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Resumen La colangiopancreatografía retrógrada endoscópica (CPRE) es un procedimiento útil en el manejo de enfermedades biliopancreáticas. Los pacientes con alteración anatómica del tracto gastrointestinal representan un desafío técnico por múltiples razones. Con técnicas como la enteroscopia de doble balón (EDB) es posible realizar una CPRE en estos pacientes. El caso que se presenta es el primero de este tipo publicado en Colombia sobre una paciente con gastrectomía total con reconstrucción en Y-de-Roux y coledocolitiasis.
Abstract Endoscopic retrograde cholangiopancreatography (ERCP) is a valuable procedure in managing biliopancreatic diseases. Patients with anatomical alteration of the gastrointestinal tract represent a technical challenge for multiple reasons. With techniques such as double-balloon enteroscopy (DBE), it is possible to perform ERCP in these patients. The case was first published in Colombia on a female patient with total gastrectomy with Roux-en-Y reconstruction and choledocholithiasis.
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ABSTRACT Background Behçet's disease is a rare immune-mediated disorder that can affect the gastrointestinal tract. The prevalence and extension of small bowel involvement is largely unknown. Objective The aim of this study was to describe the small bowel lesions diagnosed by double-balloon enteroscopy (DBE) and to verify if these findings were associated to the presence of gastrointestinal symptoms and disease activity after long-term follow-up. Methods This study included 19 Behçet's disease patients who underwent DBE. After a mean follow-up of 15 years the endoscopic findings were associated to the presence of gastrointestinal symptoms, disease activity and current therapy through collection of electronic medical records. Results A total of 63.2% patients were female and the mean age was 37 years at the time of DBE. Mean disease duration at baseline was 24 years. 11 patients had no gastrointestinal symptoms and eight patients presented either abdominal pain, gastrointestinal bleeding or diarrhea. The average procedure time was 1 hour and 30 minutes and the ileum was achieved in all patients but one. Small bowel ulcers were diagnosed in 78.9%, with 63.1% of jejunal involvement. Two patients presented only small bowel edema and two were normal by DBE. Eight patients had concomitant gastric ulcers. Gastrointestinal symptoms prior to DBE were present in 36.8% of the patients and, after follow-up, all of them persisted with some of the symptoms. Bleeding was reported by three patients at baseline and persisted in only one patient. The frequency of treatment with steroids and immunomodulators was 31.6% and 57.9% at baseline, respectively, and 21% in both at the end of the follow-up. No patient was treated with biologics at the time of the DBE procedure and the current rate of biologic use is 21%. Conclusion Small bowel involvement in Behçet's disease was frequently demonstrated by DBE even in asymptomatic patients. Understanding clinical evolution of the disease over the years and the impact of such diagnosis still represents a challenge, possibly with the need for novel treatment.
RESUMO Contexto A doença de Behçet é uma doença imunomediada rara que pode afetar o trato gastrointestinal. A prevalência e extensão do envolvimento do intestino delgado é desconhecida. Objetivo O objetivo deste estudo foi descrever as lesões do intestino delgado diagnosticadas por enteroscopia de duplo balão (EDB) e verificar se esses achados estavam associados à presença de sintomas gastrointestinais e atividade da doença após seguimento de longo prazo. Métodos Este estudo incluiu 19 pacientes com doença de Behçet que foram submetidos a EDB. Após seguimento médio de 15 anos, os achados endoscópicos foram associados à presença de sintomas gastrointestinais, atividade da doença e terapia atual por meio de coleta de prontuário eletrônico. Resultados Um total de 63,2% dos pacientes eram do sexo feminino e a média de idade era de 37 anos no momento da EDB. A duração média da doença no início do estudo foi de 24 anos. 11 pacientes não apresentaram sintomas gastrointestinais e oito pacientes apresentaram dor abdominal, sangramento gastrointestinal ou diarréia. O tempo médio do procedimento foi de 1 hora e 30 minutos e o íleo foi atingido em todos os pacientes, exceto em um. Úlceras de intestino delgado foram diagnosticadas em 78,9%, sendo 63,1% de acometimento jejunal. Dois pacientes apresentaram apenas edema de intestino delgado e dois apresentaram EDB normais. Oito pacientes tinham úlceras gástricas concomitantes. Sintomas gastrointestinais prévios à EDB estavam presentes em 36,8% dos pacientes e, após o seguimento, todos persistiram com alguns dos sintomas. Sangramento foi relatado por três pacientes no início do estudo e persistiu em apenas um paciente. A frequência de tratamento com esteroides e imunomoduladores foi de 31,6% e 57,9% no início do estudo, respectivamente, e 21% em ambos ao final do seguimento. Nenhum paciente foi tratado com biológicos no momento da EDB e a taxa atual de uso de biológicos é de 21%. Conclusão O envolvimento do intestino delgado na doença de Behçet foi frequentemente demonstrado por EDB mesmo em pacientes assintomáticos. Compreender a evolução clínica da doença ao longo dos anos e o impacto de tal diagnóstico ainda representa um desafio, possivelmente com a necessidade de novos tratamentos.
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RESUMEN Introducción : Los tumores primarios del intestino delgado (TPID) representan aproximadamente el 5% de todas las neoplasias gastrointestinales primarias; estas últimas incluyen lesiones benignas y malignas, con diferentes subtipos histológicos. Objetivo : Describir las características clínico-patológicas y el manejo de tumores de localización yeyuno-ileal. Materiales y métodos : Se realizó un estudio descriptivo, retrospectivo, en un único centro. Resultados : Se incluyó 45 pacientes, la edad promedio al diagnóstico fue de 54,2 ± 8,2 años. 27 eran de sexo masculino (60%). En el algoritmo diagnóstico se utilizó la tomografía computarizada en todos los pacientes, la enteroscopia de doble balón en 41 (91,1%) y video cápsula endoscópica en 32 (71,1%). Se realizaron procedimientos endoscópicos como: biopsias, tatuajes, resección y dilatación en 40 (88,9%), 39 (86,7%), 4 (8,9%) y 1(2,2%) paciente respectivamente. La localización más frecuente fue yeyuno en 39 (86%). Se confirmó GIST en 18 (40%), seguido de linfoma en 16 (35,6%) y adenocarcinoma en 5 (11%) casos. Todos los tumores GIST, adenocarcinoma y neuroendocrinos se sometieron a tratamiento quirúrgico y quimioterapia; el tratamiento de los linfomas consistió en tratamiento combinado principalmente; tres harmartomas y un fibroangiolipoma fueron resecados endoscópicamente. Conclusiones : Los tumores de intestino delgado yeyuno-ileal más frecuentes fueron los GIST, seguidos de linfomas y adenocarcinomas. La enteroscopia de doble balón fue la principal herramienta diagnóstica y terapéutica.
ABSTRACT Introduction : Primary tumors of the small intestine (PTID) represent approximately 5% of all primary gastrointestinal neoplasms; the latter include benign and malignant lesions, with different histological subtypes. Objective : To describe the clinical-pathological characteristics and the management of tumors located in the jejunum-ileum. Materials and methods : A descriptive, retrospective study was carried out in a single center. Results : 45 patients were included, the average age at diagnosis was 54.2 ± 8.2 years. 27 were male (60%). In the diagnostic algorithm, computed tomography was used in all patients, double-balloon enteroscopy in 41 (91.1%) and video capsule endoscopy in 32 (71.1%). Endoscopic procedures such as: biopsies, tattoos, resection and dilation were performed in 40 (88.9%), 39 (86.7%), 4 (8.9%) and 1 (2.2%) patients, respectively. The most frequent location was the jejunum in 39 (86%). GIST was confirmed in 18 (40%), followed by lymphoma in 16 (35.6%) and adenocarcinoma in 5 (11%) cases. All GIST, adenocarcinoma, and neuroendocrine tumors underwent surgical treatment and chemotherapy; treatment of lymphomas consisted mainly of combined treatment; three harmartomas and one fibroangiolipoma were resected endoscopically. Conclusions : The most frequent jejunoileal small intestine tumors were GISTs, followed by lymphomas and adenocarcinomas. Double-balloon enteroscopy was the main diagnostic and therapeutic tool.
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Resumen Introducción: el estudio de intestino delgado es un desafío, motivo de avance médico y de interés. La enteroscopia de doble balón (EDB) permite una visualización directa del intestino delgado. Objetivo: describir indicaciones, características del procedimiento, hallazgos, complicaciones y seguimiento de pacientes llevados a EDB en el Hospital de San José de Bogotá, entre noviembre de 2011 y abril de 2019. Metodología: estudio de serie de casos. Se incluyeron pacientes con indicación clínica o por imágenes diagnósticas sugerentes de lesión a nivel de intestino delgado. Se empleó estadística descriptiva. Resultados: se realizaron 45 enteroscopias a 44 pacientes, con una mediana de edad de 58 años. La principal indicación fue hemorragia digestiva potencial de intestino delgado (53,3 %) y diarrea crónica (11,1 %); fueron más frecuentes los procedimientos por vía anterógrada. La mayoría de los resultados fue normal (46,7 %); entre los hallazgos más frecuentes estuvieron los tumores (11,1 %), enfermedad de Crohn (8,9 %) y úlceras/erosiones (6,7 %). El rendimiento diagnóstico fue 53,3 %, la correlación con la videocápsula endoscópica (VCE) fue 37,5 % y con estudios de imagen, 42,9 %. No se presentaron complicaciones. Se hizo seguimiento al 91,1 % de los pacientes con una mediana de 56 meses y se observó la resolución de síntomas en el 78,1 %. La finalidad de la enteroscopia fue diagnóstica en el 84,4 %. Conclusiones: La EDB es útil en la evaluación del intestino delgado con posibilidad terapéutica. Los resultados son similares a los reportados en la literatura mundial. Si se realiza seguimiento, se puede definir la necesidad de repetición del procedimiento, realización de estudios adicionales u observar resolución de los síntomas.
Abstract Introduction: The study of the small bowel is a challenging task that has sparked interest and progress in medicine. In this context, double balloon enteroscopy (DBE) has allowed the direct visualization of the small intestine. Objective: To describe indications, procedure characteristics, findings, complications, and follow-up of patients taken to DBE at the Hospital de San José, Bogotá, between November 2011 and April 2019. Methodology: Case series study. Patients with a clinical indication or diagnostic images suggestive of small bowel lesion were included. Descriptive statistics were used. Results: 45 enteroscopies were performed in 44 patients, with a median age of 58 years. The main indication was potential small bowel bleeding (53.3%) and chronic diarrhea (11.1%). Anterograde procedures were more frequent. Most of the results were normal (46.7%); tumors (11.1%), Crohn's disease (8.9%), and ulcers/erosions (6.7%) were among the most frequent findings. The diagnostic yield was 53.3% and the correlation with capsule endoscopy (CE) was 37.5%, and with imaging studies 42.9%. There were no complications. 91.1 % of patients were followed up on after a median of 56 months, with 78.1 % reporting symptom remission. The aim of enteroscopy was diagnostic in 84.4%. Conclusions: DBE is useful in the evaluation of the small intestine with a therapeutic possibility. The results are similar to those reported in the world literature. Follow-up can define the need for repeating the procedure, performing further studies, or symptom resolution.
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Humanos , Masculino , Feminino , Adolescente , Adulto , Pessoa de Meia-Idade , Idoso , Idoso de 80 Anos ou mais , Enteroscopia de Duplo Balão , Hemorragia , Pacientes , Intestino DelgadoRESUMO
Resumen La lipomatosis intestinal es un término utilizado para describir una proliferación de tejido graso, histológicamente normal, en el tracto gastrointestinal. Se caracteriza por la presencia de tumores benignos, asintomáticos, de crecimiento lento y de origen subepitelial. En raras ocasiones, estos tumores pueden ser sintomáticos y asociarse a complicaciones importantes como obstrucción y sangrado gastrointestinal. Así, la lipomatosis intestinal es una patología rara, con pocos casos reportados en la literatura y ninguno registrado en Colombia. A continuación, presentamos dos casos evaluados y seguidos en nuestro servicio de Unión de Cirujanos S.A.S de la Universidad de Caldas. El primero es el caso de un hombre de 70 años con historia de episodios de dolor abdominal tipo cólico, asociados a distensión y diarrea posprandial. La endoscopia digestiva alta inicial reportó múltiples lesiones amarillentas, submucosas, en el duodeno, con diagnóstico histológico de lipomas. En este caso, se realizó una videocápsula endoscópica para determinar la distribución y las características de las lesiones presentes en todo el tracto gastrointestinal, así como para valorar la presencia de complicaciones. El otro caso es el de un hombre de 81 años, quien ingresó a la institución por lipotimia y sangrado rectal. Por tanto, se realizó una endoscopia alta y una colonoscopia, cuyos resultados fueron normales. Luego de ello, se efectuó una videocápsula endoscópica que mostró lesiones lipomatosas; una de ellas, con sangrado y angiodisplasia al lado. Estas lesiones se manejaron mediante enteroscopia de doble balón y terapia con argón plasma.
Abstract Intestinal lipomatosis is a proliferation of histologically normal fatty tissue in the gastrointestinal tract. It is characterized benign, asymptomatic, slow growing tumors with sub-epithelial origins. On rare occasions, they become symptomatic and can be associated with major complications such as gastrointestinal obstructions and bleeding. This rare pathology has been reported several times in the literature but not in Colombia prior to this study. We present two cases that were evaluated and followed up at the Unión de Cirujanos SAS and the University of Caldas in Manizales, Colombia. The first is a 70-year-old man who had a history of colic associated with bloating and postprandial diarrhea. The initial upper digestive endoscopy reported multiple yellowish, submucosal lesions in the duodenum. His histological diagnosis was lipomas. In this case, an endoscopic video capsule determined the distribution and characteristics of the lesions throughout the gastrointestinal tract and assessed complications. The second is an 81-year-old man who entered the institution due to lipothymia and rectal bleeding. Upper endoscopy and colonoscopy were normal, but a videocapsule endoscopy showed lipomatous lesions one of which was bleeding and had adjacent angiodysplasia. He was treated with double balloon enteroscopy and Argon plasma therapy.
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Humanos , Masculino , Idoso , Idoso de 80 Anos ou mais , Trato Gastrointestinal , LipomatoseRESUMO
Objetivo: Describir la experiencia en el uso de la enteroscopia asistida por balón simple para el diagnóstico y manejo de la patología del intestino delgado en pacientes con anatomía normal y alterada por cirugía en la Clínica Anglo Americana. Material y método: El presente es un estudio descriptivo - retrospectivo que incluye a todos los pacientes que acudieron a la Unidad de Intestino Delgado de la Clínica Anglo Americana, para realizarse una enteroscopia asistida por balón durante el periodo comprendido entre diciembre del 2012 a diciembre del 2018. Resultados: Se realizaron 80 procedimientos de enteroscopia asistida por balón simple, 49 fueron realizados por via anterógrada y 31 por vía retrógrada. La edad promedio fue 60,78 años (20 a 88 años). 48 pacientes (60%) eran varones. El tiempo de inserción media fue 80 minutos para la vía anterógrada (55 - 141 minutos) y 110 minutos para la vía retrógrada (55 -180 minutos). La principal indicación para realizar la enteroscopia por balón simple fue hemorragia digestiva oscura, 45 casos (56,25%). Se realizaron 6 estudios de enteroscopias asistida por balón en pacientes con anatomía alterada (7,5%). Setenta de los ochenta procedimientos (87,5%) fueron realizados con sedación administrada por enfermería supervisada por gastroenterólogo en base a midazolam, petidina y propofol, no se presentó ninguna complicación respiratoria o hemodinámica. Los diagnósticos obtenidos más frecuentes por enteroscopia fueron: angiodisplasias de intestino delgado (20%), úlceras yeyuno ileales (17,5%) y neoplasias a nivel del intestino delgado (7,5%). La complicación que se presentó con más frecuencia posterior a la enteroscopia fue el íleo paralítico, 2 casos, y se asoció a no utilizar insuflación con dióxido de carbono durante el procedimiento. Conclusiones: La hemorragia digestiva oscura fue la principal indicación para realizar una enteroscopia asistida por balón simple. Los diagnósticos más frecuentes fueron angiodisplasias, úlceras yeyuno ileales y neoplasias a nivel del intestino delgado. La complicación más frecuente fue el íleo paralítico y se asoció a no utilizar insuflación con dióxido de carbono durante el procedimiento.
Objetive: To describe our experience with single balloon enteroscopy in the management of small bowel disease in British American Hospital, Lima - Perú. Material and methods: Descriptive and prospective study. We include all patients that come to perform a single balloon enteroscopy in small bowel unit of British American Hospital within December 2012 to December 2018. Results: We performed 80 procedures of single balloon enteroscopy, 49 were done by oral approach, 31 by rectal approach. Mean age were 60.78 years-old (20 - 88 years). 48 patients (60%) were male. The mean insertion time for oral approach was 80 minutes (55-141 minutes), and for rectal approach was 110 minutes (55-180 minutes). The main indication for single balloon enteroscopy was obscure gastrointestinal bleeding. 6 enteroscopies were performed in patients with altered surgical anatomy (7.5%). 70 of 80 procedures (87.5%) were performed with gastroenterology-administered sedation, using midazolam, pethidine and propofol, without any respiratory or hemodinamic complication. Diagnostics achieved by single balloon enteroscopy were small bowel angiodysplasias (20%), yeyuno ileal ulcers (17.5%) and small bowel neoplasia (7.5%). Paralytic ileus was the most common complication of single balloon enteroscopy, 2 cases, and both cases were associated after no using carbon dioxide insufflation during procedure. Conclusion: Obscure gastrointestinal bleeding was the main indication for single balloon enteroscopy. Diagnostics achieved by single balloon enteroscopy were small bowel angiodysplasias (20%), yeyuno ileal ulcers (17.5%) and small bowel neoplasia (7.5%). Paralytic ileus was the most common complication of single balloon enteroscopy, 2 cases, and both cases were associated after no using carbon dioxide insufflation during procedure
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Adulto , Idoso , Idoso de 80 Anos ou mais , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Adulto Jovem , Enteroscopia de Balão Único , Enteropatias/diagnóstico , Intestino Delgado/patologia , Peru , Pseudo-Obstrução Intestinal/etiologia , Estudos Prospectivos , Estudos Retrospectivos , Angiodisplasia/complicações , Angiodisplasia/diagnóstico , Enteroscopia de Balão Único/efeitos adversos , Hemorragia Gastrointestinal/diagnóstico , Hemorragia Gastrointestinal/etiologia , Unidades Hospitalares/estatística & dados numéricos , Cooperação Internacional , Enteropatias/terapia , Neoplasias Intestinais/complicações , Neoplasias Intestinais/diagnósticoRESUMO
INTRODUCTION AND AIMS: Double-balloon enteroscopy has been improving the visualization of the entire intestine for more than a decade. It is a complementary method in the study of intestinal diseases that enables biopsies to be taken and treatments to be administered. Our aim was to describe its main indications, insertion routes, diagnostic/therapeutic yield, and complications. MATERIALS AND METHODS: All patients referred to our unit with suspected small bowel pathology were included. The insertion route (oral/anal) was determined through diagnostic suspicion. The variables measured were: insertion route, small bowel examination extent, endoscopic diagnosis/treatment, biopsy/histopathology report, complications, and surgical findings. RESULTS: The study included 28 double-balloon enteroscopies performed on 23 patients, of which 10 were women and 13 were men (mean age of 52.95 years). The oral approach was the most widely used (n=21), the main indication was overt small bowel bleeding (n=16), and the general diagnostic yield was 65.21%. The therapeutic intervention rate was 39.1% and the procedure was effective in all the cases. The most widely used treatment was argon plasma therapy (n=7). The complication rate was 8.6%; one patient presented with low blood pressure due to active bleeding and another had deep mucosal laceration caused by the argon plasma. CONCLUSIONS: Double-balloon enteroscopy is a safe and efficacious method for the study and management of small bowel diseases, with an elevated diagnostic and therapeutic yield.
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Enteroscopia de Duplo Balão , Enteropatias/diagnóstico por imagem , Enteropatias/terapia , Intestino Delgado/diagnóstico por imagem , Adulto , Idoso , Idoso de 80 Anos ou mais , Estudos Transversais , Enteroscopia de Duplo Balão/efeitos adversos , Enteroscopia de Duplo Balão/métodos , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Resultado do TratamentoRESUMO
ABSTRACT Background: The double balloon enteroscopy is an important method for the endoscopic approach of the small bowel that provides diagnosis and therapy of this segment's disorders, with low complication rate. Aim: Analysis of patients undergoing double balloon enteroscopy. The specific objectives were to establish the indications for this method, evaluate the findings by the double balloon enteroscopy, analyze the therapeutic options and the complications of the procedure. Methods: It is a retrospective analysis of 65 patients who underwent double balloon enteroscopy. Results: Sixty-five procedures were performed in 50 patients, 63.1% were women and 36.9% were men. The mean age was 50.94 years. The main indication it was gastrointestinal bleeding, followed by abdominal pain and Crohn's disease. Most procedures were considered normal. Polyps were the most prevalent finding, followed by angioectasias and duodenitis. In 49.2% of the cases, one or more therapeutic procedures were performed, (biopsy was the most prevalent). There was only one case of acute pancreatitis, which was treated clinically. Conclusion: The enteroscopy is good and safe method for the evaluation of the small bowel, and its main indications are gastrointestinal bleeding and abdominal pain. It has low complications rates and reduces the necessity of surgery.
RESUMO Racional: A enteroscopia por duplo balão é importante método endoscópico para abordagem do intestino delgado, permitindo o diagnóstico e a terapêutica de afecções com baixa taxa de complicações. Objetivo: Análise de pacientes submetidos à enteroscopia por duplo balão, estabelecendo as indicações para realização do exame e seus achados, analisando a terapêutica realizada e observando as complicações decorrentes do procedimento. Métodos: Estudo retrospectivo de análise de 65 prontuários de pacientes submetidos à enteroscopia por duplo balão. Os dados foram armazenados em planilhas e foi realizada a análise estatística. Resultados: Foram 65 enteroscopias em 50 pacientes, sendo 63,1% mulheres e 36,9% homens, com média de idade de 50,94 anos. A principal indicação foi sangramento intestinal, seguida por dor abdominal e doença de Crohn. A maioria dos procedimentos foi considerada normal, sendo que o achado mais prevalente foram os pólipos, seguido por angioectasias e duodenites. Em 49,2% dos exames foi realizado algum procedimento terapêutico, sendo a biópsia o mais prevalente. Houve apenas um caso de complicação de pancreatite aguda. Conclusão: A enteroscopia por duplo balão é bom e seguro método para a avaliação do intestino delgado, possuindo como principais indicações o sangramento intestinal e a dor abdominal. Possui baixas taxas de complicações e, por meio de suas opções terapêuticas, diminui a necessidade de procedimentos cirúrgicos.
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Humanos , Masculino , Feminino , Adulto , Pessoa de Meia-Idade , Idoso , Idoso de 80 Anos ou mais , Adulto Jovem , Enteroscopia de Duplo Balão/efeitos adversos , Gastroenteropatias/cirurgia , Gastroenteropatias/diagnóstico , Intestino Delgado , Complicações Pós-Operatórias/etiologia , Estudos RetrospectivosRESUMO
Las múltiples patologías del intestino delgado han supuesto un enorme desafío para gastroenterólogos y endoscopistas debido a las muy bajas tasas de rédito diagnóstico que las diferentes técnicas paraclínicas ofrecían. El advenimiento de la cápsula endoscópica y la enteroscopía de doble balón ha permitido una exploración total, segura y eficiente del intestino delgado lo que ha generado un impacto real en el diagnóstico, tratamiento y pronóstico de nuestros pacientes.La cápsula endoscópica es un procedimiento seguro, mínimamente invasivo, no precisa sedación, no genera dolor y permite observar la totalidad del intestino delgado. Por su parte la enteroscopía de doble balón es la técnica endoscópica complementaria necesaria para brindar una intervención terapéutica (cauterizar angiodisplasias, polipectomías, toma de biopsias) logrando así un abordaje resolutivo de las diversas patologías.
Many small bowel disorders represent a great challenge for gastroenterologists and endoscopists due to the very low rates of success showed by the different diagnosis techniques. The advent of the capsule endoscopy and double-balloon endoscopy has allowed a total, secure and efficient examination of the small bowel, which represents a real impact in diagnosis, treatment, and prognosis of our patients. The capsule endoscopy is a safe, minimally invasive procedure, which does not need sedation, does not cause pain, and allows the observation of the totality of the small bowel. Furthermore, the double-balloon endoscopy is the complementary technique necessary to provide a therapeutic procedure (cauterizing angiodysplasia, polypectomy, biopsies), and hence achieving resolution of various disorders.
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Humanos , Endoscopia por Cápsula , Enteroscopia de Duplo Balão , Enteropatias/terapia , Enteropatias/diagnóstico por imagem , Intestino Delgado/diagnóstico por imagemRESUMO
Meckel's diverticulum (MD) is estimated to affect 1%-2% of the general population, and it represents a clinically silent finding of a congenital anomaly in up to 85% of the cases. In adults, MD may cause symptoms, such as overt occult lower gastrointestinal bleeding. The diagnostic imaging workup includes computed tomography scan, magnetic resonance imaging enterography, technetium 99m scintigraphy (99mTc) using either labeled red blood cells or pertechnetate (known as the Meckel's scan) and angiography. The preoperative detection rate of MD in adults is low, and many patients ultimately undergo exploratory laparoscopy. More recently, however, endoscopic identification of MD has been possible with the use of balloon-assisted enteroscopy via direct luminal access, which also provides visualization of the diverticular ostium. The aim of this study was to review the diagnosis by double-balloon enteroscopy of 4 adults with symptomatic MD but who had negative diagnostic imaging workups. These cases indicate that balloon-assisted enteroscopy is a valuable diagnostic method and should be considered in adult patients who have suspected MD and indefinite findings on diagnostic imaging workup, including negative Meckel's scan.