Intestinal Research

Original Articles

Endoscopy

Prototype single-balloon enteroscopy with passive bending and high force transmission improves depth of insertion in the small intestine: Yasuhiro Morita, Shigeki Bamba, Osamu Inatomi, Kenichiro Takahashi, Takayuki Imai, Masaki Murata, Masashi Ohno, Masaya Sasaki, Tomoyuki Tsujikawa, Akira Andoh; Intest Res 2020;18(2):229-237. Published online April 9, 2020; DOI: https://doi.org/10.5217/ir.2019.09150

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Background/Aims
We retrospectively analyzed Crohn’s disease (CD) patients with small intestinal strictures who underwent single-balloon enteroscopy (SBE) to ascertain whether prototype SBEs with a passive bending mechanism and high force transmission insertion tube had better insertability in the small intestine than a conventional SBE.
Methods
Among 253 CD patients who underwent SBE, we identified 94 CD patients who had undergone attempted endoscopic balloon dilatation (EBD) for small intestinal stenosis for inclusion in this study. We analyzed whether the type of scope used for their initial procedure affected the cumulative surgery-free rate. For the insertability analysis, patients who underwent SBE at least twice were divided into 3 groups according to the type of scope used: conventional SBE only, prototype SBE only, and both conventional and prototype SBEs. For each group, depth of insertion, procedure time, and number of EBDs were compared in the same patient at different time points.
Results
The success rate of EBD was 88.3%. The 5- and 10-year cumulative surgery-free rate was 75.7% and 72.8%, respectively. Cox regression analysis indicated that the factors contributing to surgery were long stricture (≥2 cm), EBD failure, and elevated Crohn’s Disease Activity Index, but not the type of scope used for EBD. The prototype SBEs significantly improved the depth of insertion (P=0.03, Wilcoxon’s signed-rank test).
Conclusions
In CD patients with small intestinal stenosis, the prototype SBEs with a passive bending mechanism and high force transmission insertion tube did not improve long-term EBD outcome but did improve deep insertability. (Clinical Trial Registration No. UMIN000037102)

Citations

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Leucine-rich alpha-2 glycoprotein as a superior biomarker to C-reactive protein for detecting small bowel lesions in Crohn’s disease
Masashi Ohno, Atsushi Nishida, Akinori Otsuki, Yoshihiro Yokota, Takayuki Imai, Shigeki Bamba, Osamu Inatomi
World Journal of Gastrointestinal Endoscopy.2025;[Epub] CrossRef
Role of Device-Assisted Enteroscopy in Crohn’s Disease
Giulia Catassi, Clelia Marmo, Antonio Gasbarrini, Maria Elena Riccioni
Journal of Clinical Medicine.2024; 13(13): 3919. CrossRef
Performance of Balloon-Assisted Enteroscopy for Non-ERCP Indications in Patients with Surgically Altered Gastrointestinal Anatomy
Ji Hee Song, Seong Ran Jeon, Jin Su Kim, Bo-In Lee, Jin-Oh Kim, Han Hee Lee
Digestive Diseases and Sciences.2023; 68(6): 2545. CrossRef
Rebleeding Rate and Risk Factors for Rebleeding after Device-Assisted Enteroscopy in Patients with Obscure Gastrointestinal Bleeding: A KASID Multicenter Study
Yuna Kim, Jae-Hyun Kim, Eun-Ae Kang, Soo-Jung Park, Jae-Jun Park, Jae-Hee Cheon, Tae-Il Kim, Jihye Park, Seong-Ran Jeon
Diagnostics.2022; 12(4): 954. CrossRef
Intestinal stricture in Crohn's disease: A 2020 update
Xiao Xuan Lin, Yun Qiu, Xiao Jun Zhuang, Fen Liu, Xiao Min Wu, Min Hu Chen, Ren Mao
Journal of Digestive Diseases.2021; 22(7): 390. CrossRef
Factors Affecting Route Selection of Balloon-Assisted Enteroscopy in Patients with Obscure Gastrointestinal Bleeding: A KASID Multicenter Study
Dong Hoon Baek, Seonyeong Hwang, Chang Soo Eun, Seong Ran Jeon, Jinsu Kim, Eun Ran Kim, Dong-Hoon Yang, Hyun Joo Jang, Jong Pil Im, Soo Jung Park, Sung Hoon Jung
Diagnostics.2021; 11(10): 1860. CrossRef

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Colorectal neoplasia

Endoscopic features of gastrointestinal stromal tumor in the small intestine: Yutaro Ihara, Takehiro Torisu, Tomohiko Moriyama, Junji Umeno, Atsushi Hirano, Yasuharu Okamoto, Yoshifumi Hori, Hidetaka Yamamoto, Takanari Kitazono, Motohiro Esaki; Intest Res 2019;17(3):398-403. Published online July 25, 2019; DOI: https://doi.org/10.5217/ir.2018.00161

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Background/Aims
Gastrointestinal stromal tumor (GIST) is one of the most common types of submucosal tumors (SMTs). Because of GIST’s malignant potential, it is crucial to differentiate it from other SMTs. The present study aimed to identify characteristic endoscopic findings of GISTs in the small intestine.
Methods
We reviewed the clinicopathological and endoscopic findings of 38 patients with endoscopically or surgically resected SMTs in the small intestine. SMTs were classified into GIST and non-GIST groups, and clinicopathological and endoscopic findings were compared between the 2 groups.
Results
Fifteen patients had GIST and 23 patients had other types of SMTs in the small intestine. Comparison of the endoscopic findings between the 2 groups revealed that dilated vessels in the surrounding mucosa were significantly more in number in the GIST group than in the non-GIST group (P<0.05). However, there were no other differences in endoscopic findings between the 2 groups. Among patients with GISTs, the presence of dilated vessels in the surrounding mucosa was not associated with bleeding risk, tumor size, or metastasis rate at diagnosis.
Conclusions
Dilated vessels in the surrounding mucosa, identified during balloon-assisted endoscopy, may be a diagnostic indicator for GIST in the small intestine. However, its clinical significance should be further analyzed.

Citations

Citations to this article as recorded by

Rapidly Growing Gastrointestinal Stromal Tumor on the Esophagus
Ji Hye Park, Sung Eun Kim, Seun Ja Park, Moo In Park, Won Moon, Jae Hyun Kim, Kyoungwon Jung, Myung Hun Lee
The Korean Journal of Helicobacter and Upper Gastrointestinal Research.2025; 25(1): 64. CrossRef
Multiple Small Bowel Gastrointestinal Stromal Tumors Associated with Neurofibromatosis Type 1 that Were Not Detected by Endoscopy: A Case Report
Satomi Saito, Teppei Omori, Shun Murasugi, Maria Yonezawa, Yukiko Takayama, Takeshi Ohki, Hiromi Onizuka, Yoji Nagashima, Katsutoshi Tokushige
Case Reports in Gastroenterology.2023; 17(1): 167. CrossRef
Convolutional neural network‐based object detection model to identify gastrointestinal stromal tumors in endoscopic ultrasound images
Chang Kyo Oh, Taewan Kim, Yu Kyung Cho, Dae Young Cheung, Bo‐In Lee, Young‐Seok Cho, Jin Il Kim, Myung‐Gyu Choi, Han Hee Lee, Seungchul Lee
Journal of Gastroenterology and Hepatology.2021; 36(12): 3387. CrossRef
Small Bowel Malignancies in Patients Undergoing Capsule Endoscopy for Iron Deficiency Anemia
Su Hwan Kim, Ji Won Kim
Diagnostics.2021; 12(1): 91. CrossRef

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Case Reports

Endoscopy

Magnified single-balloon enteroscopy in the diagnosis of intestinal follicular lymphoma: a case series: Kenichiro Takahashi, Shigeki Bamba, Masahiro Kawahara, Atsushi Nishida, Osamu Inatomi, Masaya Sasaki, Tomoyuki Tsujikawa, Ryoji Kushima, Mitsushige Sugimoto, Katsuyuki Kitoh, Akira Andoh; Intest Res 2018;16(4):628-634. Published online October 10, 2018; DOI: https://doi.org/10.5217/ir.2018.00003

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The objective of this study was to evaluate the magnified endoscopic findings in the diagnosis of follicular lymphoma in the small intestine in comparison with those of intestinal follicular lymphoma and lymphangiectasia. Four patients with follicular lymphoma and 3 with lymphangiectasia in the small intestine were retrospectively analyzed. A prototype magnifying singleballoon enteroscope was used. The findings of the intestinal follicular lymphoma and lymphangiectasia were retrospectively analyzed to determine the magnified endoscopic findings of follicular lymphoma in the small intestine. Opaque white granules were observed in 3 of the 4 patients with follicular lymphoma. Magnified narrow-band imaging (NBI) of the opaque white granules showed stretched microvessels, which had a diminutive tree-like appearance. The remaining patient had no opaque white granules and only displayed whitish villi. Magnified NBI observation of the whitish villi revealed the absence of marginal villus epithelium, which was confirmed by histology. The magnified NBI enteroscopy revealed the diminutive tree-like appearance on the opaque white granules and the absence of marginal villus epithelium of the whitish villi in intestinal follicular lymphoma. These findings may be useful in diagnosing follicular lymphoma.

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A case of intestinal T‐cell lymphoma, not otherwise specified, that showed characteristic findings by magnified endoscopy combined with narrow‐band imaging
Yuki Hirose, Satoshi Saito, Takanori Nishiguchi, Dai Yamazaki, Tsubasa Tateishi, Yuuichi Saito, Yukiko Komeno, Makoto Kodama, Shiho Iwamoto, Masayuki Fukata, Minako Sako
DEN Open.2024;[Epub] CrossRef
Discordance Rate and Risk Factor of Other Diagnostic Modalities for Small Bowel Tumors Detected by Device-Assisted Enteroscopy: A Korean Association for the Study of Intestinal Disease (KASID) Multicenter Study
Jihye Park, Jin Su Kim, Joo Hye Song, Kwangwoo Nam, Seong-Eun Kim, Eui Sun Jeong, Jae Hyun Kim, Seong Ran Jeon
Gut and Liver.2024; 18(4): 686. CrossRef
Predictive factors for the progression of primary localized stage small-bowel follicular lymphoma
Akihiko Sumioka, Shiro Oka, Issei Hirata, Sumio Iio, Akiyoshi Tsuboi, Hidehiko Takigawa, Ryo Yuge, Yuji Urabe, Kazuki Boda, Tomohiko Kohno, Hideharu Okanobu, Yasuhiko Kitadai, Koji Arihiro, Shinji Tanaka
Journal of Gastroenterology.2022; 57(9): 667. CrossRef

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Steroid-refractory extensive enteritis complicated by ulcerative colitis successfully treated with adalimumab: Shinji Okabayashi, Taku Kobayashi, Tomohisa Sujino, Ryo Ozaki, Satoko Umeda, Takahiko Toyonaga, Eiko Saito, Masaru Nakano, Maria Carla Tablante, Shojiroh Morinaga, Toshifumi Hibi; Intest Res 2017;15(4):535-539. Published online October 23, 2017; DOI: https://doi.org/10.5217/ir.2017.15.4.535

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Extracolonic involvement of the gastrointestinal tract is extremely uncommon in ulcerative colitis (UC) and rarely found in the upper gastrointestinal tract or in postoperative cases since it typically responds to steroids. Here we report a case of UC complicated by extensive ileal inflammation that was refractory to steroids. A 20-year-old man was diagnosed with UC of typical pancolitis without ileal involvement and started treatment with pH-dependent mesalazine and oral prednisolone. Although his symptoms transiently resolved, the condition flared when the steroid dose was tapered down. Computed tomography revealed marked thickening of the ileal wall, and capsule endoscopy and balloon-assisted enteroscopy found diffuse mucosal inflammation with ulcers in the ileum. On the contrary, the inflammation in the colon and rectum was improving. Since the response to the second steroid course was inadequate, treatment with adalimumab and 6-mercaptopurine was initiated and finally achieved clinical and endoscopic remission. The investigation of small intestinal lesions is necessary in patients with UC whose clinical deterioration cannot be explained by colonic lesions.

Citations

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A case of relapsed pan-colonic ulcerative colitis accompanied with gastroduodenal lesions immediately after COVID-19
Katsuya Endo, Tomonori Satoh, Yuki Yoshino, Shiho Kondo, Yoko Kawakami, Daisuke Fukushi, Atsuko Takasu, Takayuki Kogure, Morihisa Hirota, Kennichi Satoh
Clinical Journal of Gastroenterology.2025; 18(3): 399. CrossRef
Clinical Features and Therapeutic Outcomes of Post-colectomy Enteritis with Ulcerative Colitis
Yuki Horio, Motoi Uchino, Kazutoshi Hori, Kurando Kusunoki, Tomohiro Minagawa, Ryuichi Kuwahara, Kozo Kataoka, Naohito Beppu, Masataka Ikeda, Hiroki Ikeuchi
Journal of the Anus, Rectum and Colon.2021; 5(4): 405. CrossRef

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Reviews

The role of small bowel endoscopy in small bowel Crohn's disease: when and how?: Mikang Kim, Hyun Joo Jang; Intest Res 2016;14(3):211-217. Published online June 27, 2016; DOI: https://doi.org/10.5217/ir.2016.14.3.211

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Endoscopy has a crucial role in the diagnosis, management, and surveillance of inflammatory bowel disease (IBD). It contributes in supporting the diagnosis of IBD with the clinical history, physical examination, laboratory findings, and targeted biopsies. Furthermore, endoscopy has a significant role in assessing disease activity and distribution in treatment efficacy evaluation, post-surgical recurrence risk, and cancer surveillance in patients with long-lasting illness. Endoscopy also provides therapeutic potential for the treatment of IBD, especially with stricture dilatation and treatment of bleeding. Small bowel (SB) endoscopy (capsule endoscopy and device-assisted enteroscopy) and cross-sectional radiologic imaging (computed tomography enterography and magnetic resonance enterography) have become important diagnostic options to diagnose and treat patients with SB Crohn's disease. We reviewed the present role of SB endoscopy in patients with SB Crohn's disease.

Citations

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Leucine-rich alpha-2 glycoprotein as a superior biomarker to C-reactive protein for detecting small bowel lesions in Crohn’s disease
Masashi Ohno, Atsushi Nishida, Akinori Otsuki, Yoshihiro Yokota, Takayuki Imai, Shigeki Bamba, Osamu Inatomi
World Journal of Gastrointestinal Endoscopy.2025;[Epub] CrossRef
Aptamer-Functionalized Microbubbles Targeted to P-selectin for Ultrasound Molecular Imaging of Murine Bowel Inflammation
Una Goncin, Laura Curiel, C. Ronald Geyer, Steven Machtaler
Molecular Imaging and Biology.2023; 25(2): 283. CrossRef
Utility of panenteric capsule endoscopy for the detection of small‐bowel Crohn's disease in patients with a normal magnetic resonance enterography: A prospective observational pilot study
Anuj Bohra, Diana Lewis, Jonathan P Segal, Abhinav Vasudevan, Daniel R Van Langenberg, Olga Niewiadomski
JGH Open.2023; 7(12): 966. CrossRef
Enteroscopy in Crohn’s Disease: Are There Any Changes in Role or Outcomes Over Time? A KASID Multicenter Study
Seong Ran Jeon, Jin-Oh Kim, Jeong-Sik Byeon, Dong-Hoon Yang, Bong Min Ko, Hyeon Jeong Goong, Hyun Joo Jang, Soo Jung Park, Eun Ran Kim, Sung Noh Hong, Jong Pil Im, Seong-Eun Kim, Ja Seol Koo, Chang Soo Eun, Dong Kyung Chang
Gut and Liver.2021; 15(3): 375. CrossRef
Small Bowel Enteroscopy – A Joint Clinical Guideline from the Spanish and Portuguese Small Bowel Study Groups
Enrique Pérez-Cuadrado-Robles, Rolando Pinho, Begoña Gonzalez, Susana Mão de Ferro, Cristina Chagas, Pilar Esteban Delgado, Cristina Carretero, Pedro Figueiredo, Bruno Rosa, Javier García Lledó, Óscar Nogales, Ana Ponte, Patrícia Andrade, Jose Francisco J
GE - Portuguese Journal of Gastroenterology.2020; 27(5): 324. CrossRef
Capsule Endoscopy Validation of the Magnetic Enterography Global Score in Patients with Established Crohn’s Disease
Eyal Klang, Marianne M Amitai, Adi Lahat, Doron Yablecovitch, Benjamin Avidan, Sandra Neuman, Nina Levhar, Noa Rozendorn, Batya Weiss, Shomron Ben-Horin, Rami Eliakim, Uri Kopylov
Journal of Crohn's and Colitis.2018; 12(3): 313. CrossRef
Quality Indicators for Small Bowel Capsule Endoscopy
Ki-Nam Shim, Seong Ran Jeon, Hyun Joo Jang, Jinsu Kim, Yun Jeong Lim, Kyeong Ok Kim, Hyun Joo Song, Hyun Seok Lee, Jae Jun Park, Ji Hyun Kim, Jaeyoung Chun, Soo Jung Park, Dong-Hoon Yang, Yang Won Min, Bora Keum, Bo-In Lee
Clinical Endoscopy.2017; 50(2): 148. CrossRef
Gastroduodenal lesions detected during small bowel capsule endoscopy: incidence, diagnostic and therapeutic impact
José Francisco Juanmartiñena Fernández, Ignacio Fernández-Urien Sainz, Beatriz Zabalza Ollo, Cristina Saldaña Dueñas, Marta Montañés Guimera, Alfonso Elosua González, Juan José Vila Costas
Revista Española de Enfermedades Digestivas.2017;[Epub] CrossRef
Clinical outcome after enteroscopy for small bowel angioectasia bleeding: A Korean Associateion for the Study of Intestinal Disease (KASID) multiceter study
Seong Ran Jeon, Jeong‐Sik Byeon, Hyun Joo Jang, Soo Jung Park, Jong Pil Im, Eun Ran Kim, Ja Seol Koo, Bong Min Ko, Dong Kyung Chang, Jin‐Oh Kim, Su Yeon Park
Journal of Gastroenterology and Hepatology.2017; 32(2): 388. CrossRef
An update on small bowel endoscopy
Hey-Long Ching, Mark E. McAlindon, Reena Sidhu
Current Opinion in Gastroenterology.2017; 33(3): 181. CrossRef
Practice patterns and clinical significance of use of capsule endoscopy in suspected and established Crohn's disease
Yonghyun Kim, Seong Ran Jeon, Sang Myung Choi, Hyun Gun Kim, Tae Hee Lee, Jun-Hyung Cho, Yunho Jung, Wan Jung Kim, Bong Min Ko, Jin-Oh Kim, Joon Sung Lee, Moon Sung Lee
Intestinal Research.2017; 15(4): 467. 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

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Magnetic resonance enterography for the evaluation of the deep small intestine in Crohn's disease: Kazuo Ohtsuka, Kento Takenaka, Yoshio Kitazume, Toshimitsu Fujii, Katsuyoshi Matsuoka, Maiko Kimura, Takashi Nagaishi, Mamoru Watanabe; Intest Res 2016;14(2):120-126. Published online April 27, 2016; DOI: https://doi.org/10.5217/ir.2016.14.2.120

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For the control of Crohn's disease (CD) a thorough assessment of the small intestine is essential; several modalities may be utilized, with cross-sectional imaging being important. Magnetic resonance (MR) enterography, i.e., MRE is recommended as a modality with the highest accuracy for CD lesions. MRE and MR enteroclysis are the two methods performed following distension of the small intestine. MRE has sensitivity and specificity comparable to computed tomography enterography (CTE); although images obtained using MRE are less clear compared with CTE, MRE does not expose the patient to radiation and is superior for soft-tissue contrast. Furthermore, it can assess not only static but also dynamic and functional imaging and reveals signs of CD, such as abscess, comb sign, fat edema, fistula, lymph node enhancement, less motility, mucosal lesions, stricture, and wall enhancement. Several indices of inflammatory changes and intestinal damage have been proposed for objective evaluation. Recently, diffusion-weighted imaging has been proposed, which does not need bowel preparation and contrast enhancement. Comprehension of the characteristics of MRE and other modalities is important for better management of CD.

Citations

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MR Enterography
Harsha K. Garg, Kumar K. Shashi, Jessica Kurian, Abbey J. Winant, Edward Y. Lee
Radiologic Clinics of North America.2025;[Epub] CrossRef
Motility Mapping Quantification Using the Classical Optical Flow Algorithm for Small Bowel Crohn’s Disease: Comparison with Balloon-assisted Enteroscopy Findings
Yoshio Kitazume, Kento Takenaka, Kazuo Ohtsuka, Yasuo Ozawa, Koichiro Kimura, Ryosuke Watanabe, Junichi Tsuchiya, Toshimitsu Fujii, Masakazu Nagahori, Mamoru Watanabe, Ukihide Tateishi
Magnetic Resonance in Medical Sciences.2023; 22(3): 325. CrossRef
Crohn’s disease at radiological imaging: focus on techniques and intestinal tract
Giuseppe Cicero, Silvio Mazziotti
Intestinal Research.2021; 19(4): 365. CrossRef
Magnetic Resonance Enterography and Capsule Endoscopy in Patients Undergoing Patency Capsule for the Evaluation of Small Bowel Crohn’s Disease: A Korean Clinical Experience
Hyun Seok Lee, Yun Jeong Lim, Jin-Hee Jung, Ji Hyung Nam, Junseok Park, Sun Hyung Kang, Ki Bae Kim, Hoon Jai Chun
Gastroenterology Research and Practice.2020; 2020: 1. CrossRef
Efficacy of Novel Ultrathin Single-Balloon Enteroscopy for Crohn’s Disease: A Propensity Score-Matched Study
Kaoru Takabayashi, Naoki Hosoe, Motohiko Kato, Yukie Hayashi, Ryoichi Miyanaga, Kosaku Nanki, Kayoko Fukuhara, Yohei Mikami, Shinta Mizuno, Tomohisa Sujino, Makoto Mutaguchi, Makoto Naganuma, Naohisa Yahagi, Haruhiko Ogata, Takanori Kanai
Gut and Liver.2020; 14(5): 619. CrossRef
High b-value computed diffusion-weighted imaging for differentiating bowel inflammation in Crohn's disease
Yoshio Kitazume, Junichi Tsuchiya, Kento Takenaka, Kazuo Ohtsuka, Koichiro Kimura, Ryosuke Watanabe, Tomoyuki Fujioka, Toshimitsu Fujii, Mamoru Watanabe, Ukihide Tateisi
European Journal of Radiology.2020; 133: 109362. CrossRef
The role of small bowel endoscopy for Crohn's disease
Stefania Chetcuti Zammit, Pierre Ellul, Reena Sidhu
Current Opinion in Gastroenterology.2019; 35(3): 223. CrossRef
Magnetic resonance enterography predicts the prognosis of Crohn's disease
Ji Hoon Lee, Yong Eun Park, Nieun Seo, Hyun Jung Lee, Soo Jung Park, Tae Il Kim, Won Ho Kim, Joon Seok Lim, Jae Hee Cheon
Intestinal Research.2018; 16(3): 445. CrossRef
Quality Indicators for Small Bowel Capsule Endoscopy
Ki-Nam Shim, Seong Ran Jeon, Hyun Joo Jang, Jinsu Kim, Yun Jeong Lim, Kyeong Ok Kim, Hyun Joo Song, Hyun Seok Lee, Jae Jun Park, Ji Hyun Kim, Jaeyoung Chun, Soo Jung Park, Dong-Hoon Yang, Yang Won Min, Bora Keum, Bo-In Lee
Clinical Endoscopy.2017; 50(2): 148. CrossRef

7,621 View
78 Download
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