Peutz-Jeghers syndrome among the 71 patients (41 males and 30 females). Sixty-two cases underwent 94 surgeries and intussusception was the most common cause of laparotomy. Sixty-five patients underwent 169 double-balloon endoscopy (DBE) therapies, and a total of 1 714 polyps were resected by DBE polypectomy. The largest major axis of small-bowel polyp was 8 cm. No severe complications occurred after DBE polypectomy except for 3 cases of intestinal perforation. Eight

  6. 症状性十二指肠憩室的临床特点分析%Analysis of the clinical features of symptomatic duodenal diverticulum

    Institute of Scientific and Technical Information of China (English)

    谭韡; 周巍; 罗和生; 陈继红; 赵亮


    Objective To investigate the clinical presentation, characteristics of endoseopy and imaging in patients symptomatic with duodenal diverticulum. Methods The clinical data of patients with symptomatic duodenal diverticulum in Renmin Hospital of Wuhan University from Jan. 2008 to Jan. 201 1 were retrospectively reviewed. Results A-mong the 35 patients with symptomatic duodenal diverticulum, 15 cases suffered from abdominal pain, 2 cases suffered from vomit, 12 cases suffered from hematemesis or melena, 6 cases suffered from jaundice, respectively. In all cases, there were 5 cases of duodenal diverticulitis, 1 case of acute pancreatitis, 6 cases of choledocholithiasis, 1 case of intestinal obstruction, and 12 cases of upper gastrointestinal bleeding. 35 cases of symptomatic duodenal diverticulum patients were located in the duodenal bulb with 9 cases, in the duodenal descending part with 22 cases, in the horizontal part with 4 cases, respectively, including single of 25 cases and multiple of 10 cases. 13 cases of duodenal diverticulum were found by the gastrointestinal barium meal examination, 9 cases were found by gastroscopy examination, 7 cases were found by endoscopic retrograde cholangiopancreatography (ERCP) , 2 cases were found by double-balloon enteros-copy, and 4 cases were found by abdominal CT scan, respectively. Conclusion The symptomatic duodenal diverticulum are not typical. Patients with unexplained upper abdominal pain, gastrointestinal bleeding and pancreatitis should be suspected of duodenal diverticulum. Conservative, endoscopic and surgical treatments are all used to treat duodenal diverticulum.%目的 探讨症状性十二指肠憩室病例的临床、内镜及影像学表现、治疗方法,并分析其临床意义.方法 回顾性分析武汉大学人民医院2008年1月-2011年1月症状性十二指肠憩室病例,分析其临床表现、内镜及影像学表现、治疗方法等临床资料.结果 共35例患者诊断为症状性十

  7. Clinical study of selective bronchial closure in the treatment of 18 patients with refractory pneumothorax%选择性支气管封堵术治疗18例难治性气胸的临床体会

    Institute of Scientific and Technical Information of China (English)

    刘萍; 王丰


    Objective To disceuse the efficacy complications and safety of exploring balloon combined with the selective bronchial blocking for the treatment of refractory.Methods Performed exploring balloon combined with the selective bronchial blocking for 18 patients with refractory pneumothorax from August 2013 to August 2015 in our hospital.To positioning the drainage bronchus of dirty pleura fistul by double balloon catheter on the basis of conventional electronic bronchoscopy,then injected different doses of whole blood plus thrombin to the target bronchus,observed efficacy and related complications.Results 16 cases were positioned successfully and were implemented smoothly autologous blood closure,13 of them got success in the first block but 3 cases recurrenced during 72 hours,2 cases of them got success during the second block,the 1 cases who was failed in the second block transferred to thoracic surgery for surgical treatment.2 cases of 16 failed to probe into the bronchus.12 cases finally successed in closure at the same time 4 cases failed.1 in 4 cases discharged with tube (review of X-ray suggests pulmonary reexpansion with a half month of follow-up,then pulled out the chest drainage tube);2 case of which did not detect the drainage bronchus received surgical treatment.Conclusions Balloon probe combined selective bronchial closure is safe,effective and feasible intervention methods in the treatment of refractory pneumothorax.%目的 探讨球囊探查加选择性支气管封堵术治疗难治性气胸的疗效、安全性及并发症.方法 选取我院2013年8月至2015年8月期间18例难治性气胸患者,进行球囊探查加选择性支气管封堵术治疗.在常规电子支气管镜检查基础上采用双腔球囊导管对脏层胸膜瘘口所属的引流支气管进行探查定位,然后经双腔导管确认的目标支气管注入不同剂量的自身全血加凝血酶,观察是否成功封堵及相关并发症.结果 16例成功定位引流支气管,2

  8. 隐源性消化道出血患者205例临床分析%Clinical analysis of obscure gastrointestinal bleeding

    Institute of Scientific and Technical Information of China (English)

    王立英; 陈春晓


    Objective To study the diagnostic method of obscure gastrointestinal bleeding(OGIB) and etiological analysis of OGIB.Methods The clinical data of OGIB were retrospectively analyzed.Endoscopy (including gastroscopy,colonoscopy,laparoscopy,endoscopy and capsule endoscopy),air barium double contrast radiography,angiography and hemorrhage were analyzed.Results In 205 patients with benign disease etiology,lesions in the intestine were 74.15% (152/205).Vascular lesions accounted for 38.54% (79/205) ; tumor accounted for 20% (41/205) ; inflammatory lesions was 11.71% (24/205) ; diverticulum accounted for 5.37% (12/205) ; intestinal polyps was 2.44% (5/205) ; hookworm was 2.44% (5/205) ; the other was 6.34% (13/ 205) ; unexplained bleeding was 13.66% (28/205) ; capsule endoscopy diagnosis rate was 67.1% (94/140).The abdominal CT enhancement diagnosis rate was 30.6% (22/72) ; double-balloon enteroscopy diagnosis rate was 63.2% (12/19) ;selective arteriography diagnosis rate was 75.0% (9/12) ; double contrast radiography diagnosis rate was 14.3% (1/7) ; enterography diagnosis rate was 16.7% (1/6).Conclusion Obscure gastrointestinal bleeding needs a high success rate of diagnosis.%目的 探讨隐源性消化道出血的病因和不同检查方法的诊断价值.方法 对2008-2012年浙江省绍兴市上虞人民医院隐源性消化道出血205例患者的临床资料进行回顾性分析,选择1种或多种检查方法如内镜(包括胃镜、结肠镜、腹腔镜、小肠镜和胶囊内镜)、气钡双重造影、血管造影检查,对出血发生的部位、病因进行分析.结果 205例患者中病因以良性病变为主,占80.0%(164/205);病变部位以小肠居多,占74.2%(152/205).血管病变占38.5%(79/205);肿瘤为20.0% (41/205);炎症病变为11.7%(24/205);憩室为5.4%(12/205);小肠息肉为2.4%(5/205);钩虫为2.4%(5/205);其他为6.3%(13/205);不明原因出血为13.7%(28/205).胶

  9. 经皮球囊肺动脉瓣成形术204例临床分析%Clinical analysis in 204 cases with percutaneous balloon pulmonary valvoplasty

    Institute of Scientific and Technical Information of China (English)

    王霄芳; 金梅; 吴邦骏; 郑可; 郭保静; 梁永梅; 肖燕燕; 李伟; 韩玲


    . Results: PBPV were performed in 204, with procedural success in 200 cases (98% ). PBPV significantly reduced transvalvular pressure gradient from (75. 75 ± 30. 04) mmHg [ (40-180)mmHg] to (30. 84 ± 15. 05) mmHg [ (2-102) mmHg] postoperatively (P =0.001) , suggesting satisfactory results. In the 4 failed cases, the guide wire failed to reach the pulmonary artery due to right ventricular outflow tract obstruction in one patient and PBPV canceled. Case 2 had significant drop of blood pressure and heart rate and hemodynamic instability condition during the guide wire entering the pulmonary artery, and PBPV canceled. Case 3 with PA/IVS had cardiac tamponade during balloon dilatation after successful radiofrequency perforation, and were switched to emergency surgery. Case 4 had tearing of right ventricular outflow tract during balloon dilatation leading to cardiac tamponade and final death. Severe complications occurred in 2 cases, including chordal rupture of the tricuspid valve in one patient and hypoxic-ischemic encephalopathy in the other patient. We choose balloon size is determined at about 120%-140% of the pulmonary valve annulus. 145 cases chose single balloon,4cases chose double balloon. In general, low inflation pressures of less than 4 atmospheres are usually sufficient to perform balloon PS. The waist of balloon disappear completely during the balloon inflation. Follow up ranges from 1 month to 12 months and it shows a good therapeutic efficacy. 6 patients with critical pulmonary valve stenosis second performed PBPV and meet with success. 1 patient stenosis again and underwent surgery treatment. 25 patients ( 12% ) occur mild pulmonary valve regurgitate during follow up. Conclusion: PBPV is a safe and effective method of treating PS and PA/ IVS. Strict abidance by procedural indications and standards can reduce the occurrence of complication.

  10. Which method is best for the induction of labour? A systematic review, network meta-analysis and cost-effectiveness analysis. (United States)

    Alfirevic, Zarko; Keeney, Edna; Dowswell, Therese; Welton, Nicky J; Medley, Nancy; Dias, Sofia; Jones, Leanne V; Gyte, Gillian; Caldwell, Deborah M


    the model. We calculated incremental cost-effectiveness ratios, expected costs, utilities and net benefit. We represent uncertainty in the optimal intervention using cost-effectiveness acceptability curves. RESULTS We identified 1190 studies; 611 were eligible for inclusion. The interventions most likely to achieve vaginal delivery (VD) within 24 hours were intravenous oxytocin with amniotomy [posterior rank 2; 95% credible intervals (CrIs) 1 to 9] and higher-dose (≥ 50 µg) vaginal misoprostol (rank 3; 95% CrI 1 to 6). Compared with placebo, several treatments reduced the odds of caesarean section, but we observed considerable uncertainty in treatment rankings. For uterine hyperstimulation, double-balloon catheter had the highest probability of being among the best three treatments, whereas vaginal misoprostol (≥ 50 µg) was most likely to increase the odds of excessive uterine activity. For other safety outcomes there were insufficient data or there was too much uncertainty to identify which treatments performed 'best'. Few studies collected information on women's views. Owing to incomplete reporting of the VD within 24 hours outcome, the cost-effectiveness analysis could compare only 20 interventions. The analysis suggested that most interventions have similar utility and differ mainly in cost. With a caveat of considerable uncertainty, titrated (low-dose) misoprostol solution and buccal/sublingual misoprostol had the highest likelihood of being cost-effective. LIMITATIONS There was considerable uncertainty in findings and there were insufficient data for some planned subgroup analyses. CONCLUSIONS Overall, misoprostol and oxytocin with amniotomy (for women with favourable cervix) is more successful than other agents in achieving VD within 24 hours. The ranking according to safety of different methods was less clear. The cost-effectiveness analysis suggested that titrated (low-dose) oral misoprostol solution resulted in the highest utility, whereas

  11. The analysis of clinical diagnosis for small intestinal stromal tumor: A review of 74 cases%小肠间质瘤74例临床诊断分析

    Institute of Scientific and Technical Information of China (English)

    章宏; 吴贞; 沈哲; 厉有名


    Objective To summarize the clinical characteristics of small intestinal stromal tumors(SIST), and evaluate the diagnostic values of various imaging or endoscope examinations for SIST. Methods From July 2004 to June 2009, 74 patients whose operation or endoscopy biopsy tissues pathologically confirmed SIST were collected. The clinical data, imageology including enteroclysis, abdominal ultrasound, spiral computered tomography (CT) and the double-balloon enteroscopy report of the patients were analyzed retrospectively. According to biological behavior, the SIST was divided into four risk degree such as extremely low risk, low risk, moderate risk and high risk. The correlation between pathologic characters and spiral CT feature was analyzed. Results The most predilection site of SIST was jejunum in 43 patients (58.1 %); secondarily duodenum in 17 cases (23%); and 10 cases (13.5%) in ileum. About 94.6 percent of patients (70/74) showed clinical signs, the most common symptom was gastrointestinal bleeding in 46 cases (67. 2 % ), abdominal pain in 23 cases (31.1%). Of various photogrammetry examinations and endoscopy, spiral CT has the highest diagnosis rate and diagnosis coincidence rate, which was 100% and 72. 1% respectively. Among the 74 SIST lesions, 14 cases were extremely low biological risk (18. 9 % ), 21 at low risk (28.4 % ), 15 at moderate risk (20. 3%) and 24 at high risk (32.4%). Spiral CT is helpful for the SIST risk diagnosis. Conclusions The onset of SIST was concealed and early diagnosis was very difficult. Spinal CT which could help to predict the tumor's risk degree and prognosis was noninvasive, convenient and reliable. Therefore, it could be the first choice for SIST examination at present.%目的 总结小肠间质瘤(SIST)的临床特征,评价多种影像、内镜诊断方法 对SIST的诊断价值.方法 收集2004年7月至2009年6月经手术或内镜病理确诊的SIST患者74例,回顾性分析患者的临床资料、影像学(小肠造影、

  12. Efficacy of pediatric colonoscopy used as push enteroscopy in the management of capsule endoscopy findings Eficacia del colonoscopio pediátrico como enteroscopio de pulsión en el manejo de los hallazgos de la cápsula endoscópica

    Directory of Open Access Journals (Sweden)

    F. Pérez Roldán


    Full Text Available Background: recent advances in endoscopy have enabled us to explore the small intestine more efficiently, both with capsule endoscopy and double-balloon enteroscopy. However, these methods are not available in all hospitals. Therefore, when capsule endoscopy reveals proximal jejunal lesions, a possible alternative for treatment could involve push enteroscopy combined with colonoscopy. Lesions can thus be marked for subsequent monitoring. Objectives: to describe the efficacy of pediatric colonoscopy for diagnosis, the marking of the area explored, and therapeutic options. Material and methods: between October 2007 and September 2008 a total of 21 enteroscopies were performed using a pediatric colonoscope. Nine of these were used to take jejunal biopsy samples due to suspected disease of the mucosa. In 10 of the remaining 12, capsule endoscopy revealed lesions (vascular malformations or jejunal bleeding, and in 2 intestinal transit time was analyzed due to suspected jejunal stenosis. We used a PENTAX EC-3470-LK pediatric colonoscope, whose 11.6-mm sectional diameter and 3.8-mm working channel make it possible to administer all the usual endoscopic treatments. Results: therapeutic endoscopy was performed on 7 men and 5 women (mean age 63.3 years. Jejunal lesions were observed in 10 cases (5 cases of angiodysplasia, 2 cases of jejunal stenosis, 1 case of nonmalignant thickened jejunal folds, 1 eroded submucosal tumor, and 1 case of duodenal and jejunal varices. The most distal area was marked with India ink (2, hemoclips (4, or both to help locate the lesions using simple abdominal radiography or capsule endoscopy. Conclusions: jejunal enteroscopy enabled a firm diagnosis to be made in most of the patients studied. We were able to treat 58% of patients and mark the areas explored for subsequent follow-up. With hemoclips we were able to locate the most distal point explored using simple abdominal radiography.Introducción: los recientes avances en

  13. Methods of term labour induction for women with a previous caesarean section. (United States)

    West, Helen M; Jozwiak, Marta; Dodd, Jodie M


    received misoprostol had a uterine rupture (RR 3.67, 95% CI 0.16 to 84.66) and one had uterine dehiscence. No other outcomes (including GRADE outcomes) were reported. Foley catheter versus intravenous oxytocin (one trial, subgroup of 53 women): no clear difference between groups for vaginal delivery not achieved within 24 hours (RR 1.47, 95% CI 0.89 to 2.44, evidence graded low), uterine hyperstimulation with fetal heart rate changes (RR 3.11, 95% CI 0.13 to 73.09, evidence graded low), and caesarean section (RR 0.93, 95% CI 0.45 to 1.92, evidence graded low). There were also no clear differences between groups for the reported secondary outcomes. The following GRADE outcomes were not reported: serious neonatal morbidity or perinatal death, and serious maternal morbidity or death. Double-balloon catheter versus vaginal PGE2 (one trial, subgroup of 26 women): no clear difference in caesarean section (RR 0.97, 95% CI 0.41 to 2.32, evidence graded very low). Vaginal delivery not achieved within 24 hours, uterine hyperstimulation with fetal heart rate changes, serious neonatal morbidity or perinatal death, and serious maternal morbidity or death were not reported. Oral mifepristone versus Foley catheter (one trial, 107 women): no primary/GRADE outcomes were reported. Fewer women induced with mifepristone required oxytocin augmentation (RR 0.54, 95% CI 0.38 to 0.76). There were slightly fewer cases of uterine rupture among women who received mifepristone, however this was not a clear difference between groups (RR 0.29, 95% CI 0.08 to 1.02). No other secondary outcomes were reported. Vaginal isosorbide mononitrate (IMN) versus Foley catheter (one trial, 80 women): fewer women induced with IMN achieved a vaginal delivery within 24 hours (RR 2.62, 95% CI 1.32 to 5.21, evidence graded low). There was no difference between groups in the number of women who had a caesarean section (RR 1.00, 95% CI 0.39 to 2.59, evidence graded very low). More women induced with IMN required oxytocin