Obscure gastrointestinal bleeding: preliminary comparison of 64-section CT enteroclysis with video capsule endoscopy

Khalife, Samer; Soyer, Philippe; Alatawi, Abdullah; Vahedi, Kouroche; Hamzi, Lounis; Dray, Xavier; Placé, Vinciane; Marteau, Philippe; Boudiaf, Mourad

doi:10.1007/s00330-010-1896-2

Cited by 66 publications

(57 citation statements)

References 42 publications

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“…The mean CE transit time was 309.4 6 173.6 min, which is slightly longer than that reported previously (265 6 111 min). 16 No serious complications were observed during both MSCT and CE examinations, suggesting that both MSCT and CE techniques described in our study were safe and effective for OGIB. However, the dose of radiation used in our study was 23.86 6 5.03 mSv, and the risk of radiation exposure still represents a potential safety hazard in MSCT diagnosis.…”

Section: Discussionsupporting

confidence: 52%

“…16,[27][28][29][30] In this study, we reported a relatively high diagnostic yield of 47.56% and 68.66% for MSCT and CE, respectively. Despite a lower overall diagnostic yield than CE, MSCT examination in our study achieved a similar diagnostic capability to CE.…”

Section: Discussionmentioning

confidence: 87%

“…14 Considering that both CE and MSCT have advantages and disadvantages, a limited number of published data have compared the two diagnostic tools in patients with OGIB. 4,6,[15][16][17] However, most of these studies did not refer to MSCTA, and apparently different results were obtained owing to the advancement of the two technologies. Thus, an updated and comprehensive comparison is required.…”

mentioning

confidence: 99%

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Obscure gastrointestinal bleeding: diagnostic performance of 64-section multiphase CT enterography and CT angiography compared with capsule endoscopy

He¹,

Gong²,

Hu³

et al. 2014

BJR

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Section: Discussionsupporting

confidence: 52%

Section: Discussionmentioning

confidence: 87%

mentioning

confidence: 99%

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Obscure gastrointestinal bleeding: diagnostic performance of 64-section multiphase CT enterography and CT angiography compared with capsule endoscopy

He¹,

Gong²,

Hu³

et al. 2014

BJR

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“…13 Among the ten patients with discrepant findings between CTE and VCE, VCE showed linear ulcers in relation to the use of NSAID (in three of them, which were unseen at CTE). In one patient, small linear ulcer was seen with VCE but not seen with CTE.…”

Section: 12mentioning

confidence: 87%

CT enteroclysis/enterography findings in drug-induced small-bowel damage

Kishi

Shimizu²,

Hashimoto³

et al. 2014

The British Journal of Radiology

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Objective: To evaluate the CT enteroclysis (CTE)/ enterography findings of patients with small-bowel mucosal damage induced by aspirin or non-steroidal antiinflammatory drugs (NSAIDs) and to compare these findings with the duration of drug use and endoscopic findings. Methods: CTE findings of 11 patients (22 lesions) with drug-induced small-bowel damage were reviewed, including 8 NSAID users and 3 aspirin users. Three patients were short-term users (6 months or shorter) and eight were long-term users (3 years or longer). Nine patients also underwent videocapsule endoscopy (VCE) or double-balloon enteroscopy (DBE). Results: Small-bowel abnormalities were visible in 8 of 11 patients (73%) on CTE. Multiple lesions were seen in five patients, including all short-term users. Lesions were classified into three types. Type 1 (mucosal patchy enhancement) was found in four of eight patients (50%, 12 lesions) all were short-term users. Small erosions with mild oedema/redness were shown by DBE. Type 2 (homogeneous hyperenhancement) was found in two of eight patients (25%, four lesions) who were long-term users. Large ulcers with marked oedema/redness were shown by DBE. Type 3 (stratification enhancement) was found in four of eight patients (50%, six lesions), both short-term and long-term users. Annular or large ulcers with strictures were shown by VCE or DBE. Conclusion: On CTE, Type 1 lesions in patients with mostly short-term aspirin or NSAID use, Type 2 lesions in patients with long-term use and Type 3 lesions in both types of patients were detected. CTE may have usefulness for the detection of mild damage. Advances in knowledge: Small-bowel abnormalities owing to aspirin or NSAID present with three different patterns on CTE.CT enteroclysis (CTE)/enterography is a technique whereby enteral contrast medium is infused into the small bowel to obtain well-expanded loops and adequate endoluminal opacification for evaluation of lesions.1,2 In recent years, it has been widely recognized that low-dose aspirin and nonsteroidal anti-inflammatory drugs (NSAIDs) can cause damage to the mucosa of both the upper gastrointestinal tract and the small bowel.3-8 The usefulness of videocapsule endoscopy (VCE) or double-balloon enteroscopy (DBE) in the diagnosis of drug-induced small-bowel damage has been established, but few comprehensive reports have evaluated the CT findings of this condition. 4,5 The CTE findings of drug-induced small-bowel damage were classified into three types, and the duration of drug use and endoscopic findings associated with each type were evaluated. The goal of this retrospective study was to describe the CTE findings in patients with small-bowel mucosal damage induced by NSAIDs, to compare CTE findings with those observed on VCE or DBE and to correlate CTE findings with the duration of drug use. METHODS AND MATERIALSWe reviewed the CTE findings of 11 (5 males and 6 females; mean age, 71 years; range, 56-85 years) patients diagnosed with drug-induced small-bowel damage, among 82 consecutive patients with obsc...

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“…However, as experience accumulates, the limitations of this technique are becoming increasingly evident and recent reports suggest that the detection of small bowel tumours may not be the preferred indication [4,10]. When a small bowel tumour is suspected on VCE, it has to be further confirmed and characterised by CT in conjunction with enterography or enteroclysis [10,11]. Conversely, in the case of a suspected small bowel tumour, negative VCE findings have to be confirmed by one of these imaging investigations [10,11].…”

mentioning

confidence: 99%

Obscure gastrointestinal bleeding: difficulties in comparing CT enterography and video capsule endoscopy

Soyer

2012

Eur Radiol

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A paper reports the results of a retrospective study that was designed to evaluate the potential role of video capsule endoscopy (VCE) in elucidating the cause of bleeding in patients with obscure gastrointestinal bleeding (OGIB) for whom CT enterography was negative. The authors highlight the limitations of dual-phase CT enterography for the detection of flat lesions of the small bowel such as ulcers, angiodysplasias or arteriovenous malformations, and confirm the superiority of VCE for the detection of this category of lesions. This commentary discusses some of the issues raised. Key Points • Video capsule endoscopy surpasses CT enterography in detecting flat small bowel lesions.• Retrospective VCE and CT enterography findings in obscure bleeding need further evaluation.• A fair and unbiased comparison of the two investigations is still needed. [2]. They used CT enterography in patients with OGIB for whom VCE was negative. Using dual phase CT enterography, they did not detect the cause of bleeding in any of the 11 patients with occult OGIB and negative VCE [2].The results of these two studies can be interpreted in two different ways. One way should be to definitely consider that CT enterography has limited or even no value for the evaluation of patients with OGIB and that VCE should be the favoured test for this indication. The alternative way would be to admit that these two techniques are complementary and not competing tests for this elective indication. I must admit that I strongly agree with the second approach for several reasons that I will discuss herein.Because of their study design with inclusion of patients with negative CT enterography, Heo et al. did not address the limitations of VCE [1]. In this regard, none of the patients in

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Obscure gastrointestinal bleeding: preliminary comparison of 64-section CT enteroclysis with video capsule endoscopy

Abstract: Our results suggest that 64-section CT enteroclysis and VCE have similar overall diagnostic yields in patients with obscure gastrointestinal bleeding. However, the two techniques are complementary in this specific population.

Cited by 66 publications

References 42 publications

Obscure gastrointestinal bleeding: diagnostic performance of 64-section multiphase CT enterography and CT angiography compared with capsule endoscopy

Obscure gastrointestinal bleeding: diagnostic performance of 64-section multiphase CT enterography and CT angiography compared with capsule endoscopy

CT enteroclysis/enterography findings in drug-induced small-bowel damage

Obscure gastrointestinal bleeding: difficulties in comparing CT enterography and video capsule endoscopy

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