scholarly journals Cecal Carcinoma: Initially Diagnosed as Crohn's Disease on Small Bowel Follow-Through

2001 ◽  
Vol 15 (5) ◽  
pp. 337-340 ◽  
Author(s):  
Donald H Taves ◽  
Linda Probyn
Keyword(s):  
Crohn’S Disease ◽  
Small Bowel ◽  
Crohn's Disease ◽  
Bowel Preparation ◽  
Terminal Ileum ◽  
Ileocecal Valve ◽  
Associated Abnormalities ◽  
Rule Out

Lesions in the terminal ileum are often difficult to visualize on routine small bowel follow-through (SBFT) and may require further investigation to rule out associated abnormalities in the ileocecal valve or cecum. This may be done by peroral pneumocolon at the same sitting as the SBFT, but may require bowel preparation. Two cases of cecal carcinoma that were initially diagnosed as Crohn's disease on SBFT without further investigation of the cecum are reported.

Capsule endoscopy in small bowel Crohn’s disease and Tuberculosis

2017 ◽  
Vol 47 (2) ◽  
pp. 113-118 ◽  
Author(s):  
Surinder Singh Rana ◽  
Vishal Sharma ◽  
Ravi Sharma ◽  
Ritambhra Nada ◽  
Rajesh Gupta ◽  
...  
Keyword(s):  
Crohn’S Disease ◽  
Gastrointestinal Tract ◽  
Small Bowel ◽  
Crohn's Disease ◽  
Capsule Endoscopy ◽  
Ileocecal Valve ◽  
Final Diagnosis ◽  
Diagnostic Challenge ◽  
Large N ◽  
Aphthous Ulcers

Differentiation of small bowel tuberculosis (SBTB) from Crohn’s disease (CD) is a diagnostic challenge. We studied 52 patients with suspected SBTB or CD with terminal ileal involvement, who were prospectively enrolled. After confirming patency of the gastrointestinal tract, 26 patients underwent capsule endoscopy (CE). A final diagnosis of CD was found in 18 patients and SBTB in eight patients. All SBTB patients had involvment of the ileocecal valve (ICV) with large (n = 6) and aphthous (n = 2) ulcers in the ileal segment. In CD, ICV involvement was seen in five (33%) patients. Large and aphthous ulcers were observed in seven (47%) and 15 (100%) patients, respectively. On comparison with CD, patients with SBTB had increased frequency of ICV involvement ( P = 0.002) and lesser frequency of aphthous ulcers ( P = 0.007). CE can help in differentiating CD from SBTB by the position of its involvement and the type of ulcers present.

scholarly journals Panenteric capsule endoscopy versus ileocolonoscopy plus magnetic resonance enterography in Crohn’s disease: a multicentre, prospective study

2020 ◽  
Vol 7 (1) ◽  
pp. e000365 ◽  
Author(s):  
David Henry Bruining ◽  
Salvatore Oliva ◽  
Mark R Fleisher ◽  
Monika Fischer ◽  
Joel G Fletcher
Keyword(s):  
Crohn’S Disease ◽  
Magnetic Resonance ◽  
Small Bowel ◽  
Crohn's Disease ◽  
Capsule Endoscopy ◽  
Terminal Ileum ◽  
Imaging Modality ◽  
Disease Diagnosis ◽  
Magnetic Resonance Enterography ◽  
Proximal Small Bowel

IntroductionCrohn’s disease diagnosis and monitoring remains a great clinical challenge and often requires multiple testing modalities. Assessing Crohn’s disease activity in the entire gastrointestinal (GI) tract using a panenteric capsule endoscopy (CE) system could be used as an alternative to colonoscopy and cross-sectional imaging. This study assessed the accuracy and safety of panenteric CE in Crohn’s disease as compared with ileocolonoscopy (IC) and/or magnetic resonance enterography (MRE).MethodsA prospective, multicentre study was performed in subjects with established Crohn’s disease. Individuals with proven small bowel patency underwent a standardised bowel preparation, followed by CE ingestion and IC either the same or following day. MRE, IC, and CE interpretations were performed by blinded central readers using validated scoring systems. The primary endpoint was the overall sensitivity of CE vs MRE and/or IC in Crohn’s disease subjects.ResultsStudy enrolment included 158 subjects from 21 sites in the USA, Austria, and Israel. Of those, 99 were included in the analysis. Imaging modality scores indicated none to mild inflammation in the proximal small bowel and colon, but discrepant levels of inflammation in the terminal ileum. Overall sensitivity for active enteric inflammation (CE vs MRE and/or IC) was 94% vs 100% (p=0.125) and specificity was 74% vs 22% (p=0.001). Sensitivity of CE was superior to MRE for enteric inflammation in the proximal small bowel (97% vs 71%, p=0.021), and similar to MRE and/or IC in the terminal ileum and colon (p=0.500–0.625). There were seven serious adverse advents of which three were related to the CE device.ConclusionPanenteric CE is a reliable tool for assessing Crohn’s disease mucosal activity and extent compared with more invasive methods. This study demonstrates high performance of the panenteric CE as compared to MRE and/or IC without the need for multiple tests in non-stricturing Crohn’s disease.Trial registration numberClinicalTrials.gov NCT03241368

Does the endoscopic appearance of the ileocecal valve suggest the severity of Crohn's disease in the terminal ileum?

2009 ◽  
Vol 3 (4) ◽  
pp. 287-290 ◽  
Author(s):  
Tamás Molnár ◽  
Klaudia Farkas ◽  
Ferenc Nagy ◽  
Zoltán Szepes ◽  
László Tiszlavicz ◽  
...  
Keyword(s):  
Crohn’S Disease ◽  
Crohn's Disease ◽  
Terminal Ileum ◽  
Ileocecal Valve ◽  
Endoscopic Appearance

scholarly journals P096 Which patients with known Crohn’s disease after an ileo-colonoscopy will benefit most from small bowel capsule endoscopy?

2021 ◽  
Vol 15 (Supplement_1) ◽  
pp. S193-S194
Author(s):  
N Viazis ◽  
A Mountaki ◽  
K Koustenis ◽  
C Veretanos ◽  
K Arvanitis ◽  
...  
Keyword(s):  
Crohn’S Disease ◽  
Small Bowel ◽  
Crohn's Disease ◽  
Capsule Endoscopy ◽  
Terminal Ileum ◽  
Imaging Techniques ◽  
Clinical Manifestations ◽  
Endoscopic Techniques ◽  
Proximal Small Bowel ◽  
Number Of Patients

Abstract Background Ileo-colonoscopy with biopsies is considered the gold standard for the diagnosis and management of Crohn’s disease (CD). In contrast, the role of small bowel capsule endoscopy (SBCE) is limited currently in cases where ileo-colonoscopy and imaging techniques raise doubts on the diagnosis or cannot explain certain clinical manifestations of Crohn’s disease. The aim of our study was to determine whether there are patients with endoscopically confirmed established CD who could get additional benefit by SBCE. Methods Retrospective analysis of prospectively collected data from 6301 patients subjected to SBCE in our department from 1st March 2003 to 18th February 2021. Patients with CD diagnosed by ileo-colonoscopy or total colonoscopy only (because the ileo-caecal valve could not be intubated) prior to SBCE were included in the study and biopsies. SBCE had been performed only in patients who lacked any clinical and/or imaging (CT/MRE) evidence of bowel obstruction. The presence and extent of mucosal lesions, namely local and/or diffuse erythema, erosions and ulcers (aphthous, superficial and/or deep) throughout the small intestine, which may be difficult to identify by traditional imaging, could either explain clinical manifestations unrelated to the findings of colonoscopy or led onto reassessment of applied treatments were sought by SBCE. Results The study sample consisted of 1002 patients (males/females: 511/491, mean age ± SD: 52.6±27.3). Among these, CD had been diagnosed with colonoscopy (and not ileo-colonoscopy) in 293 (29.2%) subjects and small bowel involvement was seen in 104 (35.5%) patients. The vast majority of these patients had lesions only in the terminal ileum (n=81, 77.8%), while the remaining patients (n=23, 22.2%) had additional lesions in more proximal parts of the small bowel. Among the 709 (70.8%) patients in whom CD had been diagnosed by ileo-colonoscopy, lesions in the terminal ileum were found in 407 (57.4 %) patients; SBCE revealed more proximal lesions in 104 patients (25.5%). In the remaining 307 patients (43.3%) in whom ileo-colonoscopy did not reveal terminal ileum involvement, more proximal small bowel lesions were seen in 35 (11.4%) patients. These lesions were mainly apthoid ulcers or larger ulcers, findings that led to a change in therapeutic management in 17 patients (48.6%). Conclusion SBCE identifies more proximal small bowel lesions in a substantial number of patients with CD established by traditional endoscopic techniques. When these lesions are more severe and extensive they may lead onto re-evaluation of the personalized therapeutic strategies.

scholarly journals Progressive Primary Appendiceal Crohn’s Disease in a 21-Year-old Female

2020 ◽  
Vol 14 (3) ◽  
pp. 504-509
Author(s):  
Cullen Roberts ◽  
Jason L. Hornick ◽  
Vanessa Mitsialis ◽  
James Yoo
Keyword(s):  
Crohn’S Disease ◽  
Crohn's Disease ◽  
Systemic Therapy ◽  
Terminal Ileum ◽  
Clinical Symptoms ◽  
Side Wall ◽  
Ileocecal Valve ◽  
Fistula Formation ◽  
Inflammatory Bowel Disorder ◽  
Low Prevalence

Crohn’s disease is an inflammatory bowel disorder that can affect any portion of the gastrointestinal tract, most commonly the terminal ileum near the ileocecal valve. Crohn’s disease can be characterized by transmural inflammation and deep fissuring ulcers that predispose to fistula formation and “skip” lesions separated by normal segments of bowel. While often affecting the terminal ileum near the ileocecal valve, Crohn’s disease presenting primarily in the appendix is a rare entity. In part due to its low prevalence, cases of appendiceal Crohn’s disease can be confused for acute, non-Crohn’s-related appendicitis on initial presentation. Although there are published cases of primary appendiceal Crohn’s disease in the medical literature, in most cases the diagnosis is made retrospectively following appendectomy for presumed appendicitis. We report on a case of Crohn’s disease that was diagnosed pre-operatively, primarily involved the appendix, and which progressed radiographically despite medical therapy and resolution of clinical symptoms. Unique management issues related to this case include the appropriateness of systemic therapy for disease isolated to the appendix, an inability to endoscopically obtain tissue for a definitive diagnosis, and the decision to proceed with surgery in an asymptomatic patient with progressive disease on imaging. Intraoperatively, the appendix was severely inflamed and densely adherent to the left pelvic side wall and adjacent to the left ovary and fallopian tube. A laparoscopic appendectomy was performed. Pathology demonstrated acute appendicitis as well as marked mural chronic inflammation and epithelioid granulomas, consistent with Crohn’s disease. Surgical resection may be the most appropriate treatment for Crohn’s disease primarily involving the appendix, obviating the need for systemic therapy and minimizing the risk for appendiceal perforation and fistula formation.

Normal-looking ileocecal valve does not exclude Crohn's disease in the terminal ileum

2009 ◽  
Vol 47 (05) ◽  
Author(s):  
K Farkas ◽  
T Molnár ◽  
F Nagy ◽  
Z Szepes ◽  
L Tiszlavicz ◽  
...  
Keyword(s):  
Crohn’S Disease ◽  
Crohn's Disease ◽  
Terminal Ileum ◽  
Ileocecal Valve

scholarly journals Implementation of European Society of Gastrointestinal Endoscopy (ESGE) recommendations for small-bowel capsule endoscopy into clinical practice: Results of an official ESGE survey

Endoscopy ◽  
2021 ◽  
Author(s):  
Lazaros-Dimitrios Lazaridis ◽  
Georgios Tziatzios ◽  
Ervin Toth ◽  
Hanneke Beaumont ◽  
Xavier Dray ◽  
...  
Keyword(s):  
Crohn’S Disease ◽  
Clinical Practice ◽  
Small Bowel ◽  
Crohn's Disease ◽  
Capsule Endoscopy ◽  
Bowel Preparation ◽  
European Society ◽  
Gastrointestinal Endoscopy ◽  
Deficiency Anemia ◽  
National Society

Abstract Background We aimed to document international practices in small-bowel capsule endoscopy (SBCE), measuring adherence to European Society of Gastrointestinal Endoscopy (ESGE) technical and clinical recommendations. Methods Participants reached through the ESGE contact list completed a 52-item web-based survey. Results 217 responded from 47 countries (176 and 41, respectively, from countries with or without a national society affiliated to ESGE). Of respondents, 45 % had undergone formal SBCE training. Among SBCE procedures, 91 % were performed with an ESGE recommended indication, obscure gastrointestinal bleeding (OGIB), iron-deficiency anemia (IDA), and suspected/established Crohn’s disease being the commonest and with higher rates of positive findings (49.4 %, 38.2 % and 53.5 %, respectively). A watchful waiting strategy after a negative SBCE for OGIB or IDA was preferred by 46.7 % and 70.3 %, respectively. SBCE was a second-line exam for evaluation of extent of new Crohn’s disease for 62.2 % of respondents. Endoscopists adhered to varying extents to ESGE technical recommendations regarding bowel preparation ( > 60 %), use in those with pacemaker holders (62.5 %), patency capsule use (51.2 %), and use of a validated scale for bowel preparation assessment (13.3 %). Of the respondents, 67 % read and interpreted the exams themselves and 84 % classified exams findings as relevant or irrelevant. Two thirds anticipated future increase in SBCE demand. Inability to obtain tissue (78.3 %) and high cost (68.1 %) were regarded as the main limitations, and implementation of artificial intelligence as the top development priority (56.2 %). Conclusions To some extent, endoscopists follow ESGE guidelines on using SBCE in clinical practice. However, variations in practice have been identified, whose implications require further evaluation.

Feasibility study using iodine quantification on dual-energy CT enterography to distinguish normal small bowel from active inflammatory Crohn’s disease

2018 ◽  
Vol 60 (6) ◽  
pp. 679-686 ◽  
Author(s):  
Isabelle De Kock ◽  
Louke Delrue ◽  
Clarisse Lecluyse ◽  
Pieter Hindryckx ◽  
Martine De Vos ◽  
...  
Keyword(s):  
Crohn’S Disease ◽  
Quantitative Analysis ◽  
Small Bowel ◽  
Crohn's Disease ◽  
Wall Thickness ◽  
Terminal Ileum ◽  
Roc Analysis ◽  
Dual Energy ◽  
Iodine Quantification ◽  
Fat Fraction

Background Assessment of Crohn’s disease (CD) activity is important to identify patients with active inflammation for therapy management. Quantitative analysis can provide objective measurement of disease presence. Purpose To evaluate the feasibility of quantitative analysis of contrast-enhanced dual-energy computed tomography (DECT) data in detection of small bowel inflammation in patients with CD with an emphasis on iodine quantification. Material and Methods DECT enterography was prospectively performed in 20 patients with active CD and in 20 healthy individuals, as the control group. Iodine overlay images were created. Wall thickness, attenuation, absolute iodine density, relative iodine density, and fat fraction were measured in the terminal ileum of all patients by two radiologists. Intraclass correlation coefficients were calculated to assess inter-rater agreement. Parameters were compared between patient groups using mixed model analysis. Receiver operating characteristic (ROC) analysis was performed. Results Both absolute and relative iodine density were significantly higher in active disease than in normal small bowel (all P < 0.001). In contrast, measurement of fat fraction was not significantly different in affected terminal ileal loops compared to normal terminal ileum ( P = 0.075). ROC analysis demonstrated a similar excellent diagnostic accuracy of wall thickness, attenuation, and absolute and relative iodine density with area under the ROC curve (AUC) values in the range of 0.96 for attenuation to 1 for relative iodine density. Conclusion DECT with iodine quantification can be used in distinguishing normal small bowel from active inflammatory CD. Further research should investigate the value of iodine quantification in grading CD activity and in monitoring therapeutic response.

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