A202 PREOPERATIVE DIAGNOSIS OF JEJUNAL ADENOCARCINOMA ASSOCIATED WITH CROHN’S DISEASE DIAGNOSED, LOCALIZED AND SURVEILLED VIA DOUBLE BALLOON ENDOSCOPY: A CASE REPORT
Notice bibliographique
Résumé
Abstract Background Small bowel carcinomas (SBC) are rare, accounting for only 1% to 5% of all gastrointestinal cancers. However, patients with Crohn’s disease face a significantly elevated risk of SBC. This case report outlines a rare case of preoperatively-diagnosed jejunal adenocarcinoma in a patient with long-standing Crohn’s disease with diagnosis and surveillance through double balloon endoscopy (DBE). Aims A 41-year-old female with a 30-year history of small bowel Crohn’s disease presents to the hospital with overt obscure GI bleeding. Throughout the course of her disease, she was thought to be in remission with Pentasa and 6-MP, though she had mild inflammation seen in the jejunal and neoterminal ileum visualized on magnetic resonance enterography (MRE). Subsequent oral DBE showed severe nodularity and friability throughout the jejunum with biopsies showing invasive moderately differentiated adenocarcinoma. Combined oral and rectal DBE was used to facilitate tattoo placement prior to open right hemicolectomy with jejunal resections, which was complicated by intraoperative bleed and anastomotic leak. Unusually, cross-sectional imaging with computer tomography (CT) and positron emission tomography (PET-CT) showed no GI tract enhancement or evidence of metastatic spread. Post-operatively, oral DBE found a saddle shaped deformity in the jejunum which had dysplasia on one biopsy. As a result of her complicated post-operative course, the patient is receiving regular surveillance with oral DBE every six months. Methods Balloon-assisted endoscopy (BAE) has the potential to allow for endoscopic and histopathologic examination of the entire gastrointestinal tract, which makes BAE an ideal modality for both diagnosis and surveillance in Crohn’s disease. In this particular case, DBE was able to detect a subtle jejunal lesion that was not identified on CT enterography or even a PET-CT scan, resulting in earlier detection of a small bowel adenocarcinoma that was curable with surgery. Results Currently, there is a gap in literature surrounding small bowel adenocarcinoma surveillance. This is further complicated by the lack of an established macroscopic appearance of SBC and the unknown prognostic significance of dysplasia on pathology in the context of small bowel inflammation. Further, many centres have limited access to BAE. Conclusions This case shows that it has an important, and underutilized role, in IBD management. It is currently the only methodology for visual assessment and biopsy of lesions in the mid gut. Small bowel endoscopy access should be increased in Canada with a focus on IBD patients. Development of high risk identifiers for possible small bowel carcinoma also need to be developed as part of ongoing guidelines. Funding Agencies None
Récupéré en direct depuis OpenAlex et désinversé. Les résumés ne sont pas conservés dans cette base de données : les index inversés représentent 8,6 Go des 9,3 Go de texte de la base, et le serveur dispose de 13 Go libres.
Comment cette classification a été obtenuedéplier
Prédiction machine sur la base complète
Imitation des enseignantsNi prévalence calibrée, ni vérité terrain. Validation humaine à venir. Le volet Gemma est une étiquette directe du modèle pour chaque travail de la base, lue sur la notice réduite au titre. Le volet Codex est un classifieur appris des 10 348 étiquettes directes de Codex et calibré sur les taux pondérés de l'échantillon; les champs sans appui suffisant ne portent aucun appel Codex. Le mode candidate est l'union des deux volets; le consensus est leur intersection. Ces sorties portent le statut machine_predicted_unvalidated et ne sont pas des étiquettes humaines.
Scores du classifieur distillé par catégorie (deux têtes)
| Catégorie | Codex | Gemma |
|---|---|---|
| Métarecherche | 0,000 | 0,003 |
| Méta-épidémiologie (sens strict) | 0,002 | 0,002 |
| Méta-épidémiologie (sens large) | 0,002 | 0,002 |
| Bibliométrie | 0,003 | 0,002 |
| Études des sciences et des technologies | 0,004 | 0,002 |
| Communication savante | 0,002 | 0,003 |
| Science ouverte | 0,001 | 0,002 |
| Intégrité de la recherche | 0,005 | 0,004 |
| Charge utile insuffisante (le modèle a refusé de juger) | 0,003 | 0,001 |
Scores machine (provisoires)
Les deux têtes enseignantes du modèle étudiant, lues sur ce travail. Un score ordonne la base pour la relecture; il n'affirme jamais une catégorie, et le statut de validation accompagne chaque rangée tel quel.
Scores de référence d'un modèle non mature (critères de maturité non atteints, 7 itérations). Un score ordonne; il n'affirme jamais une catégorie.
score_only:v0-immature-baseline · tel quel depuis la passe de notation : score_only signifie que le nombre peut ordonner les travaux, et qu'aucune étiquette de catégorie n'en découleClassification
machine, non validéePrédiction automatique; un appel candidat d’une seule source (Gemma direct ou Codex distillé), pas un consensus.
Le détail, modèle par modèle et score par score, se trouve en fin de page sous « Comment cette classification a été obtenue ».