title: Endoscopic and imaging findings in protein-losing enteropathy.
abstract: OBJECTIVE
  Protein-losing enteropathy (PLE) is often difficult to diagnose. We evaluated the diagnostic yields of underlying diseases of PLE among esophagogastroduodenoscopy, colonoscopy, fluoroscopic conventional enteroclysis (FCE), videocapsule endoscopy (VCE), and double-balloon enteroscopy (DBE) and prognosis after treatment.
  
  
  METHODS
  Between June 2003 and August 2010, 25 consecutive patients with PLE confirmed by fecal α1-antitrypsin clearance (n=18) and technetium 99m human serum albumin scintigraphy (n=19) were enrolled, investigated, and treated.
  
  
  RESULTS
  Of 25 patients, 4 (16%) with intestinal lymphangiectasia secondary to macroglobulinemia (n=1), amyloidosis (n=2), and strongyloidiasis (n=1) were diagnosed at preceding esophagogastroduodenoscopy or colonoscopy, and 7 (32%) with primary intestinal lymphangiectasia and chronic nonspecific multiple ulcers unrelated to nonsteroidal anti-inflammatory drugs of the small intestine were newly diagnosed at FCE or VCE. Other 11 (44%) patients with primary intestinal lymphangiectasia, small-bowel tumors, amyloidosis, chronic nonspecific multiple ulcers unrelated to nonsteroidal anti-inflammatory drugs of the small intestine, Crohn's disease, and small-bowel ulcers due to polyarteritis nodosa were diagnosed only at DBE with biopsy. Three patients with primary intestinal lymphangiectasia, cirrhosis after living donor liver transplantation, and congestive heart failure were not diagnosed at any small-bowel examination. The overall diagnostic yield of FCE, VCE, and DBE was 62% (8/13), 83% (14/17), and 88% (22/25), respectively. Eight patients (32%) died of underlying disorders regardless of medical treatment over the follow-up period.
  
  
  CONCLUSIONS
  DBE with pathologic findings of biopsy specimens was useful for the differential diagnosis of PLE. Noninvasive VCE might be preferable and useful for screening and follow up of PLE without stricture. Prognosis of a subgroup of PLE was poor regardless of treatment.
authors.affiliation: Department of Gastroenterology, Nagoya University Graduate School of Medicine, Nagoya, Japan.
authors.forename: Hiroyuki
authors.initials: H
authors.lastname: Takenaka
authors.forename: Naoki
authors.initials: N
authors.lastname: Ohmiya
authors.forename: Yoshiki
authors.initials: Y
authors.lastname: Hirooka
authors.forename: Masanao
authors.initials: M
authors.lastname: Nakamura
authors.forename: Eizaburo
authors.initials: E
authors.lastname: Ohno
authors.forename: Ryoji
authors.initials: R
authors.lastname: Miyahara
authors.forename: Hiroki
authors.initials: H
authors.lastname: Kawashima
authors.forename: Akihiro
authors.initials: A
authors.lastname: Itoh
authors.forename: Osamu
authors.initials: O
authors.lastname: Watanabe
authors.forename: Takafumi
authors.initials: T
authors.lastname: Ando
authors.forename: Hidemi
authors.initials: H
authors.lastname: Goto
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D053705:Capsule Endoscopes; D053704:Capsule Endoscopy / Q000379:methods*; D003113:Colonoscopy / Q000379:methods; D058582:Double-Balloon Enteroscopy / Q000379:methods*; D016145:Endoscopy, Digestive System / Q000379:methods; D016099:Endoscopy, Gastrointestinal / Q000379:methods; D005260:Female; D005471:Fluoroscopy / Q000379:methods*; D006801:Humans; D007421:Intestine, Small / Q000473:pathology; D008297:Male; D008875:Middle Aged; D011379:Prognosis; D011504:Protein-Losing Enteropathies / Q000175:diagnosis* / Q000473:pathology*; D055815:Young Adult