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Jürgen F. Riemann - One of the best experts on this subject based on the ideXlab platform.
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Capsule endoscopy, technical impact, benefits and limitations
Langenbeck's Archives of Surgery, 2004Co-Authors: Dirk Hartmann, Dieter Schilling, G. Bolz, Jürgen F. RiemannAbstract:Background The small bowel is the most difficult part of the bowel to examine owing to the distance from the mouth to anus. Conventional endoscopic techniques for examining the small bowel are limited by its length and its multiple, complex, looped configurations. However, for a wide variety of specific lesions, the diagnostic value of other tests for imaging the small bowel is low. For the first time wireless capsule endoscopy has made non-invasive imaging of the entire small bowel possible. A number of peer-reviewed studies has been published that compare the method with Push-Enteroscopy in patients with obscure gastrointestinal bleeding and have shown superior diagnostic results. Conclusion Capsule endoscopy has opened up new horizons for the diagnosis of small-bowel disease. All published studies show a higher diagnostic yield of capsule endoscopy compared with Push-Enteroscopy and standard radiographic investigations.
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Capsule endoscopy versus Push Enteroscopy in patients with occult gastrointestinal bleeding.
Zeitschrift für Gastroenterologie, 2003Co-Authors: Dirk Hartmann, Dieter Schilling, G. Bolz, Hahne M, Ralf Jakobs, Siegel E, Uwe Weickert, H E Adamek, Jürgen F. RiemannAbstract:Background Wireless capsule endoscopy is a new method enabling non-invasive diagnostic endoscopy of the entire small intestine. In this study we prospectively examined the diagnostic precision of capsule endoscopy compared with Push Enteroscopy in patients with occult gastrointestinal bleeding. Methods Between July 2001 and October 2002 we examined 48 patients with suspected disorders of the small intestine using capsule endoscopy. 33 patients with obscure bleeding (19 men, 14 women, mean age 58 +/- 23 years) were prospectively examined using capsule endoscopy and Push Enteroscopy. Results On average, the patients had been suffering from chronic gastrointestinal bleeding for 30 +/- 36 (1-120) months. The lowest haemoglobin level was 6.5 +/- 1.6 g/dl (2.3-9.6) and on average 9 +/- 10 (0-50) blood units were transfused. Each patient underwent 4 +/- 2 (1-10) hospitalisations, with a mean 9 +/- 4 (5-17) diagnostic procedures before capsule endoscopy was used. Definitive bleeding sites were diagnosed by Push Enteroscopy in 7 patients (angiodysplasia [n = 5], ulcers [n = 1], multiple jejunal diverticula [n = 1]). Capsule endoscopy showed a bleeding source in 25 cases (76 %) (angiodysplasias [n = 15], Meckel's diverticulum [n = 1], ulcers [n = 7], ileum diverticulosis [n = 1], B-cell lymphoma [n = 1]). Push Enteroscopy localised an additional bleeding source in comparison with capsule endoscopy (multiple jejunal diverticula) in one patient. Both methods of examination were safe and showed no complications. Discussion The present study shows that capsule endoscopy had the highest diagnostic yield and was superior to Push Enteroscopy in patients with chronic gastrointestinal bleeding. By using the capsule at an early stage the subsequent therapeutic procedure could be considerably shortened and diagnostic processes could possibly be optimised.
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Woreless capsule endoscopy compared to Push Enteroscopy in the management of obscure gastrointestinal bleeding
Gastroenterology, 2003Co-Authors: G. Bolz, Dirk Hartmann, Dieter Schilling, Hahne M, H E Adamek, Jürgen F. RiemannAbstract:bleeding site, 6 with normal studies, and 3 poor preps. The capsule passed naturally in all studies. Three patients with cardiac pacemakers were studied with no problems encountered. The Given M2A videocapsule has superior diagnostic utility for the evaluation of obscure gastrointestinal bleeding when compared with standard Push Enteroscopy. The Given M2A video capsule endoscope can be used to direct appropriate therapy in addition to avoiding the use of unnecessary conventional endoscopic and radiologic procedures subsequent to the identification of a small bowel lesion.
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does the insertion depth in Push Enteroscopy depend on the working length of the enteroscope
Endoscopy, 2002Co-Authors: C. Benz, R Jakobs, Jürgen F. RiemannAbstract:BACKGROUND AND STUDY AIMS: Using Push Enteroscopy, the small bowel can only be investigated in part. This preliminary prospective randomized study examined whether increasing the length of the enteroscope can have a beneficial effect on the insertion depth. PATIENTS AND METHODS: Between August 1999 and December 1999, 28 consecutive patients were investigated using Push Enteroscopy and were randomly assigned to two groups. One group was investigated using the Olympus Push enteroscope SIF-100 (working length 2200 mm). In the other group, the Olympus Push enteroscope SIF-Q140 (working length 2500 mm) was used. All investigations were carried out using an overtube. The insertion depth was estimated by counting the folds in the small bowel. In addition, the insertion length was estimated in centimeters by withdrawing the instrument to the pylorus after straightening. RESULTS: The two groups were comparable in terms of age, sex distribution, indication for Enteroscopy, investigation time, and pathological findings. There were no significant differences in the insertion length between the two types of instrument. With the SIF-100, the median number of folds was 95 (range 30 - 213) and the insertion length was 72.5 cm (range 40 - 110 cm); and with the SIF-Q140, the median number of folds was 79 (range 18 - 203) and the insertion length was 70.0 cm (range 20 - 140 cm). CONCLUSIONS: As there was no significant difference in the insertion depth between the shorter instrument (Olympus SIF-100) and the longer one (Olympus SIF-Q140), it can be concluded from this preliminary study that there is no advantage in using a longer enteroscope. To document a significant difference, further studies with a larger numbers of patients would be necessary.
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Do we need the overtube for Push-Enteroscopy?
Endoscopy, 2001Co-Authors: C. Benz, R Jakobs, Jürgen F. RiemannAbstract:BACKGROUND AND AIMS: Push-Enteroscopy is well established in many gastroenterological departments. There is no agreement about whether the use of an overtube is helpful to optimize the depth of insertion. In this prospective and randomized study we investigated the effect of the overtube for Push-type Enteroscopy. PATIENTS AND METHODS: Between August 1999 and August 2000, 80 patients (47 male, 33 female; age 63.1, range 20 - 90 years), who underwent investigation by Push-Enteroscopy were randomly allocated to two groups. Group T underwent investigation with the Olympus Push-enteroscope SIF 100 with an overtube and group NT without an overtube. The length of insertion was estimated by fluoroscopy, by counting the folds of the small bowel and by insertion length in centimeters, while the scope was drawn back to the pylorus. The number of pathological findings was documented and patient comfort was measured by means of a standard questionnaire completed after Enteroscopy. RESULTS: Both groups were comparable with regard to age, gender, indication for Enteroscopy and pathological findings. There was a highly significant correlation between the length of insertion measured in centimeters and the counted folds in both groups (correlation 0.57, P < 0.001 in group T; 0.80, P < 0.001 in group NT). The length of insertion estimated by means of fluoroscopy was not reliable in determination of the exact length of insertion. There was a significant difference (P < 0.05) in the insertion depth between group T (mean values: insertion length 72.4 cm, counted folds 99.3) and group NT (mean values: insertion length 60.8 cm, counted folds 74.1). CONCLUSIONS: The use of an overtube in Push-Enteroscopy is advantageous with respect to the depth of insertion (significant difference between group T and NT in counted folds and the insertion depth in centimeters). At this time, this gain of insertion length did not result in a higher rate of pathological findings. Nevertheless, we would recommend the use of an overtube in performing Push-type Enteroscopy in order to increase the number of pathological findings.
Paul Swain - One of the best experts on this subject based on the ideXlab platform.
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wireless capsule endoscopy a comparison with Push Enteroscopy in patients with gastroscopy and colonoscopy negative gastrointestinal bleeding
Gut, 2003Co-Authors: Maria Mylonaki, Annette Fritscherravens, Paul SwainAbstract:Background: The development of wireless capsule endoscopy allows painless imaging of the small intestine. Its clinical use is not yet defined. The aim of this study was to compare the clinical efficacy and technical performance of capsule endoscopy and Push Enteroscopy in a series of 50 patients with colonoscopy and gastroscopy negative gastrointestinal bleeding. Methods: A wireless capsule endoscope was used containing a CMOS colour video imager, transmitter, and batteries. Approximately 50 000 transmitted images are received by eight abdominal aerials and stored on a portable solid state recorder, which is carried on a belt. Push Enteroscopy was performed using a 240 cm Olympus video enteroscope. Results: Studies in 14 healthy volunteers gave information on normal anatomical appearances and preparation. In 50 patients with gastrointestinal bleeding and negative colonoscopy and gastroscopy, Push Enteroscopy was compared with capsule endoscopy. A bleeding source was discovered in the small intestine in 34 of 50 patients (68%). These included angiodysplasia (16), focal fresh bleeding (eight), apthous ulceration suggestive of Crohn’s disease (three), tumour (two), Meckel’s diverticulum (two), ileal ulcer (one), jejunitis (one), and ulcer due to intussusception (one). One additional intestinal diagnosis was made by Enteroscopy. The yield of Push Enteroscopy in evaluating obscure bleeding was 32% (16/50). The capsule identified significantly more small intestinal bleeding sources than Push Enteroscopy (p<0.05). Patients preferred capsule endoscopy to Push Enteroscopy (p<0.001). Conclusions: In this study capsule endoscopy was superior to Push Enteroscopy in the diagnosis of recurrent bleeding in patients who had a negative gastroscopy and colonoscopy. It was safe and well tolerated.
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Wireless capsule endoscopy: a comparison with Push Enteroscopy in patients with gastroscopy and colonoscopy negative gastrointestinal bleeding.
Gut, 2003Co-Authors: Maria Mylonaki, Annette Fritscher-ravens, Paul SwainAbstract:Background: The development of wireless capsule endoscopy allows painless imaging of the small intestine. Its clinical use is not yet defined. The aim of this study was to compare the clinical efficacy and technical performance of capsule endoscopy and Push Enteroscopy in a series of 50 patients with colonoscopy and gastroscopy negative gastrointestinal bleeding. Methods: A wireless capsule endoscope was used containing a CMOS colour video imager, transmitter, and batteries. Approximately 50 000 transmitted images are received by eight abdominal aerials and stored on a portable solid state recorder, which is carried on a belt. Push Enteroscopy was performed using a 240 cm Olympus video enteroscope. Results: Studies in 14 healthy volunteers gave information on normal anatomical appearances and preparation. In 50 patients with gastrointestinal bleeding and negative colonoscopy and gastroscopy, Push Enteroscopy was compared with capsule endoscopy. A bleeding source was discovered in the small intestine in 34 of 50 patients (68%). These included angiodysplasia (16), focal fresh bleeding (eight), apthous ulceration suggestive of Crohn’s disease (three), tumour (two), Meckel’s diverticulum (two), ileal ulcer (one), jejunitis (one), and ulcer due to intussusception (one). One additional intestinal diagnosis was made by Enteroscopy. The yield of Push Enteroscopy in evaluating obscure bleeding was 32% (16/50). The capsule identified significantly more small intestinal bleeding sources than Push Enteroscopy (p
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capsule endoscopy in the evaluation of patients with suspected small intestinal bleeding results of a pilot study
Gastrointestinal Endoscopy, 2002Co-Authors: Blair S Lewis, Paul SwainAbstract:Background: A video capsule has been developed to acquire photographic images of the small intestine during normal peristaltic motion. Methods: Patients between 21 and 80 years of age referred for Enteroscopy because of obscure GI bleeding were offered entry into a trial in which they would undergo both capsule endoscopy and subsequent Push Enteroscopy. Results of capsule examinations were compared with Push Enteroscopy findings. Capsule endoscopy was performed with the Given M2A video capsule system. Results: Twenty-one patients (12 women, 9 men, average age 61 years) were enrolled, all of whom completed the study. A bleeding site was found in 11 of 20 patients during capsule endoscopy. No additional intestinal diagnoses were made by Enteroscopy. The yield of Push Enteroscopy in the evaluation of obscure bleeding was 30% (6/20), the yield of capsule endoscopy 55% (11/20). This difference did not reach statistical significance (p = 0.0625). Capsule endoscopy found a distal source of bleeding in 5 of 14 patients who had normal Push enteroscopic examinations. Patients preferred capsule endoscopy to Enteroscopy. Conclusions: This pilot study demonstrates that capsule endoscopy provides excellent visualization of the small intestine, is well tolerated by patients, and is safe. Capsule endoscopy identified small intestinal bleeding sites beyond the range of Push Enteroscopy. (Gastrointest Endosc 2002;56:349-53.)
Christophe Cellier - One of the best experts on this subject based on the ideXlab platform.
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capsule endoscopy or Push Enteroscopy for first line exploration of obscure gastrointestinal bleeding
Gastroenterology, 2007Co-Authors: Antoine De Leusse, Christophe Cellier, K Vahedi, J Edery, Djamel Tiah, Elisabeth Fery Lemonnier, Yoram Bouhnik, R JianAbstract:Background & Aims: The position of capsule endoscopy (CE) relative to Push Enteroscopy (PE) in the diagnostic algorithm of obscure gastrointestinal bleeding is unclear, as previous studies involved the use of both techniques in all patients. We therefore conducted a trial in which patients were randomized to undergo one or other exploration. Methods: All consecutive patients referred for obscure gastrointestinal bleeding were randomized between CE and PE as the first-line exploration. The alternative method was only used if the first-line method revealed no definite bleeding source, or if required for clinical reasons during follow-up. Results: CE and PE, used as the first-line exploration, identified a bleeding source in 20 of 40 patients and 9 of 38 patients, respectively (50% vs 24%; P = .02). CE missed lesions in 8% of patients, and all these lesions were located in sites accessible to standard endoscopy. PE missed lesions in 26% of patients. At the end of the 12-month follow-up period, the strategy based on CE as first-line exploration followed by PE if necessary only was similar to PE followed by CE in terms of diagnostic yield, clinical outcome, and therapeutic impact, but reduced the percentage of patients needing the alternative exploration (25% vs 79%; P Conclusions: CE has a higher diagnostic yield than PE in obscure gastrointestinal bleeding, and a strategy based on CE as first-line exploration avoids unnecessary explorations.
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CLINICAL-ALIMENTARY TRACT Capsule Endoscopy or Push Enteroscopy for First-Line Exploration of Obscure Gastrointestinal Bleeding?
2007Co-Authors: Antoine De Leusse, Christophe Cellier, Kouroche Vahedi, J Edery, Djamel Tiah, Yoram Bouhnik, R JianAbstract:Background & Aims: The position of capsule endoscopy (CE) relative to Push Enteroscopy (PE) in the diagnostic algorithm of obscure gastrointestinal bleeding is unclear, as previous studies involved the use of both techniques in all patients. We therefore conducted a trial in which patients were randomized to undergo one or other exploration. Methods: All consecutive patients referred for obscure gastrointestinal bleeding were randomized between CE and PE as the first-line exploration. The alternative method was only used if the firstline method revealed no definite bleeding source, or if required for clinical reasons during follow-up. Results: CE and PE, used as the first-line exploration, identified a bleeding source in 20 of 40 patients and 9 of 38 patients, respectively (50% vs 24%; P .02). CE missed lesions in 8% of patients, and all these lesions were located in sites accessible to standard endoscopy. PE missed lesions in 26% of patients. At the end of the 12-month follow-up period, the strategy based on CE as first-line exploration followed by PE if necessary only was similar to PE followed by CE in terms of diagnostic yield, clinical outcome, and therapeutic impact, but reduced the percentage of patients needing the alternative exploration (25% vs 79%; P < .001). Conclusions: CE has a higher diagnostic yield than PE in obscure gastrointestinal bleeding, and a strategy based on CE as first-line exploration avoids unnecessary explorations.
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Predictive factors of positive findings in patients explored by Push Enteroscopy for unexplained GI bleeding.
Gastrointestinal Endoscopy, 2005Co-Authors: Céline Lepère, E. Cuillerier, Bruno Landi, Andre Van Gossum, Alexis Bezet, A. Schmit, Christophe CellierAbstract:Background The diagnostic yield of Push Enteroscopy (PE) in patients with unexplained overt GI bleeding is about 30%. The aim of this study was to assess for predictive factors of positive findings. Methods A total of 182 patients referred to two endoscopic centers (European Georges Pompidou Hospital [Paris, France] and Erasmus Hospital [Brussels, Belgium]) for unexplained overt GI bleeding (melena [57%], hematochezia [26%], or hematochezia associated with melena [17%]) were included in this retrospective study. Predictive factors associated with positive findings at upper PE were studied by using uni- and multivariate analysis. Results The overall diagnostic yield of upper PE was 34% (62/182), but lesions were found beyond the second duodenum in 25% of the patients (45/182). Factors significantly associated with positive findings at upper PE were the following. (1) In univariate analysis: the presence of melena, Hb level 4 units per patient, chronic renal failure, disorder of hemostasis or effective anticoagulant treatment, history of intestinal arteriovenous malformation, and age>65 years. (2) In multivariate analysis: chronic renal failure and presence of melena. If only jejunal lesions were considered, chronic renal failure was the only predictive factor associated with positive findings at upper PE in multivariate analysis. The severity of GI bleeding did not reach statistical significance ( p =0.06). Delay between GI bleeding and PE, number of previous standard endoscopies and previous episodes of bleeding were not associated with positive findings in upper PE. Conclusions In patients with unexplained overt GI bleeding, upper PE has a higher diagnostic yield in patients with chronic renal failure and patients with melena (vs. hematochezia).
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Clinical impact of Push Enteroscopy in patients with gastrointestinal bleeding of unknown origin.
Clinical Gastroenterology and Hepatology, 2004Co-Authors: Alexis Bezet, E. Cuillerier, Bruno Landi, Philippe Marteau, Christophe CellierAbstract:Background & Aims: Despite the frequent use of Push Enteroscopy (PE), little is known of its clinical impact. The aim of this study was to evaluate the impact of PE on diagnostic and therapeutic management of patients with gastrointestinal bleeding of unknown origin. Methods: Seventy-five consecutive patients (mean age, 56 y) referred for PE were included in this 1-year prospective study. Indications for PE were overt bleeding in 46 patients (61%) and iron-deficiency anemia in 29 patients (39%). Before the procedure, the prescribing physicians were asked to fill out a questionnaire listing the theoretical patient management plan (diagnostic procedures and/or treatment) as if PE were not available. One month after PE, the same physicians were asked about: (1) diagnostic procedures performed after PE, (2) the final diagnosis, and (3) their opinion of the usefulness of PE in clinical management. The clinical impact of PE on diagnostic and/or therapeutic management was assessed by 3 study physicians. Results: Responses to the 2 questionnaires were obtained for all patients. The diagnostic yield of PE was 32% (24 of 75). The clinical impact of PE (changes in diagnostic and/or therapeutic management) was 55% (n = 41). PE was perceived as helpful by the prescribing physicians in 55% of cases. PE tended to influence patient management more in cases of overt bleeding than in cases of occult bleeding (63% vs. 41%; P = 0.06). Conclusions: PE influenced the clinical management of more than half the patients with GI bleeding of unknown origin, and was particularly useful in patients with overt bleeding.
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Long-term outcome of patients with gastrointestinal bleeding of obscure origin explored by Push Enteroscopy.
Endoscopy, 2002Co-Authors: B. Landi, E. Cuillerier, Christophe Cellier, Marianne Gaudric, Demont H, Guimbaud R, Daniel Couturier, J. P. Barbier, Philippe MarteauAbstract:BACKGROUND AND STUDY AIMS: Little is known of the long-term outcome in patients with gastrointestinal bleeding of obscure origin, who undergo investigation by means of Push Enteroscopy. The aim of this study was to assess the rate of recurrent bleeding and its predictive factors in patients with gastrointestinal bleeding of obscure origin, after exploration by Push Enteroscopy. PATIENTS AND METHODS: 105 patients with gastrointestinal bleeding of obscure origin (iron-deficiency anemia: n = 56; overt bleeding: n = 49) underwent exploration by Push Enteroscopy from December 1994 to December 1998. They were classified into three groups according to Enteroscopy findings: no lesion found (group A; 56 patients), arteriovenous malformations (group B; 18 patients), and other gastrointestinal lesions (group C; 31 patients). Actuarial rates of rebleeding during follow-up were calculated and factors associated with rebleeding were assessed by means of univariate and multivariate analysis. RESULTS: Follow-up data were obtained for 101 patients (96 %). The mean follow-up was 29 months (6 - 54 months). The 2-year actuarial rate of rebleeding was 31 % in the overall population, and 27.6 %, 56 % and 24 % in groups A, B, and C, respectively (P = 0.13). The number of previous bleeding episodes and the number of packed red cell units transfused were two independent factors predictive of recurrent bleeding. The modality of recurrent bleeding (anemia or overt bleeding) was similar to that of the initial episode in 94 % of cases. In group A, a gastrointestinal lesion was found after rebleeding in one of the 12 patients with iron-deficiency anemia, and in four of the five patients with overt bleeding. CONCLUSION: Recurrent bleeding occurs in about one-third of patients who undergo investigation by Push Enteroscopy for gastrointestinal bleeding of obscure origin, with a trend towards more frequent rebleeding in patients with arteriovenous malformations. Frequent previous bleeding episodes and transfusion requirements are predictive of recurrent bleeding.
Paul V. Desmond - One of the best experts on this subject based on the ideXlab platform.
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RESEARCH RESEARCH Initial experience with capsule endoscopy at a major referral hospital
2010Co-Authors: André K H Chong, Ashley M. Miller, Andrew C F Taylor, Paul V. DesmondAbstract:to investigate with available technology. Push Enteroscopy allows examination of only up to 80–120 cm beyond the ligament of Treitz
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Capsule endoscopy vs. Push Enteroscopy and enteroclysis in suspected small-bowel Crohn's disease.
Gastrointestinal Endoscopy, 2005Co-Authors: André K H Chong, Andrew C. Taylor, Ashley M. Miller, Oliver Hennessy, William Connell, Paul V. DesmondAbstract:Background The diagnosis of small-bowel Crohn's disease sometimes is difficult and may be missed by conventional imaging studies. Capsule endoscopy might identify small-bowel disease undetected by other investigations. Methods Patients with or without known Crohn's disease who were suspected to have small-bowel Crohn's disease were prospectively evaluated with Push Enteroscopy, enteroclysis, and capsule endoscopy. Each examiner was blinded to results of other investigations. Referring doctors were required to complete questionnaires before and after the investigations. Results Twenty-two patients were known to have Crohn's disease (Group 1), and 21 were suspected to have small-bowel Crohn's disease (Group 2). In Group 1, capsule endoscopy detected more erosions than the other two investigations ( p Conclusions Capsule endoscopy has a higher yield than Push Enteroscopy and enteroclysis in patients with known Crohn's disease when small-bowel mucosal disease is suspected, and this leads to a change in management in the majority of these patients.
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Prospective assessment of the diagnostic and therapeutic impact of small-bowel Push Enteroscopy.
Endoscopy, 2003Co-Authors: Andrew C. Taylor, R. J. Buttigieg, I. G. Mcdonald, Paul V. DesmondAbstract:BACKGROUND AND STUDY AIMS Although the reported diagnostic yield of Push Enteroscopy has been substantial in previous studies, its clinical impact has never been prospectively evaluated. The primary aim of this study was to prospectively determine the diagnostic and therapeutic impact of Enteroscopy. In addition, the yield of new and clinically important findings was prospectively assessed. PATIENTS AND METHODS Consecutive patients referred for Enteroscopy were studied. The referring clinician completed a form indicating the working diagnosis, degree of diagnostic certainty, and the management plan had Enteroscopy been unavailable. Diagnostic certainty was indicated on a scale of 1 = very unlikely (1 - 9 %) to 6 = certain (100 %). Following Enteroscopy, the referring doctor completed another form indicating these features in the light of the enteroscopic findings. RESULTS The study group comprised 77 patients referred for 79 Push enteroscopies. There was a change in working diagnosis or management plan as a result of Enteroscopy in 39/77 (51 %) patients. The working diagnosis and the management plan changed in 29/77 (38 %) and 34/77 (44 %), respectively, and the diagnostic certainty changed in a further 29 patients (38 %). There were clinically significant small-bowel findings in 16 (20 %) and new upper gastrointestinal findings in 16 (20 %), giving an overall diagnostic yield of 40 %. CONCLUSIONS Enteroscopy has a significant impact on clinicians' working diagnoses and management plans.
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Push Enteroscopy: a single centre experience and review of published series.
ANZ Journal of Surgery, 2002Co-Authors: Robert Y M Chen, Andrew C. Taylor, Paul V. DesmondAbstract:Background: To assess the efficacy of Push Enteroscopy in a single tertiary hospital and review the available literature to assess the overall diagnostic yield of Push Enteroscopy. Methods: Review of a database on Push Enteroscopy in a tertiary hospital from 1997 to 1999. This included 100 consecutive patients who underwent Push Enteroscopy. Review of all large published series on Push Enteroscopy to date to obtain an overall diagnostic yield. Results: The diagnostic yield for patients with gastrointestinal (GI) bleeding was 47% and for patients with suspected small bowel disease was 33%. Angiodysplasia was the most common diagnosis in patients with GI blood loss. Patients with active GI bleeding had a higher diagnostic yield. The procedure was tolerated well and no complications occurred. Review of the literature showed an overall diagnostic yield of 44% (498 of 1136 patients) for patients with GI blood loss and 38% (108 of 286 patients) for suspected small bowel disease. Conclusions: Push Enteroscopy has a good diagnostic yield and is valuable in patients with GI blood loss and suspected small bowel disease.
Alain Schmit - One of the best experts on this subject based on the ideXlab platform.
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Diagnostic efficacy of Push-Enteroscopy and long-term follow-up of patients with small bowel angiodysplasias
Digestive Diseases and Sciences, 1996Co-Authors: Alain Schmit, Michael Adler, Michel Cremer, André GossumAbstract:Gastrointestinal angiodysplasias are the most common cause of obscure chronic digestive blood loss. Push-Enteroscopy is likely to detect and to treat vascular lesions. Push-Enteroscopy was performed in 83 patients (mean age 62 years) presenting with iron deficiency anemia of obscure origin. A nonrevealing preliminary evaluation included esophagogastroduodenoscopy, colonoscopy and, in 50% of the patients, small bowel barium studies. We employed a 240-cm Olympus Push-enteroscope (XSIF-100), 11.3 mm in diameter. A potential bleeding lesion was observed in 49 patients (59%). Gastrointestinal angiodysplasias were the most common lesion (33 patients). Electrocoagulation (bicap) of angiodysplasias was performed when accessible and not diffuse (
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diagnostic efficacy of Push Enteroscopy and long term follow up of patients with small bowel angiodysplasias
Digestive Diseases and Sciences, 1996Co-Authors: Alain Schmit, Michael Adler, Michel Cremer, Andre Van GossumAbstract:Gastrointestinal angiodysplasias are the most common cause of obscure chronic digestive blood loss. Push-Enteroscopy is likely to detect and to treat vascular lesions. Push-Enteroscopy was performed in 83 patients (mean age 62 years) presenting with iron deficiency anemia of obscure origin. A nonrevealing preliminary evaluation included esophagogastroduodenoscopy, colonoscopy and, in 50% of the patients, small bowel barium studies. We employed a 240-cm Olympus Push-enteroscope (XSIF-100), 11.3 mm in diameter. A potential bleeding lesion was observed in 49 patients (59%). Gastrointestinal angiodysplasias were the most common lesion (33 patients). Electrocoagulation (bicap) of angiodysplasias was performed when accessible and not diffuse (<20). If not contraindicated, hormonal treatment was proposed for patients who had at least five AD. Some patients had both treatments. Long-term follow-up (mean, 12.2 months) was obtained in 25 patients with small bowel angiodysplasias. A good outcome (neither recurrence of anemia nor blood transfusion requirements) was observed in 12 patients. The diagnostic efficacy of Push-Enteroscopy is high. Despite available and recommended therapeutic modalities, the long-term outcome was considered to be good in only 50% of the patients.
