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Indications for Imaging the Small Bowel

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Endoscopy in Small Bowel Disorders

Abstract

The small bowel has historically been difficult to evaluate because of its length and tortuosity. Over the last several years, small bowel imaging modalities have improved considerably. There has been an explosion of new technologies aimed at diagnosing and managing diseases of the small bowel. New innovative technology initially brought us the capsule endoscope which revolutionized the approach to evaluating the small bowel. Capsule endoscopy allowed for direct inspection of the small bowel mucosa. This was followed by the development of deep enteroscopy techniques, such as double- and single-balloon enteroscopy, which provide the ability to deliver therapy to lesions deep in the small bowel. In addition to these new endoscopic techniques, cross-sectional imaging with CT and MR enterography has improved considerably and provides complementary imaging. These new modalities have been particularly useful in the evaluation of patients with obscure gastrointestinal bleeding, but are also proving to be extremely useful in patients with inflammatory bowel disease, tumors, polyposis syndromes, celiac disease, and other enteropathies. This chapter reviews these new small bowel imaging modalities as well as the diseases they can evaluate and help manage.

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References

  1. Rondonotti E, Villa F, Mulder CJ, Jacobs MA, de Franchis R. Small bowel capsule endoscopy in 2007: indications, risks and limitations. World J Gastroenterol. 2007;13(46):6140–9 [Review].

    Article  PubMed Central  PubMed  Google Scholar 

  2. Delvaux M, Fassler I, Gay G. Clinical usefulness of the endoscopic video capsule as the initial intestinal investigation in patients with obscure digestive bleeding: validation of a diagnostic strategy based on the patient outcome after 12 months. Endoscopy. 2004;36(12):1067–73 [Validation Studies].

    Article  CAS  PubMed  Google Scholar 

  3. Gerson LB, Batenic MA, Newsom SL, Ross A, Semrad CE. Long-term outcomes after double-balloon enteroscopy for obscure gastrointestinal bleeding. Clin Gastroenterol Hepatol. 2009;7(6):664–9.

    Article  PubMed  Google Scholar 

  4. Triester SL, Leighton JA, Leontiadis GI, Fleischer DE, Hara AK, Heigh RI, et al. A meta-analysis of the yield of capsule endoscopy compared to other diagnostic modalities in patients with obscure gastrointestinal bleeding. Am J Gastroenterol. 2005;100(11):2407–18 [Comparative Study Meta-Analysis].

    Article  PubMed  Google Scholar 

  5. Pennazio M, Santucci R, Rondonotti E, Abbiati C, Beccari G, Rossini FP, et al. Outcome of patients with obscure gastrointestinal bleeding after capsule endoscopy: report of 100 consecutive cases. Gastroenterology. 2004;126(3):643–53 [Clinical Trial Multicenter Study Research Support, Non-U.S. Gov’t].

    Article  PubMed  Google Scholar 

  6. Nakamura M, Niwa Y, Ohmiya N, Miyahara R, Ohashi A, Itoh A, et al. Preliminary comparison of capsule endoscopy and double-balloon enteroscopy in patients with suspected small-bowel bleeding. Endoscopy. 2006;38(1):59–66 [Comparative Study].

    Article  CAS  PubMed  Google Scholar 

  7. Gross SA, Stark ME. Initial experience with double-balloon enteroscopy at a U.S. Center. Gastrointest Endosc. 2008;67(6):890–7 [Comparative Study].

    Article  PubMed  Google Scholar 

  8. Raju GS, Gerson L, Das A, Lewis B. American Gastroenterological A. American gastroenterological association (aga) institute technical review on obscure gastrointestinal bleeding. Gastroenterology. 2007;133(5):1697–717 [Review].

    Article  PubMed  Google Scholar 

  9. Zaman A, Katon RM. Push enteroscopy for obscure gastrointestinal bleeding yields a high incidence of proximal lesions within reach of a standard endoscope. Gastrointest Endosc. 1998;47(5):372–6 [Clinical Trial].

    Article  CAS  PubMed  Google Scholar 

  10. Marmo R, Rotondano G, Casetti T, Manes G, Chilovi F, Sprujevnik T, et al. Degree of concordance between double-balloon enteroscopy and capsule endoscopy in obscure gastrointestinal bleeding: a multicenter study. Endoscopy. 2009;41(7):587–92 [Clinical Trial Comparative Study Multicenter Study].

    Article  CAS  PubMed  Google Scholar 

  11. Somsouk M, Gralnek IM, Inadomi JM. Management of obscure occult gastrointestinal bleeding: a cost-minimization analysis. Clin Gastroenterol Hepatol. 2008;6(6):661–70.

    Article  PubMed Central  PubMed  Google Scholar 

  12. Pasha SF, Leighton JA, Das A, Harrison ME, Decker GA, Fleischer DE, et al. Double-balloon enteroscopy and capsule endoscopy have comparable diagnostic yield in small-bowel disease: a meta-analysis. Clin Gastroenterol Hepatol. 2008;6(6):671–6 [Comparative Study Meta-Analysis Research Support, Non-U.S. Gov’t].

    Article  PubMed  Google Scholar 

  13. Gerson L, Kamal A. Cost-effectiveness analysis of management strategies for obscure GI bleeding. Gastrointest Endosc. 2008;68(5):920–36.

    Article  PubMed  Google Scholar 

  14. Siegel R, Ma J, Zou Z, Jemal A. Cancer statistics, 2014. CA Cancer J Clin. 2014;64(1):9–29.

    Article  PubMed  Google Scholar 

  15. Giuliani A, Caporale A, Teneriello F, Alessi G, Serpieri S, Sammartino P. Primary tumors of the small intestine. Int Surg. 1985;70(4):331–4.

    CAS  PubMed  Google Scholar 

  16. Schottenfeld D, Beebe-Dimmer JL, Vigneau FD. The epidemiology and pathogenesis of neoplasia in the small intestine. Ann Epidemiol. 2009;19(1):58–69 [Research Support, N.I.H., Extramural Review].

    Article  PubMed Central  PubMed  Google Scholar 

  17. Bilimoria KY, Bentrem DJ, Wayne JD, Ko CY, Bennett CL, Talamonti MS. Small bowel cancer in the united states: changes in epidemiology, treatment, and survival over the last 20 years. Ann Surg. 2009;249(1):63–71 [Research Support, Non-U.S. Gov’t].

    Article  PubMed  Google Scholar 

  18. Lewis BS, Eisen GM, Friedman S. A pooled analysis to evaluate results of capsule endoscopy trials. Endoscopy. 2005;37(10):960–5 [Comparative Study Evaluation Studies].

    Article  CAS  PubMed  Google Scholar 

  19. Honda W, Ohmiya N, Hirooka Y, Nakamura M, Miyahara R, Ohno E, et al. Enteroscopic and radiologic diagnoses, treatment, and prognoses of small-bowel tumors. Gastrointest Endosc. 2012;76(2):344–54 [Comparative Study Evaluation Studies Research Support, Non-U.S. Gov’t].

    Article  PubMed  Google Scholar 

  20. Urquhart P, Grimpen F, Lim GJ, Pizzey C, Stella DL, Tesar PA, et al. Capsule endoscopy versus magnetic resonance enterography for the detection of small bowel polyps in Peutz-Jeghers syndrome. Fam Cancer. 2014;13:249–55.

    Article  CAS  PubMed  Google Scholar 

  21. Akin E, Demirezer Bolat A, Buyukasik S, Algin O, Selvi E, Ersoy O. Comparison between capsule endoscopy and magnetic resonance enterography for the detection of polyps of the small intestine in patients with familial adenomatous polyposis. Gastroenterol Res Pract. 2012;2012:215028.

    CAS  PubMed Central  PubMed  Google Scholar 

  22. Gupta A, Postgate AJ, Burling D, Ilangovan R, Marshall M, Phillips RK, et al. A prospective study of MR enterography versus capsule endoscopy for the surveillance of adult patients with Peutz-Jeghers syndrome. AJR Am J Roentgenol. 2010;195(1):108–16 [Comparative Study Research Support, Non-U.S. Gov’t].

    Article  PubMed  Google Scholar 

  23. Giardiello FM, Brensinger JD, Tersmette AC, Goodman SN, Petersen GM, Booker SV, et al. Very high risk of cancer in familial Peutz-Jeghers syndrome. Gastroenterology. 2000;119(6):1447–53 [Meta-Analysis Research Support, Non-U.S. Gov’t Research Support, U.S. Gov’t, P.H.S.].

    Article  CAS  PubMed  Google Scholar 

  24. Beggs AD, Latchford AR, Vasen HF, Moslein G, Alonso A, Aretz S, et al. Peutz-Jeghers syndrome: a systematic review and recommendations for management. Gut. 2010;59(7):975–86 [Consensus Development Conference].

    Article  CAS  PubMed  Google Scholar 

  25. Groves CJ, Saunders BP, Spigelman AD, Phillips RK. Duodenal cancer in patients with familial adenomatous polyposis (fap): results of a 10 year prospective study. Gut. 2002;50(5):636–41.

    Article  CAS  PubMed Central  PubMed  Google Scholar 

  26. Giardiello FM, Trimbath JD. Peutz-Jeghers syndrome and management recommendations. Clin Gastroenterol Hepatol. 2006;4(4):408–15 [Research Support, N.I.H., Extramural Research Support, Non-U.S. Gov’t Review].

    Article  PubMed  Google Scholar 

  27. Dunlop MG. Guidance on gastrointestinal surveillance for hereditary non-polyposis colorectal cancer, familial adenomatous polypolis, juvenile polyposis, and Peutz-Jeghers syndrome. Gut. 2002;51 Suppl 5:V21–7 [Guideline Practice Guideline].

    Article  PubMed Central  PubMed  Google Scholar 

  28. Farmer RG, Hawk WA, Turnbull Jr RB. Clinical patterns in Crohn’s disease: a statistical study of 615 cases. Gastroenterology. 1975;68(4 Pt 1):627–35.

    CAS  PubMed  Google Scholar 

  29. Pons Beltran V, Nos P, Bastida G, Beltran B, Arguello L, Aguas M, et al. Evaluation of postsurgical recurrence in Crohn’s disease: a new indication for capsule endoscopy? Gastrointest Endosc. 2007;66(3):533–40 [Comparative Study].

    Article  PubMed  Google Scholar 

  30. Cotter J, Dias de Castro F, Moreira MJ, Rosa B. Tailoring Crohn’s disease treatment: the impact of small bowel capsule endoscopy. J Crohn's Colitis. 2014;8:1610–5.

    Article  Google Scholar 

  31. Cheifetz AS, Kornbluth AA, Legnani P, Schmelkin I, Brown A, Lichtiger S, et al. The risk of retention of the capsule endoscope in patients with known or suspected Crohn’s disease. Am J Gastroenterol. 2006;101(10):2218–22.

    Article  PubMed  Google Scholar 

  32. Solem CA, Loftus Jr EV, Fletcher JG, Baron TH, Gostout CJ, Petersen BT, et al. Small-bowel imaging in Crohn’s disease: a prospective, blinded, 4-way comparison trial. Gastrointest Endosc. 2008;68(2):255–66 [Clinical Trial Comparative Study Research Support, Non-U.S. Gov’t].

    Article  PubMed  Google Scholar 

  33. Girelli CM, Porta P, Malacrida V, Barzaghi F, Rocca F. Clinical outcome of patients examined by capsule endoscopy for suspected small bowel Crohn’s disease. Dig Liver Dis. 2007;39(2):148–54 [Clinical Trial].

    Article  CAS  PubMed  Google Scholar 

  34. Levesque BG, Cipriano LE, Chang SL, Lee KK, Owens DK, Garber AM. Cost effectiveness of alternative imaging strategies for the diagnosis of small-bowel Crohn's disease. Clin Gastroenterol Hepatol. 2010;8(3):261–7. 267 e261–264 [Research Support, Non-U.S. Gov’t Research Support, U.S. Gov’t, P.H.S.].

    Article  PubMed  Google Scholar 

  35. Fiorino G, Bonifacio C, Peyrin-Biroulet L, Minuti F, Repici A, Spinelli A, et al. Prospective comparison of computed tomography enterography and magnetic resonance enterography for assessment of disease activity and complications in ileocolonic Crohn’s disease. Inflamm Bowel Dis. 2011;17(5):1073–80 [Clinical Trial Comparative Study Validation Studies].

    Article  CAS  PubMed  Google Scholar 

  36. Fasano A, Berti I, Gerarduzzi T, Not T, Colletti RB, Drago S, et al. Prevalence of celiac disease in at-risk and not-at-risk groups in the United States: a large multicenter study. Arch Intern Med. 2003;163(3):286–92 [Multicenter Study Research Support, Non-U.S. Gov’t].

    Article  PubMed  Google Scholar 

  37. Cellier C, Green PH, Collin P, Murray J. Icce consensus for celiac disease. Endoscopy. 2005;37(10):1055–9 [Consensus Development Conference Research Support, Non-U.S. Gov’t].

    Article  CAS  PubMed  Google Scholar 

  38. Green PH, Rubin M. Capsule endoscopy in celiac disease. Gastrointest Endosc. 2005;62(5):797–9 [Comment Editorial].

    Article  PubMed  Google Scholar 

  39. Culliford A, Daly J, Diamond B, Rubin M, Green PH. The value of wireless capsule endoscopy in patients with complicated celiac disease. Gastrointest Endosc. 2005;62(1):55–61 [Comparative Study Research Support, Non-U.S. Gov’t].

    Article  PubMed  Google Scholar 

  40. Joyce AM, Burns DL, Marcello PW, Tronic B, Scholz FJ. Capsule endoscopy findings in celiac disease associated enteropathy-type intestinal t-cell lymphoma. Endoscopy. 2005;37(6):594–6 [Case Reports].

    Article  CAS  PubMed  Google Scholar 

  41. Apostolopoulos P, Alexandrakis G, Giannakoulopoulou E, Kalantzis C, Papanikolaou IS, Markoglou C, et al. M2a wireless capsule endoscopy for diagnosing ulcerative jejunoileitis complicating celiac disease. Endoscopy. 2004;36(3):247 [Case Reports].

    Article  CAS  PubMed  Google Scholar 

  42. Rokkas T, Niv Y. The role of video capsule endoscopy in the diagnosis of celiac disease: a meta-analysis. Eur J Gastroenterol Hepatol. 2012;24(3):303–8 [Evaluation Studies Meta-Analysis].

    Article  PubMed  Google Scholar 

  43. Hadithi M, Al-toma A, Oudejans J, van Bodegraven AA, Mulder CJ, Jacobs M. The value of double-balloon enteroscopy in patients with refractory celiac disease. Am J Gastroenterol. 2007;102(5):987–96.

    Article  PubMed  Google Scholar 

  44. Fry LC, Bellutti M, Neumann H, Malfertheiner P, Monkemuller K. Utility of double-balloon enteroscopy for the evaluation of malabsorption. Dig Dis. 2008;26(2):134–9 [Clinical Trial].

    Article  PubMed  Google Scholar 

  45. Kumar P, Bartram CI. Relevance of the barium follow-through examination in the diagnosis of adult celiac disease. Gastrointest Radiol. 1979;4(3):285–9 [Comparative Study].

    Article  CAS  PubMed  Google Scholar 

  46. Tennyson CA, Semrad CE. Small bowel imaging in celiac disease. Gastrointest Endosc Clin N Am. 2012;22(4):735–46 [Review].

    Article  PubMed  Google Scholar 

  47. Katsinelos P, Tziomalos K, Fasoulas K, Paroutoglou G, Koufokotsios A, Mimidis K, Terzoudis S, Maris T, Beltsis A, Geros C, Chatzimavroudis G. Can capsule endoscopy be used as a diagnostic tool in the evaluation of nonbleeding indication in daily clinical practice? A prospective study. Med Princ Pract. 2011;20:362–7.

    Article  CAS  PubMed  Google Scholar 

  48. Katsinelos P, Fasoulas K, Beltsis A, Chatzimavroudis G, Paroutoglou G, Maris T, et al. Diagnostic yield and clinical impact of wireless capsule endoscopy in patients with chronic abdominal pain with or without diarrhea: a Greek multicenter study. Eur J Intern Med. 2011;22(5):e63–6.

    Article  PubMed  Google Scholar 

  49. May A, Manner H, Schneider M, Ipsen A, Ell C. Prospective multicenter trial of capsule endoscopy in patients with chronic abdominal pain, diarrhea and other signs and symptoms (cedap-plus study). Endoscopy. 2007;39(7):606–12.

    Article  CAS  PubMed  Google Scholar 

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Correspondence to Jonathan A. Leighton M.D. .

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Noelting, J., Leighton, J.A. (2015). Indications for Imaging the Small Bowel. In: Kozarek, R., Leighton, J. (eds) Endoscopy in Small Bowel Disorders. Springer, Cham. https://doi.org/10.1007/978-3-319-14415-3_1

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  • DOI: https://doi.org/10.1007/978-3-319-14415-3_1

  • Publisher Name: Springer, Cham

  • Print ISBN: 978-3-319-14414-6

  • Online ISBN: 978-3-319-14415-3

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