Small bowel involvement in Crohn's disease: a prospective comparison of wireless capsule endoscopy and computed tomography enteroclysis

Wa, Voderholzer; Beinhoelzl, J; Rogalla, P.; Murrer, Sascha; Schachschal, Guido; Lochs, Herbert; Ortner, M.

doi:10.1136/gut.2004.040055

Cited by 322 publications

(195 citation statements)

References 22 publications

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“…(14) it is the detection of more than ten ulcerations. Our results show that applying FICE to CE might have an impact in the management of patients with suspected CD, namely by increasing the number of erosions detected.…”

mentioning

confidence: 99%

Virtual chromoendoscopy can be a useful software tool in capsule endoscopy

Duque

Almeida

Figueiredo

et al. 2012

Rev. esp. enferm. dig.

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Background: capsule endoscopy (CE) has revolutionized the study of small bowel. One major drawback of this technique is that we cannot interfere with image acquisition process. Therefore, the development of new software tools that could modify the images and increase both detection and diagnosis of small-bowel lesions would be very useful. The Flexible Spectral Imaging Color Enhancement (FICE) that allows for virtual chromoendoscopy is one of these software tools.Aims: to evaluate the reproducibility and diagnostic accuracy of the FICE system in CE.Methods: this prospective study involved 20 patients. First, four physicians interpreted 150 static FICE images and the overall agreement between them was determined using the Fleiss Kappa Test. Second, two experienced gastroenterologists, blinded to each other results, analyzed the complete 20 video streams. One interpreted conventional capsule videos and the other, the CE-FICE videos at setting 2. All findings were reported, regardless of their clinical value. Non-concordant findings between both interpretations were analyzed by a consensus panel of four gastroenterologists who reached a final result (positive or negative finding).Results: in the first arm of the study the overall concordance between the four gastroenterologists was substantial (0.650). In the second arm, the conventional mode identified 75 findings and the CE-FICE mode 95. The CE-FICE mode did not miss any lesions identified by the conventional mode and allowed the identification of a higher number of angiodysplasias (35 vs 32), and erosions (41 vs. 24).Conclusions: there is reproducibility for the interpretation of CE-FICE images between different observers experienced in conventional CE. The use of virtual chromoendoscopy in CE seems to increase its diagnostic accuracy by highlighting small bowel erosions and angiodysplasias that weren't identified by the conventional mode. INTRODUCTIONDigestive endoscopy has evolved from a pure diagnostic technique into a major interventional and therapeutic one. Even though, its value as a diagnostic tool has been kept and multiple developments have occurred to increase its diagnostic accuracy. The current technology of imageenhanced endoscopy is available to augment the detection, diagnosis and treatment of subtle lesions (1). Conventional white light endoscopy is associated with a disproportionate miss rate for subtle lesions (mainly flat). Therefore, the endoscopic manufacturers have developed several adjunct technologies working as point enhancement. One of these software tools is the Flexible Spectral Imaging Color Enhancement (FICE). It is easier and less time consuming than topical application of stains or pigments, since it is available with a simple button change to make multiple modifications of wavelength (2).The FICE system, manufactured by Fujinon Corporation (Saitama, Japan), is implemented based on Spectral Estimation Technology, which takes a real time endoscopic image from the video processor and arithmetically processes, estimates and produce...

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mentioning

confidence: 99%

Virtual chromoendoscopy can be a useful software tool in capsule endoscopy

Duque

Almeida

Figueiredo

et al. 2012

Rev. esp. enferm. dig.

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“…The systematic review conducted by Panes et al [46] looked at the performance of CT enterography in identifying areas of stenosis in five studies [50][51][52][53][54] and found an overall sensitivity and specificity of 89 and 99 %, respectively. This method was also assessed in an interesting study by Chiorean et al [55]: compared with intraoperative findings, CT enterography exhibited 92 % sensitivity with a specificity of only 39 %.…”

Section: Computed Tomographymentioning

confidence: 99%

Surgery and diagnostic imaging in abdominal Crohn’s disease

et al. 2013

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Surgery is well-established option for the treatment of Crohn's disease that is refractory to medical therapy and for complications of the disease, including strictures, fistulas, abscesses, bleeding that cannot be controlled endoscopically, and neoplastic degeneration. For a condition like Crohn's disease, where medical management is the rule, other indications for surgery are considered controversial, because the therapeutic effects of surgery are limited to the resolution of complications and the rate of recurrence is high, especially at sites of the surgical anastomosis. In the authors' opinion, however, surgery should not be considered a last-resort treatment: in a variety of situations, it should be regarded as an appropriate solution for managing this disease. Based on a review of the literature and their own experience, the authors examine some of the possibilities for surgical interventions in Crohn's disease and the roles played in these cases by diagnostic imaging modalities.Riassunto La chirurgia è un'opzione terapeutica consolidata per il trattamento della malattia di Crohn refrattaria alla terapia medica e per le complicanze legate a tale patologia quali stenosi, fistole, ascessi, sanguinamento non trattabile endoscopicamente, oltre che per i casi di degenerazione neoplastica. Per condizioni come la malattia di Crohn nelle quali il trattamento medico ha un ruolo primario, altre indicazioni per la chirurgia sono controverse, poiché i suoi effetti terapeutici sono limitati alla risoluzione delle complicanze, e la frequenza di recidive è alta, soprattutto a livello dell'anastomosi. Secondo l'opinione degli autori, tuttavia, la chirurgia non deve essere considerata come ultima opzione di trattamento: in diverse situazioni dovrebbe essere ritenuta come una soluzione adeguata nel trattamento multidisciplinare della patologia. Basandosi sulla revisione della letteratura corrente e sulla propria esperienza, gli autori hanno esaminato alcune possibilità di intervento chirurgico nella malattia di Crohn ed il ruolo che svolgono in queste condizioni le tecniche di imaging.

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“…diagnosis of small bowel CD (Papadakis et al,2005) has been examined in several studies and found to be superior to small bowel follow-through (Fireman et al .,2003;Herrerias et al, 2003;Mow et al,2004Mow et al, ), enteroclysis (chong et al,2005Liangpunsakul et al,2003), push enteroscopy (chong et al,2005) and CT enteroclysis (Voderholzer et al,2005) for identifying small intestinal disease. the Diagnostic yield of CE was compared with other modalities in patients with suspected small bowel CD, yield of CE was 63% compared with 23% for barium radiography.…”

Section: Crohn's Diseasementioning

confidence: 99%