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Early Identification of Chronic Mesenteric Ischemia with Endoscopic Duplex Ultrasound. | LitMetric

Early Identification of Chronic Mesenteric Ischemia with Endoscopic Duplex Ultrasound.

Vasc Health Risk Manag

Department of Vascular Surgery, Division of Cardiovascular and Pulmonary Diseases, Oslo University Hospital, Ullevål, Oslo, Norway.

Published: April 2022

AI Article Synopsis

  • Chronic mesenteric ischemia (CMI) is commonly misdiagnosed due to delays, but using endoscopic duplex ultrasound (E-DUS) could help identify patients suspected of having CMI more quickly than traditional methods.
  • A study involving 50 patients confirmed that E-DUS demonstrated higher sensitivity in detecting significant stenosis of the celiac artery and superior mesenteric artery compared to transabdominal duplex ultrasound (TA-DUS), particularly in patients who hadn't undergone prior treatment.
  • The findings suggest that E-DUS should be the preferred initial diagnostic tool for suspected CMI cases, as it provides more accurate results than TA-DUS.

Article Abstract

Introduction: Due to diagnostic delay, chronic mesenteric ischemia (CMI) is underdiagnosed. We assumed that the patients suspected of CMI of the atherosclerotic origin or median arcuate ligament syndrome (MALS) could be identified earlier with endoscopic duplex ultrasound (E-DUS).

Patients And Methods: Fifty CMI patients with CTA-verified stenosis of either ≥50% and ≥70% of celiac artery (CA) and superior mesenteric artery (SMA) were examined with E-DUS and transabdominal duplex ultrasound (TA-DUS). Peak systolic velocities (PSV) of ≥200cm/s and ≥275cm/s for CA and SMA, respectively, were compared with CTA. Subgroup analysis was performed for the patients with (n=21) and without (n=29) prior revascularization treatment of CMI. The diagnostic ability of E-DUS and TA-DUS was tested with crosstabulation analysis. Receiver operating characteristics (ROC) curve analysis was performed, and the area under the curve (AUC) was calculated to investigate the test accuracy.

Results: In the patients with ≥70% stenosis, E-DUS had higher sensitivity than TA-DUS (91% vs 81% for CA and 100% vs 92% for SMA). AUC for SMA ≥70% in E-DUS was 0.75 and with TA-DUS 0.68. The sensitivity of E-DUS for CTA-verified stenosis ≥70% for CA was 100% in the patients without prior treatment. E-DUS demonstrated higher sensitivity than TA-DUS for both arteries with stenosis ≥50% and ≥70% in the treatment-naive patients.

Conclusion: E-DUS is equally valid as TA-DUS for the investigation of CMI patients and should be used as an initial diagnostic tool for patients suspected of CMI.

Download full-text PDF

Source
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC9005355PMC
http://dx.doi.org/10.2147/VHRM.S358570DOI Listing

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