Technetium-99m HMPAO-labeled leukocyte imaging compared with endoscopy, ultrasonography, and contrast radiology in children with inflammatory bowel disease

BACKGROUND: The purpose of this study was to evaluate retrospectively the value of leukocyte-labeled scintigraphy, ultrasonography, and contrast radiography compared with endoscopy in children suspected of having inflammatory bowel disease (IBD). METHODS: Twenty-eight children (17 boys; mean age, 10.2 years) with IBD based on standard colonoscopic, histologic, and radiologic criteria (16 with Crohn's disease, 5 with ulcerative colitis, 5 with nonspecific colitis, I with granulomatous disease, and I with Beh,cet's disease) were included. Endoscopic, ultrasonographic, and contrast radiologic examinations were realized for 28, 23, and 19 children respectively. RESULTS: Sensitivity and specificity were 75% and 92% for leukocyte-labeled scintigraphy, 39% and 90% for ultrasonography, and 58% and 83% for contrast radiography. The authors noted discontinuous uptake for 14 of 15 true-positive results for patients with Crohn's disease and continuous uptake for 4 of 4 true-positive results for patients with ulcerative colitis. A negative correlation between scan activity index and Lloyd-Still clinical score was found for 11 patients with Crohn's disease (r = -0.77). CONCLUSIONS: Leukocyte-labeled scintigraphy, a noninvasive and reproducible technique, is a useful tool in the diagnosis and therapeutic strategy of IBD, and provides information on the presence, the intensity, and the extent of the disease, particularly in the terminal ileum. Leukocyte-labeled scintigraphy may not replace colonoscopy with biopsies for diagnosis confirmation. Its reliability seems higher than that of ultrasonography.     

Assessment of terminal ileal and colonic inflammation in Crohn's disease with 99mTc-WBC

We evaluated the sensitivity and specificity of Technetium-99m (^99mTc)-white blood cell (WBC) for identifying terminal ileum inflammation in children with Crohn's disease (CD). In 40 children, total colonoscopy was done within a few days of a ^99mTc-WBC scan carried out to evaluate the inflammation in children with CD. In 38 patients the intensity and the location of inflammation shown on the ^99mTc-WBC scan of the colon were similar to the biopsy result of the colonoscopy. The sensitivity of the ^99mTc-WBC scan was 97% in assessing colonic inflammation compared with colonoscopy. The ^99mTc-WBC scan allowed evaluation of inflammation in the terminal ileum in 21 patients in whom the endoscopist did not cannulate the terminal ileum. Of the 19 patients in whom the terminal ileum was visualized endoscopically (14) or surgically (5), the ^99mTc-WBC scan findings showed a similar degree of inflammation in 17. The ^99mTc-WBC scan was abnormal in 10 of these 21 children in whom the gastroenterologist did not reach the terminal ileum. In these children with no ileoscopy the results of the ^99mTc-WBC scan were consistent with the laboratory values, the gastroenterologist's clinical assessment and with long-term clinical follow-up. Finally, the ^99mTc-WBC scan of 83 controls did not reveal any false-positive findings in the terminal ileum (colonoscopy result available in 30 controls). When total colonoscopy or ileoscopy is not performed or when contrast radiography is negative or unable to differentiate CD from lymphoid nodular hyperplasia, scintigraphy can demonstrate the presence of ileitis and/or colitis.     

Evaluation of 99mTc-HMPAO leukocyte scintigraphy in the investigation of pediatric inflammatory bowel disease

OBJECTIVE: To evaluate (99m)Tc-HMPAO leukocyte scintigraphy as an investigation for inflammatory bowel disease (IBD). STUDY DESIGN: Scintigraphy was performed in 95 children undergoing investigation for IBD in a tertiary Gastroenterology Department. Diagnosis was based on conventional investigations including small bowel barium contrast radiology (BCR), upper gastrointestinal endoscopy (UGIE), colonoscopy, and endoscopic biopsy (the "gold standards"). IBD was confirmed in 73 (57 Crohn's disease; 10 ulcerative colitis; 6 indeterminate colitis) and excluded in 22 (controls). Scintigraphy was (1) evaluated as a screening test, (2) compared with individual conventional tests, (3) assessed for each gut segment. RESULTS: Screening test: sensitivity 0.75 (95% CI, 0.63-0.85), specificity 0.82 (95% CI, 0.59-0.94), PPV 0.93, NPV 0.5. Comparison with BCR: sensitivity 0.87 (95% CI, 0.72-0.96), specificity 0.57 (95% CI, 0.39-0.73), PPV 0.69, NPV 0.2. Comparison with UGIE: specificity 0.9 (95% CI, 0.79-0.96), NPV 0.13 (sensitivity and PPV unavailable). Comparison with colonoscopy: sensitivity 0.57 (95% CI, 0.41-0.73), specificity 0.71 (95% CI, 0.54-0.85), PPV 0.71, NPV 0.42. Comparison with biopsies paralleled that with endoscopy. False negatives were especially common (NPV< or =0.2) in the proximal gut. CONCLUSIONS: (99m)Tc-HMPAO leukocyte scintigraphy should not be relied on as a screening test for IBD because false negative results are common. This method is especially unreliable at detecting disease in the proximal gut.     

Sonographic evaluation of inflammatory bowel disease: a prospective, blinded, comparative study

Background Children with inflammatory bowel disease (IBD) undergo invasive and repeated investigations, including contrast radiology and endoscopy.Objective To assess transabdominal sonography of the colon and distal ileum compared to colonoscopy and barium radiology in known or suspected IBD.Materials and methods A prospectively recruited cohort of 44 children (median age 12 years, range 3.5–16.5 years; 24 males) underwent transabdominal sonography prior to colonoscopy (n=33) or barium follow-through (n=25). Diagnoses were: Crohn disease (n=25), ulcerative colitis (n=12), indeterminate colitis (n=1), normal (n=6).Results Bowel wall thickness (BWT) and endoscopic severity were compared in 153 colonic segments. No difference was found between normal and mildly affected segments. BWT was less in normal bowel than moderate (P<0.001) or severe (P<0.001) lesions. Where BWT was >2.9 mm, sensitivity for moderate/severe disease was 48%, specificity 93%, positive predictive value 83% (likelihood ratio 7). Barium radiology showed terminal ileum abnormality in ten patients (40%). Where ileal BWT was >2.5 mm, comparative sensitivity was 75%, specificity 92%, positive predictive value 88% (likelihood ratio 9). Superior mesenteric artery Doppler did not correlate with disease severity.Conclusion Increased BWT has good positive predictive value for moderate/severe disease in the colon proximal to the rectum (>3 mm), and terminal ileum (>2.5 mm). BWT below this cannot exclude moderate/severe mucosal lesions.     

Antigranulocyte monoclonal antibody immunoscintigraphy in inflammatory bowel disease in children and young adolescents

Aim: Diagnostic delay for inflammatory bowel disease (IBD) is frequent, especially in paediatric patients. Scintigraphy with labelled leucocytes has been proposed as a very sensitive diagnostic tool for detecting bowel inflammation. The aim of this study was to evaluate the sensitivity and specificity of immunoscintigraphy in the diagnosis and follow-up of children with IBD and to compare this technique with other diagnostic techniques.

Methods: Sixty-six children with histologically confirmed IBD were enrolled in the study. Twenty-one children in whom IBD was suspected but subsequently not confirmed were used as controls. A total of 138 immunoscintigraphies were performed using 99m Technetium-labelled monoclonal anti-granulocyte antibodies. Immunoscintigraphy was also compared with other diagnostic techniques.

Results: Overall sensitivity of monoclonal antibody immunoscintigraphy (MoAb-IS) in patients with clinically active disease was 94% for Crohn's disease (CD) and 85% for ulcerative Ultrasonography, endoscopy and radiology were carried out at the same time in 29 patients with CD and in 6 patients with UC: sensitivity of IS was 90% compared with 76% of colonoscopy, 75% for enemas, and 55% for sonography. IS was negative (specificity) in 24% of patients with CD and in 67% of patients with UC during remission, and in 64% of controls with other causes of intestinal inflammation. Diagnostic delay was significantly shorter when compared with a historical cohort of patients.

Conclusion: Immunoscintigraphy is a highly sensitive detector of intestinal inflammation in young patients with IBD and can be useful for reducing diagnostic delay. However, its specificity is low and all positive cases must be confirmed histologically. colitis (UC).     

99 mTc antigranulocyte monoclonal antibody imaging for the detection and assessment of inflammatory bowel disease newly diagnosed by colonoscopy in children

Objective: This prospective study evaluated a ^99mTc antigranulocyte monoclonal antibody Fab' imaging agent (Sulesomab) in children with inflammatory bowel disease (IBD) newly diagnosed by colonoscopy. Materials and methods: Ten children (4 boys, 6 girls; mean age 14 years) with newly diagnosed Crohn's disease (n = 6) or ulcerative colitis (n = 4) were studied. Colonoscopy was performed in all of these patients. Within 24 h after colonoscopy, they underwent scintigraphy with ^{99 m}Tc-Sulesomab. Abdominal/pelvic images were acquired at 30 min (planar) and 2–4 h (planar and SPECT) after injection of Sulesomab. Eighty bowel segments were evaluated semi-quantitatively by the investigators, using these three sets of images. The Pediatric Disease Activity (PDA) was correlated with the erythrocyte sedimentation rate (ESR), white blood cell (WBC) count, albumin, Kirschner's score, the Sulesomab bowel segment with maximum uptake, and the sum of Sulesomab score in each segment. Results: The median PDA score was 26 (range 12.5–40). Three children had normal ESR and six normal WBC counts. All patients had at least one positive mucosal biopsy for IBD. While using the Kirschner's scale, the maximal severity of colonoscopy findings was graded as none (n = 2), mild (n = 4), moderate (n = 3), or severe (n = 1). Of the 59 segments evaluated with endoscopy, 35 were found to be endoscopically abnormal. The planar images identified 17 of these abnormal segments and the SPECT images 20. Nine of these ten children had abnormal bowel uptake by scintigraphy. Thus, the sensitivity of Sulesomab per patient was 90 % and per bowel segment 57 %. The correlation coefficient between the scintigraphic score for the segment with the Sulesomab maximum activity and the PDA was 0.3 (P = 0.41). Conclusion: In pediatric IBD assessment, planar imaging with Sulesomab did not prove very sensitive in detecting inflammation in each bowel segment. However, SPECT detected the presence of inflammation in the majority of patients. A trial comparing ^{99 m}Tc-HmPAO-WBC with Sulesomab in a large number of patients is required. Received: 23 January 2001 Accepted: 14 May 2001     

357例儿童结肠镜检查回顾性研究

目的探讨结肠镜检查在儿科应用的临床价值及安全性,了解不同年龄段儿童结肠镜检查原因及检出肠道疾病分布情况。方法收集2018-01-01—2020-12-31中国医科大学附属盛京医院0～14岁于内镜中心接受肠镜检查的患儿临床资料并行回顾性分析。结果 357例患儿共计进行399次结肠镜检查,94.5%(377/399)能够完成全结肠检查,219例(61.3%)肠镜下有阳性发现,357例结肠镜检查无1例出现严重并发症。<3岁组发现疾病18例,最主要疾病为克罗恩病7例(36.8%); 3～6岁组检出疾病46例(90.2%),占比最大为结肠息肉(56.9%);>6～14岁组儿童共发现疾病155例(54%),以炎症性肠病检出率最高(19.2%)。结论儿童结肠镜检查安全有效、诊断率高,具有重要的临床诊疗价值。腹泻、便血为0～6岁患儿进行结肠镜检查的主要原因,>6～14岁患儿实施结肠镜检查的原因主要依次为腹痛、腹泻;结直肠息肉是3～6岁儿童结肠镜发现主要病变,0～3岁、>6～14岁患儿以炎症性肠病为主要发现疾病。     

99mTc-HMPAO-leukocyte-labeled scintigraphy in the detection and follow-up of inflammatory bowel disease

To assess the clinical value of 99mTc-HMPAO-leukocyte-labeled scintigraphy (LLS) in the detection and follow-up of inflammatory bowel disease (IBD) in the pediatric population, we retrospectively reviewed 33 patients (15 boys; mean age 10.7 +/- 2.2 years) with suspected IBD. A total of 58 examinations were performed: 29 for screening purposes, 23 for follow-up and 6 to detect relapses. LLS was compared with clinical symptoms (PCDAI index), biologic markers of inflammation, barium contrast radiology (BCR; n = 22), sonography (n = 22), colonoscopy (n = 16), and biopsy (n = 13). The final diagnosis was Crohn's disease in 12, ulcerative colitis in 4, and no IBD in 17. In the 17 patients without IBD, LLS was always negative. Among the 16 patients with IBD, LLS showed concordant results with BCR in 7/10 patients, with sonography in 6/11, with colonoscopy in 9/12 and with biopsy in 8/9. The severity of LLS increased with the PCDAI index (p < 0.001), with a positive correlation between the scintigraphic activity index/PCDAI r = 0.76. An increase in the PCDAI index with the severity of LLS (p < 0.001) was also observed in the follow-up, and a weak correlation (r = 0.50) between erythrocyte sedimentation rate/scintigraphic activity index was obtained. In 5 patients with normal biologic markers, LLS detected inflammation. All 6 patients with relapses were symptomatic; 5 had inflammation on LLS and 5 had abnormal biologic markers. In conclusion, LLS can be a useful screening tool in the detection of IBD in children to assess the grade of inflammation and extension of IBD. This technique can detect the presence of inflammation during follow-up and should be performed when relapses are suspected.     

Usefulness of wireless capsule endoscopy for detecting inflammatory bowel disease in children presenting with arthropathy

Inflammatory bowel disease (IBD) is a cause of chronic intestinal inflammation in children. In a subset of patients affected by IBD, arthropathy may be the leading presenting sign. In the past years, remarkable advances in gastrointestinal endoscopy techniques have been achieved; recently, the development of capsule endoscopy (CE) provided a non-invasive method for the complete endoscopic evaluation, including small bowel assessment. We report three children suffering from IBD but presenting with articular complaints in whom CE was a useful tool for detecting gut inflammation. Patients were investigated with the wireless CE: PillCam™ SB2 (Given Imaging, Yoqneam, Israel) capsule, the second-generation capsule, was used in our paediatric patients. Three patients were initially evaluated for arthropathy. Enteropathic arthritis was suspected for gastrointestinal symptoms and/or persistence of inflammatory markers elevation. In one of these children, conventional endoscopy was refused by parents, while in the other two children, CE was proposed as first-line diagnostic tool. In all patients, CE revealed to be safe and provided information that led to diagnosis. Paediatric rheumatologists should consider CE as a valid, non-invasive tool, eventually first level diagnostic approach in order to evaluate the presence of IBD in children presenting with chronic articular complaints.     

Diagnostic role of upper gastrointestinal endoscopy in pediatric inflammatory bowel disease

BACKGROUND: Discrimination between ulcerative colitis (UC) and Crohn disease (CD) may be difficult on ileo-colonoscopy alone because of a lack of definitive lesions. Retrospective studies show upper gastrointestinal endoscopy may be helpful in confirming diagnosis in such cases. AIMS: To prospectively determine importance of upper gastrointestinal endoscopy in diagnosis of inflammatory bowel disease (IBD) and assess factors predictive of upper gastrointestinal involvement in IBD. METHODS: All pediatric patients were enrolled prospectively and consecutively over a 2-year period and investigated with an ileo-colonoscopy and barium meal follow-through. Children with procto-sigmoiditis, later confirmed histologically to be typical of UC, were excluded from the study. The remainder underwent upper gastrointestinal endoscopy. The protocol and methodology were determined a priori. RESULTS: 65 children suspected of IBD underwent colonoscopy. Of the total, 11 had recto-sigmoiditis with typical macroscopic appearances of UC; once this was confirmed on histology these patients were excluded from the study. Of the 54 children (males, 31; median age, 11.1 years) remaining, 23 were initially diagnosed with CD on ileo-colonoscopy and 18 (33%) were diagnosed with UC. The diagnosis remained ambiguous in 13 (six colonic, four ileo-colonic, three normal colon) on clinical, radiologic and histologic grounds. Upper GI endoscopy helped to confirm CD in a further 11 (20.4%). Two patients were diagnosed with indeterminate colitis.Upper gastrointestinal inflammation was seen in 29 of 54 (22 CD; 7 UC ). Epigastric and abdominal pain, nausea and vomiting, weight loss and pan-ileocolitis were predictive of upper gastrointestinal involvement (P < 0.05). However, 9 children with upper gastrointestinal involvement were asymptomatic at presentation (31%). Overall upper gastrointestinal tract inflammation was most common in the stomach (67%), followed by the esophagus (54%) and duodenum (22%). CONCLUSIONS: Upper gastrointestinal tract endoscopy should be part of the first-line investigation in all new cases suspected of IBD. Absence of specific upper gastrointestinal symptoms do not preclude presence of upper gastrointestinal inflammation.     

胶囊内镜在以便血为主诉的小肠疾病患儿中的应用价值

目的 评估胶囊内镜在以便血为主诉的小肠疾病患儿中的价值。方法 回顾性收集2015年5月至2019年1月复旦大学附属儿科医院收治的以便血为主诉且行胶囊内镜检查的93例患儿的临床资料及胶囊内镜检查结果,根据胶囊内镜检查结果（空肠及回肠段）分为阳性病变组（n=39）及阴性病变组（n=54）,对两组的临床资料及胶囊内镜下的病变特征进行分析。结果 阳性病变组和阴性病变组患儿的年龄、性别、胶囊内镜检查时间、胃通过时间及小肠通过时间比较差异均无统计学意义（P > 0.05）。阳性病变组患儿的血红蛋白水平低于阴性病变组（P < 0.05）。血红蛋白值与胶囊内镜下阳性病变率呈负相关（r=-0.342,P=0.001）。胶囊内镜下发现有阳性病变的病例中,诊断为梅克尔憩室的比例最高（41%,16/39）,其次为炎症性肠病（21%,8/39）。结论 胶囊内镜对下消化道出血患儿小肠疾病,特别是空肠及回肠段疾病的阳性检出具有一定价值。     

儿童炎症性肠病53例临床分析

目的　探讨儿童炎症性肠病 (IBD)的临床特点 ,以提高儿童IBD的诊治和管理水平。方法　对 1992～2 0 0 2年 5 3例IBD患儿的临床资料进行回顾性分析。结果　IBD的患病率逐渐增加 ,5 3例IBD中克罗恩病 (CD)2 6例 ,溃疡性结肠炎 (UC) 2 7例。 2 7%的CD和 4 5 %的UC发病在 6岁以下 ,有 5例 (19% )UC发病在 1岁以内 ;男女性别无显著性差异 (P >0 0 5 ) ;发病至确诊平均时间CD为 5 0周 ,UC为 4 8周。临床表现CD以发热、腹痛为主要表现 ,UC以腹泻、便血为主要表现 ;胃肠外表现CD可见口腔溃疡、关节炎等 ,UC可见肛周病变、口腔溃疡等 ,两组患儿生长发育障碍的发生率均较高 (CD 6 5 % ,UC 5 9% ,P >0 0 5 )。病理改变CD以破坏和慢性增殖改变并存为特点 ,病灶均累及回肠末端及回盲部 ;而UC以急性炎症和渗出为主 ,病灶均累及直肠。外科合并症的发生率CD为 15 4 % ,UC为 14 8% ;儿童IBD治疗效果不满意 ,短期缓解率CD为 5 9% ,UC为 5 6 %。结论　IBD可以累及包括婴幼儿在内的各年龄组儿童 ,诊断的滞后以及缺乏系统的管理是临床亟待解决的问题。     

Gastric and small bowel Crohn's disease assessed with leukocytes-Tc99m scintigraphy

We reviewed 312 ^99mTc leukocyte ^99mTc-WBC studies to evaluate the sensitivity and specificity of ^99mTc-WBC for identifying small-bowel and gastric inflammation in children with Crohn's disease. The ^99mTc-WBC scans were interpreted blindly and compared to the results of colonoscopy with biopsies and surgical specimens. In 46 children, total colonoscopy was done within a few days of a ^99mTc- WBC scan and in 13 others surgical specimens were available. Of the 37 children in whom the terminal ileum was visualized endoscopically (24) or surgically (13), the WBC-Tc^99m scan showed a similar degree of inflammation in 33. The sensitivity of ^99mTc-WBC scanning was 91% and the specificity 96%. The scans allowed evaluation of inflammation in the terminal ileum in 22 children in whom the endoscopist did not cannulate it; the scans were abnormal in 10 of these 22 children. In the children with no ileoscopy the results of the ^99mTc-WBC scan were consistent with the laboratory values, the gastroenterologist's clinical assessment, and long-term clinical follow-up. Finally, the scans of 46 controls did not reveal any false-positive findings in the terminal ileum. Five children with gastritis documented by gastroscopy had normal ^99mTc-WBC scans and upper gastrointestinal barium studies. This study demonstrates in a large number of normal and abnormal children with different pre-test probabilities of having inflammatory bowel disease that scintigraphy is reliable in identifying small-bowel inflammation. Accepted: 2 December 1998     

Magnetic resonance imaging to distinguish the type and severity of pediatric inflammatory bowel diseases

BACKGROUND: The distinction between ulcerative colitis and Crohn's disease is important, because treatment options and clinical course may vary. Magnetic resonance imaging (MRI) allows noninvasive transmural assessment of the intestine and may facilitate differentiation of ulcerative colitis from Crohn's disease. The objective of this prospective study was to determine whether MRI differentiates Crohn's disease from ulcerative colitis in children as effectively as colonoscopy with mucosal biopsies. METHODS: Fifteen patients underwent colonoscopy with biopsies followed by abdominal MRI. The MRI diagnosis, determined by two radiologists independently completing a standardized form was compared with the gastroenterologic diagnosis. RESULTS: After colonoscopy and review of histology, Crohn's disease was diagnosed in nine patients, ulcerative colitis in five, and indeterminate colitis in one, who was excluded from study. Agreement of the MRI diagnosis with the gastroenterologic diagnosis was 4 of 4 (100%) for ulcerative colitis, 4 of 10 (40%) for Crohn's disease considering both radiologists, and 5 of 10 (50%) for Crohn's disease for each radiologist individually. Percentage of enhancement by MRI did not correlate with the severity of inflammation determined at endoscopy among the patients with Crohn's disease (r = -0.3, P = 0.366). There was agreement on severity of inflammation in three of four patients with ulcerative colitis. CONCLUSIONS: Current MRI interpretation of inflammatory bowel disease did not adequately recognize Crohn's disease in children. Therefore, colonoscopy with biopsy remains the most accurate tool for determining the type and severity of inflammatory bowel disease in children and adolescents.     

Fecal calprotectin: validation as a noninvasive measure of bowel inflammation in childhood inflammatory bowel disease

BACKGROUND: Calprotectin is an abundant neutrophil protein, which is extremely stable in feces. This study aimed to validate fecal calprotectin as a marker of bowel inflammation against invasive measures in children with inflammatory bowel disease (IBD), including colitis and small bowel Crohn disease. METHODS: Fecal calprotectin was measured using a simple enzyme-linked immunosorbent assay in 36 spot stool samples from 22 children before colonoscopy and from 14 children before technetium-99 (99Tc) scanning. Using standard scoring systems, the severity of inflammation was assessed macroscopically and histologically at six standard sites in those who underwent colonoscopy and also at six standard sites in those who underwent 99Tc scanning. The subscores from each site were summated to give combined severity and extent scores for macroscopic and for histologic inflammation in the group undergoing colonoscopy and total inflammation in the group undergoing 99Tc scanning. RESULTS: In the 22 children who underwent colonoscopy, median fecal calprotectin was 4.9 mg/L (0.1-272.5 mg/L) (range). Disease groups included six normal cases, nine ulcerative colitis cases, two isolated Crohn colitis cases, two indeterminate colitis cases, and three allergic colitis cases. Fecal calprotectin correlated closely with colonic macroscopic inflammation (r = 0.75, P < 0.001) and histologic inflammation (r = 0.85, P < 0.001). Of the 14 children undergoing 99Tc scanning, 10 had Crohn disease, 3 had ulcerative colitis, and 1 had allergic colitis. Median fecal calprotectin was 9.1 mg/L (0.3-141.7 mg/L), and this correlated closely with the 99Tc scanning score (r = 0.80, P = 0.001). CONCLUSION: Fecal calprotectin correlates closely with the best invasive measures of colonic and small bowel inflammation in childhood inflammatory bowel disease. As a sensitive objective measure of bowel inflammation that is risk-free and noninvasive, fecal calprotectin lends itself particularly to the monitoring of and assessment of therapeutic interventions in children with inflammatory bowel disease.     

仿真CT肠镜与大肠镜在小儿外科的应用

目的 对仿真CT肠镜与大肠镜在小儿外科的应用进行比较。方法 对33例患儿采用日本Olympus PCF20大肠镜及美国GE公司Hispead型螺旋CT仿真大肠镜进行检查。大肠镜检查使用Endoview软件记录内镜图像，完毕后再进行CT检查，使用Insight软件进行CT三维图像重建，利用Modify Endoscopy程序显示肠腔内的形态结构。结果 本组33例患儿，仿真CT肠镜（CTVE）检出肠重复畸形2例，肠旋转不良3例，结肠冗长症5例，大肠息肉10例（漏诊5例），溃疡性结肠炎、大肠血管畸形未能检出；大肠镜检出肠放置不良2例（漏诊1例），结肠冗长症5例，大肠息肉15例，溃疡性结肠炎6例，大肠血管畸形2例，肠重复畸形未能检出。仿真CT肠镜对诊断肠道畸形具有较高的准确性，但对于直径小于0.5cm的大肠息肉、肠血管畸形检出率低，易漏诊；对小儿溃疡性结肠炎的粘膜显示不理想。大肠镜则对于诊断大肠息肉、溃疡性结肠炎、大肠血管畸形有较高的准确性。结论 仿真CT肠镜是诊断肠道畸形的一种有效途径，但是对肠道粘膜的病变的显示不理想；是大肠镜检的一种重要补充手段。     

Colonoscopy in children and juveniles (author's transl)

Colonoscopy, as an established endoscopic procedure in adults, is thought to be of great value in children and juveniles as well. The main indications for its use are intestinal hemorrhage, polypectomy, diarrhoea of uncertain origin, uncertain x-ray findings as well as the confirmation of a diagnosis made by biopsy. The choice of instruments used, preparations prior to the examination and premedication are dependent upon the child's age. 32 children, aged between 1--14 years, and 41 juveniles between 15 and 18 years were examined. Most common diagnoses were Crohn's disease (29), polyps (7) and ulcerative colitis (4). Others were unspecific colitis (3), follicular hyperplasia of the terminal ileum (2), lymphangiectasia (2), one hemangioma and one rectal ulcer. In 24 patients endoscopy revealed nothing pathological within the colon. Examinations should be performed only by skilled endoscopists with special experience of the problems of colonoscopy in children.     

胶囊内镜在以便血为主诉的小肠疾病患儿中的应用价值

目的 评估胶囊内镜在以便血为主诉的小肠疾病患儿中的价值。方法 回顾性收集2015年5月至2019年1月复旦大学附属儿科医院收治的以便血为主诉且行胶囊内镜检查的93例患儿的临床资料及胶囊内镜检查结果,根据胶囊内镜检查结果（空肠及回肠段）分为阳性病变组（n=39）及阴性病变组（n=54）,对两组的临床资料及胶囊内镜下的病变特征进行分析。结果 阳性病变组和阴性病变组患儿的年龄、性别、胶囊内镜检查时间、胃通过时间及小肠通过时间比较差异均无统计学意义（P > 0.05）。阳性病变组患儿的血红蛋白水平低于阴性病变组（P < 0.05）。血红蛋白值与胶囊内镜下阳性病变率呈负相关（r=-0.342,P=0.001）。胶囊内镜下发现有阳性病变的病例中,诊断为梅克尔憩室的比例最高（41%,16/39）,其次为炎症性肠病（21%,8/39）。结论 胶囊内镜对下消化道出血患儿小肠疾病,特别是空肠及回肠段疾病的阳性检出具有一定价值。     

Pre-pouch ileitis after colectomy in paediatric ulcerative colitis

Colectomy and ileal pouch anal anastomosis (IPAA) is a potentially curative option for patients with ulcerative colitis (UC). A rare, postoperative complication is terminal ileitis which has been poorly documented in paediatric patients. A search of our paediatric inflammatory bowel disease (IBD) database revealed two boys with UC who were resistant to medical therapy. They each underwent colectomy with IPAA. One year later, both children represented with bloody diarrhoea and weight loss. Several endoscopies and biopsies showed acute on chronic mucosal inflammation in the pouch and up to 50 cm into the terminal ileum (TI). Biopsies revealed mixed inflammatory infiltrate with no granulomas. CONCLUSION: Development of terminal ileitis after colectomy and IPAA can occur in children with UC. Although every effort should be made to exclude Crohn's disease as a cause of the terminal ileitis, this poorly defined condition should not be considered to be against the diagnosis of UC. More research is needed to develop a better understanding of the aetiopathogenesis of this uncommon condition.     

Crohn's-like ileo-colitis in patients affected by glycogen storage disease Ib: two years' follow-up of patients with a wide spectrum of gastrointestinal signs

AIM: To investigate the presence of inflammatory bowel disease (IBD) and to evaluate the progression of bowel involvement after two years' follow-up in seven patients affected by glycogen storage disease type Ib (GSDIb). METHODS: Seven patients (5F, 2M, aged 4.5-20.6 y) entered the study. Bowel involvement was evaluated by ileocolonoscopy and specific IBD serologic markers. To evaluate disease activity, Paediatric Crohn's Disease Activity Index (PCDAI), terminal ileum wall thickness detected at ultrasonography (US), 99mTechnetium labelled autologous White Cell Scan (Tc-WCS) and barium meal with follow-through were investigated. RESULTS: Ileocolonoscopy and histology examination revealed variable degrees of bowel involvement in all patients. The results of serologic markers were indicative of a Crohn's-like ileocolitis. US and Tc-WCS, could clearly define patients with severe inflammatory involvement, but failed to identify all patients with mild to moderate disease. For the most severely affected patients, anti-inflammatory agents and steroids were prescribed, whereas nutritional therapy with polymeric formula and antibiotics were assumed by two other patients and antibiotics only by one patient. Granulocyte colony-stimulating factor (G-CSF) was prescribed to all patients. Ileocolonoscopy and histology data improved in all patients. The assumption of G-CSF and/or gastric drip feeding (g.d.f.) was inversely associated with the PCDAI results (p < 0.05). CONCLUSION: IBD is common in patients affected by GSDIb independently of the severity of gastrointestinal signs and symptoms. Different therapeutic approaches can be used according to the severity of IBD. G-CSF treatment and g.d.f. can be protective factors for IBD.