Comparison of magnetic resonance enteroclysis and capsule endoscopy with balloon-assisted enteroscopy in patients with obscure gastrointestinal bleeding

Wiarda, Bart M.; Heine, Dimitri; Mensink, Peter; Stolk, M. F. J.; Dees, Jan; Hazenberg, H.J.A.; Stoker, J.; Kuipers, Ernst J.

doi:10.1055/s-0032-1309386

Cited by 44 publications

(31 citation statements)

References 12 publications

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“…Imaging can be performed using either enterography technique, which requires ingestion of large volumes of contrast medium, or enteroclysis with direct administration of enteric fl uid by a nasoenteric tube. Enteroclysis provides superior small bowel distension; however, it is not as well tolerated or widely used ( 150 ). Th e fl uid administered should be a neutral contrast or near water density to improve detection of hyperenhancing abnormalities or bleeding.…”

Section: Usage Of Abdominal Imagingmentioning

confidence: 99%

“…In another study of 52 patients with nondiagnostic VCE, subsequent CTE had a 50% positive yield in those patients with overt small bowel bleeding ( 151 ). Because of the small number of studies regarding MR enterography ( 150,162 ), this exam is not routinely recommended in lieu of CTE, but can be considered in patients aged <40 years because of lower radiation exposure.…”

Section: Usage Of Abdominal Imagingmentioning

confidence: 99%

See 1 more Smart Citation

ACG Clinical Guideline: Diagnosis and Management of Small Bowel Bleeding

Gerson

Fidler

Cave³

et al. 2015

American Journal of Gastroenterology

583

559

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Bleeding from the small intestine remains a relatively uncommon event, accounting for ~5-10% of all patients presenting with gastrointestinal (GI) bleeding. Given advances in small bowel imaging with video capsule endoscopy (VCE), deep enteroscopy, and radiographic imaging, the cause of bleeding in the small bowel can now be identified in most patients. The term small bowel bleeding is therefore proposed as a replacement for the previous classification of obscure GI bleeding (OGIB). We recommend that the term OGIB should be reserved for patients in whom a source of bleeding cannot be identified anywhere in the GI tract. A source of small bowel bleeding should be considered in patients with GI bleeding after performance of a normal upper and lower endoscopic examination. Second-look examinations using upper endoscopy, push enteroscopy, and/or colonoscopy can be performed if indicated before small bowel evaluation. VCE should be considered a first-line procedure for small bowel investigation. Any method of deep enteroscopy can be used when endoscopic evaluation and therapy are required. VCE should be performed before deep enteroscopy if there is no contraindication. Computed tomographic enterography should be performed in patients with suspected obstruction before VCE or after negative VCE examinations. When there is acute overt hemorrhage in the unstable patient, angiography should be performed emergently. In patients with occult hemorrhage or stable patients with active overt bleeding, multiphasic computed tomography should be performed after VCE or CTE to identify the source of bleeding and to guide further management. If a source of bleeding is identified in the small bowel that is associated with significant ongoing anemia and/or active bleeding, the patient should be managed with endoscopic therapy. Conservative management is recommended for patients without a source found after small bowel investigation, whereas repeat diagnostic investigations are recommended for patients with initial negative small bowel evaluations and ongoing overt or occult bleeding.

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Section: Usage Of Abdominal Imagingmentioning

confidence: 99%

Section: Usage Of Abdominal Imagingmentioning

confidence: 99%

ACG Clinical Guideline: Diagnosis and Management of Small Bowel Bleeding

Gerson

Fidler

Cave³

et al. 2015

American Journal of Gastroenterology

583

559

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“…However, the data are limited regarding the role of MRE in suspected smallbowel bleeding. 107,108 Multiphase CT or CTA refers to a technique that is similar to CTE but without oral contrast.…”

Section: Role Of Intraoperative Enteroscopymentioning

confidence: 99%

The role of endoscopy in the management of suspected small-bowel bleeding

Gurudu¹,

Bruining²,

Acosta³

et al. 2017

Gastrointestinal Endoscopy

130

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“…A smaller number of studies have been performed using CT enteroclysis [58,59], MR enterography [60,61], and MR enteroclysis for the evaluation of OGIB [62]. These studies show a similar complementary role to capsule endoscopy.…”

Section: Diagnostic Techniquesmentioning

confidence: 99%

“…The main advantage of the MR techniques over CTE is the lack of ionizing radiation, but larger scale studies are necessary to support their use for this indication of OGIB. Capsule endoscopy performs uniformly better in the demonstration of vascular abnormalities [45,[58][59][60][61][62]. Cross-sectional imaging can identify masses [58][59][60] and some inflammatory changes [61] missed at capsule endoscopy.…”

Section: Diagnostic Techniquesmentioning

confidence: 99%

Gastrointestinal hemorrhage: evaluation with MDCT

2015

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Gastrointestinal (GI) bleeding is a common medical problem, with high associated morbidity and mortality. The clinical presentation of gastrointestinal hemorrhage varies with the location of the bleeding source, the intensity of the bleed, and the presence of comorbidities that affect the ability to tolerate blood loss. Conventional endoscopic examinations are usually the initial diagnostic tests in patients presenting with overt gastrointestinal hemorrhage. However, implementation of upper tract endoscopy and colonoscopy in the emergency setting can be challenging due to inconsistent availability of the service and difficulties in achieving adequate colonic cleansing in emergent situations. Thus, imaging tests are often relied upon to establish the location and the cause of bleeding, either for initial diagnosis or after non-revealing upper and lower tract endoscopies ("obscure" bleeding). This article discusses the imaging evaluation of patients with gastrointestinal bleeding and reviews the imaging appearance of the most common causes, taking into account the two most relevant clinical presentations: overt bleeding and obscure bleeding.

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Comparison of magnetic resonance enteroclysis and capsule endoscopy with balloon-assisted enteroscopy in patients with obscure gastrointestinal bleeding

Abstract: Capsule endoscopy performed better than MRE in the detection of small-bowel abnormality in patients with OGIB. MRE may be considered as an alternative for the initial examination in patients with clinical suspicion of small-bowel stenosis.

Cited by 44 publications

References 12 publications

ACG Clinical Guideline: Diagnosis and Management of Small Bowel Bleeding

ACG Clinical Guideline: Diagnosis and Management of Small Bowel Bleeding

The role of endoscopy in the management of suspected small-bowel bleeding

Gastrointestinal hemorrhage: evaluation with MDCT

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