Prospective Blinded Comparison of Wireless Capsule Endoscopy and Multiphase CT Enterography in Obscure Gastrointestinal Bleeding

Huprich, James E.; Fletcher, Joel G.; Fidler, Jeff L.; Alexander, Jeffrey A.; Guimarães, Luís; Siddiki, Hassan; McCollough, Cynthia H.

doi:10.1148/radiol.11110143

Cited by 145 publications

(110 citation statements)

References 42 publications

(39 reference statements)

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“…In addition, although higher diagnostic yields of CE compared with CT and of CTE compared with CE have been reported, CT and CTE can not be compared directly. In addition, it is difficult to consider the difference in diagnostic yield between CT and CTE as meaningful based on the CTE study, considering that 56% of patients had small bowel tumors (12). In our study, the type of CT and whether oral neutral agents were used did not affect the diagnostic yield of CT.…”

Section: Original Article Jeon Et Al Capsule Endoscopy and Computed mentioning

confidence: 61%

“…With regard to CT examinations, the type of CT, method of dye injection, method of administering the contrast medium, and the type of oral contrast in this study were mixed. However, previous studies have found differences in the pharmaceuticals used as oral neutral contrast agents and their administration (11,12,20,21). In addition, although higher diagnostic yields of CE compared with CT and of CTE compared with CE have been reported, CT and CTE can not be compared directly.…”

Section: Original Article Jeon Et Al Capsule Endoscopy and Computed mentioning

confidence: 99%

“…However, in another prospective study that included a considerable number of small bowel tumors, the diagnostic yield of CTE was significantly greater than that of CE (88% vs. 38%) (12). Therefore, the overall evidence is inconsistent.…”

Section: Introductionmentioning

confidence: 98%

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Is there a difference between capsule endoscopy and computed tomography as a first-line study in obscure gastrointestinal bleeding?

Jeon¹,

Kim²,

gun³

et al. 2014

Turk J Gastroenterol

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Background/Aims: Capsule endoscopy (CE) is currently recommended as the first-line study in the evaluation of obscure gastrointestinal bleeding (OGIB), while computed tomography (CT) is often thought of as complementary to CE. This study evaluated CT as a first-line study in OGIB and compared it with CE. Materials and Methods: Ninety-nine patients with OGIB who received both CE and CT were included. CT included conventional CT and CT enterography (CTE). Patients were divided into two groups: the CT before CE group (CT first group; n=75) and the CE before CT group (CE first group; n=24). The two groups were compared retrospectively. Results: Overt OGIB was present in 92% of patients. Mucosal lesions (46%) were the most common diagnoses, while tumors accounted for 7%. The diagnostic yield of CE was significantly higher than that of CT for both groups (CT first group, p<0.001; CE first group, p=0.013). In the CT first group, the diagnostic yield using both CT and CE (48/75; 64%) was significantly higher than that for CT alone (12/75; 16%, p=0.005). In the CE first group, the diagnostic yield with both CT and CE versus CE alone was 70.9% versus 62.5%, respectively, with a significant difference (p=0.045). Conclusion: There was no significant clinical difference associated with the order in which the tests were performed. However, CE and CT, when used together, had a significantly greater diagnostic yield than did CE or CT when used alone.

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Section: Original Article Jeon Et Al Capsule Endoscopy and Computed mentioning

confidence: 61%

Section: Original Article Jeon Et Al Capsule Endoscopy and Computed mentioning

confidence: 99%

See 1 more Smart Citation

Is there a difference between capsule endoscopy and computed tomography as a first-line study in obscure gastrointestinal bleeding?

Jeon¹,

Kim²,

gun³

et al. 2014

Turk J Gastroenterol

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“…In order to achieve a high level of efficacy, optimal technique is critical, especially in evaluating patients with obscure gastrointestinal bleeding [6][7][8][9][10][11][12][13][14][15][16][17][18][19][20][21][22]. Further, because CT is now the greatest, single source of nonbackground ionizing radiation in the United States [23] (exposure from medical sources of ionizing radiation in 2006 accounted for 48% of the total exposure as opposed to 50% from background; CT contributes 49% of the medical exposure), dose reduction techniques should be utilized, especially in Crohn's patients, given the chronicity of their disease and the likelihood that they will have repeated examinations in their lifetime.…”

mentioning

confidence: 99%

CT enterography for Crohn’s disease: optimal technique and imaging issues

et al. 2015

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CT enterography (CTE) is a common examination for patients with Crohn's disease. In order to achieve high quality, diagnostic images, proper technique is required. The purpose of this treatise is to review the processes and techniques that can optimize CTE for patients with suspected or known Crohn's disease. We will review the following: (1) how to start a CT enterography program; (2) workflow issues, including patient and ordering physician education and preparation; (3) oral contrast media options and administration regimens; (4) intravenous contrast media injection for uniphasic and multiphasic studies; (5) CTE radiation dose reduction strategies and the use of iterative reconstruction in lower dose examinations; (6) image reconstruction and interpretation; (7) imaging Crohn's patients in the acute or emergency department setting; (8) limitations of CTE as well as alternatives such as MRE or barium fluoroscopic examinations; and (9) dictation templates and a common nomenclature for reporting findings of CTE in Crohn's disease. Many of the issues discussed are summarized in the Abdominal Radiology Society Consensus MDCT Enterography Acquisition Protocol for Crohn's Disease.

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“…In a 2011 study, 58 patients with obscure GI bleeding underwent VCE and CTE examinations in a blinded fashion. The sensitivity of CTE exceeded VCE (88 vs. 38 %), due to the superior ability of CTE to detect small bowel neoplasms [21]. In addition to an enhanced capability for the detection of submucosal masses, enterography may also be able to visualize submucosal vascular lesions.…”

mentioning

confidence: 99%

Long-Term Outcomes After Single-Balloon Enteroscopy: Are They Any Different from Double-Balloon Enteroscopy for Vascular Lesions?

Gerson

2013

Dig Dis Sci

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Obscure GI bleeding is uncommon, accounting for approximately 5 % of all GI bleeding episodes [1]. With the advent of capsule endoscopy and introduction of balloon enteroscopy to the United States in 2004, endoscopic visualization of the small bowel has become feasible and successful. Double-balloon enteroscopy (DBE) is associated with diagnostic yields of approximately 50-60 %, which exceed 70 % in patients with obscure gastrointestinal bleeding (OGIB) [2]. Performance of video capsule endoscopy (VCE) prior to deep enteroscopy is associated with increased diagnostic yields. In an updated metaanalysis, the yield for DBE was 75 % when a prior VCE study was abnormal, but only 27 % after a negative VCE examination [3].Single-balloon enteroscopy (SBE) was subsequently introduced into US clinical practice in 2008 in an effort to reduce time and complexity of the double-balloon procedure. Instead of using a second balloon on the distal end of the enteroscope as an anchor when the overtube is advanced, the tip of the enteroscope is deflected during the SBE procedure, creating a ''hook'' which functions similarly to the second balloon on the DBE enteroscope. Although less data have been published regarding SBE outcomes compared with DBE, initial studies reported somewhat lower diagnostic yields, potentially due to decreased rates of total enteroscopy [4,5]. Higher total enteroscopy rates and therapeutic interventions with DBE compared to SBE were reported when the enteroscope balloon was removed from the Fujinon system [6]. Nevertheless, a subsequent randomized controlled trial did not confirm these results [7].In this issue of Digestive Diseases and Sciences, Kushnir et al. [8] from Washington University School of Medicine performed a retrospective cohort study in order to determine long-term outcomes after SBE. While longterm outcomes studies have been performed for DBE and are discussed below [9,10], this literature contribution is the first long-term outcomes assessment for SBE. Given the conflicting data regarding efficacy of SBE compared to DBE, the major question is whether recurrent bleeding rates differ post-SBE compared to published rates post-DBE. In this study, the authors reviewed 147 SBE examinations performed for the evaluation of OGIB between 2008 and 2010, following 110 (75 %) patients for a mean of 24 months post-procedure. Patients who participated in the follow-up phone calls or visits were more likely to have undergone SBE with positive findings in the small bowel leading to endoscopic therapy compared with patients who were lost to follow-up post-enteroscopy (69 vs. 35 %, p \ 0.001). Seventy percent of the patients had undergone VCE studies before the enteroscopy examination. Significant lesions in the small bowel including vascular, ulcerative, and/or suspected neoplasms were detected in 91 % of the patients undergoing capsule endoscopy. A source of bleeding was identified in 95/147 (65 %) SBE examinations including vascular lesions in 54 %, ulcers or erosions in 5 %, and small bowel masses in 3 %...

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Prospective Blinded Comparison of Wireless Capsule Endoscopy and Multiphase CT Enterography in Obscure Gastrointestinal Bleeding

Cited by 145 publications

References 42 publications

Is there a difference between capsule endoscopy and computed tomography as a first-line study in obscure gastrointestinal bleeding?

Is there a difference between capsule endoscopy and computed tomography as a first-line study in obscure gastrointestinal bleeding?

CT enterography for Crohn’s disease: optimal technique and imaging issues

Long-Term Outcomes After Single-Balloon Enteroscopy: Are They Any Different from Double-Balloon Enteroscopy for Vascular Lesions?

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