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Enteroscopia por cápsula na suspeita de doen?a de Crohn: há lugar para o Score de Lewis na prática clínica?
Rosa,Bruno; Moreira,Maria Jo?o; Rebelo,Ana; Cotter,José;
Jornal Português de Gastrenterologia , 2010,
Abstract: introduction: suspected crohn?s disease (cd) is a common indication for capsule enteroscopy (ce). however, lesions are nonspecific and no gold standard is available for diagnosing cd. lewis score (ls) measures inflammatory activity based on oedematous villous appearance, ulcers and stenoses. aim: to evaluate the role of sl in the diagnosis of cd in clinical practice. methods: thirty patients who underwent ce for suspected cd were included and followed up for at least six months. inflammatory activity was classified in three levels: clinically insignificant (score<135), mild (135≤score≤790) or moderate to severe (score > 790). results: diagnosis of cd was established in 10 patients (33%). clinically significant inflammatory activity (score ≥ 135) had a positive predictive value (vpp) = 75%, negative predictive value (vpn) = 94%, sensitivity (s) = 90% and specificity (e) = 85% for the diagnosis of cd. conclusions: ls seems to be a useful index in the setting of suspected cd, increasing the objectivity of ce findings; it also has a good correlation with the diagnosis established during follow-up.
Enteroscopia por Cápsula na Suspeita da Doen a de Crohn: Há Lugar para o Score de Lewis na Prática Clínica?  [cached]
Bruno Rosa,Maria Jo?o Moreira,Ana Rebelo,José Cotter
Jornal Português de Gastrenterologia , 2011,
Abstract:
Enteroscopia Intra-Operatória e Hemorragia Enteral: A Indica o Mantém-se Intraoperative Enteroscopy In Small Bowel Bleeding: The Indication Stands  [cached]
Pedro Figueiredo,Alexandre Duarte,Patrícia Duarte,André Oliva
Jornal Português de Gastrenterologia , 2011,
Abstract: Relatamos o caso de um doente de 63 anos com hemorragia originária no intestino delgado. Dada a presen a de insta-bilidade hemodinamica, que obrigou à suspens o da enteroscopia com duplo bal o, foi submetido a enteroscopia intra-operatória com abordagem por via oral. As les es encontradas incluem três angiodisplasias, tratadas com árgon-plasma, e duas úlceras, que foram ressecadas. A enteroscopia intra-operatória poderá ser uma op o terapêutica em pacientes com sangramento com origem no intestino delgado, designadamente quando evidenciem instabilidade hemodinamica We report the case of a 63-year-old with small intestinal bleeding. Due to the fact that he was hemodynami-cally unstable, double-balloon enteroscopy had to be suspended. Urgent laparotomy with intraoperative enteroscopy by an orally passed endoscope was done. Three angiodysplasic lesions were treated with argon-plasma coagulation and two bleeding ulcers were accurately identified and resected. Intraoperative enteroscopy may be a therapeutic option, namely in unstable patients with small intestinal bleeding
Divertículo de Meckel: diagnóstico por enteroscopia de duplo bal o Meckel′s diverticulum diagnosed by double ballon enteroscopy  [cached]
Susana M?o de Ferro,Jaime Mid?es Correia,António Dias Pereira,Paula Chaves
Jornal Português de Gastrenterologia , 2010,
Abstract: Homem de 18 anos, com três episódios de hemorragia digestiva nos últimos 5 anos. Foram efectuadas endoscopia digestiva alta, colonoscopia, enteroclise, enteroscopia por cápsula, TAC abdominal, cintigrafia com 99mTc-pertecnetato e enteroscopia de duplo bal o por via oral que n o identificaram a etiologia da hemorragia. Realizou-se enteroscopia de duplo bal o por via retrógrada tendo-se observado, no íleon, forma o sugestiva de divertículo de Meckel. Foi submetido a diverticulectomia por laparoscopia. A histologia revelou mucosa gástrica ulcerada. O divertículo de Meckel é um dos diagnósticos diferenciais em jovens com hemorragias digestivas obscuras. A enteroscopia por duplo bal o tem-se mostrado útil no diagnóstico desta entidade em indivíduos com um estudo cintigráfico negativo. An 18 year-old man presented with recurrent (three episodes) GI bleeding. Esophagogastroduodenoscopy, colonoscopy, enteroclysis, capsule endoscopy, abdominal CT, 99mTc-pertechnetate scintigraphy and double balloon enteroscopy using the oral route failed to identify the source of the bleeding. Double-balloon enteroscopy using the anal route was performed. We detected in the mid-ileum a diverticular formation compatible with the diagnosis of Meckel’s diverticulum. Laparoscopic diverticulectomy was performed and ulcerated ectopic gastric mucosa was detected at histology. Meckel′s diverticulum should be suspected in young patients with recurrent GI bleeding. Double-balloon enteroscopy has been reported to be useful in the diagnosis of this entity in patients with a negative scintigraphic study.
Primera enteroscopia de doble balón por vía oral total realizada en Cuba First double-baloon oral enteroscopy carried out in Cuba  [cached]
Héctor Rubén Hernández Garcés,Caridad Ruenes Domech,Sacha Lazo del Vallin
Revista Cubana de Medicina , 2012,
Abstract: Se presenta un paciente atendido en el Departamento de Endoscopia Digestiva del Instituto de Gastroenterología, al que se le realizó enteroscopia de doble balón por vía oral. Se logró la exploración de totalidad del intestino delgado mediante la intubación de la válvula ileocecal por vía anterógrada, se exploraron los primeros centímetros del colon derecho. No se presentaron complicaciones y la enteroscopia se realizó en un tiempo total de 115 min. No se ha reportado hasta el momento en el país, la exploración total del intestino delgado mediante esta novedosa técnica. This is the case of a patient came to Digestive Endoscopy Department of the Gastroenterology Institute, who undergoes an oral double-baloon enteroscopy and exploration of whole small bowel, intubation of ileocecal valve via anterograde and of the first centimeters of right colon. There were not complications and procedure was performed in 115 minutes. Until now there was not report in our country of the total exploration of small bowel using this novel technique.
Importancia da enteroscopia de duplo bal o no diagnóstico de um caso de linfoma do intestino delgado The importance of double ballon enteroscopy on the diagnosis of a small bowel lymphoma case  [cached]
R. Ramos,M. Herrera,D. Cruz,J. Mascarenhas
Jornal Português de Gastrenterologia , 2009,
Abstract: A enteroscopia de duplo bal o é um método endoscópico que permite a visualiza o e biópsias de todo o intestino delgado. Os autores apresentam o caso clínico de um doente, de 55 anos, observado no Servi o de Urgência por dor abdominal e vómitos, apresentando nas análises uma anemia microcítica. Após a realiza o de vários exames auxiliares de diagnóstico, a tomografia computorizada abdominal mostrou um espessamento de uma ansa do intestino delgado. Realizou enteroscopia de duplo bal o que permitiu o diagnóstico de linfoma n o-Hodgkin B. Realizou quimioterapia com remiss o completa. Double-balloon enteroscopy allows endoscopic study and biopsies of the entire small bowel, allowing histological diagnosis throughout the procedure. The authors report a case of a 55 year-old man, observed in our emergency department with abdominal pain and vomiting. The blood tests has revealed a microcytic anemia. The abdominal computed tomography has shown a thick zone in the small bowel. A double-balloon enteroscopy was performed and it was diagnosed a B-cell Non-Hodgkin′s lymphoma. The patient was submitted to chemotherapy, with total remission.
Double-balloon enteroscopy: a descriptive study of 50 explorations Enteroscopia de doble balón: estudio descriptivo de 50 exploraciones  [cached]
E. Pérez-Cuadrado,P. Más,H. Hallal,J. Shanabo
Revista Espa?ola de Enfermedades Digestivas , 2006,
Abstract: Aim: to evaluate the utility of double-balloon enteroscopy for small-bowel disease. Design: a prospective study of 50 consecutive enteroscopies performed from December 2004 to July 2005 to analyze diagnoses and treatments. Patients: 44 patients (33 had undergone a previous capsule endoscopy) with indications for obscure digestive hemorrhage, angiodysplasia, Peutz-Jeghers syndrome, ulcer, suspected Crohn's disease, tumors, and refractory celiac disease. Results: we carried out enteroscopy studies in 44 patients by the oral route and, in 6 additional patients, by both the oral and anal routes. We reached the ileon with the oral route in all cases but one (jejunal stenosis), and in 4 cases out of 7 with the anal route, with an average duration of 73 minutes. We found angiodysplasia in 19 cases, as well as NSAID-related enteropathy, Crohn's disease, diverticulosis, and Waldenstr m's disease. We performed biopsies in 31% of cases with diagnoses of adenocarcinoma, lymphangiectasia secondary to tumor in celiac disease, and Whipple's disease. We treated 19 patients with angiodysplasia (1 to 20 synchronous lesions) with argon, and 4 patients with polyps using polipectomy (sporadic polyps or Peutz-Jeghers syndrome). A retained capsule in one patient with stenosis was removed. Conclusions: double-balloon enteroscopy is a useful and effective technique in the diagnosis and treatment of small intestine diseases, thus complementing capsule endoscopy. More studies are needed to analyze its impact on the management of this condition. Objetivo: valorar la utilidad de la enteroscopia de doble balón en enfermedades de intestino delgado. Dise o: estudio prospectivo descriptivo de 50 enteroscopias consecutivas (diciembre 2004 a julio 2005), analizando diagnóstico y terapéutica. Pacientes: cuarenta y cuatro pacientes (33 con cápsula endoscópica previa) con hemorragia digestiva oculta o lesiones detectadas mediante cápsula (angiodisplasias, pólipos, úlceras, enfermedad de Crohn, celiaca refractaria y tumores). Resultados: se realizó enteroscopia vía oral a 44 pacientes y vía oral más anal a 6. Por vía oral se progresó hasta íleon en todos los casos excepto uno (estenosis yeyunal), por vía anal en 4 de 7 (3 casos con dificultad de paso por Bahuin). La duración media fue 73 minutos. Se detectaron angiodisplasias (19 casos), úlceras en enteropatía por AINE, enfermedad de Crohn, enfermedad de Waldenstr m, y divertículos. Se realizaron biopsias en yeyuno-íleon en un tercio de los casos (adenocarcinoma, linfangiectasias secundarias a tumor sobre celíaca, enfermedad de Whipple). Se
Enteroscopia de doble balón: estudio descriptivo de las primeras 14 exploraciones realizadas en el Instituto de Gastroenterología de Cuba Double balloon enteroscopy: a descriptive study of the first 14 explorations performed in the Institute of Gastroenterology of Cuba  [cached]
Héctor Rubén Hernández Garcés,Caridad Ruenes Domech,Olga Marina Hano García,Milagros Sáenz Ba?os
Revista Cubana de Medicina , 2008,
Abstract: Los medios diagnósticos para explorar el intestino delgado no son los ideales. La enteroscopia con doble balón es una alternativa nueva con potencial diagnóstico y terapéutico. Se realizaron 14 enteroscopias: 4 anterógradas, 9 retrógradas y 1 por ambas vías, en el período comprendido entre julio y diciembre de 2007, a 8 mujeres y 6 hombres entre 18 y más de 80 a os de edad para evaluar la utilidad, eficacia y seguridad de la enteroscopia de doble balón, realizada en el Instituto de Gastroenterología de Cuba. Se incluyeron 14 pacientes adultos de ambos sexos a los que se les estaba estudiando por: diarrea crónica, hemorragia de origen desconocido, melena de causa no precisada, sospecha o seguimiento de enfermedad intestinal y anemia crónica. Se realizaron abordajes anterógrado (oral) y retrógrado (anal) y se evaluó tiempo de realización del proceder, hallazgos y complicaciones. Los 14 pacientes recibieron sedación profunda. Los tiempos promedio de realización del proceder por las vías anterógrada y retrógada fueron 65 y 90 min, respectivamente. Se estudiaron 6 pacientes con diagnóstico clínico y radiológico de enfermedad de Crohn, 4 con el de diarreas crónicas, 3 con el de anemia crónica, y el resto por otros motivos. En 10 pacientes (71,4 %) se confirmaron hallazgos endoscópicos de enfermedad del intestino delgado y en 4 (28,6 %), la exploración fue normal. Los efectos adversos fueron leves y transitorios. Se concluyó que la enteroscopia de doble balón es un método diagnóstico y terapéutico, útil en pacientes con afecciones del intestino delgado, que permite explorar todo el órgano, así como la toma de biopsia de cada lesión observada y el uso de métodos tintoriales, si se requiere, posee escasas contraindicaciones, con un tiempo de realización aceptable, prácticamente sin complicaciones. The diagnostic aids to explore the small intestine are not the ideal ones. The double balloon enteroscopy is a new alternative with diagnostic and therapeutic potential. 14 enteroscopies were performed: 4 anterogrades, 9 retrogrades, and 1 by both routes, from July to December, 2007. 14 adult patients of both sexes, 8 females and 6 males, aged 18-over 80 took part in the study to evaluate the usefulness, efficacy and safety of double balloon enteroscopy performed in the Institute of Gastroenterology of Cuba. These patients were under study due to chronic diarrhea, hemorrhage of unknown origin, melena of undetermined cause, suspicion or follow-up of intestinal disease and chronic anemia. Anterograde (oral) and retrograde (anal) approaches were carried out and the time de
Enteroscopia de un balón: Una nueva herramienta para la evaluación gastrointestinal Single balloon enteroscopy: A new tool for gastrointestinal evaluation  [cached]
John Ospina Nieto,John Villamizar Suárez
Revista Colombiana de Gastroenterologia , 2009,
Abstract: Introducción y objetivos. Las herramientas más útiles, dise adas hasta el momento, para la evaluación del intestino delgado eran la cápsula endoscópica y el enteroscopio de doble balón; sin embargo, la búsqueda de una técnica segura, menos compleja y más rápida han permitido el desarrollo del enteroscopio de un balón. En el presente trabajo se presenta la experiencia con esta técnica en el Hospital Cardiovascular del Ni o de Cundinamarca (Soacha-Colombia) y una revisión breve de los aspectos más importantes para la realización del procedimiento. Pacientes y métodos. Se realizó un estudio prospectivo entre el 15 de febrero de 2008 y el 15 de enero de 2009 en 29 pacientes que consultaron al Hospital Cardiovascular del Ni o de Cundinamarca (Soacha-Colombia) y a quienes se les realizaron 41 enteroscopias con la técnica de un balón. En ellos se estudió la indicación, el tiempo del procedimiento, los hallazgos y las complicaciones. Resultados. El tiempo promedio diagnóstico fue de 28,5 minutos, con un tiempo total de procedimiento de 71 minutos. La exploración completa fue realizada en dos pacientes con abordaje mixto (16%). Los hallazgos incluyeron cuerpo extra o, angiodisplasias, enfermedad de Crohn, síndrome de Peutz-Jeghers, vasculitis, hiperplasia nodular linfoide, várices intestinales y neoplasias; el rendimiento diagnóstico para la hemorragia oculta fue del 81%. No se registraron complicaciones. Conclusiones. Aunque faltan trabajos con esta técnica, es factible concluir que la enteroscopia de un balón es una técnica segura, rápida y confiable para la evaluación del intestino delgado. Introduction and aims: Until recently the most useful tools designed for evaluating the small intestine were the endoscopic capsule and double balloon enteroscopy. However, the search for a safer, faster, less complicated technique has led to the development of the single balloon enteroscopy system. This paper presents our experience with this technique in the Hospital Cardiovascular del Ni o in Cundinamarca (Soacha-Colombia) along with a brief review of the most important aspects of performing this procedure. Patients and Methods: Between January 15, 2009 and February 15, 2009 a prospective study was conducted on 29 patients at the Hospital Cardiovascular 'El ni o'. A total of 41 single balloon enteroscopies were performed on these patients. Indications, times of procedures, findings and complications were studied in all of these patients. Results: Average diagnostic time was 28.5 minutes with 71 minutes of total procedure time. Total explorations using mixed approaches w
Is there still a role for intraoperative enteroscopy in patients with obscure gastrointestinal bleeding? Tiene aún sentido la enteroscopia intraoperatoria en pacientes con hemorragia gastrointestinal de origen oscuro?  [cached]
Pedro Monsanto,Nuno Almeida,Clotilde Lérias,Pedro Figueiredo
Revista Espa?ola de Enfermedades Digestivas , 2012,
Abstract: Background: in 21st century, endoscopic study of the small intestine has undergone a revolution with capsule endoscopy and balloon-assisted enteroscopy. The difficulties and morbidity associated with intraoperative enteroscopy, the gold-standard in the 20th century, made this technique to be relegated to a second level. Aims: evaluate the actual role and assess the diagnostic and therapeutic value of intraoperative enteroscopy in patients with obscure gastrointestinal bleeding. Patients and methods: we conducted a retrospective study of 19 patients (11 males; mean age: 66.5 ± 15.3 years) submitted to 21 IOE procedures for obscure GI bleeding. Capsule endoscopy and double balloon enteroscopy had been performed in 10 and 5 patients, respectively. Results: with intraoperative enteroscopy a small bowel bleeding lesion was identified in 79% of patients and a gastrointestinal bleed-ing lesion in 94%. Small bowel findings included: angiodysplasia (n = 6), ulcers (n = 4), small bowel Dieulafoy's lesion (n = 2), bleed-ing from anastomotic vessels (n = 1), multiple cavernous hemangiomas (n = 1) and bleeding ectopic jejunal varices (n = 1). Agreement between capsule endoscopy and intraoperative enteroscopy was 70%. Endoscopic and/or surgical treatment was used in 77.8% of the patients with a positive finding on intraoperative enteroscopy, with a rebleeding rate of 21.4% in a mean 21-month follow-up period. Procedure-related mortality and postoperative complications have been 5 and 21%, respectively. Conclusions: intraoperative enteroscopy remains a valuable tool in selected patients with obscure GI bleeding, achieving a high diagnostic yield and allowing an endoscopic and/or surgical treatment in most of them. However, as an invasive procedure with relevant mortality and morbidity, a precise indication for its use is indispensable.
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