Evidence map›Paper›PMID 29372393›Full record

Observational studyJournal of gastrointestinal surgery : official journal of the Society for Surgery of the Alimentary Tract2018

Approach to the Diagnostic Workup and Management of Small Bowel Lesions at a Tertiary Care Center.

Jonathan Green, Christopher R Schlieve, Ann K Friedrich, Kevin Baratta, David H Ma, May Min, Krunal Patel, David Stein, David R Cave, Demetrius E Litwin and 1 more

Abstract readObservational Study
PubMed Publisher
In one paragraph

Observational study in Journal of gastrointestinal surgery : official journal of the Society for Surgery of the Alimentary Tract, 2018. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 3 papers.

0numbers the graph read from it
0cells of the map it votes in
3citing papers in PubMed
1.0field-weighted citation impact, top 25% of its field
1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

The trial behind it

Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.

Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.

3 · Its place in the literature

Who cites it

3 citing papers in PubMed, 10 citations in OpenAlex.

  1. Article
  2. Causes and Clinical Characteristics of Small Bowel Bleeding in Northern Vietnam.Canadian journal of gastroenterology & hepatology · 2020
    Article
  3. The Changing Platform of Small Bowel Endoscopy: a 15-Year Experience of Demand and Outcomes.Journal of gastrointestinal surgery : official journal of the Society for Surgery of the Alimentary Tract · 2018
    Article
4 · The record

Corrections and comments

5 · Who and what money

Authors and funding

11 authors at 2 institutions in 1 country.

Jonathan GreenDepartment of Surgery, University of Massachusetts Medical School, 55 Lake Ave North, Worcester, MA, 01655, USA.
Christopher R SchlieveDepartment of Surgery, University of Massachusetts Medical School, 55 Lake Ave North, Worcester, MA, 01655, USA.
Ann K FriedrichDepartment of Surgery, Saint Mary's Hospital, 56 Franklin Street, Waterbury, CT, 06706, USA.
Kevin BarattaDepartment of Medicine, Saint Mary's Hospital, 56 Franklin Street, Waterbury, CT, 06706, USA.
David H MaUniversity of Massachusetts Medical School, 55 Lake Ave North, Worcester, MA, 01655, USA.
May MinDepartment of Medicine, University of Massachusetts Medical School, 55 Lake Ave North, Worcester, MA, 01655, USA.
Krunal PatelDivision of Gastroenterology, Department of Medicine, University of Massachusetts Medical School, 55 Lake Ave North, Worcester, MA, 01655, USA.
David SteinUniversity of Massachusetts Medical School, 55 Lake Ave North, Worcester, MA, 01655, USA.
David R CaveDivision of Gastroenterology, Department of Medicine, University of Massachusetts Medical School, 55 Lake Ave North, Worcester, MA, 01655, USA.
Demetrius E LitwinDepartment of Surgery, University of Massachusetts Medical School, 55 Lake Ave North, Worcester, MA, 01655, USA.
Mitchell A CahanDepartment of Surgery, University of Massachusetts Medical School, 55 Lake Ave North, Worcester, MA, 01655, USA. Mitchell.Cahan@umassmed.edu.
University of Massachusetts Chan Medical School · USSt Mary's Hospital · US

Funding

University of Massachusetts Center for Clinical and Translational ScienceTL1TR001454 · NCATS · UNIV OF MASSACHUSETTS MED SCH WORCESTER · PI LEWIS, BRIAN C · 2015 to 2024
$3.6M
NIH HHS TL1TR001454
6 · The paper itself

Abstract

backgroundSmall bowel lesions (SBL) are rare, representing diagnostic and management challenges. The purpose of this cross-sectional study was to evaluate diagnostic modalities used and management practices of patients with SBL at an advanced endoscopic referral center.

methodsWe analyzed patients undergoing surgical management for SBL from 2005 to 2015 at a single tertiary care center. Patients were stratified into gastrointestinal bleed/anemia (GIBA) or obstruction/pain (OP).

resultsOne hundred and twelve patients underwent surgery after presenting with either GIBA (n = 67) or OP (n = 45). The mean age of our study population was 61.8 years and 45% were women. Patients with GIBA were more likely to have chronic or acute-on-chronic symptoms (100% vs 67%) and more often referred from outside hospitals (82 vs. 44%) (p < 0.01). The most common preoperative imaging modalities were video capsule endoscopy (VCE) (96%) for GIBA and computer tomography CT (78%) for OP. Findings on VCE and CT were most frequently concordant with operative findings in GIBA (67%) and OP (54%) patients, respectively. Intraoperatively, visual inspection or palpation of the bowel successfully identified lesions in 71% of patients. When performed in GIBA (n = 26), intraoperative enteroscopy (IE) confirmed or identified lesions in 69% of patients. Almost all (90%) GIBA patients underwent small bowel resections; most were laparoscopic-assisted (93%). Among patients with OP, 58% had a small bowel resection and the majority (81%) were laparoscopic-assisted. Surgical exploration failed to identify lesions in 10% of GIBA patients and 24% of OP patients. Among patients who underwent resections, 20% of GIBA patients had recurrent symptoms compared with 13% of OP patients.

conclusionManagement and identification of SBL is governed by presenting symptomatology. Optimal management includes VCE and IE for GIBA and CT scans for OP patients. Comprehensive evaluation may require referral to specialized centers.

Indexed as

Abdominal PainAdultAgedAnemiaCapsule EndoscopyCross-Sectional StudiesEndoscopy, GastrointestinalFemaleGastrointestinal HemorrhageHumansIntestinal DiseasesIntestinal ObstructionIntestine, SmallMaleMiddle AgedRecurrenceGastrointestinal bleedMinimally-invasive surgerySmall bowel

Identifiers

PMID29372393
OpenAlexW2793357021

What OpenQuestion holds

Textmetadata
Read underepoch 390

Registered trials

None linked

Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.