Clinical Review of Small-Bowel Endoscopic Imaging

Abstract

Endoscopic imaging of the small bowel, frequently used in gastroenterology practice, encompasses mainly video capsule endoscopy (VCE) and device-assisted enteroscopy (DAE). Both tests are essential diagnostic tools to evaluate obscure gastrointestinal bleeding and suspected small-bowel disorders, such as Crohn's disease. VCE solely identifies and localizes small-bowel pathology, whereas DAE offers both visualization and tissue sampling to diagnose diseased structures and perform therapeutic maneuvers, such as those needed to achieve hemostasis. In this context, VCE is frequently used as a screening test for small-bowel abnormalities that, when present, are then managed with DAE.

Keywords: Crohn’s disease; Device-assisted enteroscopy; obscure gastrointestinal bleeding; video capsule endoscopy.

Figure 1

Video capsule endoscopy and enteroscopy images of normal studies and common benign conditions. Normal findings on video capsule endoscopy (A). Arteriovenous malformations in the proximal jejunum on video capsule endoscopy (B). Biopsy-proven Crohn’s disease presenting with deep linear and stellate ulcers (C) as well as edema with strictures (D). Biopsy-proven nonsteroidal anti-inflammatory drug enteropathy, which is characterized by an ulcerating stricture (E) and sharply demarcated ulcerations and erosions (F).

Figure 2

Video capsule endoscopy and enteroscopy images of less common benign conditions. Findings in celiac disease include absent or shortened villi, a mosaic mucosal pattern, and scalloped valvulae (A) as well as fissures and ulcers (B). An enteroscopy image of a Meckel diverticulum with an ulcerated base (C). An entrapped video capsule enteroscope visualized on enteroscopy (D). Radiation enteropathy with pale mucosa, edematous folds, ulcers, and ectatic vessels (E). Eosinophilic enteritis with smooth, erythematous patches and absent villi and without visible ulcers (F).

Figure 3

Video capsule endoscopy and enteroscopy images of small-bowel malignancies. A gastrointestinal stromal tumor presenting as a nodule with enlarged mucosal folds (A) or as a mass with abnormal surface vessels (B). A carcinoid tumor presenting with a submucosal nodule or bulge, which can be associated with an ulcer (C, D). A lymphoma with variable degrees of nodular mucosa (E) and occasional ulcerations and strictures (F).