Mucosal Changes in the Small Intestines in Portal Hypertension: First Study Using the Pillcam SB3 Capsule Endoscopy System
1
조회
0
다운로드
1
인용
0
참고문헌
키워드
초록
Background/Aims: To evaluate patients with portal hypertension (PH) of varied etiologies for portal hypertensive enteropathy (PHE)using the PillCam SB3 capsule endoscopy (CE) system. Methods: Consecutive patients with PH presenting with unexplained anemia and/or occult gastrointestinal bleeding were evaluatedusing the PillCam SB3 CE system. Abnormal findings were categorized as vascular or non-vascular. The patients with ongoing bleedingcaused by PHE were treated. The correlation of the CE scores of PHE with the clinical, laboratory, and endoscopic features wasdetermined. Results: Of the 43 patients included in the study, 41 (95.3%) showed PHE findings. These included varices (67.4%), red spots (60.5%),erythema (44.2%), villous edema (46.5%), telangiectasia (16.3%), and polyps (16.3%). The CE scores varied from 0 to 8 (mean±standarddeviation, 4.09±1.8). Five patients (11.6%) showed evidence of ongoing or recent bleeding due to PHE. Three of these five patientsunderwent endotherapy, and one patient underwent radiological coil placement. Conclusions: The PillCam SB3 CE system revealed a high prevalence of PHE in the patients with PH. Using this system, evidence ofbleeding due to PHE was found in a small but definite proportion of the patients.
Abstract
Background/Aims: To evaluate patients with portal hypertension (PH) of varied etiologies for portal hypertensive enteropathy (PHE)using the PillCam SB3 capsule endoscopy (CE) system. Methods: Consecutive patients with PH presenting with unexplained anemia and/or occult gastrointestinal bleeding were evaluatedusing the PillCam SB3 CE system. Abnormal findings were categorized as vascular or non-vascular. The patients with ongoing bleedingcaused by PHE were treated. The correlation of the CE scores of PHE with the clinical, laboratory, and endoscopic features wasdetermined. Results: Of the 43 patients included in the study, 41 (95.3%) showed PHE findings. These included varices (67.4%), red spots (60.5%),erythema (44.2%), villous edema (46.5%), telangiectasia (16.3%), and polyps (16.3%). The CE scores varied from 0 to 8 (mean±standarddeviation, 4.09±1.8). Five patients (11.6%) showed evidence of ongoing or recent bleeding due to PHE. Three of these five patientsunderwent endotherapy, and one patient underwent radiological coil placement. Conclusions: The PillCam SB3 CE system revealed a high prevalence of PHE in the patients with PH. Using this system, evidence ofbleeding due to PHE was found in a small but definite proportion of the patients.
참고문헌 (37)
- Bornman PC, "Management of oesophageal varices", Lancet, 343, pp.1079~1084 (1994)
- McCormack TT, "Gastric lesions in portal hypertension: inflammatory gastritis or congestive gastropathy?", Gut, 26, pp.1226~1232 (1985)
- Ganguly S, "The prevalence and spectrum of colonic lesions in patients with cirrhotic and noncirrhotic portal hypertension", Hepatology, 21, pp.1226~1231 (1995)
- Goenka MK, "Rectosigmoid varices and other mucosal changes in patients with portal hypertension", Am J Gastroenterol, 86, pp.1185~1189 (1991)
- Chen LS, "Portal hypertensive colopathy in patients with cirrhosis", Scand J Gastroenterol, 31, pp.490~494 (1996)
- Hosking SW, "Anorectal varices, haemorrhoids, and portal hypertension", Lancet, 1, pp.349~352 (1989)
- Misra V, "Histomorphometric study of portal hypertensive enteropathy", Am J Clin Pathol, 108, pp.652~657 (1997)
- Nagral AS, "Congestive jejunopathy in portal hypertension", Gut, 34, pp.694~697 (1993)
- Viggiano TR, "Portal hypertensive intestinal vasculopathy:a review of the clinical, endoscopic, and histopathologic features", Am J Gastroenterol, 87, pp.944~954 (1992)
- Misra SP, "Ileal varices and portal hypertensive ileopathy in patients with cirrhosis and portal hypertension", Gastrointest Endosc, 60, pp.778~783 (2004)
- Ohtani T, "Ileal varices associated with recurrent bleeding in a patient with liver cirrhosis", J Gastroenterol, 34, pp.264~268 (1999)
- Lewis P, "Massive gastrointestinal haemorrhage due to ileal varices", Br J Surg, 77, pp.1277~1278 (1990)
- Arst HF, "Acute ileal variceal hemorrhage secondary to esophageal sclerotherapy", J Clin Gastroenterol, 8, pp.603~604 (1986)
- Chandrasekar TS, "Spectrum of small-bowel mucosal abnormalities identified by capsule endoscopy in patients with portal hypertension of varied etiology", Indian J Gastroenterol, 36, pp.32~37 (2017)
- Dabos KJ, "Small bowel capsule endoscopy and portal hypertensive enteropathy in cirrhotic patients: results from a tertiary referral centre", Ann Hepatol, 15, pp.394~401 (2016)
- Aoyama T, "Major predictors of portal hypertensive enteropathy in patients with liver cirrhosis", J Gastroenterol Hepatol, 30, pp.124~130 (2015)
- Jeon SR, "Portal hypertensive enteropathy diagnosed by capsule endoscopy in cirrhotic patients: a nationwide multicenter study", Dig Dis Sci, 59, pp.1036~1041 (2014)
- Abdelaal UM, "Evaluation of portal hypertensive enteropathy by scoring with capsule endoscopy: is transient elastography of clinical impact?", J Clin Biochem Nutr, 47, pp.37~44 (2010)
- Akyuz F, "Is portal hypertensive enteropathy an important additional cause of blood loss in portal hypertensive patients?", Scand J Gastroenterol, 45, pp.1497~1502 (2010)
- Kovács M, "Small bowel alterations in portal hypertension: a capsule endoscopic study", Hepatogastroenterology, 56, pp.1069~1073 (2009)
- Goulas S, "Capsule endoscopy in the investigation of patients with portal hypertension and anemia", Can J Gastroenterol, 22, pp.469~474 (2008)
- Figueiredo P, "Effect of portal hypertension in the small bowel: an endoscopic approach", Dig Dis Sci, 53, pp.2144~2150 (2008)
- De Palma GD, "Mucosal abnormalities of the small bowel in patients with cirrhosis and portal hypertension: a capsule endoscopy study", Gastrointest Endosc, 62, pp.529~534 (2005)
- Monteiro S, "PillCam® SB3 capsule: does the increased frame rate eliminate the risk of missing lesions?", World J Gastroenterol, 22, pp.3066~3068 (2016)
- Kunihara S, "Third-generation capsule endoscopy outperforms second-generation based on the detectability of esophageal varices", Gastroenterol Res Pract, 2016, pp.9671327~ (2016)
- Eliakim R., "Where do I see minimally invasive endoscopy in 2020: clock is ticking", Ann Transl Med, 5, pp.202~ (2017)
- Mekaroonkamol P, "Portal hypertensive enteropathy", World J Hepatol, 7, pp.127~138 (2015)
- Kodama M, "Endoscopic characterization of the small bowel in patients with portal hypertension evaluated by double balloon endoscopy", J Gastroenterol, 43, pp.589~596 (2008)
- Højhus JH, "Cirrhosis and bleeding ileal varices without previous intraabdominal surgery. A case report", Acta Chir Scand, 152, pp.479~480 (1986)
- Varanasi RV, "Colonoscopic sclerotherapy of ileal varices", Gastrointest Endosc, 52, pp.109~111 (2000)
- Norton ID, "Management of ectopic varices", Hepatology, 28, pp.1154~1158 (1998)
- 구소미, "Jejunal Variceal Bleeding Successfully Treated with Percutaneous Coil Embolization", Journal of Korean Medical Science, 27(3), pp.321~324 (2012), 대한의학회
- Lemmers A, "Gastrointestinal polypoid lesions:a poorly known endoscopic feature of portal hypertension", United European Gastroenterol J, 2, pp.189~196 (2014)
- Guth E, "Recurrent bleeding from ileal varices treated by transjugular intrahepatic portosystemic shunt: value of Doppler ultrasonography in diagnosis and follow-up", J Ultrasound Med, 15, pp.67~69 (1996)
- Haskal ZJ, "Intestinal varices: treatment with the transjugular intrahepatic portosystemic shunt", Radiology, 191, pp.183~187 (1994)
- Lu Y, "Meta-analysis of capsule endoscopy in patients diagnosed or suspected with esophageal varices", World J Gastroenterol, 15, pp.1254~1258 (2009)
- Chavalitdhamrong D, "Capsule endoscopy is not as accurate as esophagogastroduodenoscopy in screening cirrhotic patients for varices", Clin Gastroenterol Hepatol, 10, pp.254~258 (2012)