Small Intestine Disease: A Comprehensive Guide to Diagnosis and Management

Description

This book covers all aspects of small intestinal disease with the aim of providing an up-to-date reference of the highest quality that will assist in everyday clinical practice. After introductory chapters on anatomy, pathophysiology, epidemiology, and signs and symptoms, the roles of different imaging modalities in the diagnosis of small intestinal disease are clearly explained, focusing particularly on capsule endoscopy, device-assisted enteroscopy, CT and MR enterography, and nuclear medicine techniques. A series of chapters then address each of the diseases and conditions that may be encountered. The coverage is wide ranging, including, for example, obscure gastrointestinal bleeding, Crohn’s disease and other inflammatory conditions, celiac disease, Behçet’s disease, Meckel’s diverticulum, intestinal tuberculosis, and various malignancies. Numerous informative clinical cases are presented to identify characteristic imaging findings and assist in treatment decision making. Small intestinal disease continues to represent a significant challenge. The scope and detail of this book will make it an invaluable asset for gastroenterologists and other clinicians. Preface Contents About the Editors and Contributors About the Editors Contributors Part I: Structure and Function of Small Bowel Anatomy of the Small Intestine Anatomy and Structure of the Wall Anatomical Division Structure of the Small Bowel Wall Vascular and Nerve System Blood Vessels and Lymphatics Nervous System Physiological Function of the Small Intestine Movement of the Small Intestine Absorption of Small Intestine (Fig. 1) Nutrient Absorption Fat Absorption Monosaccharides: The Primary Absorption Form of Carbohydrates Proteins Absorbed in Dipeptides, Tripeptides, and Amino Acid Form Absorption of Water by Osmosis Ion Absorption Bicarbonate Absorption in the Duodenum and Jejunum Absorption at Ileum Active Transport of Sodium Active Absorption of Calcium, Iron, Potassium, Magnesium, and Phosphorus Secretory Function of Small Intestine Mucus Secretion Secretion of Bile Acid Gastrointestinal Secretion Digestive Enzyme References Part II: Epidemiology of Small Bowel Diseases Small-bowel Bleeding Causes and Prevalence of Small-bowel Bleeding Diagnostic Yield According to Clinical Manifestations of Small-bowel Bleeding Remark References Inflammatory Diseases of Small Bowel Causes of Inflammatory Diseases of the Small Bowel Infectious Diseases Noninfectious Diseases Radiation Enteritis Drug-induced Enteropathy Ischemic Enteritis Eosinophilic Enteritis Inflammatory Bowel Disease Cryptogenic Multifocal Ulcerous Stenosing Enteritis (CMUSE) Amyloidosis Meckel’s Diverticulum Small-intestinal Bacterial Overgrowth (SIBO) References Small Bowel Tumors Introduction Epidemiology Risk Factors Conclusion References Other Small-bowel Disorders Meckel’s Diverticulum Amyloidosis Small-bowel Involvement of Connective Tissue Disorders Celiac Disease Primary Lymphangiectasia Symptoms and Signs of Suspected Small Bowel Disease Small Bowel Bleeding Inflammatory Diseases of the Small Bowel Small Bowel Tumors Conclusion References Part III: Radiologic and Imaging Studies to Evaluate Small Intestinal Disorders Radiologic Imaging for Small-Bowel Evaluation Introduction Barium Examination Small-Bowel Follow-through Barium Enteroclysis Computed Tomography (CT) Enterography and CT Enteroclysis MR Enterography Angiography Conclusion References Nuclear Medicine Imaging Introduction Nuclear Medicine Imaging for Bleeding in the Small Bowel Gastrointestinal (GI) Bleeding Scan Introduction 99mTc-sulfur Colloid 99mTc Red Blood Cell (99mTc-RBC) Labeling of 99mTc-RBC Method of Examination Interpretation Gastric Mucosa Scan (Scintigraphy for Meckel’s Diverticulum) Introduction Method Pretreatment Method of Examination Clinical Application and Interpretation Nuclear Medicine Imaging in Oncology 18F-fluorodeoxyglucose Positron Emission Tomography (18F-FDG PET) Adenocarcinoma Lymphoma GI Stromal Tumors (GISTs) Small-Bowel Metastasis Somatostatin Receptor Imaging References Part IV: Capsule Endoscopy History of Capsule Endoscopy The Birth of a Capsule Endoscope Growth of Capsule Endoscopy Capsule Storage Device Workstation Clinical Application of Capsule Endoscopy References Current Trends in Capsule Endoscopy Types of Capsule Endoscopy Small Bowel Esophagus Colon Efficacy of Capsule Endoscopy Small Bowel Bleeding Crohn’s Disease Small Bowel Tumor Recent Trends of Capsule Endoscopy References The Future of Capsule Endoscopy Perfect Images Without Blind Spots Identifying the Exact Location of Lesions Tissue Biopsy and Therapeutic Endoscopy Automatic Interpretation Through Artificial Intelligence Active Control of Capsule Endoscopy Conclusion References Indications and Contraindications of Small-bowel Capsule Endoscopy Indications Obscure Gastrointestinal Bleeding (OGIB) Crohn’s Disease Small-bowel Tumors and Polyposis Syndrome Celiac Disease Abdominal Pain of Unknown Origin Contraindications Patients at a Risk of Gastrointestinal Obstruction, Stenosis, or Fistula Pediatric Patients Patients with Swallowing Disorders Pregnant Patients Patients with Implantable Cardiac Devices References Preparation Before Capsule Endoscopy Informed Consent Form Contents of the Informed Consent Form Precautions in the Consent Form General Preparation The Week Before Capsule Endoscopy The Day Before Capsule Endoscopy The Day of Capsule Endoscopy Diet Diet Before the Examination Diet on the Day of Capsule Endoscopy Enteric Lavage Fasting Simethicone Polyethylene Glycol Solution Prokinetic Drugs Other Pretreatment Methods Booster Effect with Ingestion of Picolax Purgative After Taking 2 L PEG Solution Coffee Enema After Ingesting Magnesium Citrate Gum Chewing Conclusion References Procedure and Informed Consent of Patients for Capsule Endoscopy Capsule Endoscopy Informed Consent of Patients Consent form of Capsule Endoscopy Closing Remarks Interpretation of Small Bowel Capsule Endoscopy Development of Reading Software History of the RAPID Program Interpretation Lesion Localization Quality Indicators for Interpretation Frame Rate View Mode References Normal Findings of Capsule Endoscopy Introduction Pharynx and Larynx Esophagus Stomach Small Intestine Duodenum Jejunum and Ileum Conclusion References Terminology Standard Terminology Description Descriptions Lesions Localization Small Bowel Preparation Quality Diagnosis Closing Remarks References Capsule Endoscopy in Special Circumstances Capsule Endoscopy in Children Capsule Endoscopy in Pregnant Women Capsule Endoscopy in Patients with Structural Changes in the Gastrointestinal Tract Capsule Endoscopy in Patients with Gastrointestinal Motility Disease Capsule Endoscopy in Patients with Swallowing Disorders Capsule Endoscopy in Patients with Implantable Cardiac Devices Conclusion References Complications Capsule Retention Patency Capsule Summary References Part V: Device-Assisted Enteroscopy History of Small-Intestinal Enteroscopy Conclusion References Types of Enteroscopy Types of Enteroscopy Double Balloon Enteroscopy Single Balloon Enteroscopy Spiral Enteroscopy Balloon-Guided Endoscopy References Indications and Contraindications of Device-Assisted Enteroscopy Introduction Main Indications of Device-Assisted Enteroscopy (Table 1) [1] Small Intestinal Bleeding or Suspected Small Intestinal Bleeding Crohn’s Disease Small Intestinal Polyps or Tumor Strictures or Inflammatory Lesions of Small Intestine Therapeutic Endoscopic Procedures ERCP for the Patients with Surgically Altered Anatomy Difficult Colonoscopy Diagnostic Yields of Device-Assisted Enteroscopy Contraindications of Device-Assisted Enteroscopy Summary References Common Preparation for Device-Assisted Enteroscopy Fasting and Bowel Preparation Sedation Usage of Carbon Dioxide Insufflator Preparation of Procedure by Device Type Double-Balloon Enteroscope Double-Balloon Enteroscope Components Double-Balloon Enteroscope Preparation Balloon Attachment to Distal End of Enteroscope Overtube Preparation (Fig. 3) Air Pressure Controller Preparation Single-Balloon Enteroscope (Olympus, Tokyo, Japan) Single-Balloon Enteroscope Components Overtube Preparation Balloon and Air Pump System Check Insertion Method in Balloon-Assisted Enteroscopy Basic Operation Methodology Insertion of the Enteroscope Oral Insertion Anal Insertion Other Tips for Deep Insertion Differences in and Characteristics of Insertion Techniques According to type of Balloon-Assisted Enteroscopy Introduction DBE SBE Comparison of Efficacy and Safety Between DBE and SBE Spiral Enteroscopy Conclusion References Therapeutic Enteroscopy (Hemostasis, Polypectomy, Balloon Dilation, and Others) Introduction Enteroscopic Hemostasis Indications Types of Enteroscopic Hemostasis Injection Method Argon Plasma Coagulation Clip Application Other Hemostatic Methods Clinical Outcome and Complications of Enteroscopic Hemostasis Enteroscopic Polypectomy Indications Enteroscopic Polypectomy Methods Clinical Outcome and Complications of Enteroscopic Polypectomy Enteroscopic Balloon Dilation Indications Small Bowel Strictures in Crohn’s Disease Benign Strictures Other than Crohn’s Disease Balloon Dilation Procedures Clinical Outcome of Enteroscopic Balloon Dilation Small Bowel Strictures in Crohn’s Disease Small Bowel Strictures from Other Etiologies Complications of Enteroscopic Balloon Dilation Other Therapeutic Enteroscopy Procedures Stenting Enteroscopic Foreign Body Removal Conclusion References Complications Related to Device-Assisted Enteroscopy Major Complications Bleeding Perforation Acute Pancreatitis Sedation-Related Complications Other Complications Conclusions References Various Applications of Device-Assisted Enteroscopy Device-Assisted Enteroscopy in Altered Anatomy Device-Assisted Enteroscopy in Incomplete Colonoscopy Small Bowel Stenting with Device-Assisted Enteroscopy References Part VI: Miscellaneous Tests for Small Bowel Disorders Principle and Clinical Application of the Hydrogen Breath Test Principles Methods Results Limitations Clinical Applications Conclusion References The Principles and Practice of Alpha-1 Antitrypsin Clearance Introduction α1-Antitrypsin α1-Antitrypsin Clearance Summary or Conclusion References Part VII: Diagnostic Approach to the Suspected Small Bowel Bleeding or Obscure Gastrointestinal Bleeding Hemodynamically Unstable Patients with Acute Gastrointestinal Bleeding Introduction Systematic Diagnostic Approach Clinical Manifestations and Physical Examination Hemodynamically Unstable Patients with Acute GI Bleeding Second-Look Endoscopy Diagnostic Tools for Patients with Small-Bowel Bleeding Angiography Double-Balloon Enteroscopy Intraoperative Enteroscopy Conclusions References Hemodynamically Stable Acute or Chronic Small-Bowel Bleeding Etiology Diagnosis Second-Look Endoscopy Small-Bowel Capsule Endoscopy Small-Bowel Enteroscopy Radiographic Examination Computed Tomography (CT) Enterography CT Angiography Summary References Part VIII: Vascular Disorders of Small Bowel Vascular Diseases of the Small Intestine Vascular Anatomy and Physiology of the Small Intestine Ischemic Disorders Portal Hypertensive Enteropathy Vasculitis Thromboangiitis Obliterans Angioectasia Hemangioma Summary References Part IX: Small Bowel Crohn’s Disease Diagnostic Criteria for Crohn’s Disease Medical History Taking and Physical Examination Laboratory Tests Endoscopy Radiology Histopathology Diagnostic Criteria Conclusions References Clinical Features of Small Bowel Crohn’s Disease Incidence of Small-Bowel Crohn’s Disease Clinical Features of Small-Bowel Crohn’s Disease Conclusion References Indication of Small Bowel Evaluation in Crohn’s Disease Initial Diagnosis of Crohn’s Disease Evaluation of Small Bowel Lesions for Established Crohn’s Disease References Part X: Usefulness of the Diagnostic Studies to Evaluated Small Bowel Involvement of Crohn’s Disease Radiologic Examination: Small-Bowel Follow-Through, Computed Tomography Enterography, and Magnetic Resonance Enterography Introduction SBFT CT Enterography MR Enterography Conclusion References Effectiveness of Endoscopic Examinations for the Detection of Small Bowel Crohn’s Disease: Capsule Endoscopy and Device-Assisted Enteroscopy Introduction Capsule Endoscopy Suspected Crohn’s Disease Confirmed Crohn’s Disease Device-Assisted Enteroscopy Summary and Conclusion References Non-steroidal Anti-inflammatory Drug Enteropathy Epidemiology Pathogenesis Clinical Manifestations Iron Deficiency Anemia Protein-Losing Enteropathy Small Bowel Stricture High-Risk Groups Diagnosis History-Taking Capsule Endoscopy and Device-Assisted Enteroscopy Isotopic Tests Fecal Calprotectin Computed Tomography (CT) and Magnetic Resonance (MR) Enterography Treatment and Prevention Selective COX-2 Inhibitors Mucoprotective Agents Manipulation of the Gut Microbiota Others Conclusion References Small Intestinal Tuberculosis Epidemiology and Routes of Infection Clinical Manifestations Diagnosis Endoscopic Findings Radiologic Findings Histopathologic Findings Skin Test Interferon-Gamma Releasing Assay Treatment References Cryptogenic Multifocal Ulcerous Stenosing Enteritis Clinical Characteristics Diagnosis Treatment Conclusion References Peutz–Jeghers syndrome Prevalence and Related Genes Clinical Features Extraintestinal Tumor Summary References Small Bowel Adenocarcinoma Epidemiology Etiology and Pathogenesis Clinical Features and Diagnosis Prognosis Treatment Conclusion References Small Bowel Lymphoma Epidemiology Diagnosis Treatment Prognosis References Other Small Bowel Tumors Introduction Malignant Tumors Gastrointestinal Stromal Tumor Pathophysiology Diagnosis Treatment Carcinoid Tumor Pathophysiology Diagnosis Treatment Metastatic Small Bowel Tumors Benign Tumors Conclusion References Meckel’s Diverticulum Introduction Clinical Features Gastrointestinal Bleeding Intestinal Obstruction Meckel’s Diverticulitis Tumor Diagnosis Treatment Summary References Amyloidosis of the Small Bowel Introduction Types of Amyloidosis Clinical Features and Histopathology Diagnosis and Treatment Conclusion References Small-bowel Involvement of Connective Tissue Diseases Systemic Sclerosis (SSc) SLE Henoch–Schönlein Purpura (HSP) Inflammatory Myopathies Mixed CTD (MCTD) Rheumatoid Arthritis References Celiac Disease Introduction Epidemiology Pathogenesis Symptoms Diagnosis Treatment Prognosis References Small-Bowel Behcet’s Disease Introduction Clinical Presentation Diagnostic Evaluation Blood Tests Endoscopy Imaging Histopathology Diagnosis and Differential Diagnosis Diagnosis Differential Diagnosis Assessment of Disease Activity Treatment Conclusion References Primary Intestinal Lymphangiectasia Introduction Definition Pathophysiology Classification Symptoms Diagnosis Treatment Conclusion References Index