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Small Intestinal Case 1

Dr. Mohan Ramchandani

Director of Interventional Endoscopy- AIG Hospital Hyderabad, India.

Procedure Information

Scope: SIF-H190

Case: Multiple deep ulcers with increased friability in the jejunum

Organ: Small Intestine

Patient information: 44-year-old female

Medical history: Recurrent abdominal pain, weight loss and iron deficiency anaemia for 9 months. CT enterography showed multifocal thickening in the jejunum, hs-CRP and faecal calprotectin was elevated.

1. WLI Observation
Deep ulcer with surrounding erythematous mucosa suggesting active inflammation

Enhancement : A7
NBI Mode : NA
TXI Mode : NA
RDI Mode : NA
BAI-MC : On

2. TXI Observation
Enhanced color tone, brightness in TXI mode sharpens the delineation between the ulcer & the edge and improves the detection

Enhancement : A7
NBI Mode : NA
TXI Mode : 1& 2
RDI Mode : NA
BAI-MC : On

3. WLI Observation
Deep ulcer with surrounding erythematous mucosa suggesting active inflammation

Enhancement : A7
NBI Mode : NA
TXI Mode : NA
RDI Mode : NA
BAI-MC : On

4. TXI Observation
Enhanced color tone, brightness in TXI mode sharpens the delineation between the ulcer & the edge and improves the detection

Enhancement : A7
NBI Mode : NA
TXI Mode : 1& 2
RDI Mode : NA
BAI-MC : On

5. WLI Observation
Deep ulcer with surrounding erythematous mucosa with friability suggesting active inflammation

Enhancement : A7
NBI Mode : NA
TXI Mode : NA
RDI Mode : NA
BAI-MC : On

6. TXI Observation
Enhanced color tone, brightness in TXI mode sharpens the delineation between the ulcer & the edge and shows clear active bleeding due to increased friability not clearly visible on WLI

Enhancement : A7
NBI Mode : NA
TXI Mode : 1& 2
RDI Mode : NA
BAI-MC : On

7. WLI Observation
Deep ulcer with surrounding erythematous mucosa suggesting active inflammation

Enhancement : A7
NBI Mode : NA
TXI Mode : NA
RDI Mode : NA
BAI-MC : On

8. TXI Observation
Enhanced color tone, brightness in TXI mode sharpens the delineation between the ulcer & the edge and enhances mucosal visibility

Enhancement : A7
NBI Mode : NA
TXI Mode : 1& 2
RDI Mode : NA
BAI-MC : On

9. WLI Observation
Deep ulcer with surrounding erythematous mucosa suggesting active inflammation

Enhancement : A7
NBI Mode : NA
TXI Mode : NA
RDI Mode : NA
BAI-MC : On

10. TXI Observation
Enhanced color tone, brightness in TXI mode sharpens the delineation between the ulcer & the edge and improves the detection

Enhancement : A7
NBI Mode : NA
TXI Mode : 1& 2
RDI Mode : NA
BAI-MC : On

11. WLI Observation
Deep ulcer with surrounding erythematous mucosa suggesting active inflammation

Enhancement : A7
NBI Mode : NA
TXI Mode : NA
RDI Mode : NA
BAI-MC : On

12. TXI Observation
Enhanced color tone, brightness in TXI mode sharpens the delineation between the ulcer & the edge and improves the detection

Enhancement : A7
NBI Mode : NA
TXI Mode : 1& 2
RDI Mode : NA
BAI-MC : On

13. WLI Observation
Deep ulcer with surrounding erythematous mucosa suggesting active inflammation

Enhancement : A7
NBI Mode : NA
TXI Mode : NA
RDI Mode : NA
BAI-MC : On

14. TXI Observation
Enhanced color tone, brightness in TXI mode sharpens the delineation between the ulcer & the edge and improves the detection

Enhancement : A7
NBI Mode : NA
TXI Mode : 1& 2
RDI Mode : NA
BAI-MC : On

15. WLI Observation
Deep ulcer with surrounding erythematous mucosa suggesting active inflammation

Enhancement : A7
NBI Mode : NA
TXI Mode : NA
RDI Mode : NA
BAI-MC : On

16. TXI Observation
Enhanced color tone, brightness in TXI mode sharpens the delineation between the ulcer & the edge and improves the detection

Enhancement : A7
NBI Mode : NA
TXI Mode : 1& 2
RDI Mode : NA
BAI-MC : On

17. WLI Observation
Deep ulcer with surrounding erythematous mucosa suggesting active inflammation

Enhancement : A7
NBI Mode : NA
TXI Mode : NA
RDI Mode : NA
BAI-MC : On

18. TXI Observation
Enhanced color tone, brightness in TXI mode sharpens the delineation between the ulcer & the edge and improves the detection

Enhancement : A7
NBI Mode : NA
TXI Mode : 1& 2
RDI Mode : NA
BAI-MC : On

19. WLI Observation
Deep ulcer with surrounding erythematous mucosa suggesting active inflammation

Enhancement : A7
NBI Mode : NA
TXI Mode : NA
RDI Mode : NA
BAI-MC : On

20. TXI Observation
Enhanced color tone, brightness in TXI mode sharpens the delineation between the ulcer & the edge and improves the detection

Enhancement : A7
NBI Mode : NA
TXI Mode : 1& 2
RDI Mode : NA
BAI-MC : On

21. WLI Observation
Deep ulcer with surrounding erythematous mucosa suggesting active inflammation

Enhancement : A7
NBI Mode : NA
TXI Mode : NA
RDI Mode : NA
BAI-MC : On

22. TXI Observation
Enhanced color tone, brightness in TXI mode sharpens the delineation between the ulcer & the edge and improves the detection

Enhancement : A7
NBI Mode : NA
TXI Mode : 1& 2
RDI Mode : NA
BAI-MC : On

Case video

Single balloon enteroscopy with overlying transparent cap was performed with SIF-H190. In this case, WLI showed multiple deep ulcers in the jejunum with increased friability suggestive of Inflammatory bowel disease. Switching to TXI mode, also called as the new white light improved colour tone and the overall brightness of the small bowel mucosal surface. It helps delineating the lesions better and demarcates the deep ulcer from the surrounding erythematous mucosal surface. TXI improves detection of the small ulcers and reduce the miss rates. TXI also helps in selecting the best site of the biopsy. Overall TXI in single balloon enteroscopy adds to the clinical benefit of the patient.

Overall Comment

In this case, WLI showed multiple deep ulcers in the jejunum with increased friability. Switching to TXI mode, also called as the new white light improved colour tone and the overall brightness of the small bowel mucosal surface. It helps delineating the lesions better and demarcates the deep ulcer from the surrounding erythematous mucosal surface. TXI improves detection of the small ulcers and reduces the miss rates. TXI also helps in selecting the site of the biopsy. Overall TXI in single balloon enteroscopy adds to the clinical benefit of the patient.

* Specifications, design and accessories are subject to change without any notice or obligation on the part of the manufacturer.

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