Subject(s)
Abdominal Pain/etiology , Digestive System Abnormalities/complications , Gallbladder/abnormalities , Adult , Aniline Compounds , Cholangiopancreatography, Magnetic Resonance , Digestive System Abnormalities/diagnosis , Female , Gallbladder/diagnostic imaging , Glycine , Humans , Imino Acids , Organotechnetium Compounds , Radionuclide Imaging , Radiopharmaceuticals , UltrasonographySubject(s)
Fistula/complications , Pericardial Effusion/diagnosis , Pericardial Effusion/etiology , Peritoneal Diseases/pathology , Portasystemic Shunt, Transjugular Intrahepatic , Adult , Ascites/pathology , Fistula/pathology , Humans , Liver Cirrhosis, Alcoholic/pathology , Male , Pericardial Effusion/surgeryABSTRACT
BACKGROUND: Computed tomography (CT) and magnetic resonance (MR) enterography are now widely used to diagnose and monitor Crohn's disease. AIM: We sought to assess the use of enterography for management of inflammatory bowel disease (IBD) in our medical center. METHODS: We performed a retrospective review of all patients diagnosed with IBD who underwent MR or CT enterography from November 1, 2010 to October 25, 2012 at our institution. We assessed disease complications identified by enterography, agreement between disease activity determined by endoscopy and enterography, association between inflammatory markers and enterography-determined disease activity and recommended changes in medical and surgical management following enterography. RESULTS: A total of 311 enterography studies (291 MR and 20 CT enterographies) were performed on 270 patients, including 258 (83.0 %) on patients with presumed Crohn's disease and 53 (17.0 %) with presumed ulcerative colitis. Active small bowel (SB) disease was noted in 73/311 (23.5 %) studies. Complications including strictures, perianal fistulas, abscesses and SB fistulas were noted in 108/311 (34.7 %) studies. Endoscopic and enterography defined active disease had an agreement of κ = 0.36 in the ileum (n = 179). A total of 142/311 (45.7 %) enterographies were associated with recommended medication changes within 90 days while surgery or endoscopic dilation of stricture was recommended following 41/311 (13.2 %) enterographies. Enterography resulted in a change in diagnosis from ulcerative colitis to Crohn's in 5/311 (1.6 %) studies. CONCLUSION: Enterography reveals active disease and complications not evident on endoscopy and should be considered in the initial diagnosis, assessment of disease activity, and monitoring of therapy in patients with IBD.
Subject(s)
Inflammatory Bowel Diseases/diagnosis , Intestine, Small/diagnostic imaging , Magnetic Resonance Imaging/methods , Tomography, X-Ray Computed , Adult , Endoscopy, Digestive System , Female , Humans , Inflammatory Bowel Diseases/diagnostic imaging , Male , Middle Aged , ROC Curve , Retrospective StudiesABSTRACT
BACKGROUND: Patients with malignant biliary obstruction are commonly living longer than previously due to improved oncologic therapies, often exceeding expected times of self-expanding metal stent patency. AIMS: The purpose of this study was to assess the long-term risk and impact of cholangitis in these patients. METHODS: Retrospective review of electronic medical records at an academic medical center. RESULTS: One hundred and one patients had a self-expanding metal stent placed for malignant biliary obstruction. The median survival after SEMS was 214 days. Of these patients, 22 % developed at least one episode of cholangitis requiring inpatient admission, 20 % (9/45) of patients were hospitalized for cholangitis at 6 months, 40 % (8/20) at 1 year, and 75 % (3/4) at 2 years. All of the (8/8) patients receiving chemotherapy prior to hospitalization for cholangitis experienced delays in subsequent chemotherapy. Follow-up of 36 episodes of cholangitis revealed a 14 % 30-day mortality. CONCLUSIONS: Cholangitis develops commonly in long-term survivors with self-expanding metal stents for malignant biliary obstruction, and is associated with delays in chemotherapy and a 14 % 30-day mortality.
