Clinical Features of Ischemic Enteritis Diagnosed by Double-Balloon Endoscopy

Abstract

Introduction. Ischemic enteritis (IE) is a relatively rare small bowel disease that is diagnosed via double-balloon endoscopy (DBE), although the lack of established diagnostic criteria can make it difficult to confirm the diagnosis. This study aimed to describe the clinical characteristics, endoscopic imaging features, and treatments for IE at our center. Patients and Methods. We retrospectively searched the DBE database (1,521 patients) at Nagoya University Hospital for patients with IE and collected data regarding endoscopic findings, clinical background, and histological findings. The cases were categorized according to whether they involved transient or stenotic IE. Results. The DBE database included 24 patients (14 men) with IE. Transient IE was identified in 9 patients, and stenotic IE was identified in 15. Half of the patients had a history of cerebrovascular and cardiovascular disease. A granular structure at the ulcer base was the most frequently observed DBE finding at the stenotic site. Enterography using the contrast medium revealed that transient IE had a similar stenotic lesion length, relative to stenotic IE, although stenotic IE had a significantly higher stenosis ratio (81% vs. 63%, P = 0.033 ). Small bowel enteroclysis revealed the “lead pipe” sign (11 patients), thumbprinting (3 patients), and the serrated lumen sign (1 patient). Only 1 patient with stenotic IE experienced recurrence after conservative treatment. Conclusion. During DBE, IE was characterized by cannular stenosis with extended and variable ulceration types, which spread over the edge of the stenosis, and a granular appearance at the ulcer base. These findings may help guide the diagnosis of IE.

Clinical characteristics of Dieulafoy’s Lesion in the Small Bowel Diagnosed and Treated by Double-Balloon Endoscopy

“…Our analysis revealed that many patients with DL had underlying diseases and comorbidity index of the patients were relatively high as previously reported 15 (Table 1). Intestinal vessel diseases of the small bowel such as angiodysplasia and ischemic enteritis are often complicated with severe underlying diseases and are related to the peripheral vein [3,19]. Although DL is an artery-related disease, it is also affected by underlying diseases.…”

“…This protocol for this retrospective study was approved by the Ethics Committee of the Nagoya University Hospital, Nagoya, Japan (2015-0485). Our clinical practice for diagnosing small bowel disease involves previously described DBE examinations [19,20]. Peroral and/or transanal routes were selected according to the location of the suspected lesion, which was determined from the results of a clinical examination, computed tomography (CT) scan, SBCE, and small bowel barium series.…”

Smooth muscle degeneration of the mesenteric and branching veins causing ischemic enteritis: a case report

“…The differential diagnosis for small bowel stricture includes inflammatory bowel disorders, malignant tumor, tuberculosis, nonsteroidal anti-inflammatory drug-associated enteritis, trauma, antiphospholipid antibody syndrome, and abdominal adhesions related to previous surgery [ 4 , 6 , 7 , 13 ]. In addition, intestinal anisakiasis can exhibit a similar clinical course, making it important to take a history of the illness [ 7 ].…”

“…With respect to future follow-ups, detection of small bowel disorders is challenging. Previous reports have shown that the recent development of double-balloon endoscopy or capsule endoscopy has enabled the observation and detection of small bowel lesions [ 6 , 7 , 18 ]. Double-balloon endoscopy or capsule endoscopy may be required and it is important to include ischemic enteritis caused by this disease in the differential diagnosis when the patient experiences a relapse of abdominal symptoms.…”

“…Ischemic enteritis is more uncommon than ischemic colitis because of the rich blood flow in the small bowel [ 4 , 5 ]. Surgery is often required for diagnosis and treatment, owing to the severity of the stricture and the difficulty of examination using endoscopy [ 6 , 7 ]. We present the case of a patient who exhibited rare pathological changes of the mesentery to branching veins, causing ischemic enteritis associated with small bowel obstruction.…”