Intestinal Research

Original Articles

Endoscopy

Difficult colonoscopy: air, carbon dioxide, or water insufflation?: Alisha Chaubal, Vikas Pandey, Ruchir Patel, Prateik Poddar, Aniruddha Phadke, Meghraj Ingle, Prabha Sawant; Intest Res 2018;16(2):299-305. Published online April 30, 2018; DOI: https://doi.org/10.5217/ir.2018.16.2.299

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Background/Aims

This study aimed to compare tolerance to air, carbon dioxide, or water insufflation in patients with anticipated difficult colonoscopy (young, thin, obese individuals, and patients with prior abdominal surgery or irradiation).

Methods

Patients with body mass index (BMI) less than 18 kg/m² or more than 30 kg/m², or who had undergone previous abdominal or pelvic surgeries were randomized to air, carbon dioxide, or water insufflation during colonoscopy. The primary endpoint was cecal intubation with mild pain (less than 5 on visual analogue scale [VAS]), without use of sedation.

Results

The primary end point was achieved in 32.7%, 43.8%, and 84.9% of cases with air, carbon dioxide and water insufflation (P<0.001). The mean pain scores were 5.17, 4.72, and 3.93 on the VAS for air, carbon dioxide, and water insufflation (P<0.001). The cecal intubation rate or procedure time did not differ significantly between the 3 groups.

Conclusions

Water insufflation was superior to air or carbon dioxide for pain tolerance. This was seen in the subgroups with BMI <18 kg/m² and the post-surgical group, but not in the group with BMI >30 kg/m².

Citations

Citations to this article as recorded by

Retrograde colon imaging through colonic transendoscopic enteral tubing helps to confirm the cause of difficult colonoscopy: a case report
Xiaomeng Jiang, Runqing Wang, Haibo Sun, Faming Zhang
Therapeutic Advances in Gastrointestinal Endoscopy.2024;[Epub] CrossRef
Causes of intraprocedural discomfort in colonoscopy: a review and practical tips
Jabed F. Ahmed, Ara Darzi, Lakshmana Ayaru, Nisha Patel
Therapeutic Advances in Gastrointestinal Endoscopy.2024;[Epub] CrossRef
Research on driving force of capsule endoscope in fluid
Zhifan Teng, Jianhua Liu, Hongbo Sun, Quanyue Liu, Yujia Zhai, Qiuliang Wang
Archive of Applied Mechanics.2023; 93(12): 4387. CrossRef
Robot-assisted magnetic capsule endoscopy; navigating colorectal inclinations
Salman Mahmood, Sebastian Schostek, Marc O. Schurr, Jacob Bergsland, Ilangko Balasingham, Erik Fosse
Minimally Invasive Therapy & Allied Technologies.2022; 31(6): 930. CrossRef
Magnetic endoscopic imaging as a rational investment for specific colonoscopies: a systematic review and meta-analysis
Xiangzhou Tan, Weimin Yang, Doerte Wichmann, Changhao Huang, Benedikt Mothes, K.E. Grund, Zhikang Chen, Zihua Chen
Expert Review of Gastroenterology & Hepatology.2021; 15(4): 447. CrossRef
Screening colonoscopy: The present and the future
Chelsea V Hayman, Dinesh Vyas
World Journal of Gastroenterology.2021; 27(3): 233. CrossRef
Transparent cap‐assisted, water‐exchange colonoscopy in previous incomplete difficult colonoscopy patients: A retrospective study
Lien‐Fu Lin, Pi‐Teh Huang
Advances in Digestive Medicine.2020; 7(3): 118. CrossRef
Can water insufflation and carbon dioxide overcome the difficulties of colonoscope insertion?
Choong-Kyun Noh, Kee Myung Lee
Intestinal Research.2018; 16(2): 166. CrossRef

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Spectrum of chronic small bowel diarrhea with malabsorption in Indian subcontinent: is the trend really changing?: Nirav Pipaliya, Meghraj Ingle, Chetan Rathi, Prateik Poddar, Nilesh Pandav, Prabha Sawant; Intest Res 2016;14(1):75-82. Published online January 26, 2016; DOI: https://doi.org/10.5217/ir.2016.14.1.75

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Background/Aims

This study aimed to document the recent etiological spectrum of chronic diarrhea with malabsorption and also to compare features that differentiate tropical sprue from parasitic infections, the two most common etiologies of malabsorption in the tropics.

Methods

We analyzed 203 consecutive patients with malabsorption. The etiological spectrum and factors that differentiated tropical sprue from parasitic infections were analyzed.

Results

The most common etiology was tropical sprue (n=98, 48.3%) followed by parasitic infections (n=25, 12.3%) and tuberculosis (n=22, 10.8%). Other causes were immunodeficiency (n=15, 7.3%; 12 with human immunodeficiency virus and 3 with hypogammaglobulinemia), celiac disease (n=11, 5.4%), Crohn's disease (n=11, 5.4%), small intestinal bacterial overgrowth (n=11, 5.4%), hyperthyroidism (n=4, 1.9%), diabetic diarrhea (n=4, 1.9%), systemic lupus erythematosus (n=3, 1.4%), metastatic carcinoid (n=1, 0.5%) and Burkitt's lymphoma (n=1, 0.5%). On multivariate analysis, features that best differentiated tropical sprue from parasitic infections were larger stool volume (P=0.009), severe weight loss (P=0.02), knuckle hyperpigmentation (P=0.008), low serum B12 levels (P=0.05), high mean corpuscular volume (P=0.003), reduced height or scalloping of the duodenal folds on endoscopy (P=0.003) and villous atrophy on histology (P=0.04). Presence of upper gastrointestinal (GI) symptoms like bloating, nausea and vomiting predicted parasitic infections (P=0.01).

Conclusions

Tropical sprue and parasitic infections still dominate the spectrum of malabsorption in India. Severe symptoms and florid malabsorption indicate tropical sprue while the presence of upper GI symptoms indicates parasitic infections.

Citations

Citations to this article as recorded by

The etiological profile of chronic organic non-bloody diarrhea in India: Emergence of inflammatory bowel disease as a dominant cause
Prachi Daga, Amarender Singh Puri, Lipika Lipi, Sumit Bhatia, Randhir Sud
Indian Journal of Gastroenterology.2025; 44(2): 181. CrossRef
Inflammatory Bowel Disease in Children
Asha Jois, George Alex
Indian Journal of Pediatrics.2024; 91(5): 490. CrossRef
The etiological profile of chronic organic non-bloody diarrhea in India: A closer look
Uday C. Ghoshal, Subhamoy Das, Mahesh K. Goenka
Indian Journal of Gastroenterology.2024;[Epub] CrossRef
Enterotoxigenic Escherichia coli heat-labile toxin drives enteropathic changes in small intestinal epithelia
Alaullah Sheikh, Brunda Tumala, Tim J. Vickers, John C. Martin, Bruce A. Rosa, Subrata Sabui, Supratim Basu, Rita D. Simoes, Makedonka Mitreva, Chad Storer, Erik Tyksen, Richard D. Head, Wandy Beatty, Hamid M. Said, James M. Fleckenstein
Nature Communications.2022;[Epub] CrossRef
Acute Bacterial Gastroenteritis
James M. Fleckenstein, F. Matthew Kuhlmann, Alaullah Sheikh
Gastroenterology Clinics of North America.2021; 50(2): 283. CrossRef
Clinical, endoscopic, and histological differentiation between celiac disease and tropical sprue: A systematic review
Pragya Sharma, Vandana Baloda, Gaurav PS Gahlot, Alka Singh, Ritu Mehta, Sreenivas Vishnubathla, Kulwant Kapoor, Vineet Ahuja, Siddhartha Datta Gupta, Govind K Makharia, Prasenjit Das
Journal of Gastroenterology and Hepatology.2019; 34(1): 74. CrossRef
What makes non-cirrhotic portal hypertension a common disease in India? Analysis for environmental factors
Ashish Goel, Banumathi Ramakrishna, Uday Zachariah, K.G. Sajith, Deepak K. Burad, Thomas A. Kodiatte, Shyamkumar N. Keshava, K.A. Balasubramanian, Elwyn Elias, C.E. Eapen
Indian Journal of Medical Research.2019; 149(4): 468. CrossRef
Nutritional Approach in Tropical Sprue Patients
Stefanie Knebusch Toriello
Current Tropical Medicine Reports.2018; 5(3): 211. CrossRef
The clinical and phenotypical assessment of seronegative villous atrophy; a prospective UK centre experience evaluating 200 adult cases over a 15-year period (2000–2015)
Imran Aziz, Mohammad F Peerally, Jodie-Hannah Barnes, Vigneswaran Kandasamy, Jack C Whiteley, David Partridge, Patricia Vergani, Simon S Cross, Peter H Green, David S Sanders
Gut.2017; 66(9): 1563. CrossRef

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The role of capsule endoscopy in etiological diagnosis and management of obscure gastrointestinal bleeding: Vikas Pandey, Meghraj Ingle, Nilesh Pandav, Pathik Parikh, Jignesh Patel, Aniruddha Phadke, Prabha Sawant; Intest Res 2016;14(1):69-74. Published online January 26, 2016; DOI: https://doi.org/10.5217/ir.2016.14.1.69

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Background/Aims

To investigate the various etiologies, yields, and effects of capsule endoscopy (CE) on management and complications, along with follow up of patients with obscure gastrointestinal (GI) bleeding.

Methods

The study group of patients included those having obscure, overt, or occult GI bleeding. The findings were categorized as (A) obvious/definitive, (B) equivocal, or (C) negative. Any significant alteration in patient management post CE in the form of drug or surgical intervention was noted.

Results

Total patients included in the study were 68 (48 males and 20 females). The ratio of male:female was 2.4:1. The age ranged between 16 years to 77 years. Mean age for males was 62±14 years, for females 58±16 years. The total yield of CE with definitive lesions was in 44/68 (65.0%) of patients. In descending order (A) angiodysplasia 16/68 (23.53%), (B) Crohn's disease 10/68 (14.70%), (C) non-steroidal anti-inflammatory drug enteropathy 8/68 (11.76%), (D) small bowel ulcers 4/68 (5.88%), (E) jejunal and ileal polyps 2/68 (2.94%), (F) intestinal lymphangiectasis 2/68 (2.94%), and (G) ileal hemangiomas 2/68 (2.94%) were followed. Equivocal findings 12/68 (17.65%) and negative study 12/68 (17.65%) was found. Complications in the form of capsule retention in the distal ileum were noted in 2/68 (2.94%) subjects. Statistically, there was a higher probability of finding the etiology if the CE was done during an episode of bleeding.

Conclusions

CE plays an important role in diagnosing etiologies of obscure GI bleeding. Its role in influencing the management outcome is vital.

Citations

Citations to this article as recorded by

Capsule endoscopy for obscure gastrointestinal bleed in the tropics: A single-center experience on 350 patients
Uday C. Ghoshal, Piyush Mishra, Akash Mathur, Sai Prathap Reddy, Bushra Fatima, Asha Misra
Indian Journal of Gastroenterology.2024; 43(5): 1045. CrossRef
Capsule endoscopy for small bowel bleed: Current update
Uday C. Ghoshal, Akash Roy, Mahesh K. Goenka
Indian Journal of Gastroenterology.2024; 43(5): 896. CrossRef
An intelligent intestinal bleeding diagnosis and treatment capsule system based on color recognition
Panpan Qiao, Luo Yu, Hongying Liu, Xueping Yan, Xitian Pi
Biomedical Microdevices.2023;[Epub] CrossRef
Systematic review and meta‐analysis of the diagnostic and therapeutic yield of small bowel endoscopy in patients with overt small bowel bleeding
Genta Uchida, Masanao Nakamura, Takeshi Yamamura, Kazuhiro Furukawa, Hiroki Kawashima, Takashi Honda, Masatoshi Ishigami, Mitsuhiro Fujishiro
Digestive Endoscopy.2021; 33(1): 66. CrossRef
Comparison in the Diagnostic Yield between “Pillcam SB3” Capsule Endoscopy and “OMOM Smart Capsule 2” in Small Bowel Bleeding: A Randomized Head-to-Head Study
Gerardo Blanco-Velasco, Raúl Antonio Zamarripa-Mottú, Omar Michel Solórzano-Pineda, Miguel Mascarenhas-Saraiva, Juan Manuel Blancas-Valencia, Oscar Victor Hernández-Mondragón
Digestive Diseases.2021; 39(3): 211. CrossRef
Heterotopia de mucosa gástrica en intestino delgado, hallazgo en videocápsula endoscópica. Reporte de caso
Santiago Castaño, Natalia Calvache, Mauricio Sepúlveda
Revista Colombiana de Gastroenterología.2019; 34(3): 314. CrossRef
Meta-analysis shows similar re-bleeding rates among Western and Eastern populations after index video capsule endoscopy
Georgios Tziatzios, Paraskevas Gkolfakis, Cesare Hassan, Ervin Toth, Angelo Zullo, Anastasios Koulaouzidis, George D. Dimitriadis, Konstantinos Triantafyllou
Digestive and Liver Disease.2018; 50(3): 226. CrossRef
Lanreotide in the management of small bowel angioectasias: seven-year data from a tertiary centre
S. Chetcuti Zammit, D. S. Sanders, R. Sidhu
Scandinavian Journal of Gastroenterology.2017; : 1. CrossRef
Role of capsule endoscopy in suspected or established Crohn's disease in real practice
Hyun Joo Jang
Intestinal Research.2017; 15(4): 431. CrossRef
The Role of Dynamic Contrast-enhanced Multidetector-row Computed Tomography in Diagnosis of Obscure Gastrointestinal Bleeding
Jee Hyun Kim, Jong Pil Im
The Korean Journal of Gastroenterology.2016; 67(4): 165. CrossRef

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Case Report

A Rare Case of Hypermobile Mesentery With Segmental Small Bowel Pneumatosis Cystoides Intestinalis: Chetan Rathi, Nirav Pipaliya, Prateik Poddar, Vikas Pandey, Meghraj Ingle, Prabha Sawant; Intest Res 2015;13(4):346-349. Published online October 15, 2015; DOI: https://doi.org/10.5217/ir.2015.13.4.346

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Pneumatosis intestinalis is a rare condition that affects 0.03% of the population. Pneumatosis cystoides intestinalis (PCI) is characterized by the presence of multiple gas-filled cysts in the intestinal wall and the submucosa and/or intestinal subserosa. It is usually a secondary finding caused by a wide variety of underlying gastrointestinal or extragastrointestinal diseases. Here, we present the case of a 47-year-old man who was referred to our gastroenterology department with a history suggestive of intermittent small bowel obstruction associated with abdominal pain. Abdominal computed tomography demonstrated PCI of the small bowel. The mesentery and branches of the superior mesenteric artery and superior mesenteric vein were twisted with minimal pneumoperitoneum. Exploratory laparotomy was performed, and demonstrated segmental small bowel PCI secondary to hypermobile mesentery. The affected segment of the ileum was resected, and jejunoileal anastomosis was performed. Here, we report a rare case of segmental PCI probably due to repeated twisting of hypermobile mesentery. The clinical and imaging features of this disorder may mimic those of visceral perforation or bowel ischemia. PCI can be a cause of severe abdominal pain that may require surgical intervention.

Citations

Citations to this article as recorded by

Not all small bowel pneumatosis is ischaemia: a case-based systematic review of non-ischaemic causes
S. Olusola, M. Choudhry, V. Panem, J. Wilson, S. Rana, C. Parmar, M. Kathirvel
The Annals of The Royal College of Surgeons of England.2026;[Epub] CrossRef
Pneumatosis cystoides intestinalis presenting as pneumoperitoneum in a patient with chronic obstructive pulmonary disease
Genna Logue, Mubeen Chaudhry
BJR|case reports.2023;[Epub] CrossRef
Pneumatosis cystoides intestinalis with pneumoperitoneum in an 87-years-old male patient: a case report
Rodrigo Piltcher-da-Silva, Vivian Laís Sasaki, Matheus Antonio Chiconelli Zangari, Felipe Melloto Gallotti, Bruna Freitas Saenger, Mariana Piltcher-Recuero, Gabriela de Melo Rocha, Marco Raeder da Costa, Júlio Cezar Uili Coelho
Journal of Surgical Case Reports.2022;[Epub] CrossRef
Portal vein gas combined with pneumatosis intestinalis and emphysematous cystitis: A case report and literature review
Shi-Fu Hu, Han-Bo Liu, Yuan-Yuan Hao
World Journal of Clinical Cases.2022; 10(25): 8945. CrossRef
Case Report: An unusual case of small bowel volvulus due to appendicitis associated with pneumatosis intestinalis: Review of the literature
Alia Zouaghi, Dhafer Hadded, Mesbahi Meryam, Yazid Benzarti, Mona Cherif, Haithem Zaafouri, Khalil Ben Massoud, Chiraz Chamekhi, Anis Ben Maamer
F1000Research.2022; 10: 951. CrossRef
Case Report: An unusual case of small bowel volvulus associated with pneumatosis intestinalis
Alia Zouaghi, Dhafer Hadded, Mesbahi Meryam, Yazid Benzarti, Mona Cherif, Haithem Zaafouri, Khalil Ben Massoud, Chiraz Chamekhi, Anis Ben Maamer
F1000Research.2021; 10: 951. CrossRef
Gastric Outlet Obstruction and Sigmoid Volvulus in a Patient with Pneumatosis intestinalis: An Etiology or a Complication
Osama Shaheen, Wassim Ahmad, Najm Aldin Mhammad, Boris Kirshtein
Case Reports in Surgery.2019;[Epub] CrossRef
Rapid reversal of colonic pneumatosis with restoration of mesenteric arterial supply
Hussein Abidali, Lauren Cole, Anil Bellur Seetharam
Clinical Journal of Gastroenterology.2018; 11(6): 461. CrossRef

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