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ABSTRACT: The management of ultrasound (US) detected gallbladder (GB) polyps remains a dilemma. The aim of this study was to assess the size distribution and the outcome of US follow-up of GB polyps.
The study was approved by the Danish Data Protection Agency. US reports from patients examined with abdominal US in our department from January 2008 to the end of December 2009 were reviewed with a view to including all patients with GB polyps. Patients with GB polyps are routinely recommended a 2-year follow-up with US every six months. The GB polyp size was recorded at baseline and at subsequent US reports. Pathology reports were finally reviewed for all patients with GB polyps to check who underwent cholecystectomy and to register the histological diagnosis.
A total of 203 patients (median age 54 years; range 19-95 years) with GB polyps were included; 89 (44%) men and 114 (56%) women. The mean polyp size was 5 mm (range 2-40 mm). In 143 patients (70%) the GB polyp diameter was less than 6 mm. The first US follow-up was performed in 120 patients (59%), and only 31 (15%) completed the full 2-year US follow-up programme. Polyp size was stable in 100 patients, decreased in five patients, increased in eight and resolved in 15 patients. A total of 13 patients (6%) underwent cholecystectomy. Of the 203 patients, none showed neoplastic or malignant GB polyps.
We recommend that follow-up US of patients with GB polyps < 6 mm is avoided. Alternatively, the intervals between US follow-up of GB polyps < 6 mm may be extended.
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Danish medical journal. 10/2012; 59(10):A4503.
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ABSTRACT: In suspected Crohn's disease (CD), current diagnostic guidelines recommend additional small bowel imaging irrespective of the findings at ileocolonoscopy. Magnetic resonance imaging enterography (MRE) and computed tomography enterography (CTE) are regarded first line imaging techniques and should generally precede capsule endoscopy.
This article brings together results from a prospective blinded diagnostic study of MRE, CTE, capsule endoscopy and faecal calprotectin (fCal) in 93 patients undergoing their first diagnostic work-up for CD.
In patients with suspected CD, fCal is useful for the identification patients without need for colonoscopy or small bowel imaging. Patients with an elevated fCal should undergo colonoscopy including a persistent attempt to intubate the terminal ileum. CD isolated in the upper small bowel is rare, and in patients with a normal ileocolonoscopy or non-complicated CD in the colon and/or terminal ileum, small bowel imaging provides little extra information compared to ileoscopy alone. Small bowel imaging is primarily indicated if ileoscopy is not achieved and capsule endoscopy is recommended as first line imaging technique. If small bowel stenosis is not ruled out, a preceding test with a patency capsule can be performed to avoid capsule retention. MRE and CTE are complimentary modalities preferably used in patients with stenosis detected at ileocolonoscopy or suspicion of extra-intestinal disease complications.
Our results suggest that a diagnostic approach different to that described in the guidelines may be expedient.
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The study was approved by the Ethics Committee of Southern Denmark (S-20070072) and the Danish Data Protection Agency (journal number: 2007-41-0675). ClinicalTrials.gov identifier: NCT01019460.
Danish medical journal. 09/2012; 59(9):A4491.
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ABSTRACT: A 39-year-old man was referred to hospital with a rectal tumour and underwent gastrointestinal endoscopy and diagnostic imaging. The tumour had immunohistochemical characteristics for gastrointestinal stromal tumour (GIST). The differential diagnosis of GIST to adenocarcinoma is important to be aware of for the rectal multidisciplinary team. On suspicion of GIST, patients should be referred to a sarcoma centre. The diagnosis of rectal GIST can be suggested on MRI by the presence of a well-defined heterogeneously large mass with a necrotic center associated with a prominent extra-luminal component and hyperechoic appearance on ultrasound.
Ugeskrift for laeger 06/2012; 174(26):1826-7.
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ABSTRACT: In patients, with symptomatic Crohn's disease (CD), valid information about the presence or absence of small bowel disease activity and stenosis is clinically important. Such information supports decisions about medical or surgical therapy and can be obtained with MR enterography (MRE) or CT enterography (CTE).
A total of 50 patients with symptomatic pre-existing CD and a demand for small bowel imaging to support changes in treatment strategy were included in this prospective and blinded study. MRE and CTE were performed on the same day in alternating order and subsequently compared with the gold standard: pre-defined lesions at ileoscopy (n = 30) or surgery with (n = 12) or without (n = 3) intra-operative enteroscopy.
A total of 35 patients had active small bowel CD (jejunum 0, ileum 1, (neo)-terminal ileum 34) and 20 had small bowel stenosis. The sensitivity and specificity of MRE for detection of small bowel CD was 74% and 80% compared to 83% and 70% with CTE (p ≥ 0.5). MRE and CTE detected small bowel stenosis with 55% and 70% sensitivities, respectively (p = 0.3) and 92% specificities.
MRE and CTE have comparable diagnostic accuracies for detection of small bowel CD and stenosis. In symptomatic patients with CD and high disease prevalence, positive predictive values are favorable but negative predictive values are low. Consequently, MRE and CTE can be relied upon, if a positive result is obtained whereas a negative enterography should be interpreted with caution.
Scandinavian journal of gastroenterology 09/2011; 46(12):1449-57. · 2.08 Impact Factor
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ABSTRACT: Magnetic resonance enterography (MRE) and computed tomography enterography (CTE) visualizes small bowel Crohn's disease (CD) and its complications with high accuracy. The aim of this study was to determine the interobserver and intermodality agreement for detection of small bowel CD.
Fifty patients with suspected or known CD were included in the study and all patients underwent MRE and CTE on the same day. Four radiologists with experience in MRE and CTE techniques participated. Observers were blind to patient histories, results of ileocolonoscopies, and other small bowel examinations. Readers assessed the image quality, the presence of small bowel CD, and seven findings consistent with CD.
The image quality was better with CTE than MRE (P < 0.001) but the diagnostic yields were comparable (P = 0.4). For detection of small bowel CD, the interobserver agreement was substantial in CTE (κ = 0.64) and moderate in MRE (κ = 0.48). The intermodality agreement was fair to substantial (κ = 0.40-0.64) for different observers. Two abscesses were detected and confirmed at subsequent surgery. One abscess was not detected with MRE and only recorded by two observers in CTE. A total of 10 fistulas were detected: three were confirmed at subsequent surgery and four were false-positive findings.
MRE and CTE have comparable diagnostic yields in patients with suspected or known CD. However, CTE provides better image quality and interobserver agreement. In a substantial number of patients the diagnosis of small bowel CD is observer- and modality-dependent.
Inflammatory Bowel Diseases 05/2011; 17(5):1081-8. · 4.86 Impact Factor
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ABSTRACT: Capsule endoscopy (CE) detects small bowel Crohn's disease with greater diagnostic yield than radiologic procedures, although there are concerns that CE has low specificity. We compared the sensitivity and specificity of CE, magnetic resonance imaging enterography (MRE) and computed tomography enterography (CTE) in patients with suspected or newly diagnosed Crohn's disease.
We performed a prospective, blinded study of 93 patients scheduled to undergo ileocolonoscopy, MRE, and CTE and subsequently CE if stenosis was excluded. Physicians reporting CE, MRE, and CTE results were blinded to patient histories and findings from ileocolonoscopy and other small bowel examinations. Results were compared with those from ileoscopy (n = 70), ileoscopy and surgery (n = 4), or surgery (n = 1).
Twenty-one patients had Crohn's disease in the terminal ileum. The sensitivity and specificity for diagnosis of Crohn's disease of the terminal ileum were 100% and 91% by CE, 81% and 86% by MRE, and 76% and 85% by CTE, respectively. Proximal Crohn's disease was detected in 18 patients by using CE, compared with 2 and 6 patients by using MRE or CTE, respectively (P < .05). Small bowel stenosis was observed in 5 patients by using CTE and 1 patient by using MRE. Cross-sectional imaging results indicated additional stenoses in only 2 of the patients who received complete ileocolonoscopies.
In suspected or newly diagnosed Crohn's disease, MRE and CTE have comparable sensitivities and specificities. In patients without endoscopic or clinical suspicion of stenosis, CE should be the first line modality for detection of small bowel Crohn's disease beyond the reach of the colonoscope.
Clinical gastroenterology and hepatology: the official clinical practice journal of the American Gastroenterological Association 11/2010; 9(2):124-9. · 5.64 Impact Factor
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ABSTRACT: To determine the frequency and clinical impact of incidental findings detected with magnetic resonance imaging (MRI)-enterography in patients with suspected or known Crohn's disease (CD).
Incidental findings were defined as unexpected lesions outside the small intestine, not previously known or suspected at the time of referral, and not related to inflammatory bowel disease. Through a systematic review of medical charts we analyzed the clinical impact of incidental findings, and compared the MRI findings with subsequent diagnostic procedures.
A total of 283 patients were included in the analysis, and MRI detected active CD in 31%, fistula in 1.4% and abscess in 0.7%. Extra-intestinal findings not related to CD were recorded in 72 patients (25%), of which 58 patients (20%) had 74 previously unknown lesions. Important or incompletely characterized findings were detected in 17 patients (6.0%). Incidental findings led to 12 further interventions in 9 patients (3.2%) revealing previously unknown pathological conditions in 5 (1.8%). One patient (0.4%) underwent surgery and one patient was diagnosed with a malignant disease. MRI detected incidental colonic lesions in 16 patients of which additional work-up in 4 revealed normal anatomy. Two patients (0.7%) benefitted from the additional examinations, whereas incidental findings led to unnecessary examinations in 9 (3.2%).
In a minority of patients with suspected or known CD, important incidental findings are diagnosed at MRI-enterography. However, a substantial number of patients experience unnecessary morbidity because of additional examinations of benign or normal conditions.
World Journal of Gastroenterology 01/2010; 16(1):76-82. · 2.47 Impact Factor
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ABSTRACT: Diagnosing Crohn's disease in the small intestine can be troublesome. Traditionally, the small bowel is evaluated by ileocolonoscopy and small bowel follow-through or enteroclysis. In recent years MRI, CT, ultrasound and capsule endoscopy have emerged. All are validated and implemented in clinical practice. Double-balloon enteroscopy, PET-CT and SPECT are newer methods, which are still being evaluated in clinical trials. The purpose of this article is to review clinical studies focusing on the validity of modalities for diagnosing Crohn's disease of the small intestine.
Ugeskrift for laeger 09/2009; 171(34):2383-8.
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ABSTRACT: The aim of this study was to investigate the possible effect of a COX-2 inhibitor in addition to chemoradiation of locally advanced rectal cancer.
The study included 35 patients with rectal adenocarcinoma. All patients had a tumor localised <or=10 cm from the anal verge and a circumferential margin <or=5 mm on a magnetic resonance scan. The patients were scheduled to receive external radiation with a tumor dose of 60 Gy supplemented with an endorectal boost of 5 Gy. Concurrent with radiation, the patients received uracil-tegafur 300 mg/m(2) daily. Celexocib was scheduled throughout the radiation period in a dose of 400 mg x 2 daily.
A macular papular rash was seen in 17 (49%) of the patients leading to stop of medication with celecoxib. Thirty-three patients were operated, and all patients responded to treatment. Complete pathological remission was found in 21% of the patients and further 24% had only microscopic residual tumor cells. The results did not suggest any difference according to the accomplishment of the COX-2 medication.
The addition of a COX-2 inhibitor to chemotherapy-enhanced radiation treatment of rectal cancer was not feasible due to a high incidence of rash in the present study.
International Journal of Colorectal Disease 03/2008; 23(3):251-5. · 2.38 Impact Factor
