• Emergency
• Imaging
• Neuroendocrine tumors

• Humans
• Neuroendocrine Tumors/diagnostic imaging
• Neuroendocrine Tumors/therapy
• Neuroendocrine Tumors/pathology
• Emergency Medical Services/methods

• Abdomen
• Emergencies
• Oncology
• Pelvic

• Humans
• Emergencies
• Diagnostic Imaging
• Neoplasms
• Medical Oncology

• capsule endoscopy
• diagnosis
• imaging
• neoplasm
• small bowel tumor

• Bowel endometriosis
• CT-enterography
• Deep infiltrative endometriosis
• Endometriosis
• Ileocecal endometriosis
• MR enterography

• Humans
• Inflammatory Bowel Diseases/diagnostic imaging
• Inflammatory Bowel Diseases/therapy
• Intestines/diagnostic imaging
• Magnetic Resonance Imaging
• Ultrasonography/methods
• Wound Healing

• CT
• Crohn’s disease
• enterography

Crohn’s disease (CD) is a chronic inflammatory disorder with a predilection for the small bowel. Although awareness of this disorder has increased over the years, it remains a diagnostic challenge for many physicians. This is exacerbated by the rising incidence and high recurrence rate following therapy in certain individuals. It is currently agreed that a multimodality approach is the best one, but with the advent of new modalities, that could be changing. Furthermore, given its impact on the mental health of patients and the cost of treatment, it is pertinent that we arrive at not only convenient but accurate modalities in its diagnosis and management. Among these investigative modalities is the relatively novel capsule endoscopy (CE) that not only provides a more patient-friendly alternative but avoids the need for invasiveness. Asides from its diagnostic capability, its influence on therapy and monitoring of known CD patients following treatment has been shown. This article has reviewed the current literature comparing the relevance of CE with other available modalities in diagnosing CD patients. We explored its therapeutic impact and how it influences monitoring post-treatment in CD. This article also discusses the complications of CE and the possible solutions to these complications in the future.

Background and objectives

To perform contrast-enhanced computed tomography (CECT) of the abdomen with water, mannitol, or iodinated positive contrast as an oral contrast agent, and compare the distension and enhancement pattern of the bowel.

Methods

This was a prospective observational study conducted on 90 patients over a period of 12 months who were referred for CECT abdomen. Patients were randomly divided into three groups (30 each) and were given water, mannitol, or positive oral contrast before the CECT study. Quantitative and qualitative analysis of the bowel for distension, mural fold pattern, and enhancement was analyzed at various anatomical levels. A qualitative examination of bowel loops was done in the three groups by using a continuous 4-point scale.

Results

The mean distension at the duodenum was 1.89 ± 0.33 cm (mean ± SD) with water, 2.28 ± 0.36 cm with mannitol, and 2.01 ± 0.33 cm with positive oral contrast. Overall, maximum luminal distension was seen at the level of the duodenum, followed by the jejunum across all the groups. Bowel characteristics were far superior in the mannitol group compared to water and positive oral contrast at all anatomical levels.

Conclusion

Small bowel distension was excellent with mannitol, followed by positive oral contrast, and least with water. Mural characteristics and enhancement patterns were better with mannitol as compared with water and with positive oral contrast.

• Diagnostic imaging
• Intestinal obstruction
• Ultrasonics
• Ultrasonography

• Capsule endoscope
• Helical computed tomography
• Small intestine
• Tuberculosis

• MR enteroclysis
• MR enterography
• MR imaging
• MR staging
• Small bowel neoplasms

• Contrast Media
• Diagnosis, Differential
• Humans
• Image Enhancement/methods
• Image Interpretation, Computer-Assisted/methods
• Intestinal Neoplasms/diagnostic imaging
• Intestine, Small
• Magnetic Resonance Imaging/methods

• Computed tomography
• colonoscopy
• gastrointestinal
• response to therapy
• serology
• stricture
• tuberculosis

The Indian Society of Gastroenterology (ISG) Task Force on Inflammatory Bowel Disease and the Indian Radiological and Imaging Association (IRIA) developed combined ISG-IRIA evidence-based best-practice guidelines for imaging of the small intestine in patients suspected to have or having Crohn's disease. The 29 consensus statements, developed through a modified Delphi process, are intended to serve as reference for teaching, clinical practice, and research.

• Biologics
• computerized tomography enterography
• enterography
• imaging
• inflammatory bowel disease
• magnetic resonance imaging
• tuberculosis

• CT
• CT enterography
• Computed tomography
• Crohn’s disease
• dual-energy CT
• iodine quantification

• confocal laser endomicroscopy
• inflammatory bowel disease
• light-sheet fluorescence microscopy
• magnetic resonance imaging
• multimodality imaging

• Animals
• Colitis/diagnostic imaging
• Colon/diagnostic imaging
• Coloring Agents/pharmacology
• Disease Progression
• Endoscopy
• Inflammation
• Inflammatory Bowel Diseases/diagnostic imaging
• Lasers
• Magnetic Resonance Imaging
• Male
• Mice
• Mice, Inbred C57BL
• Microscopy, Confocal
• Microscopy, Fluorescence

• Ileocaecal resection
• Montreal B2 phenotype
• NOD2

• CT enterography
• Crohn disease
• biomarkers
• disease activity
• inflammatory bowel disease

• Abdominal surgery
• Laparoscopy
• Mechanical obstruction
• Postoperative adhesions
• Small bowel obstruction (SBO)

• Biologics
• Computerized tomography enterography
• Enterography
• Imaging
• Inflammatory bowel disease
• Magnetic resonance imaging
• Tuberculosis

• Anatomic imaging
• CT
• Functional imaging
• Gallium-68 somatostatin analog PET
• MRI
• Neuroendocrine tumor
• Octreotide scan

• Humans
• Magnetic Resonance Imaging
• Neuroendocrine Tumors/diagnostic imaging
• Positron-Emission Tomography
• Radiopharmaceuticals
• Tomography, X-Ray Computed

• CT-enteroclysis
• Lesion detection
• Obscure gastrointestinal bleeding
• Small bowel tumours
• Virtual enteroscopy

• Au@MIL-88(Fe)
• gliomas
• gold nanorods
• metal-organic frameworks
• triple modality

• Glioma
• Gold
• Humans
• Metal-Organic Frameworks
• Multimodal Imaging
• Nanotubes

• Bowel
• Children
• Crohn disease
• Inflammatory bowel disease
• Magnetic resonance enterography
• Ultrasound

• CT enterography
• CT-enteroclysis
• Capsule endoscopy
• Device-assisted enteroscopy
• MR enterography
• MR-enteroclysis
• Small bowel tumors

• Crohn’s disease
• Enterography
• Imaging
• Magnetic resonance imaging
• Pediatric

The accurate evaluation of Crohn’s disease activity is important for the treatment of the disease and for monitoring the response. Computerized tomography (CT) enterography is a useful imaging modality that reflects enteric inflammation, as well as extramural complications.

The aim of this study was to evaluate the correlation between CT enterographic (CTE) findings of active Crohn’s disease and the Crohn’s disease activity index (CDAI) and C-reactive protein (CRP).

Fifty CT enterographies of 39 patients with Crohn’s disease in the small bowel were used in our study. The CDAI was assessed through clinical and laboratory variables. Multiple CT parameters, including mural hyperenhancement, mural thickness, mural stratification, comb sign, and mesenteric fat attenuation, were evaluated with a four-point scale. The presence or absence of enhanced lymph nodes, fibrofatty proliferation, sinus or fistula, abscess, and stricture were also assessed. Two gastrointestinal radiologists independently reviewed all CT images, and inter-observer agreement was examined. Correlations between CT findings, CRP, and CDAI were assessed using Spearman’s rank correlation and logistic regression analysis. To assess the predictive accuracy of the model, a receiver-operating characteristic curve analysis for the sum of CT enterographic scores was used.

Mural hyperenhancement, mural thickness, comb sign, mesenteric fat density, and fibrofatty proliferation were significantly correlated with CDAI and CRP (P < 0.05). The binary logistic regression model demonstrated that mesenteric fat density, mural stratification, and the presence of enhanced lymph nodes (P < 0.05) had an influence on CDAI severity. The area under the receiver operating characteristic curve (AUROC) of the CTE index for predicting disease activity was 0.85. Using a cut-off value of 8, the sensitivity and negative predictive values were 95% and 94%, respectively.

Most CTE findings correlated with CDAI and CRP in patients with active Crohn’s disease.

• CRP
• CT Enterography
• Crohn’s Disease
• Crohn’s Disease Activity Index
• Small Intestine

Adenocarcinoma of small intestines (SBA) is a relatively rare malignancy with poor outcomes due to delayed diagnosis. Fifty percent of patients have metastases on presentation and therefore early detection and treatment offers the best long term outcomes. Certain genetic polyposis syndromes and familial diseases are associated with increased risks for SBA. These include familial adenomatous polyposis (FAP), Lynch syndromes (LS), Juvenile polyposis syndrome, Peutz-Jeghers syndrome, Crohn’s disease (CD) and celiac disease. Mutations in APC gene, Mismatch repair genes, STK11 gene, and SMAD4 gene have been implicated for the genetic diseases respectively. While there are no specific inherited genetic mutations for CD, genome-wide association studies have established over 140 loci associated with CD. CpG island mutations with defects in mismatch repair genes have been identified in celiac disease. Significant diagnostic advances have occurred in the past decade and intuitively, it would seem beneficial to use these advanced modalities for surveillance of these patients. At present it is debatable and no clear data exists to support this approach except for established guidelines to diagnose duodenal polyps in FAP, and LS. Here we discuss the genetic alterations, cancer risks, signaling mechanisms and briefly touch the surveillance modalities available for these genetic and clinical syndromes. English language articles from PubMed/Medline and Embase was searched were collected using the phrases “small-bowel adenocarcinoma, genetics, surveillance, familial adenomatous polyposis, lynch syndromes, Peutz-Jeghers syndrome, juvenile polyposis syndrome, CD and celiac disease”. Figures, tables and schematic diagram to illustrate pathways are included in the review.

• Small intestinal adenocarcinoma
• Genetic risks
• Mutations
• Signaling pathways
• Surveillance

• Carbohydrate malabsorption
• Fat malabsorption
• Intestinal malabsorption
• Plasma citrulline level
• Protein losing enteropathy
• Small bowel bacterial overgrowth
• Small bowel malabsorption

• Blind Loop Syndrome/diagnosis
• Blind Loop Syndrome/physiopathology
• Carbohydrate Metabolism, Inborn Errors/diagnosis
• Carbohydrate Metabolism, Inborn Errors/physiopathology
• Humans
• Intestinal Absorption/physiology
• Lipid Metabolism Disorders/diagnosis
• Lipid Metabolism Disorders/physiopathology
• Malabsorption Syndromes/diagnosis
• Malabsorption Syndromes/physiopathology
• Protein-Losing Enteropathies/diagnosis
• Protein-Losing Enteropathies/physiopathology
• Short Bowel Syndrome/diagnosis
• Short Bowel Syndrome/physiopathology

• Lean
• Practice quality improvement
• Quality
• Safety

• Bowel ischemia
• Bowel strangulation
• Closed loop obstruction
• Intussusception
• Large bowel obstruction
• Small bowel obstruction
• Volvulus

Small-bowel neoplasms are the 3%–6% of all gastrointestinal tract neoplasms. Due to the rarity of these lesions, the low index of clinical suspicion, and the inadequate radiologic examinations or incorrect interpretation of radiologic findings, a delay in diagnosis of 6–8 months from the first symptoms often occurs. Even if conventional enteroclysis and capsule endoscopy are the most common procedures used to accurately depict the bowel lumen and mucosal surface, their use in evaluating the mural and extramural extents of small-bowel tumors is limited. Instead multidetector computed tomographic enteroclysis and magnetic resonance enteroclysis have the potential to simultaneously depict intraluminal, mural, and extraintestinal abnormalities. In particular MR enteroclysis has an excellent soft tissue contrast resolution and multiplanar imaging capability. It can provide anatomic, functional, and real time information without the need of ionizing radiation. MR findings, appearances of the lesions, combined with the contrast-enhancement behavior and characteristic of the stenosis are important to differentiate small-bowel neoplasm from other nonneoplastic diseases.

• Fractal technology
• Genetic algorithm (GA)
• Multi-scale curvelet
• Small bowel tumor
• Support vector machine (SVM)
• Textural features

• Capsule Endoscopy
• Chronic Disease
• Gastrointestinal Hemorrhage
• Intestinal Neoplasms
• Small Intestine

Aim. To compare the diagnostic value of multidetector CT enterography (MDCTE) and double-balloon enteroscopy (DBE) for patients with suspected small bowel diseases. Methods. From January 2009 to January 2014, 190 patients with suspected small bowel diseases were examined with MDCTE and DBE. The characteristics of the patients, detection rates, diagnostic yields, sensitivity, specificity, positive predictive value, and negative predictive value were described and analyzed. Results. The overall detection rates of DBE and MDCTE were 92.6% and 55.8%, respectively (P<0.05), while the overall diagnostic yields were 83.2% and 33.7%, respectively (P<0.05). The sensitivity, specificity, positive predictive value, and negative predictive value of DBE were all higher than those of MDCTE. DBE had a higher diagnostic yield for OGIB (87.3% versus 20.9%, P<0.05). The diagnostic yields of DBE were higher than those of MDCTE for inflammatory diseases, angioma/angiodysplasia, and diverticulums, while being not for gastrointestinal tumors/polyps. Conclusions. The diagnostic value of DBE for small bowel diseases is better than that of MDCTE as a whole, but if gastrointestinal tumors are suspected, MDCTE is also needed to gain a comprehensive and accurate diagnosis.

• Crohn’s disease
• Magnetic resonance imaging
• Radionuclide imaging
• Ultrasound
• X-ray computed tomography

• Adolescent
• Adult
• Aged
• Crohn Disease/diagnostic imaging
• Crohn Disease/pathology
• Female
• Humans
• Irritable Bowel Syndrome/diagnostic imaging
• Irritable Bowel Syndrome/pathology
• Magnetic Resonance Imaging
• Male
• Middle Aged
• Positron-Emission Tomography
• Reference Standards
• Sensitivity and Specificity
• Tomography, X-Ray Computed
• Ultrasonography
• Young Adult

Introduction. Celiac disease is associated with an increased risk of small bowel malignancies, particularly lymphoma. Its association with small bowel carcinoma is less known. Case Description. We report a case of an 89-year-old woman with celiac disease who experienced recurrent episodes of gastrointestinal bleeding and was ultimately found to have adenocarcinoma of the small intestine. Discussion and Evaluation. Diagnosis of small bowel adenocarcinoma is often delayed because of the need for specialized modalities, which are often deferred in the inpatient setting. Although resection is the modality of choice for small bowel tumors, a majority is either locally advanced or metastatic at diagnosis, and even localized cancers have worse prognosis than stage-matched colorectal tumors. The role of adjuvant chemotherapy is uncertain, but it is often offered extrapolating data from other gastrointestinal cancers. Small bowel carcinomas occurring in the context of celiac disease appear to be associated with higher rates of microsatellite instability than sporadic tumors, although other specific genomic abnormalities and mechanisms of carcinogenesis in celiac disease remain unknown. Conclusion. Recurrent episodes of gastrointestinal bleeding in a patient with celiac disease should prompt an early evaluation of the small bowel to assure timely diagnosis of carcinoma at an early curable stage.