Sônia Nádia Fylyk

Behçet’s disease: clinical value of the video capsule endoscopy for small intestine examination

We described a pilot study using Video capsule endoscopy (VCE) aiming the assessment of small bowel in Behçet’s disease (BD). Ten patients with BD and abdominal complaints underwent VCE with Given Pillcam SB (Given Imaging Ltd., Yoqneam). VCE revealed small bowel lesions in all ten subjects. Five patients had active symptoms of BD while five others had clinically inactive disease. Jejune was the most frequently affected GI segment being involved in eight cases, four from each group. We suggest that small bowel involvement may be frequent in BD patients, even in the absence of oral ulcerations.

Double-balloon endoscopy reveals sea-blue histiocytosis affecting the small bowel (with video)

1 ommentary chinococcus granulosus is the most common of the 4 species of the worldwide tapeworm Echinococcus to infect humans; the others re E multilocularis, E vogeli, and E oligarthus. The name Echinococcus probably derives from the fact that Echinococcus embryos have ultiple hooklets that give them a spiny appearance (Greek: echinos, hedgehog, sea urchin). The eggs of E granulosus are passed ith the feces of the definitive host (dogs and other canines), and it is the ingestion of these eggs by sheep, goats, swine—and umans—that leads to infection in the intermediate host. Although intermediate hosts ingest eggs to get infected, definitive hosts ust eat infected, cyst-containing organs. Ingested eggs hatch in the small intestine of the intermediate host to release oncospheres hat penetrate the intestinal wall and migrate via arteries and lymphatics to distant organs—in particular the liver and lungs—where hey develop into hydatid cysts and can survive for many years. Cysts develop 3 layers: a host-derived outer membrane that can alcify and offer a radiologic clue to diagnosis; a middle, acellular layer; and a thin, germinal epithelium from which brood capsules evelop and subsequently give rise to daughter cysts, in which protoscolices asexually develop and then eventually mature into dult worms. Think of hepatobiliary echinococcosis whenever you see a patient from an area where dogs are used in the presence f grazing livestock, and the patient has fever, tender hepatomegaly, and eosinophilia. As for cholangitis, this has been reported to esult from cyst rupture into the bile duct, bacterial superinfection of cysts, and from use of formalin to sterilize cyst contents. Surgical emoval of the cysts combined with chemotherapy (albendazole and/or mebendazole) before and after surgery is the standard herapy. For cysts in multiple organs or in high-risk locations, chemotherapy alone or PAIR (puncture-aspiration-injectioneaspiration) alone or with chemotherapy is a therapeutic option. ERCP can be used to diagnose the type and extent of disease, to xclude concomitant disease, to remove echinococcal material, to help plan surgery, and to treat postoperative complications. I am gain reminded that in the shrinking world in which we live, we are likely to see things we think we recognize but which are, in fact, utside our usual experience. We all should broaden our differential diagnoses—even when findings appear familiar. Surprise may orce quick decisions, but an appropriate and well-thought-out plan is always preferable. Lawrence J. Brandt, MD Associate Editor for Focal Points