Christian Maaser,a Andreas Sturm,b Stephan R. Vavricka,c Torsten Kucharzik,d Gionata Fiorino,e Vito Annese,f Emma Calabrese,g Daniel C. Baumgart,h Dominik Bettenworth,i Paula Borralho Nunes,j, Johan Burisch,k, Fabiana Castiglione,l Rami Eliakim,m Pierre Ellul,n Yago González-Lama,o Hannah Gordon,p Steve Halligan,q Konstantinos Katsanos,r Uri Kopylov,m Paulo G. Kotze,s Eduards Krustiņš,t Andrea Laghi,u Jimmy K. Limdi,v Florian Rieder,w Jordi Rimola,x Stuart A. Taylor,y Damian Tolan,z Patrick van Rheenen,aa Bram Verstockt,bb, Jaap Stokercc; on behalf of the European Crohn’s and Colitis Organisation [ECCO] and the European Society of Gastrointestinal and Abdominal Radiology [ESGAR]

https://www.zora.uzh.ch/id/eprint/181209/9/2018_05_02_Manuscript1_ECCO_ESGAR-DiagnosticsGL_c1-3.pdf

ECCO-ESGAR Guideline for Diagnostic Assessment in IBD Part 1: Initial diagnosis, monitoring of known IBD, detection of complications

ACG Clinical Guideline: Management of Crohn’s Disease in Adults

Small-bowel capsule endoscopy (SBCE)
 1 ESGE recommends that prior to SBCE patients ingest a purgative (2 L of polyethylene glycol [PEG]) for better visualization. Strong recommendation, high quality evidence. However, the optimal timing for taking purgatives is yet to be established. 2 ESGE recommends that SBCE should be performed as an outpatient procedure if possible, since completion rates are higher in outpatients than in inpatients. Strong recommendation, moderate quality evidence. 3 ESGE recommends that patients with pacemakers can safely undergo SBCE without special precautions. Strong recommendation, low quality evidence. 4 ESGE suggests that SBCE can also be safely performed in patients with implantable cardioverter defibrillators and left ventricular assist devices. Weak recommendation, low quality evidence. 5 ESGE recommends the acceptance of qualified nurses and trained technicians as prereaders of capsule endoscopy studies as their competency in identifying pathology is similar to that of medically qualified readers. The responsibility of establishing a diagnosis must however remain with the attending physician. Strong recommendation, moderate quality evidence. 6 ESGE recommends observation in cases of asymptomatic capsule retention. Strong recommendation, moderate quality evidence. In cases where capsule retrieval is indicated, ESGE recommends the use of device-assisted enteroscopy as the method of choice. Strong recommendation, moderate quality evidence. Device-assisted enteroscopy (DAE)
 1 ESGE recommends performing diagnostic DAE as a day-case procedure in patients without significant underlying co-morbidities; in patients with co-morbidities and/or those undergoing a therapeutic procedure, an inpatient stay is recommended. Strong recommendation, low quality evidence The choice between different settings also depends on sedation protocols. Strong recommendation, low quality evidence. 2 ESGE suggests that conscious sedation, deep sedation, and general anesthesia are all acceptable alternatives: the choice between them should be governed by procedure complexity, clinical factors, and local organizational protocols. Weak recommendation, low quality evidence. 3 ESGE recommends that the findings of previous diagnostic investigations should guide the choice of insertion route. Strong recommendation, moderate quality evidence. If the location of the small-bowel lesion is unknown or uncertain, ESGE recommends that the antegrade route should be generally preferred. Strong recommendation, low quality evidence. In the setting of massive overt bleeding, ESGE recommends an initial antegrade approach. Strong recommendation, low quality evidence. 4 ESGE recommends that, for balloon-assisted enteroscopy (i. e., single-balloon enteroscopy [SBE] and double-balloon enteroscopy [DBE]), small-bowel insertion depth should be estimated by counting net advancement of the enteroscope during the insertion phase, with confirmation of this estimate during withdrawal. Strong recommendation, low quality evidence. ESGE recommends that, for spiral enteroscopy, insertion depth should be estimated during withdrawal. Strong recommendation, moderate quality evidence. Since the calculated insertion depth is only a rough estimate, ESGE recommends placing a tattoo to mark the identified lesion and/or the deepest point of insertion. Strong recommendation, low quality evidence. 5 ESGE recommends that all endoscopic therapeutic procedures can be undertaken at the time of DAE. Strong recommendation, moderate quality evidence. Moreover, when therapeutic interventions are performed, additional specific safety measures are needed to prevent complications. Strong recommendation, high quality evidence.

/pdf/small-bowel-capsule-endoscopy-and-device-assisted-4dltzyt3z1.pdf

Small-bowel capsule endoscopy and device-assisted enteroscopy for diagnosis and treatment of small-bowel disorders: European Society of Gastrointestinal Endoscopy (ESGE) Clinical Guideline.

Clinical Practice Guidelines for the Use of Video Capsule Endoscopy

Evidence Specific negative emotions have been related to adverse cardiac events, but a general propensity to psychological distress may also affect cardiovascular outcomes. In this summary article, we provide a reliable estimate of the prognostic risk associated with Type D (distressed) personality, a general propensity to distress that is defined by high scores on the “negative affectivity” and “social inhibition” traits. Quantitative analyses of prospective studies that included a total of 6121 patients with a cardiovascular condition indicated that Type D personality was associated with a more than 3-fold increased risk of adverse events (9 studies) and long-term psychological distress (11 studies). In addition, a narrative review of 29 studies showed that Type D personality and depression are distinct manifestations of psychological distress, with different and independent cardiovascular effects. There are also plausible biological and behavioral pathways that may explain this adverse effect of Type D personality. The findings reported in this summary article support the simultaneous use of specific and general measures of distress in cardiovascular research and practice.

Depression, anxiety, anger, and posttraumatic stress are specific markers of distress that have been related to cardiac disorder,1,–,5 whereas broader markers of psychological distress have received substantially less attention in cardiovascular research.6 However, the general distress shared across these specific markers may predict the development of coronary heart disease1 and may also partly account for the association of depression and anxiety with myocardial infarction,3 poor cardiac prognosis,4 and autonomic cardiac dysregulation.7 Hence, the conceptual idea of psychological distress as a cardiovascular risk marker may be broadened to include a general propensity to distress.

Many studies report on depression, anxiety, and cardiovascular outcomes.2,–,4 Although patients may go in and out of depressive and anxious episodes, there …

A General Propensity to Psychological Distress Affects Cardiovascular Outcomes Evidence From Research on the Type D (Distressed) Personality Profile

Radiological Response Is Associated With Better Long-Term Outcomes and Is a Potential Treatment Target in Patients With Small Bowel Crohn's Disease

Acute gastrointestinal (GI) bleeding is common and necessitates rapid diagnosis and treatment. Bleeding can occur anywhere throughout the GI tract and may be caused by many types of disease. The variety of enteric diseases that cause bleeding and the tendency for bleeding to be intermittent may make it difficult to render a diagnosis. The workup of GI bleeding is frequently prolonged and expensive, with examinations commonly needing to be repeated. The use of computed tomography (CT) for evaluation of acute GI bleeding is gaining popularity because it can be used to rapidly diagnose active bleeding and nonbleeding bowel disease. The CT examinations used to evaluate acute GI bleeding include CT angiography and multiphase CT enterography. Understanding the clinical evaluation of acute GI bleeding, including the advantages and limitations of endoscopic evaluation, is necessary for the appropriate selection of patients who may benefit from CT. Multiphase CT enterography is used primarily to evaluate stable patients who have undergone upper and lower endoscopy without identification of a bleeding source. CT angiography is used to examine stable and unstable patients who respond to resuscitation, are believed to be actively bleeding, and are considered unlikely to have an upper GI source of hemorrhage. In the emergent setting, CT may yield critical information regarding the presence, location, and cause of active bleeding-data that can guide the choice of subsequent therapy. Recent developments in the use of and techniques for performing CT angiography have made it a potential first-line tool for evaluating acute GI bleeding. ©RSNA, 2018.

https://pubs.rsna.org/doi/pdf/10.1148/rg.2018170138

CT for Evaluation of Acute Gastrointestinal Bleeding.

OBJECTIVE. By use of multiphase CT enterography (CTE), small-bowel vascular lesions associated with gastrointestinal bleeding can be classified into three categories—angioectasias, arterial lesions, and venous abnormalities—on the basis of common morphology and enhancement patterns. This article will review the unique patterns of enhancement and lesion morphology seen on multiphase CTE and how those findings enable detection and characterization of specific lesions in many cases. CONCLUSION. Because of the high prevalence in nonbleeding patients and frequent multiplicity of angioectasias, determining the clinical benefit from their detection by multiphase CTE and endoscopy is problematic. Although arterial lesions are less commonly encountered clinically, their detection is critically important because of a high risk of life-threatening bleeding. Along with wireless capsule endoscopy and balloon-assisted endoscopy, multiphase CTE is a useful tool for the evaluation of patients with obscure gastrointestina...

https://www.ajronline.org/doi/pdf/10.2214/AJR.12.10414

Stephanie L. Hansel

Papers

Radiological Response Is Associated With Better Long-Term Outcomes and Is a Potential Treatment Target in Patients With Small Bowel Crohn's Disease

CT for Evaluation of Acute Gastrointestinal Bleeding.

Multiphase CT Enterography Evaluation of Small-Bowel Vascular Lesions

Obesity Is Associated With Increased 48-h Esophageal Acid Exposure in Patients With Symptomatic Gastroesophageal Reflux

Functional Gallbladder Disorder: Gallbladder Dyskinesia