Burden and outcomes for complex perianal fistulas in Crohn's disease:Systematic review

AIM To systematically review the literature on epidemiology,disease burden, and treatment outcomes for Crohn's disease(CD) patients with complex perianal fistulas.METHODS PubMed, Embase, and Cochrane were searched for relevant articles(published 2000-November 2016) and congress abstracts(published 2011-November 2016).RESULTS Of 535 records reviewed, 62 relevant sources were identified(mostly small observational studies). The cumulative incidence of complex perianal fistulas in CD from two referral-centre studies was 12%-14%(follow-up time, 12 years in one study; not reported in the second study). Complex perianal fistulas result in greatly diminished quality of life; up to 59% of patients are at risk of faecal incontinence. Treatments include combinations of medical and surgical interventions and expanded allogeneic adipose-derived stem cells. High proportions of patients experience lack of or inadequate response to treatment(failure and relapse rates,respectively: medical, 12%-73% and 0%-41%; surgical:0%-100% and 11%.20%; combined medical/surgical:0%-80% and 0%-50%; stem cells: 29%-47% and not reported). Few studies(1 of infliximab; 3 of surgical interventions)have been conducted in treatment-refractory patients, a population with high unmet needs. Limited data exist on the clinical value of anti-tumour necrosis factor-α dose escalation in patients with complex perianal fistulas in CD.CONCLUSION Complex perianal fistulas in CD pose substantial clinical and humanistic burden. There is a need for effective treatments, especially for patients refractory to antitumour necrosis factor-α agents, as evidenced by high failure and relapse rates.     

双气囊小肠镜在诊断小肠克罗恩病中的价值

目的 探讨双气囊小肠镜在诊断小肠克罗恩病中的价值.方法 对65例临床怀疑小肠克罗恩病的患者进行检查,并与先前进行的插管法小肠钡灌肠和胶囊内镜检查结果进行对比分析.结果 65例患者行双气囊小肠镜检查诊断为小肠克罗恩病58例,并经病理和临床随访确诊.其中45例患者首选从肛门进镜行小肠镜检查,确认克罗恩病34例（75.6%）,另11例后从口腔进镜,发现病变者8例（72.7%）;20例首选经口进镜,检出克罗恩病11例（55%）,另9例患者日后经肛进镜检查中检出5例（55.6%）.先前进行的46例小肠钡灌肠检查中,24例诊断或疑似小肠克罗恩病,诊断率为52.2%,与小肠镜结果比较,符合小肠克罗恩病诊断例数为18例,诊断正确率为75%（18/24）.22例胶囊内镜检查者中,14例诊断或疑似小肠克罗恩病,诊断率为63.6%,最终经双气囊小肠镜确诊的病例数为11例,诊断准确率为78.6%（11/14）.结论 经口和经肛方式结合能使双气囊小肠镜完成对全小肠的检查;双气囊小肠镜是小肠克罗恩病诊断的较为理想的方法,并能对病变范围和严重程度作出正确判断,插管法小肠钡灌肠是一项决定小肠镜进镜方式选择上有价值的筛选性手段.     

单气囊小肠镜诊治疗小肠疾病的安全性及其临床价值观察

目的 评价单气囊小肠镜在小肠疾病诊治过程中的安全性及其临床应用价值.方法 回顾2009年4月至2010年7月间采用单气囊小肠镜榆查或治疗的83例患者的临床资料,对准备时间、检查时间、病变检出率及并发症发生率等情况进行总结分析.结果 83例患者包括不明原因消化道出血37例、不明原因慢性腹痛38例、慢性腹泻1例、不明原因发...     

Evaluation of deep small bowel involvement by double-balloon enteroscopy in Crohn's disease

OBJECTIVES: Double-balloon enteroscopy (DBE) enables inspection of deep small bowel, and total small bowel examination can be performed by either antegrade or retrograde DBE. The aim of this study was to evaluate ileal involvement, which cannot be achieved using conventional colonoscopy, by DBE in patients with Crohn's disease. METHODS: From December 2003 to September 2005, a total of 44 patients with Crohn's disease underwent 53 examinations using DBE. RESULTS: Forty patients with Crohn's disease, seven women and 33 men, underwent DBE, and the ileum was investigated in 38 patients. There were 25 cases of ileitis, 2 of colitis, and 13 of ileocolitis. Jejunal lesions were found in two and ileal lesions proximal to the terminal ileum were found in 24 patients with Crohn's disease. DBE was superior to radiological study to detect aphthae, erosions, and small ulcers in the ileum. Small bowel stricture was demonstrated in six and nine patients with DBE and small bowel barium study (SBBS), respectively. An additional mucosal finding was demonstrated in one of the eight patients who underwent wireless capsule endoscopy, and one patient had a capsule removed by DBE that had become lodged because of an ileal stricture. One ileal perforation because of overtube balloon pressure occurred in 53 examinations of patients with Crohn's disease (1.9%). CONCLUSION: DBE is useful to evaluate small bowel lesions in patients with Crohn's disease; however, special attention should be paid to mesenteric longitudinal ulcers during insertion and the overtube balloon should not be inflated if a clear intestinal view is not possible.     

Impact of double-balloon enteroscopy findings on the management of Crohn's disease

Abstract

Objective. It is estimated that 10%–30% of Crohn's disease (CD) patients have small-bowel lesions, but the exact frequency and clinical relevance of these findings are unknown. Double-balloon enteroscopy (DBE) enables endoscopic visualization of the small bowel. The aim of this study was to evaluate the use of DBE for detecting small-bowel lesions in CD patients suspected of having small-bowel involvement. Furthermore, the clinical impact of adjusting treatment in these patients was assessed. Material and methods. A prospective study was performed in a tertiary referral center. CD patients suspected of small-bowel involvement and in whom distal activity had previously been excluded were included. All patients underwent DBE, followed by step-up therapy in patients with small-bowel lesions. The presence of small-bowel lesions during DBE was noted and clinical outcome was assessed after adjusting therapy. Results. Thirty-five patients (70%) showed small-bowel lesions; these lesions could not be assessed by conventional endoscopy in 23 (46%). At 1-year follow-up, step-up therapy in 26 patients (74%) led to clinical remission in 23 (88%). This was confirmed by a significant decrease in Crohn's disease activity index and mucosal repair on second DBE. Conclusions. DBE showed a high frequency of small-bowel lesions in known CD patients with clinically suspected small-bowel activity. Most of these lesions were not accessible for conventional endoscopy. Adjusting treatment in patients with small-bowel CD involvement led to clinical remission and mucosal repair in the majority of cases.     

Novel use of a plastic overtube facilitates intraoperative enteroscopy in Crohn's disease

Patients with Crohn's disease often need multiple operations. Intraoperative endoscopy may obviate the need for repeated operations. A novel use of a plastic overtube was applied to facilitate intraoperative endoscopy. The overtube was an inexpensive way to prevent contamination; it was applied easily and was found to be very helpful. Use of the overtube is suggested for all such endoscopically-assisted operations.     

The experience of modern methods of enteroscopy in the diagnosis of Crohn's disease

The aim of the study is to evaluate the possibilities of videocapsule endoscopy (VCE), single and double balloon enteroscopy in diagnosis of small bowel Crohn's disease. MATERIAL AND METHODS: From V.2003 to IV.2011 we observed 52 pts. with suspected small bowel Crohn's disease; 8 (15.4%) of them were operated urgently because of complications. Another 44 pts (m-23, f-21, ranged from 15-72 years, mean age 37.5 +/- 12.0 years) underwent complex examination including 19 VCE and 49 BAE in 32 pts.(incl. 7 after VCE). RESULTS: Typical Crohn's disease appearance was found in 15 (34.1%) pts (incl. 4pts after VCE) from 44 who were examined endoscopically. In 8 pts we've revealed stenosis, in 4 of them we've passed through the ileocecal valve stenosis by bouginage with the enteroscope and were able to examine superior area. After performing target biopsy from the small bowel mucosal lesions Pirogov - Langhans cells were found in 5 (33.3%) pts. We haven't found any signs of Crohn's disease in 17 pts. (no abnormalities found-6, enteritis-9, celiac disease-1, NSAID-ulcers-1). Conservative treatment has been applied in 10 (66.7%) pts., surgical intervention - in 5 (33.3%) pts. There was a capsule retention in 2 (10.5%) pts. There were no any complications in BAE. CONCLUSION; The use of the new enteroscopic techniques substantially improves the diagnosis of small bowel     

Colonoscopic balloon dilation of Crohn's strictures: a review of long-term outcomes

OBJECTIVE: To study the long-term outcomes of patients who have had endoscopic balloon dilation of Crohn's strictures. DESIGN: Retrospective case-note review over a 16-year period. PATIENTS: Patients with a Crohn's stricture causing obstructive symptoms and who had at least 6 months' follow-up data or a surgical outcome following dilation were sought; 59 patients (124 dilations) were identified. INTERVENTION: Patients all underwent endoscopic balloon dilation. RESULTS: Strictures were anastomotic in 53 patients (111 dilations) and de novo in six patients (13 dilations). The median stricture length was 3.0 cm. Median follow-up time was 29.4 months. Out of the total group, 41% of patients achieved long-term clinical benefit following dilation and in 17% after only a single dilation. The median number of dilations per patient was one. A total of 35 (59%) patients required surgery for their stricture during follow-up. There were two (1.6%) perforations as a result of dilation, one in an anastomotic stricture (managed conservatively) and one in a de-novo stricture (requiring surgery). There were no deaths. CONCLUSIONS: Colonoscopic balloon dilation of Crohn's strictures can achieve long-term clinical benefit in many patients. Repeat dilations are justified in initial non-responders. In this series, the procedure appears safe with low morbidity.     

Capsule endoscopy vs. push enteroscopy and enteroclysis in suspected small-bowel Crohn's disease

BACKGROUND: The diagnosis of small-bowel Crohn's disease sometimes is difficult and may be missed by conventional imaging studies. Capsule endoscopy might identify small-bowel disease undetected by other investigations. METHODS: Patients with or without known Crohn's disease who were suspected to have small-bowel Crohn's disease were prospectively evaluated with push enteroscopy, enteroclysis, and capsule endoscopy. Each examiner was blinded to results of other investigations. Referring doctors were required to complete questionnaires before and after the investigations. RESULTS: Twenty-two patients were known to have Crohn's disease (Group 1), and 21 were suspected to have small-bowel Crohn's disease (Group 2). In Group 1, capsule endoscopy detected more erosions than the other two investigations (p < 0.001). In Group 2, a new diagnosis of Crohn's disease was made in two patients, but there was no significant difference in yield compared with the other two investigations. Referring physicians rated the usefulness of capsule endoscopy as 4.4 on a scale of 5. Capsule endoscopy changed management for 30 patients (70%). CONCLUSIONS: Capsule endoscopy has a higher yield than push enteroscopy and enteroclysis in patients with known Crohn's disease when small-bowel mucosal disease is suspected, and this leads to a change in management in the majority of these patients.     

Double balloon enteroscopy examinations in general anesthesia

AIM:To demonstrate that the double balloon enteroscopy(DBE) can be safely performed in general anesthesia with intubation.METHODS:We performed a retrospective examination between August 2005 and November 2008 amongpatients receiving intubation narcosis due to DBE examination.The patients were grouped based on sex,age and physical status.Anesthesia records includedduration of anesthesia,quantity of medication usedand anesthesia-related complications.We determinedthe frequency of complications in the differen...