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Crohn Disease: HELP
Articles by Emanuele Casciani
Based on 7 articles published since 2008

Between 2008 and 2019, Emanuele Casciani wrote the following 7 articles about Crohn Disease.
+ Citations + Abstracts
1 Review Enteroscopy in paediatric Crohn's disease. 2013

Di Nardo, Giovanni / de Ridder, Lissy / Oliva, Salvatore / Casciani, Emanuele / Escher, Johanna C / Cucchiara, Salvatore. ·Department of Pediatrics, Pediatric Gastroenterology and Liver Unit, Sapienza University of Rome, Italy. ·Dig Liver Dis · Pubmed #22947488.

ABSTRACT: Small bowel evaluation is crucial in children with suspected inflammatory bowel disease to differentiate Crohn's disease from other enteropathies, in making therapeutic decisions and planning the follow-up. Endoscopic investigation of small bowel has historically been difficult due to the length and tortuosity of the organ itself. New technology, introduced over the past decade, allows minimally invasive and detailed endoscopic evaluation of the entire small bowel mucosa. While understudied in the paediatric population, literature is emerging supporting the use of these techniques in children. In this review we will provide an overview on the currently available technology, on its feasibility in paediatric age and on the available literature concerning the use of enteroscopy in paediatric Crohn's disease.

2 Review Investigation of small bowel in pediatric Crohn's disease. 2012

Di Nardo, Giovanni / Aloi, Marina / Oliva, Salvatore / Civitelli, Fortunata / Casciani, Emanuele / Cucchiara, Salvatore. ·Department od Pediatrics and Infantile Neuropsychiatry, Pediatric Gastroenterology and Liver Unit, Sapienza University of Rome, University Hospital Umberto I, Rome, Italy. ·Inflamm Bowel Dis · Pubmed #22275336.

ABSTRACT: Investigation of the small bowel has been traditionally a challenge for pediatric gastroenterologists due to its location, anatomical tortuosity, and invasiveness of the available techniques. Recently, there has been a remarkable improvement in imaging and endoscopic tools aimed at exploring successfully the small intestine in inflammatory bowel disease. The former are represented by ultrasonography (either alone or with administration of oral contrast agents) and by magnetic resonance: both have provided accurate methods to detect structural bowel changes, diminishing patient discomfort and precluding radiation hazard. The use of traditional radiologic techniques such as fluoroscopy have been markedly reduced due to radiation exposure and inability to depict transmural inflammation or extraluminal complications. Among the novel endoscopic tools, capsule endoscopy and balloon-assisted enteroscopy have tremendously opened new diagnostic and therapeutic perspectives, by allowing the direct visualization of small intestinal mucosa and, through enteroscopy, histological diagnosis as well as therapeutic interventions such as stricture dilation and bleeding treatment. These endoscopic techniques should always be preceded by imaging of the intestine in order to identify strictures. This review describes the most recent progress with the employment of novel imaging and endoscopic methodologies for investigating the small bowel in children with suspected or established Crohn's disease.

3 Clinical Trial Colon capsule endoscopy compared with other modalities in the evaluation of pediatric Crohn's disease of the small bowel and colon. 2016

Oliva, Salvatore / Cucchiara, Salvatore / Civitelli, Fortunata / Casciani, Emanuele / Di Nardo, Giovanni / Hassan, Cesare / Papoff, Paola / Cohen, Stanley A. ·Pediatric Gastroenterology and Liver Unit, Sapienza University of Rome, Rome, Italy. · Radiology DEA, Sapienza-University of Rome, Rome, Italy. · Gastrointestinal Endoscopy Unit, Chatolic University of Rome, Rome, Italy. · Pediatric Intensive Care Unit, Sapienza-University of Rome, Rome, Italy. · Children's Center for Digestive Health Care, Atlanta, Georgia, USA. ·Gastrointest Endosc · Pubmed #26363334.

ABSTRACT: BACKGROUND AND AIMS: Data on colon capsule endoscopy (CCE) in evaluating the small bowel and colon concurrently are rare. This study aimed to evaluate the accuracy of CCE in assessing disease activity of the small bowel and colon in pediatric Crohn's disease (CD) by comparison with magnetic resonance enterography (MRE), small-intestine contrast US (SICUS), and ileocolonoscopy. METHODS: We prospectively enrolled 40 consecutive patients (22 male, 18 female, mean age 13.1 ± 3.1 years) with CD of the small bowel and colon. All underwent SICUS, MRE, CCE, and ileocolonoscopy sequentially over 5 days. All investigators were blinded to patient history and test results. Patients were classified as active or inactive for the small bowel and the colon according to specific criteria for each tool (simple endoscopic score for CD, Lewis score, US and magnetic resonance parameters of activity). For colon mucosa evaluation, ileocolonoscopy was the comparator. For the small bowel, a consensus panel was convened. RESULTS: Sensitivity of CCE to detect colon inflammation was 89%, and specificity was 100%. The positive predictive value (PPV) and negative predictive value (NPV) of CCE for colon inflammation were 100% and 91%, respectively. In the small bowel, CCE showed 90% sensitivity, 94% specificity, with PPV and NPV of 95% and 90%, respectively. Accuracy parameters for SICUS (sensitivity 90%, specificity 83%) and MRE (sensitivity 85%, specificity 89%) were lower than those for CCE. No serious adverse events related to the CCE procedure or preparation were reported. CONCLUSIONS: CCE is of great usefulness in evaluating both small bowel and colon mucosa in pediatric CD. This single, noninvasive tool makes it possible to evaluate the small-bowel and the colon concurrently with high diagnostic accuracy. Future multicenter studies need to define the role of CCE in the routine management of pediatric patients with CD. ( CLINICAL TRIAL REGISTRATION NUMBER: NCT02199626.).

4 Clinical Trial Usefulness of single-balloon enteroscopy in pediatric Crohn's disease. 2012

Di Nardo, Giovanni / Oliva, Salvatore / Aloi, Marina / Rossi, Paolo / Casciani, Emanuele / Masselli, Gabriele / Ferrari, Federica / Mallardo, Saverio / Stronati, Laura / Cucchiara, Salvatore. ·Department of Pediatrics, Sapienza University of Rome, Rome, Italy. ·Gastrointest Endosc · Pubmed #21855873.

ABSTRACT: BACKGROUND: Single-balloon enteroscopy (SBE) has not been reported in pediatric Crohn's disease (CD). OBJECTIVE: To determine technical performance, yield, safety, and clinical impact of SBE in pediatric patients with suspected and established CD. DESIGN: Prospective, cohort study. SETTING: Academic tertiary-care referral center. PATIENTS: This study involved 16 patients (group A) with suspected CD and unspecific upper and lower GI endoscopy results and 14 patients (group B) with longstanding CD with previous surgery and showing signs unaccountable by conventional endoscopy. All underwent magnetic resonance imaging, and 14 patients in group A also underwent wireless capsule endoscopy. INTERVENTION: SBE. MAIN OUTCOME MEASUREMENTS: SBE diagnostic and therapeutic yield, technical performance, clinical impact, and safety. RESULTS: In group A, SBE aided diagnosis of CD in 12 patients and eosinophilic enteropathy in 2 patients, whereas no lesions were found in 2 patients. WCE was diagnostic of CD in 3 patients, suggestive of CD in 7 patients, and unspecific in the remaining patients. In group B, SBE revealed moderate-to-severe disease activity in most patients, leading to the introduction of or change in biological therapy, with a marked decrease in the pediatric Crohn's disease activity index scores. SBE allowed successful dilation of small-bowel strictures in 2 patients in group A and 3 in group B. No complications occurred. LIMITATIONS: Small sample size, no direct comparison with imaging or other endoscopic techniques. CONCLUSION: SBE is a useful and safe endoscopic procedure for evaluating the small bowel in pediatric patients with suspected or established CD. Not only does it allow a definite diagnosis of CD when the latter is uncertain, but it is also very effective in the management of small-bowel strictures, thus avoiding surgery. It may be helpful in redirecting therapy in selected CD patients.

5 Article Magnetic resonance enterography, small-intestine contrast US, and capsule endoscopy to evaluate the small bowel in pediatric Crohn's disease: a prospective, blinded, comparison study. 2015

Aloi, Marina / Di Nardo, Giovanni / Romano, Giusy / Casciani, Emanuele / Civitelli, Fortunata / Oliva, Salvatore / Viola, Franca / Maccioni, Francesca / Gualdi, Gianfranco / Cucchiara, Salvatore. ·Pediatric Gastroenterology and Liver Unit, Sapienza University of Rome, Rome, Italy. · Radiology DEA, Sapienza University of Rome, Rome, Italy. · Radiologic, Oncologic and Anatomophatological Sciences, Sapienza University of Rome, Rome, Italy. ·Gastrointest Endosc · Pubmed #25115363.

ABSTRACT: BACKGROUND: Small-bowel (SB) disease is a severe clinical entity among the phenotypes of Crohn's disease (CD). OBJECTIVE: To assess sensitivity, specificity, and accuracy of magnetic resonance enterography (MRE), small-intestine contrast US (SICUS), and capsule endoscopy (CE) in the diagnosis of pediatric SB-CD. DESIGN: Prospective, blinded, comparison study. SETTING: Tertiary center for pediatric inflammatory bowel disease. PATIENTS: Children with known or suspected CD. Diagnosis of SB obstruction at SICUS or MRE excluded patients from the study. INTERVENTION: Patients underwent ileocolonoscopy, MRE, SICUS, and CE over a 7-day period. For the imaging evaluation, SB was divided into 3 segments: jejunum, proximal and mid ileum, and terminal ileum. MAIN OUTCOME MEASUREMENTS: The performance of each method was compared to a consensus reference standard for upper SB and to ileocolonoscopy for the terminal ileum. RESULTS: Twenty-five patients completed the study. In the jejunum, the sensitivity of SICUS and CE was 92%, which was not significantly higher than MRE (75%); the specificity of CE (61%) was significantly lower than that of MRE (P = .04). In the proximal and mid ileum, MRE and CE did not have significantly higher sensitivity (100%) than SICUS (80%), but CE was less specific (P > .05). At the terminal ileum, SICUS and MRE were slightly more sensitive than CE (94% vs. 81%); however, the latter was more specific. LIMITATIONS: Use of the consensus reference standard for upper SB. Small number of patients. CONCLUSION: SICUS, MRE, and CE are all effective options for imaging SB. An integrated use of different tools should be suggested to achieve a complete assessment of the SB in children with suspected or confirmed CD.

6 Article Disease course and efficacy of medical therapy in stricturing paediatric Crohn's disease. 2013

Aloi, Marina / Viola, Franca / D'Arcangelo, Giulia / Di Nardo, Giovanni / Civitelli, Fortunata / Casciani, Emanuele / Oliva, Salvatore / Nuti, Federica / Dilillo, Anna / Cucchiara, Salvatore. ·Department of Pediatrics, Pediatric Gastroenterology and Liver Unit, Sapienza University of Rome, Italy. ·Dig Liver Dis · Pubmed #23465684.

ABSTRACT: BACKGROUND: Stricturing is the most common complicated phenotype in paediatric Crohn's disease, but only few studies have described its course, while data on the outcome of medical treatment are scanty. AIM: To retrospectively describes the course of paediatric stricturing Crohn's disease and assess clinical and imaging response to medical therapy. PATIENTS AND METHODS: Thirty-six patients with stricturing Crohn's disease were identified by our department database. Paediatric Crohn's disease activity index, need of surgery and magnetic resonance were evaluated as outcomes at 6, 12, 18 and 24 months after detection of stenosis. RESULTS: Strictures were ileal, ileocolonic and colonic in 61%, 28% and 11% of patients. Thirteen (36%) had stricturing disease at the diagnosis of Crohn's disease, while 64% developed it at the follow-up. At baseline, 89% had medical treatment, while 11% surgery. At 6, 12, 18, and 24 months, 53%, 50%, 42%, and 35% had complete response to medical treatment, respectively. Overall, 44% were unresponsive to medical therapy and required surgery at the follow-up. Responders and non-responders significantly differed for inflammatory imaging findings at the stenosis detection. CONCLUSIONS: A stricturing phenotype is not uncommon at the diagnosis of Crohn's disease in children. Medical therapy seems poorly effective in avoiding intestinal resection. Magnetic resonance imaging is valuable in identifying patients who will benefit from medical therapy.

7 Article MR enterography versus capsule endoscopy in paediatric patients with suspected Crohn's disease. 2011

Casciani, Emanuele / Masselli, Gabriele / Di Nardo, Giovanni / Polettini, Elisabetta / Bertini, Luca / Oliva, Salvatore / Floriani, Irene / Cucchiara, Salvatore / Gualdi, Gianfranco. ·Radiology DEA, Azienda Policlinico Umberto I, La Sapienza University, Via del Policlinico, 155, 00166 Rome, Italy. emanuelecasciani@gmail.com ·Eur Radiol · Pubmed #20922391.

ABSTRACT: OBJECTIVE: The aim of this prospective study was to compare the diagnostic yield of MR enterography (MRE) with small-bowel capsule endoscopy (SBCE) in paediatric patients with suspected Crohn's disease (CD). METHODS: Paediatric patients with suspected CD were considered eligible to be enrolled in the study. All patients underwent diagnostic work-up including 1.5-T MRE, ileo-colonoscopy and oesophagogastroduodenoscopy. SBCE was not performed if MRE showed SB stricture or extra-intestinal findings consistent with symptoms. RESULTS: Sixty consecutive paediatric patients (36 male; average age 14) were enrolled into the study. A positive diagnosis for CD was made in 19 patients, 29 had a negative result and 12 were affected by other gastro-intestinal conditions. SBCE was performed in 37 patients (61.7%); 23 patients were excluded (strictures in five, extra-intestinal findings in 11 and parents' refusal in seven cases). The accuracy, sensitivity, and specificity of MRE and SBCE were 98.3%, 100%, 97.6%, and 91.9%, 90.9%, 92.3%, respectively. CONCLUSION: Both MRE and SBCE are accurate methods for patients with suspected CD. MRE can be used as a primary imaging technique in suspected CD, in that it allows access to the ileal stricture, which forms a contra-indication for SBCE and provides extra-intestinal information.