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This article, published in the journal Endoscopy, discusses diaphragm disease, a rare condition characterized by the presence of multiple rings in the small bowel that narrow the lumen. The symptoms of diaphragm disease can vary and may include iron-deficiency anemia, bleeding, obstruction, alteration of intestinal habits, or acute abdomen due to perforation. The main cause of diaphragm disease is the use of non-steroidal anti-inflammatory drugs (NSAIDs), although other factors such as potassium intake, celiac disease, eosinophilic gastroenteritis, and radiation damage have also been reported. The article presents three cases of diaphragm disease diagnosed through capsule endoscopy, highlighting the challenges and risks associated with this procedure. [Extracted from the article]

Patients and methods A comprehensive literature search was conducted. We measured pooled rate of lesion visualization improvement and improvement in lesion detection comparing FICE settings 1 - 3 and WLE, for angioectasias and ulcers/erosions. Pooled results were derived using the random-effects model because of high heterogeneity as measured by I2. Repeated-measures analysis of variance (ANOVA) was used to measure differences in lesion detection between WLE and the three FICE modes. Results 13 studies were analyzed. All studies used the PillCam SB 1 and/or SB 2 devices. Most used experienced readers. Improvement in delineation had been investigated in 4 studies; in the 3 studies entered into the meta-analysis, using FICE setting 1, 89 % of angioectasias and 45 % of ulcer/erosions were considered to show improved delineation. For FICE settings 2 and 3, small proportions of images showed improved delineation. Heterogeneity of studies was high with I2 > 90 % in 4/6 analyses. Lesion detection had been investigated in 10 studies; meta-analysis included 5 studies. Lesion detection did not differ significantly between any of the FICE modes and WLE. Conclusions Overall, the use of the three FICE modes did not significantly improve delineation or detection rate in SBCE. In pigmented lesions, FICE setting 1 performed better in lesion delineation and detection. [ABSTRACT FROM AUTHOR]

The article offers information on the clinical guidelines imposed by the organization the European Society of Gastrointestinal Endoscopy (ESGE). The document explores on the important role of device-assisted enteroscopy and small-bowel endoscopy in the diagnosis as well as the treatment of the small-bowel disorders. Moreover, the recommendations of the ESGE are also stated.

Multifocal stenosing enteritis, not related to Crohn's disease or drug intake, has been described under two different terms: "cryptogenic multifocal ulcerous stenosing enteritis" (CMUSE) and "neuromuscular and vascular hamartoma" (NMVH). We present three new cases of this condition and argue that the two terms reflect the same disease entity. Although etiology and pathogenesis of the disease remain largely unclear, obliterative vascular changes may play an important role. [ABSTRACT FROM AUTHOR]

Abbreviations: CO2, carbon dioxide; DBE, doubleballoon enteroscopy; MGCE, magnetic-guided capsule endoscopy; PC, patency capsule; PEG, polyethylene glycol; SBE, single-balloon enteroscopy; VCE, video capsule endoscopy. [ABSTRACT FROM AUTHOR]

Biodegradable stents, which are made of various synthetic polymers, such as polylactide or polyglycolide, or co-polymers, such as polydioxanone, can be used for the treatment of benign refractory stenoses of the gastrointestinal tract. Here we report 11 patients (median age 41) with stenosing Crohn’s disease of the small and/or large intestine. Endoscopic insertion of a biodegradable stent was successful at the first attempt in all patients except one. Subsequent follow-up was for a mean of 16 months, median 17 months, range 12 – 29 months. Early stent migration (between 2 days and 8 weeks) was seen in three patients. Mucosal overgrowth (epithelial hyperplasia) was not observed in any of the patients during the follow-up period. The high rate of early stent migration might be solved by appropriate tailoring and further improvements in the design of the biodegradable stents. Proof of long-term efficacy and safety requires further studies. [ABSTRACT FROM AUTHOR]

Background and study aims: Double-balloon enteroscopy (DBE) is the first choice endoscopic technique for small-bowel visualization. However, preparation and handling of the double-balloon enteroscope is complex. Recently, a singleballoon enteroscopy (SBE) system has been introduced as being a simplified, less-complex balloon- assisted enteroscopy system. Patients and methods: This study was a randomized international multicenter trial comparing two balloon-assisted enteroscopy systems: DBE vs. SBE. Consecutive patients referred for balloon- assisted enteroscopy were randomized to either DBE or SBE. Patients were blinded with regard to the type of instrument used. The primary study outcome was oral insertion depth. Secondary outcomes included complete small-bowel visualization, anal insertion depth, patient discomfort, and adverse events. Patient discomfort during and after the procedure was scored using a visual analog scale. Results: A total of 130 patients were included over 12 months: 65 with DBE and 65 with the SBE technique. Patient and procedure characteristics were comparable between the two groups. Mean oral intubation depth was 253 cm with DBE and 258 cm with SBE, showing noninferiority of SBE vs. DBE. Complete visualization of the small bowel was achieved in 18% and 11% of procedures in the DBE and SBE groups, respectively. Mean anal intubation depth was 107 cm in the DBE group and 118 cm in the SBE group. Diagnostic yield and mean pain scores during and after the procedures were similar in the two groups. No adverse events were observed during or after the examinations. Conclusions: This head-to-head comparison study shows that DBE and SBE have a comparable performance and diagnostic yield for evaluation of the small bowel. [ABSTRACT FROM AUTHOR]

Background and study aims: Double-balloon enteroscopy (DBE) has been established as an invaluable tool for the diagnosis and treatment of small-bowel diseases. To evaluate complications, procedural data, and diagnostic yield of DBE examinations in Germany the presented database was introduced. Methods: A prospective database of all DBE examinations in 62 endoscopic centers in Germany was developed using data from a standard questionnaire. Information requested included data on personal information, indications, procedural information, interventions, diagnostic yield, and complications. Results: In total, 2245 DBE examinations in 1765 patients were reported prospectively over a 2- year period. The most frequent indication was overt or occult bleeding in the small intestine and the most frequent intervention was argon plasma coagulation of angiodysplasia. The rate of complete enteroscopy was only 23%. A clear dependency of indication and diagnostic yield could be documented, ranging widely from a diagnostic yield of 16% in patients with abdominal pain and 82% in patients with Peutz-Jeghers syndrome. A total of 27 complications produced a complication rate for all examinations of 1.2 %. Pancreatitis was diagnosed in four cases (0.3% of oral-route DBE). Perforations occurred in three patients, two of whom had undergone polypectomy in the small bowel (1.5% of 137 polypectomies). Conclusion: DBE is a safe endoscopic technique according to this large prospective database, with a complication rate of 1.2 %. The diagnostic yield of DBE examinations depends upon the quality of indication, and is very low in patients with the single indications of "diarrhea" or "abdominal pain". [ABSTRACT FROM AUTHOR]

Background and study aims: Spiral enteroscopy is a new, promising rapid enteroscopy technique. A prospective cross-over study was carried out to compare this new method with the established technique of double-balloon enteroscopy (DBE). Patients and methods: From an initial group of 18 patients with suspected mid-gastrointestinal bleeding due to vascular malformations but no previous history of small-bowel or colonic surgery, 10 patients (mean age 69 years) completed the study. Patients underwent both enteroscopy techniques with an oral approach, in a randomized sequence. The deepest point reached during advancement in the first enteroscopy was marked with India ink. The primary end point of the study was the total examination time. Results: For spiral enteroscopy, the mean examination time was significantly shorter than with DBE (43 minutes vs. 65 minutes; P = 0.007), as was the mean time required for advancement of the enteroscope to the deepest point (24 minutes vs. 43 minutes; P = 0.03). However, the median maximum insertion depth was greater in the DBE group than in the spiral enteroscopy group (310 cm vs. 250 cm; P = 0.004). In all cases in which DBE followed spiral enteroscopy, DBE passed the India ink mark by a mean of over 100 cm. When DBE was performed first, spiral enteroscopy was either unable to reach the mark or else unable to advance deeper into the small bowel. No severe complications occurred. Conclusions: The results confirm that the new spiral enteroscopy technique reduces the examination time, although the insertion depth with DBE is at present superior. [ABSTRACT FROM AUTHOR]

The article discusses the role of capsule endoscopy during insertion of double-balloon enteroscopy (DBE) as diagnostic examination for small-bowel diseases. An overview of the advantages and disadvantages of capsule endoscopy is presented. It examines the therapeutic impact of single-balloon or double-balloon techniques in enteroscopy as well as the long-term effect in patients with unclear gastrointestinal bleeding by DBE.

BACKGROUND AND STUDY AIMS: Spiral enteroscopy is a new technique for deep small-bowel intubation that uses a special overtube (Discovery Small Bowel, DSB) to pleat small bowel. The aims of this prospective study were to evaluate the use of a new-design DSB over new, longer and smaller-diameter enteroscopes, the Fujinon EN-450T5 and the Olympus SIF-Q180. PATIENTS AND METHODS: This is a prospective study of 75 patients at two referral centers. All enteroscopies were performed by two experienced endoscopists. Patients underwent spiral enteroscopy perorally with the DSB and either the Fujinon EN-450T5 or the Olympus SIF-Q180 enteroscope. Procedure time and depth of insertion past the ligament of Treitz were determined for all patients. RESULTS: Peroral spiral enteroscopy with DSB was performed in 50 patients with the Fujinon enteroscope and in 25 patients with the Olympus. Average estimated depth of insertion was 243?cm (range 50?-?380?cm) vs. 256?cm (range 50?-?400?cm) and the average time to reach this depth was 18.7 minutes (range 7?-?52 minutes) vs. 16.2 minutes (range 7?-?33 minutes) in the Fujinon and the Olympus groups respectively. Overall findings were 10 angiodysplasias, 2 small-bowel tumors, 1 Peutz-Jeghers polyp, 1 case of celiac sprue, 2 of small-bowel strongyloidiasis, and 2 small-bowel ulcers. All angiodysplasias were treated with bipolar cauterization. Biopsies were taken from the small-bowel tumors. There were no major complications. CONCLUSIONS: The new DSB is a means of rapid, safe, and effective deep small-bowel intubation. Depth of insertion into the small bowel and total procedure time compare favorably with other deep enteroscopy techniques. The DSB performed equally well with both enteroscopes. [ABSTRACT FROM AUTHOR]

Background and study aims: The aim of this retrospective study was to assess safety and efficacy of stepwise radical endoscopic resection (SRER) in patients with Barrett’s esophagus with high-grade intraepithelial neoplasia (HGIN) or early cancer. Patients and methods: Patients undergoing SRER between 2000 and 2006 were retrospectively evaluated. Patients with Barrett’s esophagus who also had HGIN or early cancer were included if they had no signs of submucosal infiltration or metastases. SRER was performed using the cap-technique, at 8-week intervals until all Barrett’s esophagus was removed. Follow-up endoscopy was scheduled every 6 months. Results: A total of 34 patients were included (31 male, mean 67 years, median Barrett’s dimensions C1M4). HGIN / early cancer was eradicated in all patients in a median of two endoscopic resection sessions (IQR 1–2 sessions). Twelve patients underwent additional argon plasma coagulation for small islets or an irregular Z-line. Barrett’s esophagus was eradicated in 28 patients (82 %). Complications occurred in 3/34 patients (9 %): two perforations, one delayed bleeding. In all, 19 patients (56 %) developed dysphagia, which was resolved with dilatation or stent placement. During a median follow-up period of 23 months (IQR 15 – 41 months), HGIN / early cancer recurred in three patients (9 %): two were retreated with endoscopic resection and one patient was referred for curative surgery. Five patients (15 %) had recurrence of nondysplastic Barrett’s esophagus. At the end of the follow-up period all patients were free of HGIN / early cancer (one patient after surgery), and 23 patients (68 %) had complete endoscopic and histological eradication of Barrett’s esophagus. Conclusions: SRER resulted in complete eradication of HGIN/early cancer in all patients, and eradication of Barrett’s esophagus in a majority of cases. A significant number of patients develop dysphagia, which can be successfully treated endoscopically. [ABSTRACT FROM AUTHOR]

Double balloon endoscopy (DBE) was developed for the examination of the small intestine. DBE together with capsule endoscopy have improved the endoscopic approach to the small intestine, and revolutionized the management of small-intestinal diseases. DBE features not only deep intubation of the small bowel, but also the improved control of the endoscope tip, even in the distal small intestine. This improved control is provided by stabilization from the overtube balloon. In this article, we explain how to use DBE effectively and safely. The basic principles of DBE are discussed as well as proper techniques, tips for effective insertion of the double balloon endoscope, proper indications of DBE, and endoscopic therapies in the small intestine. [ABSTRACT FROM AUTHOR]

The article presents a case study of a 72-year-old woman with history of recurrent abdominal pain and bloating, the patient was diagnosed with a mass in the small intestine which was diagnosed through double-balloon endoscopy (DBE) and endoscopic lithotripsy procedures were performed.

The article presents a case study of a seven-day-old female infant who was born at 33 weeks' gestation with bilious vomiting and jaundice. The baby was diagnosed with duodenal artesia with apple-peel configuration of her small intestine an absent of superior mesenteric artery and associated malrotation. The malrotation was corrected by releasing the Ladd's bands and widening the duodenocolic isthmus, followed by appendicectomy.

Computed virtual chromoendoscopy with the Fujinon intelligent color-enhancement (FICE) system was reported to improve visualization of neoplastic and non-neoplastic lesions at gastroscopy and colonoscopy. The technique is based on narrowing the bandwidth of the conventional endoscopic image arithmetically by a spectral estimation technology. Implementation of the FICE software in the video capsule workstation might also allow for contrast-enhanced assessment of nature and extent of small-bowel mucosal lesions. Here we propose this novel technique and report on 10 consecutive patients who underwent small-bowel video capsule endoscopy that was evaluated with FICE-enhanced imaging. [ABSTRACT FROM AUTHOR]

Double-balloon endoscopy (DBE) is a new technique that allows diagnosis and treatment throughout the entire small intestine. We have recently developed a method that allows a single operator to perform DBE, by employing “grip and pinch” and “hold (or ‘keep’) and slide” techniques. This one-person method obviates the need for two operators who must cooperate closely. [ABSTRACT FROM AUTHOR]

The article presents a case study of a 78-year-old woman who had iatrogenic colonic perforation on her colon cancer. The topics discussed include the over-the-scope-clip (OTSC) and polypectomy carried out to close her intestinal defects, the results of her laparotomy, and photographs showing the before and after effects of the surgical procedure.

The article presents a case study of a 73-year-old woman with history of fistulizing Crohn's disease who was presented with recurrent small-bowel obstruction and diagnosed from benign distal jejunal stricture. Topics discussed include balloon dilation with a through-the-scope-balloon performed in the patient, insertion of a self-expandable metallic stent (SEMS), and disappearance of small-bowel obstruction in the patient after 6 months.

The article presents a case study of a 67-year-old man with nonspecific right upper quadrant pain and icterus. The endoscopy conducted to the patient showed the detection of a huge villous duodenal adenoma. The patient was diagnosed with obstructive jaundice, which can be caused by neoplastic and non-neoplastic lesions.

The article presents a case study of a 64-year-oldman presented with abdominal pain, anemia and positive hemocult. The patient was diagnosed with small-bowel diverticulosis using On Demand Enteroscopy (ODE) technique. The topics discussed include endoscopic imagining methods, mucosal atrophy and anemia.

The article presents a case study of an old man diagnosed with a terminal ileal prolapse, which is presented as a polyp. The chromoendoscopy results of the patient demonstrate the existence of villi. It notes the consistency of his endoscopic appearance with prolapsing ileum. It points out the significance of evaluating the colonic lesions that occur in the ileocecal valve region to prevent misidentification.

The article presents a case study of a 41-year-old woman who was admitted due to massive melena and symptomatic anemia. It notes that she had previously undergone a cesarian section and tubal ligation 3 years ago. Single-balloon endoscopy was performed, which revealed jejunal choriocarcinoma. To control the continued heavy gastrointestinal bleeding, she underwent an emergency laparoscopy. The incidence of choriocarcinomas of the small intestine is explored.

The article presents a case study of a 67-year-old man who is suffering from biliary and duodenal obstruction due to unresectable pancreatic cancer. It mentions that the echoendoscope remained in its position to ensure the guide wire remained in position while a 5.4-millimeter endoscope was inserted near and passed into the duodenum. Moreover, fluoroscopic guidance alone, gentle traction of the guide wire allowed balloon dilation of the stent interstices and biliary stricture.

The article discusses the case of a patient suspected to have gastrointestinal bleeding and was examined via endoscopic ultrasonography (EUS) of the small bowel using a mechanical rotating ultrasound probe.

The article presents a case study of a patient diagnosed with severe stenosing Crohn's disease of the small bowel. Topics discussed include wireless capusle endoscopy, the retention of the capsule which led to small bowel obstruction, and treatment with hydrocortisone and infliximab to reduce the swelling and stenosis.

The article discusses the case of a patient with obscure gastrointestinal bleeding due to pyogenic granuloma of the small bowel which was managed with the help of double-balloon enteroscopy.

A letter to the editor is presented in response to the article "Novel Single-Balloon Enteroscopy for Diagnosis and Treatment of the Small Intestine: Preliminary Experiences" by Y. Tsujikawa and colleagues published in the journal in 2008.

The article presents a case study of a 67-year-old woman who was presented for a medical evaluation from a fecal immunochemical testing. The patient underwent colonoscopy which showed the presence of a submucosal nodule in the patient's terminal ileum. The article also notes the use of over-the-scope clip (OTSC)-assisted resection for submucosal nodules in the small intestine.

A correction to the article "Long-term outcome after argon plasma coagulation of small-bowel lesions using double-balloon enteroscopy in patients with mid-gastrointestinal bleeding" that was published in the 2011 is presented.

The article presents a case study of a 55-year-old man who developed small-bowel obstruction (SBO) following bowel preparation for screening colonoscopy. The patient with a history of appendectomy was presented to the emergency department after undergoing a screening colonoscopy, complaining of emesis, worsening abdominal pain and persistent nausea. A laparotomoy revealed an ileum obstruction secondary to a stricture caused by adhesion.

The article focuses on the difficulty of diagnosing mucosa-associated lymphoid tissue (MALT) lymphoma of small intestine by endoscopy. Topics discussed include 75-year-old man who was presented at the hospital bloating, distension, and diarrhea, stricture in jejenum revealed by abdominal computed tomography (CT), and diagnosis of marginal zone B-cell lymphoma of MALT. Also mentioned are nonsteroidal anti-inflammatory agents (NSAIDs), antibiotic treatment, and rituximab.

The article presents a case study of a Whipple's disease patient who showed endoscopic changes in the small bowel and mentions topics including the symptoms of the patient, capsule endoscopy of the small bowel, and ulcerations and hemorrhagic spots observed in the bowel.

A response from the author of the article "Novel Single-Balloon Enteroscopy for Diagnosis and Treatment of the Small Intestine: Preliminary Experiences" published in the journal in 2008 is presented.

The article describes the case of a 78-year-old woman diagnosed by double-balloon enteroscopy (DBE) with chronic anemia masking a primary large B-cell lymphoma of the small intestine. Topics discussed include the identification of a polypoid elevated mucosal lesion, observations of a lymphoma of the small bowel, and the histological analysis of the biopsies taken during DBE.

The article describes the case of a 57-year-old woman with acute myeloid leukemia who suffered from severe hemorrhagic diarrhea after receiving a peripheral blood stem cell transplantation (PBSCT) from a human leukocyte antigen (HLA)-identical sibling. Topics discussed include the morbidity and mortality associated with graft-versus-host disease (GvHD), the small-bowel involvement in the GvHD, and the use of video capsule endoscopy to diagnose the involvement of the small intestine in GvHD.