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Idiopathic pneumoperitoneum has an unknown etiology despite exploratory laparotomy. However, it may occur without definite abdominal symptoms; thus, adequate management could be in clinical dilemma. We experienced three cases of idiopathic nonsurgical pneumoperitoneum in healthy individuals during a health check-up. Their cases were not accompanied by any relevant etiology or definite abdominal symptoms. All of the three cases exhibited a benign clinical course. The three patients underwent an abdominal computed tomography (CT) scan as part of a health check-up program, which incidentally revealed free air in the right paracolic gutter without evidence of visceral perforation or inflammation. Among the three cases, two patients underwent colonoscopy before abdominal CT, whereas one patient did not. Two cases were completely asymptomatic and were observed without any treatment in the outpatient clinic. Only the third case with minimal symptoms was treated conservatively for a short time. If a small amount of free air typically located in the right paracolic gutter is detected in the absence of perforation during colonoscopy, close observation without unnecessary treatment would be sufficient. [ABSTRACT FROM AUTHOR]

Crohn’s disease (CD) is an idiopathic inflammatory bowel disease involving the small and/or large intestine. More than 50% of Western CD patients and up to 88% of Asian CD patients may have small intestinal involvement. Video capsule endoscopy (VCE) has a higher diagnostic yield than small bowel barium radiography and computed tomography enterography for the detection of small intestinal involvement of CD. VCE also provides diagnostic yields comparable to magnetic resonance- (MR-) based enterography or enteroclysis and may have several advantages over MR-based tests for the detection of early small intestinal lesions. Several studies have suggested the use of VCE-based disease activity scoring systems to evaluate small intestinal mucosal disease activity, although their clinical relevance needs to be further studied. A possible indication for VCE is recurrence monitoring after complete surgical excision of CD-involved segments but its usefulness and efficacy compared with conventional endoscopy should be evaluated. The capsule retention rate ranges from 0 to 5.4% in suspected CD patients and from 0 to 13.2% in established CD patients. If VCE is necessary, significant small bowel stricture should be ruled out before VCE by performing a patency capsule study and/or small bowel radiological study in suspected or established CD patients. [ABSTRACT FROM AUTHOR]

Background and Aims. Balloon-assisted enteroscopy (BAE) can be used to retrieve small intestinal foreign bodies (FBs). Here, we aimed at exploring the clinical usefulness of BAE for the retrieval of small intestinal FBs. Methods. We retrospectively reviewed the medical records of 34 patients who underwent BAE to retrieve small intestinal FBs at 3 tertiary referral centers between April 2005 and June 2017. Results. The retained materials included capsule endoscopes (CEs; n = 18 [52.9%]), self-expandable metal stents (SEMSs; n = 5 [14.7%]), biliary drainage catheters (n = 4 [11.8%]), gallstones (n = 3 [8.8%]), an embolization coil (2.9%), a needle, an intragastric bariatric balloon, and a razor blade. FBs were located or stuck in the ileum (n = 17 [50%]), jejunum (n = 16 [47.1%]), and an undetermined small intestinal segment (n = 1). Seventeen cases of FBs (50%; 7 CEs, 3 biliary drainage catheters, 3 SEMSs, 2 gallstones, 1 intragastric balloon, and 1 needle) were successfully retrieved enteroscopically. FBs of 4 asymptomatic patients (3 CEs and 1 razor blade) passed spontaneously. The remaining 13 patients underwent surgery for persistent or symptomatic FBs: 12 were successfully removed and 1 CE removal procedure failed due to severe peritoneal adhesions. The presence of symptoms was the only independent predictor of successful retrieval using BAE (odds ratio 13.40, 95% confidence interval 1.10–162.56, P = 0.042). BAE-related complications such as bowel perforation and acute pancreatitis occurred in 2 patients (5.9%). Conclusions. BAE can be the first option for FB removal in the small intestine. The presence of symptoms was associated with successful enteroscopic retrieval. [ABSTRACT FROM AUTHOR]

Background. Although immunomodulators are increasingly used in Crohn’s disease (CD), a significant number of gastroenterologists still use 5-aminosalicylate (5-ASA) in combination with azathioprine (AZA) or 6-mercaptopurine (6-MP); there is limited evidence regarding the benefit of concomitant 5-ASA with AZA/6-MP compared with AZA/6-MP monotherapy for the treatment of CD. Study Design. A total of 106 patients who received AZA/6-MP for more than 3 months between January 1991 and May 2014 were identified retrospectively. Each patient was matched with 3 randomly selected controls who were treated with concomitant therapy during the same period. Results. The cumulative probabilities of steroid use at 5 and 10 years were 24.9% and 75.8% in the 5-ASA + AZA/6-MP group and 31.2% and 87.8% in the AZA/6-MP group, respectively (P=0.187). The cumulative probabilities of anti-TNF use, resectional surgery, and disease-related hospitalization were comparable between the groups. The younger age and the use of lower doses of immunomodulators were associated with higher requirement of rescue therapy. Conclusions. This study did not demonstrate that the concomitant use of 5-ASA with AZA/6-MP showed the proof or effect in terms of steroid requirements, anti-TNF use, resectional surgery, or disease-related hospitalization compared with that of AZA/6-MP alone. [ABSTRACT FROM AUTHOR]