Development of a Multidisciplinary Program to Expedite Care of Esophageal Emergencies.

Background: Level 1 programs have improved outcomes by expediting the multidisciplinary care of critically ill patients. We established a novel level 1 program for the management of esophageal emergencies.

Methods: After institutional review board approval, we performed a retrospective analysis of patients referred to our level 1 esophageal emergency program from April 2013 through November 2015.

Balloon expulsion testing for the diagnosis of dyssynergic defecation in women with chronic constipation.

Introduction And Hypothesis: Dyssynergic defecation can be difficult to diagnose. Anorectal manometry and defecography are often used to make this diagnosis. However, these tests are expensive and require expertise.

CT enterography for Crohn's disease: optimal technique and imaging issues.

CT enterography (CTE) is a common examination for patients with Crohn's disease. In order to achieve high quality, diagnostic images, proper technique is required. The purpose of this treatise is to review the processes and techniques that can optimize CTE for patients with suspected or known Crohn's disease.

Pelvic floor disorders: what's the best test?

Pelvic floor dysfunctions represent a common health problem affecting particularly post-menopausal women impacting significantly the quality of life. A large number of these patients suffer for many years without proper treatment often due to the lack of objective findings necessary to plan proper treatment. Because abnormalities of the different pelvic compartments are frequently associated, thorough diagnostic characterization of how many compartments are affected is paramount in order to plan the management approach that can include a multidisciplinary surgical approach.

Neoadjuvant chemotherapy followed by simultaneous robotic radical trachelectomy and reversal of tubal sterilization in stage IB2 cervical cancer.

Introduction: The aim of this study was to report a case of cervical cancer stage IB2 treated with neoadjuvant chemotherapy, followed by simultaneous robotic-assisted radical trachelectomy and reversal of tubal sterilization.

Case Description: This case occurred in a university hospital involving a 31-y-old woman with stage IB2 cervical cancer treated using neoadjuvant chemotherapy, robotic surgery, and tubal anastomosis to determine cancer disease status and achieve restoration of tubal patency.

Discussion: A successful radical trachelectomy with patent tubes was done bilaterally.

Fluoroscopic and CT enteroclysis: evidence-based clinical update.

Fluoro/radiographic contrast examination of the small bowel (SB) and its cross-sectional hybrid (computed tomographic enteroclysis) have evolved into important consultative tools in formulating a more confident management course in the treatment of SB disease. The low incidence of SB diseases and their nonspecific clinical presentation require the proven performance characteristics of enteral volume-challenged examination to shorten the lag time of diagnosis or exclude its presence. Reliable exclusion of a SB abnormality is an important diagnosis for radiologists to make in the work-up of the patient with persistent unexplained abdominal symptoms.

Comparison between dynamic cystocolpoproctography and dynamic pelvic floor MRI: pros and cons: which is the "functional" examination for anorectal and pelvic floor dysfunction?

"Functional" imaging of anorectal and pelvic floor dysfunction has assumed an important role in the diagnosis and management of these disorders. Although defecography has been widely practiced for decades to evaluate the dynamics of rectal emptying, debate concerning its clinical relevance, how it should be done and interpreted continues. Due to the recognition of the association of defecatory disorders with pelvic organ prolapse in women, the need to evaluate the pelvic floor as a unit has arisen.

Functional imaging of the pelvic floor.

The clinical treatment of patients with anorectal and pelvic floor dysfunction is often difficult. Dynamic cystocolpoproctography (DCP) has evolved from a method of evaluating the anorectum for functional disorders to its current status as a functional method of evaluating the global pelvic floor for defecatory disorders and pelvic organ prolapse. It has both high observer accuracy and a high yield of positive diagnoses.

Air (CO2) double-contrast barium enteroclysis.

In the 1980s and 1990s in North America and Europe, air (CO(2)) double-contrast barium enteroclysis took a back seat to biphasic methylcellulose double-contrast enteroclysis in the investigation of small-bowel diseases. The widespread application of capsule endoscopy in the 21st century has identified a number of limitations of radiologic examinations in the investigation of mucosal diseases of the small intestine. Evidence-based studies comparing barium, computed tomographic (CT), and magnetic resonance (MR) enteroclysis have shown that in spite of improvements in small-bowel examination methods using CT and MR, barium examinations remain superior in the depiction of mucosal abnormalities, particularly the apthoid lesions of early Crohn disease.

CT enteroclysis in small bowel Crohn's disease.

The diagnostic evaluation of small bowel Crohn's disease has changed dramatically over the last decade. The introduction of wireless capsule endoscopy, double balloon endoscopy and the introduction of newer therapeutic agents have changed the role of imaging in the small bowel. Additionally, advances in multidetector CT technology have further changed how radiologic investigations are utilized in the diagnosis and management of small bowel Crohn's disease.

CT enteroclysis in incomplete small bowel obstruction.

The timing of surgical intervention as well as the optimal method of radiologic investigation for patients with incomplete, open loop small bowel obstruction has changed over the past two decades. This review focuses on the role of computed tomographic enteroclysis in the evaluation of patients with suspected small bowel obstruction. The technique of examination is described and an overview of its clinical applications and imaging controversy are presented.

Comparison of capsule endoscopy with enteroclysis in the investigation of small bowel disease.

Purpose: To compare results of capsule endoscopy with those of barium enteroclysis or CT enteroclysis.

Methods: Retrospective review of hospital records revealed 65 patients who had an enteroclysis and small bowel capsule endoscopy. The diagnostic yield of capsule endoscopy was compared with the enteroclysis using Fisher's exact test.

Conscious sedation for patients undergoing enteroclysis: comparing the safety and patient-reported effectiveness of two protocols.

Objective: To compare the safety and patient-reported effectiveness of two regimens for conscious sedation during enteroclysis.

Materials And Methods: We surveyed two groups of outpatients and retrospectively reviewed procedure records for conscious sedation and complications. Patients were divided into Group One (received sedative/amnesic diazepam), and Group Two, (received amnesic/sedative, midazolam and analgesic fentanyl).

Fluoroscopic and CT enteroclysis in children: initial experience, technical feasibility, and utility.

Background: Partial small-bowel obstruction can be difficult to diagnose on clinical examination. These obstructions might not be detected on routine abdominal/pelvic CT.

Objective: To evaluate the feasibility, safety, and techniques of fluoroscopic enteroclysis (FE) and CT enteroclysis (CTE), and to review their indications and findings in children.

Small-bowel obstruction: state-of-the-art imaging and its role in clinical management.

Small-bowel obstruction (SBO) is a common clinical condition with signs and symptoms similar to other acute abdominal disorders. The radiologic investigation of patients with SBO as well as the indications and timing of surgical intervention have changed over the past 2 decades. This review focuses on modern imaging techniques and their role in both the diagnosis and treatment of patients with SBO.

CT Enteroclysis.

Computed tomographic (CT) enteroclysis is a hybrid technique that combines the methods of fluoroscopic intubation-infusion small-bowel examinations with that of abdominal CT. The use of multidetector CT technology has made this a versatile examination that has evolved into two distinct technical modifications. CT enteroclysis can be performed by using positive enteral contrast material without intravenous contrast material and neutral enteral contrast material with intravenous contrast material.

Correlation of CT enteroclysis with surgical pathology in Crohn's disease.

Background: The response to therapy in Crohn's disease (CD) depends on the inflammatory or fibrostenotic nature of the underlying pathological process. Standard diagnostic tests cannot reliably distinguish between these two entities. Although CT enteroclysis (CTE) has shown promise in the evaluation of small bowel disorders, its accuracy for the differentiation of CD phenotypes is unknown.

Disconnection of the pancreatic duct: an important but overlooked complication of severe acute pancreatitis.

In patients with severe acute pancreatitis, the percentage of necrosis of pancreatic glandular parenchyma is an important predictor of prognosis. However, little attention has been paid to necrosis of ductal epithelium, which may result in disconnection of the main pancreatic duct. In pancreatic duct disconnection, a viable segment of the pancreatic body or tail is isolated from the gastrointestinal tract; the result is a persistent end fistula, that is, an uncontrolled leak of pancreatic secretions into peripancreatic spaces without communication to the gastrointestinal tract.

Radiologic investigations complement and add diagnostic information to capsule endoscopy of small-bowel diseases.

Objective: The purpose of our study was to review how commonly performed radiologic examinations compare with capsule endoscopy in the investigation of small-bowel diseases, to analyze the limitations of capsule imaging, and to propose an algorithm for use of specific radiologic examinations to complement wireless capsule endoscopy.

Conclusion: The diagnostic yield of capsule endoscopy is superior to that of radiologic examinations except air double-contrast enteroclysis for mucosal details. Radiologic investigations find new applications in clinical practice by complementing capsule endoscopy to overcome its limitations.

CT enteroclysis: techniques and applications.

CT enteroclysis overcomes the individual deficiencies of both barium enteroclysis and conventional CT and combines the advantages of both into one technique whose clinical applicability has been simplified and made more reliable with multidetector CT technology. This article examines the techniques of CT enteroclysis and presents an overview of its clinical applications relative to other methods of small bowel imaging.

CT findings in small bowel angioedema: a cause of acute abdominal pain.

A patient who presented with acute abdominal pain secondary to small bowel angioedema is reported. Characteristic imaging features are highlighted with clarifying images. The importance of considering this diagnosis in patients presenting with acute abdominal pain correlated with the appropriate history is discussed.

Dynamic imaging of posterior compartment pelvic floor dysfunction by evacuation proctography: techniques, indications, results and limitations.

The clinical management of patients with anorectal and pelvic floor dysfunction is often difficult. Evacuation proctography has evolved from a method to evaluate the anorectum for functional disorders to its current status as a practical method for evaluating anorectal dysfunction and pelvic floor prolapse. It has a high observer accuracy and yield of positive diagnosis.