2016, Number 3
<< Back Next >>
Ann Hepatol 2016; 15 (3)
Small bowel capsule endoscopy and portal hypertensive enteropathy in cirrhotic patients: results from a tertiary referral centre
Dabos KJ, Yung DE Bartzis L, Hayes PC, Plevris JN, Koulaouzidis A
Language: English
References: 14
Page: 394-401
PDF size: 220.42 Kb.
ABSTRACT
Background and rationale. Portal hypertensive enteropathy (PHE) remains difficult to diagnose in patients with cirrhosis and
portal hypertension. Limited test choices exist for the inspection of the small bowel in these patients. Small bowel capsule endoscopy
(SBCE) is ideal in this situation but rarely performed. We aimed to determine the prevalence of PHE using SBCE in a cirrhotic
patient population and correlate its presence with clinical and CT imaging findings.
Material and methods. We retrospectively
analysed data from cirrhotic patients who underwent SBCE at our unit. Studies were evaluated for the presence of cirrhosis-related
findings in the oesophagus, stomach and small-bowel. The relationships between PHE and patients’ clinical characteristics were evaluated.
Results. 53 patients with cirrhosis underwent SCBE. We used PillCam®SB on 36 patients and MiroCam® capsule on 17.
Thirty patients were referred for iron deficiency anaemia, 15 for obscure gastrointestinal bleeding, and 4 for other indications. Four
data sets were not available for review, leaving 49 patients. Mean age was 61.19 ± 14.54 years (M/F = 27/22). Six SBCE examinations
were incomplete. Thirty three patients had evidence of portal hypertensive gastropathy (PHG) and 17 had evidence of oesophageal
varices. In total, 29 patients had SCBE evidence of PHE (57%). 28/29 (96.5%) patients with PHE had also evidence of PHG.
13/17 (76.4%) patients with oesophageal varices had also evidence of PHE.
Conclusions. The prevalence of PHE in our study
was 57%. SBCE is a useful tool in evaluating PHE in cirrhotic patients irrespective of aetiology.
REFERENCES
Krystallis C, Masterton GS, Hayes PC, Plevris JN. Update on endoscopy in liver disease; more than just treating varices. World J Gatroenterol 2012; 18: 401-11.
Therapondos G, Hayes PC. Management of gastro-oesophageal varices. Clin Med 2002; 2: 297-302.
Koulouzidis A, Rondonotti E, Karargyris A. Small bowel capsule endoscopy: a ten point contemporary review. World J Gastroenterol 2013; 19: 3726-46.
De Palma G, Rega M, Masone S, Persico F, Siciliano S, Patrone F, Matantuono L, et al. Mucosal abnormalities of the small bowel in patients with cirrhosis and portal hypertension: a capsule endoscopy study. Gastrointest Endosc 2005; 62: 529-34.
Jeon SR, Kim JO, Kim JM, Ye BD, Chung DK, Shim KN, Cheung DY, et al. Portal hypertensive enteropathy diagnosed by capsule endoscopy in cirrhotic patients: a nationwide multicentre study. Dig Dis Sci 2014; 59: 1036-41.
Canlas KR, Dobozi BM, Smith AD, Rockey DC, Muir AJ, Agrawal NM, Poleski MH, et al. Using capsule endoscopy to identify GI tract lesions in cirrhotic patients with portal hypertension and chronic anemia. J Clin Gastroenterol 2008; 42: 844-8.
Akyuz F, Pinarbasi B, Ermis F, Uyanikoglu A, Demir K, Ozdil S, Besisik F, et al. Is portal hypertensive enteropathy an important additional cause of blood loss in portal hypertensive patients? Scand J Gastroenterol 2010; 45: 1497-502.
Takahashi Y, Fujimori S, Narahara Y, Gudis K, Ensaka Y, Kosugi Y, Suzuki M, et al. Small intestinal edema has the strongest correlation with portal venous pressure amongst capsule endoscopy findings. Digestion 2012; 85: 48-54.
Aoyama T, Oka S, Aikata H, Igawa A, Nakano M, Naeshiro N, Yoshida S, et al. Major predictors of portal hypertensive enteropathy in patients with liver cirrhosis. JGH 2014.
Goulas S, Triantafyllidou K, Karagiannis S, Nicolaou P, Galanis P, Vafiadis I, Tzivras M, et al. Capsule endoscopy in the investigation of patients with portal hypertension and anemia. Can J Gastroenterol 2008; 5: 469-73.
Urbain D, Hindryckx P, Reynaert H, Van Vlierberghe H. Capsule endoscopy findings in cirrhosis with portal hypertension: a prospective study. Dig Liver Dis 2008; 40: 392-3.
Ganc RL, Malheiros CA, Nakakubo S, Szutan LA, Ganc AJ. Small-bowel lesions caused by portal hypertension of schistosomal origin: a capsule endoscopy pilot study. Gastrointestinal Endoscopy 2010; 71: 861-6.
Abdelaal UM, Morita E, Nouda S, Kuramoto, T, Miyiaji K, Fukui H, Tsuda Y, et al. Evaluation of portal hypertensive enteropathy by scoring with capsule endoscopy: is transient elastography of clinical impact. J Clin Biochem Nutr 2010; 47: 37-44.
Figueiredo P, Almeida N, Lerias C, Lopes S, Gouvela H, Leitao MC, Freitas D. Effect of portal hypertension in the small bowel: An endoscopic approach. Dig Dis Sci 2008; 53: 2144-50.