Objective evaluation of blood flow in the small-intestinal villous: quantification of findings from dynamic endoscopy with concomitant narrow-band imaging

Abstract

Background and aims We have previously shown that the increase in blood flow volume in jejunum villi after spraying of 10 % dextrose solution correlates with pancreatic exocrine function (PEF). The aim of this study was to establish an objective method to evaluate the amount of jejunum villous blood flow using a novel image analysis system.

Patients and methods The subjects were 26 patients who underwent upper gastrointestinal endoscopy with a newly developed small intestine endoscope (SIF-Y0007, Olympus, Tokyo, Japan). By defining the ratio of capillary occupancy in each villus at levels from 1 to 5, villous blood flow was evaluated subjectively on the villous blood flow scale (VBFS). Objective evaluation was performed based on luminance analysis. The morphological opening process was used to make images with leveled brightness. A histogram was prepared from the luminance information and the standard deviation was determined and defined as SDOV (Standard Deviation calculated from a histogram made by luminance analysis Of Villi). PEF was evaluated by measuring the BT-PABA (N-benzoyl-L-tyrosyl-p-aminobenzoic acid) excretion rate.

Results There was a significant positive correlation between VBFS and SDOV (P < 0.0001, ρ = 0.5882). SDOV was also positively correlated with PEF (P = 0.0004, ρ = 0.6421).

Conclusions SDOV is a new objective index for evaluation of blood flow volume in jejunum villi. SDOV may be useful in clinical practice to estimate PEF and for clarification of the mechanisms underlying the functional correlation between the pancreas and small intestine.

• References

• 1 Bachmann J, Heiligensetzer M, Krakowski-Roosen H. et al. Cachexia worsens prognosis in patients with resectable pancreatic cancer. J Gastrointest Surg 2008; 12: 1193-1201
• 2 Dewys WD, Begg C, Lavin PT. et al. Prognostic effect of weight loss prior to chemotherapy in cancer patients. Eastern Cooperative Oncology Group. Am J Med 1980; 69: 491-497
• 3 Altmann GG. Influence of bile and pancreatic secretions on the size of the intestinal villi in the rat. Am J Anat 1971; 132: 167-177
• 4 Senegas-Balas F, Bastie MJ, Balas D. et al. Histological variations of the duodenal mucosa in chronic human pancreatitis. Dig Dis Sci 1982; 27: 917-922
• 5 Gubergrits NB, Linevskiy YV, Lukashevich GM. et al. Morphological and functional alterations of small intestine in chronic pancreatitis. JOP 2012; 13: 519-528
• 6 Nakamura Y, Itoh A, Kawashima H. et al. Investigation of morphological and functional changes in the small intestine with pancreatic disease. Pancreas 2015; 44: 1352-1357
• 7 Hayashi D, Hirooka Y, Kawashima H. et al. Functional correlation between the pancreas and the small intestine in humans: the first evaluation using a newly developed enteroscopy. Pancreas 2018; 47: 601-608
• 8 Shimosegawa T, Kataoka K, Kamisawa T. et al. The revised Japanese clinical diagnostic criteria for chronic pancreatitis. J Gastroenterol 2010; 45: 584-591
• 9 Shimosegawa T, Chari ST, Frulloni L. et al. International consensus diagnostic criteria for autoimmune pancreatitis: guidelines of the International Association of Pancreatology. Pancreas 2011; 40: 352-358
• 10 Vincent L. Morphological grayscale reconstruction in image analysis: Applications and efficient algorithms. IEEE Trans Image Process 1993; 2: 176-201
• 11 Haralick RM, Sternberg SR, Zhuang X. Image analysis using mathematical morphology. IEEE Trans Pattern Anal Mach Intell 1987; PAMI-9: 532-550
• 12 Ihaka R, Gentleman R. R: a language for data analysis and graphics. J Comp Graph Stat 1996; 5: 299-314
• 13 Wickham H. ggplot2: Elegant graphics for data analysis. New York: Springer-Verlag; 2009
• 14 Baumler MD, Nelson DW, Ney DM. et al. Loss of exocrine pancreatic stimulation during parenteral feeding suppresses digestive enzyme expression and induces Hsp70 expression. Am J Physiol Gastrointest Liver Physiol 2007; 292: G857-866
• 15 Baumler MD, Koopmann MC, Thomas DD. et al. Intravenous or luminal amino acids are insufficient to maintain pancreatic growth and digestive enzyme expression in the absence of intact dietary protein. Am J Physiol Gastrointest Liver Physiol 2010; 299: G338-347
• 16 Rasmussen HH, Irtun O, Olesen SS. et al. Nutrition in chronic pancreatitis. World J Gastroenterol 2013; 19: 7267-7275
• 17 Gilliland TM, Villafane-Ferriol N, Shah KP. et al. Nutritional and metabolic derangements in pancreatic cancer and pancreatic resection. Nutrients 2017; 9: E243