AIM: To study the role of retrograde terminal ileoscopy in patients suspected to have ileocolonic tuberculosis. METHODS: A retrospective analysis was performed for patients undergoing colonoscopy for suspected ileocol...AIM: To study the role of retrograde terminal ileoscopy in patients suspected to have ileocolonic tuberculosis. METHODS: A retrospective analysis was performed for patients undergoing colonoscopy for suspected ileocolonic tuberculosis between January 2000 and June 2004, in whom retrograde ileoscopy had been performed. Only patients diagnosed with tuberculosis on the basis of histological findings of either a caseating granuloma or those having non-caseating granuloma or a collection of epithelioid cells at a minimum of one endoscopic lesion (either in the colon or the terminal ileum) on histology with good responses to conventional anti-tuberculous drugs were enrolled for the study. RESULTS: Fifty-three patients were included. The terminal ileum was involved in only 11 patients. Eight of these patients had involvement of the cecum too. Two patients had ileal lesions without cecal involvement; however, lesions were noted in the ascending colon. In one patient the whole colon was normal and only the terminal ileum showed nodularity and ulceration. Histological examination of the ileal biopsies obtained from the ileal lesions showed noncaseating granulomas in five, collection of epithelioid cells in four and nonspecific histology in two patients. Mucosal biopsies obtained from the lesion in the terminal ileum, in the patient in whom mucosal abnormality was observed to be confined to the ileum, showed noncaseating granulomas. In two other patients the ileal biopsies alone showed histological evidence of tuberculosis with biopsies from the colonic lesions showing non-specific inflammatory changes only. CONCLUSION: Retrograde ileoscopy should be performed in all patients undergoing colonoscopy for suspected ileocolonic tuberculosis. In some patients only the terminal ileum may be involved and histological examination may reveal evidence of tuberculosis only from the lesions in the terminal ileum. This approach would lead to additional lesions being picked up andincreasing the chances of well-timed diagnosis of tuberculosis.展开更多
AIM： To evaluated the role of hyoscine butyl bromide in facilitating retrograde ileoscopy. METHODS： Retrograde terminal ileoscopy was attempted in 200 consecutive patients undergoing colonoscopy. After intubation of...AIM： To evaluated the role of hyoscine butyl bromide in facilitating retrograde ileoscopy. METHODS： Retrograde terminal ileoscopy was attempted in 200 consecutive patients undergoing colonoscopy. After intubation of the cecum and visualization of the ileocecal valve, butyl bromide injection or normal saline was given intravenously to the patients in a double blind random fashion. The pulse rate and oxygen saturation were measured continuously. After completion of the procedure, endoscopists were then asked to score the ease of intubation and the ease of visualization of the terminal ileum on a visual scale of 1 to 10. The patients were also asked to score the pain after receiving hyoscine butyl bromide injection on a score of 1 to 10. RESULTS： Terminal ileoscopy could be performed in 188 patients. The mean （SD） visual analogue score for the ease of intubation of the cecum was 7.4 （0.65） in the injection group and 5.9 （0.8） in the placebo group （P 〈 0.001）. The mean （SD） length of ileum visualized in the injection group was 14.4 （3.3） cm and 10.4 （2.7） cm in the placebo group （P 〈 0.001）. The mean （SD） visual analogue score for ease of visualization of the terminal ileum was 7.5 （0.69） in the injection group and 5.9 （0.7） in the placebo group （P 〈 0.001）. The pain score experienced by the patients was 6.5 （0.7） in the injection group and 6.7 （0.69） in the placebo group （P 〈 0.008）. Although the pulse rate increased significantly in patients receiving the drug, no statistically significant difference was noted in the oxygen saturation between the two groups either before or after administration of the drug. No complications were observed in either of the groups. CONCLUSION： Hyoscine butyl bromide injection is a useful adjunct in helping the intubation and visualization of terminal ileum during colonoscopy.展开更多
Crohn's disease(CD) is a chronic inflammatory condition of the gastrointestinal tract resulting in inflammation, stricturing and fistulae secondary to transmural inflammation. Diagnosis relies on clinical history,...Crohn's disease(CD) is a chronic inflammatory condition of the gastrointestinal tract resulting in inflammation, stricturing and fistulae secondary to transmural inflammation. Diagnosis relies on clinical history, abnormal laboratory parameters, characteristic radiologic and endoscopic changes within the gastrointestinal tract and most importantly a supportive histology. The article is intended mainly for the general gastroenterologist and for other interested physicians. Management of small bowel CD has been suboptimal and limited due to the inaccessibility of the small bowel.Enteroscopy has had a significant renaissance recently, thereby extending the reach of the endoscopist,aiding diagnosis and enabling therapeutic interventions in the small bowel. Radiologic imaging is used as the first line modality to visualise the small bowel. If the clinical suspicion is high, wireless capsule endoscopy(WCE) is used to rule out superficial and early disease, despite the above investigations being normal. This is followed by push enteroscopy or device assisted enteroscopy(DAE) as is appropriate. This approach has been found to be the most cost effective and least invasive. DAE includes balloon-assisted enteroscopy, [double balloon enteroscopy(DBE), single balloon enteroscopy(SBE) and more recently spiral enteroscopy(SE)]. This review is not going to cover the various other indications of enteroscopy, radiological small bowel investigations nor WCE and limited only to enteroscopy in small bowel Crohn's. These excluded topics already have comprehensive reviews.Evidence available from randomized controlled trials comparing the various modalities is limited and at best regarded as Grade C or D(based on expert opinion).The evidence suggests that all three DAE modalities have comparable insertion depths, diagnostic and therapeutic efficacies and complication rates, though most favour DBE due to higher rates of total enteroscopy. SE is quicker than DBE, but lower complete enteroscopy rates. SBE has quicker procedural times and is evolving but the least available DAE today. Larger prospective randomised controlled trial's in the future could help us understand some unanswered areas including the role of BAE in small bowel screening and comparative studies between the main types of enteroscopy in small bowel CD.展开更多
Objective: Intestinal graft-versus-host disease (GVHD) represents one of the most serious complications of allogeneic stem cell transplantation (allo-SCT). Endoscopic and histological proof is required due to the numb...Objective: Intestinal graft-versus-host disease (GVHD) represents one of the most serious complications of allogeneic stem cell transplantation (allo-SCT). Endoscopic and histological proof is required due to the number of differential diagnoses manifesting as diarrhea. We investigated the safety of endoscopic biopsies, and the role of conducting biopsies and inspections of the terminalileum. Patients: Thirty two colonoscopic examinations and 29 biopsies were performed for 19 patients after allo-SCT in our institute between October 2011 and May 2015. Results: Endoscopic examinations and biopsies were performed safely under the policy of transfusing platelets for thrombocytopenia (3/μL). For biopsied cases, the diagnostic consistency rate with endoscopic findings was 60%, with a tendency toward negative correlations with early examinations after diarrhea onset (25% for 0 - 1 days;62.5% for later) or low-grade GVHD according to Freiburg criteria (41.2% for grade 1, 66.7% for grade 2, 100% for higher). The terminal ileum was inspected with colonoscopy in 13 cases. Endoscopic diagnoses of the ileum were provided in 11 cases and histological diagnoses in 9 cases. Diagnostic consistency for diagnosis of the terminal ileum between endoscopy and histology was 77.8%. Conclusion: Because endoscopic and histopathological findings do not always match, caution is required when focusing on endoscopic findings alone, as there is a risk of misdiagnosis. Extensive inspection of the terminal ileum with biopsy appears useful to identify otherwise undetected lesions. Our data thus support invasive endoscopic examinations for gastrointestinal complications, including ileac inspection and biopsies under appropriate management.展开更多
Background:Recurrence of Crohn’s disease(CD)can occur after surgery,including end ileostomy(EI).The Rutgeerts score(RS)was developed to predict postsurgical CD recurrence via ileocolonoscopy in patients having ileoco...Background:Recurrence of Crohn’s disease(CD)can occur after surgery,including end ileostomy(EI).The Rutgeerts score(RS)was developed to predict postsurgical CD recurrence via ileocolonoscopy in patients having ileocolonic resection.The role of ileoscopic evaluation via stoma for assessing recurrence of CD has not been investigated.The aim of this study was to evaluate the role of ileoscopy for predicting disease recurrence in CD patients after EI with the use of RS.Methods:A total of 73 eligible CD patients with at least two ileoscopies in our institution following EI were included.Mucosal inflammation of the neo-terminal ileum was graded based on the RS.The primary outcomes were the need for endoscopic stricture dilation and subsequent surgery due to recurrence of disease.The secondary outcomes were CDrelated hospitalization and the need to escalate CD-associated medications.Results:The median duration of CD until EI was 9 years(interquartile range:4-13 years),and themedian duration from EI to the first ileoscopy was 28months(interquartile range:11-93 months).The RSs in the neo-terminal ileum close to EI were calculated,and subjects were divided into two groups:the normal RS group with the score being zero(n=25)and the abnormal RS group with the RS score being(n=48).Patients in the abnormal RS group weremore likely to have recurrence of CD(92%vs 27%)and need endoscopic dilation of stricture(40%vs 10%),subsequent bowel surgery(68%vs 15%),disease-related hospitalizations(80%vs 23%)and escalation of CDmedications(64%vs 25%)than those in the normal RS group.Time-to-event analysis showed that patients in the abnormal RS group were at a higher risk of endoscopic dilation(odds ratio(OR)=1.5;95%CI:1.09–1.9),need of second bowel surgery(OR=1.5;95% CI:1.2–1.8)and disease-related hospitalizations(OR=1.3;95% CI:1.1–1.6)after adjusting for factors such as duration from surgery to sensor,duration of disease and the patient’s sex(all P<0.001).Further multivariable analysis showed that patients in the abnormal RS group were more likely to need escalation of CD-related medications after adjusting for duration from surgery and age(OR¼5.3;95%CI:1.7–16.5;P=0.004).Conclusion:RS can be used to predict the recurrence of CD in patients with EI.A high RS score based on ileoscopy appeared to be associated with poor outcomes.This may be considered a useful decision-making tool for monitoring disease after ileostomy surgery.展开更多
文摘AIM: To study the role of retrograde terminal ileoscopy in patients suspected to have ileocolonic tuberculosis. METHODS: A retrospective analysis was performed for patients undergoing colonoscopy for suspected ileocolonic tuberculosis between January 2000 and June 2004, in whom retrograde ileoscopy had been performed. Only patients diagnosed with tuberculosis on the basis of histological findings of either a caseating granuloma or those having non-caseating granuloma or a collection of epithelioid cells at a minimum of one endoscopic lesion (either in the colon or the terminal ileum) on histology with good responses to conventional anti-tuberculous drugs were enrolled for the study. RESULTS: Fifty-three patients were included. The terminal ileum was involved in only 11 patients. Eight of these patients had involvement of the cecum too. Two patients had ileal lesions without cecal involvement; however, lesions were noted in the ascending colon. In one patient the whole colon was normal and only the terminal ileum showed nodularity and ulceration. Histological examination of the ileal biopsies obtained from the ileal lesions showed noncaseating granulomas in five, collection of epithelioid cells in four and nonspecific histology in two patients. Mucosal biopsies obtained from the lesion in the terminal ileum, in the patient in whom mucosal abnormality was observed to be confined to the ileum, showed noncaseating granulomas. In two other patients the ileal biopsies alone showed histological evidence of tuberculosis with biopsies from the colonic lesions showing non-specific inflammatory changes only. CONCLUSION: Retrograde ileoscopy should be performed in all patients undergoing colonoscopy for suspected ileocolonic tuberculosis. In some patients only the terminal ileum may be involved and histological examination may reveal evidence of tuberculosis only from the lesions in the terminal ileum. This approach would lead to additional lesions being picked up andincreasing the chances of well-timed diagnosis of tuberculosis.
文摘AIM： To evaluated the role of hyoscine butyl bromide in facilitating retrograde ileoscopy. METHODS： Retrograde terminal ileoscopy was attempted in 200 consecutive patients undergoing colonoscopy. After intubation of the cecum and visualization of the ileocecal valve, butyl bromide injection or normal saline was given intravenously to the patients in a double blind random fashion. The pulse rate and oxygen saturation were measured continuously. After completion of the procedure, endoscopists were then asked to score the ease of intubation and the ease of visualization of the terminal ileum on a visual scale of 1 to 10. The patients were also asked to score the pain after receiving hyoscine butyl bromide injection on a score of 1 to 10. RESULTS： Terminal ileoscopy could be performed in 188 patients. The mean （SD） visual analogue score for the ease of intubation of the cecum was 7.4 （0.65） in the injection group and 5.9 （0.8） in the placebo group （P 〈 0.001）. The mean （SD） length of ileum visualized in the injection group was 14.4 （3.3） cm and 10.4 （2.7） cm in the placebo group （P 〈 0.001）. The mean （SD） visual analogue score for ease of visualization of the terminal ileum was 7.5 （0.69） in the injection group and 5.9 （0.7） in the placebo group （P 〈 0.001）. The pain score experienced by the patients was 6.5 （0.7） in the injection group and 6.7 （0.69） in the placebo group （P 〈 0.008）. Although the pulse rate increased significantly in patients receiving the drug, no statistically significant difference was noted in the oxygen saturation between the two groups either before or after administration of the drug. No complications were observed in either of the groups. CONCLUSION： Hyoscine butyl bromide injection is a useful adjunct in helping the intubation and visualization of terminal ileum during colonoscopy.
文摘Crohn's disease(CD) is a chronic inflammatory condition of the gastrointestinal tract resulting in inflammation, stricturing and fistulae secondary to transmural inflammation. Diagnosis relies on clinical history, abnormal laboratory parameters, characteristic radiologic and endoscopic changes within the gastrointestinal tract and most importantly a supportive histology. The article is intended mainly for the general gastroenterologist and for other interested physicians. Management of small bowel CD has been suboptimal and limited due to the inaccessibility of the small bowel.Enteroscopy has had a significant renaissance recently, thereby extending the reach of the endoscopist,aiding diagnosis and enabling therapeutic interventions in the small bowel. Radiologic imaging is used as the first line modality to visualise the small bowel. If the clinical suspicion is high, wireless capsule endoscopy(WCE) is used to rule out superficial and early disease, despite the above investigations being normal. This is followed by push enteroscopy or device assisted enteroscopy(DAE) as is appropriate. This approach has been found to be the most cost effective and least invasive. DAE includes balloon-assisted enteroscopy, [double balloon enteroscopy(DBE), single balloon enteroscopy(SBE) and more recently spiral enteroscopy(SE)]. This review is not going to cover the various other indications of enteroscopy, radiological small bowel investigations nor WCE and limited only to enteroscopy in small bowel Crohn's. These excluded topics already have comprehensive reviews.Evidence available from randomized controlled trials comparing the various modalities is limited and at best regarded as Grade C or D(based on expert opinion).The evidence suggests that all three DAE modalities have comparable insertion depths, diagnostic and therapeutic efficacies and complication rates, though most favour DBE due to higher rates of total enteroscopy. SE is quicker than DBE, but lower complete enteroscopy rates. SBE has quicker procedural times and is evolving but the least available DAE today. Larger prospective randomised controlled trial's in the future could help us understand some unanswered areas including the role of BAE in small bowel screening and comparative studies between the main types of enteroscopy in small bowel CD.
文摘Objective: Intestinal graft-versus-host disease (GVHD) represents one of the most serious complications of allogeneic stem cell transplantation (allo-SCT). Endoscopic and histological proof is required due to the number of differential diagnoses manifesting as diarrhea. We investigated the safety of endoscopic biopsies, and the role of conducting biopsies and inspections of the terminalileum. Patients: Thirty two colonoscopic examinations and 29 biopsies were performed for 19 patients after allo-SCT in our institute between October 2011 and May 2015. Results: Endoscopic examinations and biopsies were performed safely under the policy of transfusing platelets for thrombocytopenia (3/μL). For biopsied cases, the diagnostic consistency rate with endoscopic findings was 60%, with a tendency toward negative correlations with early examinations after diarrhea onset (25% for 0 - 1 days;62.5% for later) or low-grade GVHD according to Freiburg criteria (41.2% for grade 1, 66.7% for grade 2, 100% for higher). The terminal ileum was inspected with colonoscopy in 13 cases. Endoscopic diagnoses of the ileum were provided in 11 cases and histological diagnoses in 9 cases. Diagnostic consistency for diagnosis of the terminal ileum between endoscopy and histology was 77.8%. Conclusion: Because endoscopic and histopathological findings do not always match, caution is required when focusing on endoscopic findings alone, as there is a risk of misdiagnosis. Extensive inspection of the terminal ileum with biopsy appears useful to identify otherwise undetected lesions. Our data thus support invasive endoscopic examinations for gastrointestinal complications, including ileac inspection and biopsies under appropriate management.
文摘Background:Recurrence of Crohn’s disease(CD)can occur after surgery,including end ileostomy(EI).The Rutgeerts score(RS)was developed to predict postsurgical CD recurrence via ileocolonoscopy in patients having ileocolonic resection.The role of ileoscopic evaluation via stoma for assessing recurrence of CD has not been investigated.The aim of this study was to evaluate the role of ileoscopy for predicting disease recurrence in CD patients after EI with the use of RS.Methods:A total of 73 eligible CD patients with at least two ileoscopies in our institution following EI were included.Mucosal inflammation of the neo-terminal ileum was graded based on the RS.The primary outcomes were the need for endoscopic stricture dilation and subsequent surgery due to recurrence of disease.The secondary outcomes were CDrelated hospitalization and the need to escalate CD-associated medications.Results:The median duration of CD until EI was 9 years(interquartile range:4-13 years),and themedian duration from EI to the first ileoscopy was 28months(interquartile range:11-93 months).The RSs in the neo-terminal ileum close to EI were calculated,and subjects were divided into two groups:the normal RS group with the score being zero(n=25)and the abnormal RS group with the RS score being(n=48).Patients in the abnormal RS group weremore likely to have recurrence of CD(92%vs 27%)and need endoscopic dilation of stricture(40%vs 10%),subsequent bowel surgery(68%vs 15%),disease-related hospitalizations(80%vs 23%)and escalation of CDmedications(64%vs 25%)than those in the normal RS group.Time-to-event analysis showed that patients in the abnormal RS group were at a higher risk of endoscopic dilation(odds ratio(OR)=1.5;95%CI:1.09–1.9),need of second bowel surgery(OR=1.5;95% CI:1.2–1.8)and disease-related hospitalizations(OR=1.3;95% CI:1.1–1.6)after adjusting for factors such as duration from surgery to sensor,duration of disease and the patient’s sex(all P<0.001).Further multivariable analysis showed that patients in the abnormal RS group were more likely to need escalation of CD-related medications after adjusting for duration from surgery and age(OR¼5.3;95%CI:1.7–16.5;P=0.004).Conclusion:RS can be used to predict the recurrence of CD in patients with EI.A high RS score based on ileoscopy appeared to be associated with poor outcomes.This may be considered a useful decision-making tool for monitoring disease after ileostomy surgery.
