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Flynn DJ, Feuerstein JD. In transfusion-dependent, angiodysplasia-related anemia, adding octreotide to usual care reduced transfusions at 1 y. Ann Intern Med 2024; 177:JC69. [PMID: 38830221 DOI: 10.7326/annals-24-00517-jc] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 06/05/2024] Open
Abstract
SOURCE CITATION Goltstein LC, Grooteman KV, Bernts LH, et al. Standard of care versus octreotide in angiodysplasia-related bleeding (the OCEAN study): a multicenter randomized controlled trial. Gastroenterology. 2024;166:690-703. 38158089.
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Affiliation(s)
- Duncan J Flynn
- Beth Israel Deaconess Medical Center, Boston, Massachusetts, USA (D.J.F., J.D.F.)
| | - Joseph D Feuerstein
- Beth Israel Deaconess Medical Center, Boston, Massachusetts, USA (D.J.F., J.D.F.)
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Tai FWD, Chetcuti-Zammit S, Sidhu R. Small bowel angioectasia-The clinical and cost impact of different management strategies. Clin Res Hepatol Gastroenterol 2023; 47:102193. [PMID: 37553067 DOI: 10.1016/j.clinre.2023.102193] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/31/2023] [Revised: 07/26/2023] [Accepted: 08/06/2023] [Indexed: 08/10/2023]
Abstract
BACKGROUND The management of patients with recurrent anaemia and small bowel angioectasia (SBA) is costly and challenging. AIMS/METHODS In this retrospective cohort study, we examined the clinical and cost implication of a combination therapy of Somatostatin analogues (SA) and endoscopic ablation, endoscopic therapy alone, and conservative management. RESULTS Median number of bleeding episodes reduced from 3.5 (IQR 4) in the year before, to 1 (IQR 2) in the year after starting combination therapy with SA (p = 0.002). There were no differences in number of bed days (13.7 vs. 15.3, p = 0.66) and cost (£10,835 vs £11,653, p = 0.73) in the year before and after starting combination therapy. There was a trend towards a reduction in median number of blood transfusions episodes (17 vs 5, p = 0.07) and therapeutic endoscopies (1 vs. 0, p = 0.05) after starting SA. In patients suitable for endoscopic therapy alone, time spent in hospital was reduced (-3.5 days, p = 0.004), but bleeding episodes, transfusions and cost of treatment were not different. Patients requiring a combination therapy were significantly more co-morbid with a mean (± sd) Charlson comorbidity index (CCI) of 7.1 (± 2.7). Higher CCI (OR 2.1, 95% CI 1.1-3.9) and presence of chronic renal failure (OR 4.1, 95% CI 1.4-12.4) predicted escalation to combination therapy. CONCLUSIONS SAs may be a useful adjunct to endoscopic therapy for transfusion dependent comorbid patients. In the first year they reduce bleeding episodes. Cost in the 1-year before and after adding on SA are no different suggesting additional clinical benefit can be gained without additional cost.
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Affiliation(s)
- Foong Way David Tai
- Academic Unit of Gastroenterology, Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield, UK.
| | | | - Reena Sidhu
- Academic Unit of Gastroenterology, Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield, UK
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Correia J, Pinho R, Rodrigues A, Ponte A, Gomes C, Afecto E, Estevinho M, Freitas T. Small-Bowel Angioectasias: Are They Responsible for a Real Impact on Survival? GE PORTUGUESE JOURNAL OF GASTROENTEROLOGY 2023; 30:336-342. [PMID: 37868636 PMCID: PMC10586209 DOI: 10.1159/000524268] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/09/2021] [Accepted: 01/24/2022] [Indexed: 09/02/2023]
Abstract
Introduction This study aimed to evaluate the effect of small-bowel angioectasia on survival, given the hypothesis that angioectasia might be an independent risk factor of frailty and poor outcomes. Methods In this retrospective cohort study, all patients undergoing small-bowel capsule endoscopy between 2010 and 2013 for obscure gastrointestinal bleeding from a Portuguese tertiary centre were included. Follow-up started after capsule endoscopy and ended upon death or end of the study (November 2020). Survival analysis was performed using a Cox proportional-hazards model, in order to analyse the effect of small-bowel angioectasia on survival as well as potentially confounding factors (age, vascular diseases and chronic kidney disease). Results A total of 176 patients were included in this study (50.6% male), with a median age of 68.5 years (IQR 24). The median follow-up was 7 years (IQR 4), during which 67 (38.1%) patients died. Seventy-three (41.5%) patients had at least one small-bowel angioectasia on capsule endoscopy. On multivariate Cox regression analysis, only age, peripheral arterial disease, history of previous mesenteric ischaemia and chronic kidney disease were independent risk factors of death. The presence of small-bowel angioectasia did not affect survival in this analysis (HR 1.30; 95% CI 0.75-2.23; p = 0.35). Conclusion In this retrospective cohort study, some comorbidities and age were independent predictors of poor survival. The presence of small-bowel angioectasia per se did not affect survival.
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Affiliation(s)
- João Correia
- Serviço de Gastrenterologia, Centro Hospitalar de Vila Nova de Gaia/Espinho, EPE, Vila Nova de Gaia, Portugal
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Nationwide cohort study identifies clinical outcomes of angioectasia in patients with acute hematochezia. J Gastroenterol 2022; 58:367-378. [PMID: 36564578 DOI: 10.1007/s00535-022-01945-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/17/2022] [Accepted: 12/18/2022] [Indexed: 12/24/2022]
Abstract
BACKGROUND While angioectasia is an important cause of acute hematochezia, relevant clinical features remain unclear. This study aims to reveal risk factors, clinical outcomes, and the effectiveness of therapeutic endoscopy for patients with acute hematochezia due to angioectasia. METHODS This retrospective cohort study was conducted at 49 Japanese hospitals between January 2010 and December 2019, enrolling patients hospitalized for acute hematochezia (CODE BLUE-J study). Baseline factors and clinical outcomes for angioectasia were analyzed. RESULTS Among 10,342 patients with acute hematochezia, 129 patients (1.2%) were diagnosed with angioectasia by colonoscopy. The following factors were significantly associated with angioectasia: chronic kidney disease, liver disease, female, body mass index < 25, and anticoagulant use. Patients with angioectasia were at a significant increased risk of blood transfusions compared to those without angioectasia (odds ratio [OR] 2.61; 95% confidence interval [CI] 1.69-4.02). Among patients with angioectasia, 36 patients (28%) experienced rebleeding during 1-year follow-up. The 1-year cumulative rebleeding rates were 37.0% in the endoscopic clipping group, 14.3% in the coagulation group, and 32.8% in the conservative management group. Compared to conservative management, coagulation therapy significantly reduced rebleeding risk (P = 0.038), while clipping did not (P = 0.81). Multivariate analysis showed coagulation therapy was an independent factor for reducing rebleeding risk (hazard ratio [HR] 0.40; 95% CI 0.16-0.96). CONCLUSIONS Our data showed patients with angioectasia had a greater comorbidity burden and needed more blood transfusions in comparison with those without angioectasia. To reduce rebleeding risk, coagulation therapy can be superior for controlling hematochezia secondary to angioectasia.
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Limsrivilai J, Chaemsupaphan T, Khamplod S, Srisajjakul S, Kositamongkol C, Phisalprapa P, Maipang K, Kaosombatwattana U, Pausawasdi N, Charatcharoenwitthaya P, Leelakusolvong S, Pongprasobchai S. "MURAL" model to predict bleeding from mural-based lesions in potential small bowel bleeding may improve diagnostic capability and decrease cost. Medicine (Baltimore) 2022; 101:e31989. [PMID: 36482571 PMCID: PMC9726317 DOI: 10.1097/md.0000000000031989] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Abstract
In potential small bowel bleeding, video capsule endoscopy (VCE) is excellent to detect mucosal lesions, while mural-based lesions are better detected by computed tomography enterography (CTE). A predictive tool to identify mural-based lesions should guide selecting investigations. In this retrospective study, we developed and validated the "MURAL" model based on logistic regression to predicts bleeding from mural-based lesions. Cost-effectiveness analysis comparing diagnostic strategy among VCE, CTE, and MURAL model was performed. Of 296 patients, 196 and 100 patients were randomly included in the derivative and validation cohorts, respectively. The MURAL model comprises 5 parameters: age, presence of atherosclerosis, chronic kidney disease, antiplatelet use, and serum albumin level. The area under the receiver operating characteristic curve was 0.778 and 0.821 for the derivative and validation cohorts, respectively. At a cutoff value of 24.2%, the model identified mural-based lesions with 70% sensitivity and 83% specificity in the validation cohort. Cost-effectiveness analysis revealed that application of the MURAL model demonstrated a comparable missed lesion rate but had a lower missed tumor rate, and lower cost compared to VCE strategy. The model for predicting mural-based lesions provide some guidance in investigative decision-making, which may improve diagnostic efficiency and reduce costs.
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Affiliation(s)
- Julajak Limsrivilai
- Division of Gastroenterology, Department of Medicine, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand
| | - Thanaboon Chaemsupaphan
- Division of Gastroenterology, Department of Medicine, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand
| | - Sipawath Khamplod
- Division of Gastroenterology, Department of Medicine, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand
| | - Sitthipong Srisajjakul
- Department of Radiology, Division of Diagnostic Radiology, Faculty of Medicine, Siriraj Hospital, Mahidol University, Bangkok, Thailand
| | - Chayanis Kositamongkol
- Division of Ambulatory Medicine, Department of Medicine, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand
| | - Pochamana Phisalprapa
- Division of Ambulatory Medicine, Department of Medicine, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand
| | - Kochakon Maipang
- Division of Gastroenterology, Department of Medicine, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand
| | - Uayporn Kaosombatwattana
- Division of Gastroenterology, Department of Medicine, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand
| | - Nonthalee Pausawasdi
- Division of Gastroenterology, Department of Medicine, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand
| | - Phunchai Charatcharoenwitthaya
- Division of Gastroenterology, Department of Medicine, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand
| | - Somchai Leelakusolvong
- Division of Gastroenterology, Department of Medicine, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand
| | - Supot Pongprasobchai
- Division of Gastroenterology, Department of Medicine, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand
- * Correspondence: Supot Pongprasobchai, Associate Professor of Medicine, Division of Gastroenterology, Department of Medicine, Faculty of Medicine Siriraj Hospital, Mahidol University, 2 Wanglang Road, Bangkoknoi, Bangkok 10700, Thailand (e-mail: )
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Goltstein LC, Rooijakkers MJ, Görtjes NC, Akkermans RP, Zegers ES, Pisters R, van Wely MH, van der Wulp K, Drenth JP, van Geenen EJ, van Royen N. Reduction of Gastrointestinal Bleeding in Patients With Heyde Syndrome Undergoing Transcatheter Aortic Valve Implantation. Circ Cardiovasc Interv 2022; 15:e011848. [PMID: 35861798 PMCID: PMC9287099 DOI: 10.1161/circinterventions.122.011848] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/14/2022] [Accepted: 04/29/2022] [Indexed: 11/21/2022]
Abstract
BACKGROUND Heyde syndrome is the co-occurrence of aortic stenosis and gastrointestinal bleeding secondary to angiodysplasias. Surgical aortic valve replacement effectively reduces bleeding, but the effects of transcatheter aortic valve implantation (TAVI) are largely unknown. This study aimed to describe the reduction of gastrointestinal bleeding in patients with Heyde syndrome after TAVI and to identify the factors associated with rebleeding. METHODS We enrolled patients with Heyde syndrome from a prospective TAVI registry. Gastrointestinal bleeding episodes were assessed by the Bleeding Academic Research Consortium classification, and cumulative incidence functions were used to calculate cessation rates. Factors potentially associated with rebleeding were analyzed using logistic regression. Differences between Heyde and non-Heyde patients were assessed through a case-cohort study. RESULTS Between December 2008 and June 2020, 1111 patients underwent TAVI. There were 70 patients with Heyde syndrome (6.3%). In the first year following TAVI, gastrointestinal bleeding ceased in 46 of 70 patients (62% [95% CI, 50%-74%]). Bleeding episodes decreased from 3.2 (95% CI, 2.5-4.2) to 1.6 ([95% CI, 1.2-2.2] P=0.001) and hemoglobin levels increased from 10.3 (95% CI, 10.0-10.8) to 11.3 (95% CI, 10.8-11.6) g/dL (P=0.007). Between 1 and 5 years after TAVI (35 [interquartile range, 21-51] months), 53 of 62 patients (83% [95% CI, 72%-92%]) no longer experienced gastrointestinal bleeding. Paravalvular leakage (≥mild) was associated with rebleeding risk (odds ratio, 3.65 [95% CI, 1.36-9.80]; P=0.010). Periprocedural bleeding was more common in Heyde than in control patients (adjusted odds ratio, 2.55 [95% CI, 1.37-4.73]; P=0.003). CONCLUSIONS Patients with Heyde syndrome are at increased risk for periprocedural bleeding. Post-TAVI, gastrointestinal bleeding disappears in the majority of patients. Paravalvular leakage may curtail these clinical benefits.
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Affiliation(s)
- Lia C.M.J. Goltstein
- Department of Gastroenterology and Hepatology (L.C.M.J.G., N.C.C.G., J.P.H.D., E.J.M.v.G.), Radboud University Medical Center, Nijmegen, the Netherlands
| | - Maxim J.P. Rooijakkers
- Department of Cardiology (M.J.P.R., M.H.v.W., K.v.d.W., N.v.R.), Radboud University Medical Center, Nijmegen, the Netherlands
| | - Natasha C.C. Görtjes
- Department of Gastroenterology and Hepatology (L.C.M.J.G., N.C.C.G., J.P.H.D., E.J.M.v.G.), Radboud University Medical Center, Nijmegen, the Netherlands
| | - Reinier P. Akkermans
- Scientific Institute for Quality of Healthcare (IQ Healthcare) (R.P.A.), Radboud University Medical Center, Nijmegen, the Netherlands
| | - Erwin S. Zegers
- Department of Cardiology, Canisius Wilhelmina Ziekenhuis, Nijmegen, the Netherlands (E.S.Z.)
| | - Ron Pisters
- Department of Cardiology, Rijnstate, Arnhem, the Netherlands (R.P.)
| | - Marleen H. van Wely
- Department of Cardiology (M.J.P.R., M.H.v.W., K.v.d.W., N.v.R.), Radboud University Medical Center, Nijmegen, the Netherlands
| | - Kees van der Wulp
- Department of Cardiology (M.J.P.R., M.H.v.W., K.v.d.W., N.v.R.), Radboud University Medical Center, Nijmegen, the Netherlands
| | - Joost P.H. Drenth
- Department of Gastroenterology and Hepatology (L.C.M.J.G., N.C.C.G., J.P.H.D., E.J.M.v.G.), Radboud University Medical Center, Nijmegen, the Netherlands
| | - Erwin J.M. van Geenen
- Department of Gastroenterology and Hepatology (L.C.M.J.G., N.C.C.G., J.P.H.D., E.J.M.v.G.), Radboud University Medical Center, Nijmegen, the Netherlands
| | - Niels van Royen
- Department of Cardiology (M.J.P.R., M.H.v.W., K.v.d.W., N.v.R.), Radboud University Medical Center, Nijmegen, the Netherlands
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Kim Y, Kim JH, Kang EA, Park SJ, Park JJ, Cheon JH, Kim TI, Park J, Jeon SR. Rebleeding Rate and Risk Factors for Rebleeding after Device-Assisted Enteroscopy in Patients with Obscure Gastrointestinal Bleeding: A KASID Multicenter Study. Diagnostics (Basel) 2022; 12:diagnostics12040954. [PMID: 35454002 PMCID: PMC9027880 DOI: 10.3390/diagnostics12040954] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2022] [Revised: 04/01/2022] [Accepted: 04/10/2022] [Indexed: 11/16/2022] Open
Abstract
Introduction: The impact of device-assisted enteroscopy (DAE) on long-term rebleeding in patients with obscure gastrointestinal bleeding (OGIB) exhibiting detectable small-bowel lesions remains unclear. We investigated the long-term rebleeding rate and predictive factors for DAE in patients with OGIB. Method: Patients with OGIB with small bowel lesions detected through DAE were enrolled at three Korean tertiary hospitals. Predictive risk factors associated with rebleeding were analyzed using the Cox regression analysis. Results: From April 2008 to April 2021, 141 patients were enrolled, including 38 patients (27.0%) with rebleeding. The rebleeding rates at 1, 2, and 3 years were 25.0%, 29.6%, and 31.1%, respectively. The Cox regression analysis revealed that multiple small-bowel lesions (hazard ratio [HR]: 2.551, 95% confidence interval [CI]: 1.157–5.627, p = 0.020), the need for more than five packed red blood cells (RBC) transfusions (HR: 2.704, 95% CI: 1.412–5.181, p = 0.003), and ulcerative lesions (HR: 1.992, 95% CI: 1.037–3.826, p = 0.039) were positively associated with rebleeding. Therapeutic interventions for patients with detectable lesions, overt bleeding (vs. occult bleeding), comorbidities, and medications were not associated with rebleeding. Conclusion: More than 25% of patients with OGIB having detectable small-bowel lesions had rebleeding. Patients with multiple lesions, a requirement of more than five packed RBC transfusions, and ulcerative lesions were associated with a higher risk of rebleeding.
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Affiliation(s)
- Yuna Kim
- Department of Internal Medicine and Institute of Gastroenterology, Yonsei University College of Medicine, Seoul 03722, Korea; (Y.K.); (E.-A.K.); (S.-J.P.); (J.-J.P.); (J.-H.C.); (T.-I.K.)
| | - Jae-Hyun Kim
- Division of Gastroenterology, Department of Internal Medicine, Kosin University College of Medicine, Busan 49267, Korea;
| | - Eun-Ae Kang
- Department of Internal Medicine and Institute of Gastroenterology, Yonsei University College of Medicine, Seoul 03722, Korea; (Y.K.); (E.-A.K.); (S.-J.P.); (J.-J.P.); (J.-H.C.); (T.-I.K.)
| | - Soo-Jung Park
- Department of Internal Medicine and Institute of Gastroenterology, Yonsei University College of Medicine, Seoul 03722, Korea; (Y.K.); (E.-A.K.); (S.-J.P.); (J.-J.P.); (J.-H.C.); (T.-I.K.)
| | - Jae-Jun Park
- Department of Internal Medicine and Institute of Gastroenterology, Yonsei University College of Medicine, Seoul 03722, Korea; (Y.K.); (E.-A.K.); (S.-J.P.); (J.-J.P.); (J.-H.C.); (T.-I.K.)
| | - Jae-Hee Cheon
- Department of Internal Medicine and Institute of Gastroenterology, Yonsei University College of Medicine, Seoul 03722, Korea; (Y.K.); (E.-A.K.); (S.-J.P.); (J.-J.P.); (J.-H.C.); (T.-I.K.)
| | - Tae-Il Kim
- Department of Internal Medicine and Institute of Gastroenterology, Yonsei University College of Medicine, Seoul 03722, Korea; (Y.K.); (E.-A.K.); (S.-J.P.); (J.-J.P.); (J.-H.C.); (T.-I.K.)
| | - Jihye Park
- Department of Internal Medicine and Institute of Gastroenterology, Yonsei University College of Medicine, Seoul 03722, Korea; (Y.K.); (E.-A.K.); (S.-J.P.); (J.-J.P.); (J.-H.C.); (T.-I.K.)
- Correspondence: (J.P.); (S.-R.J.)
| | - Seong-Ran Jeon
- Institute for Digestive Research, Digestive Disease Center, Soonchunhyang University College of Medicine, Seoul 04401, Korea
- Correspondence: (J.P.); (S.-R.J.)
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Ismail B, Alayoubi MS, Abdelwadoud M, Castro FJ. Rebleeding after hemoclip versus argon plasma coagulation for gastrointestinal angiodysplasias: a retrospective multicenter study. Eur J Gastroenterol Hepatol 2022; 34:184-191. [PMID: 33731586 DOI: 10.1097/meg.0000000000002098] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/10/2022]
Abstract
BACKGROUND Hemoclips are utilized for treating bleeding gastrointestinal angiodysplastic lesions (GIADs); however, the supporting evidence is limited. AIMS Our aim is to evaluate the efficacy of hemoclips in preventing bleeding secondary to GIADs compared to argon plasma coagulation (APC). METHODS This retrospective study included patients with bleeding gastric, small bowel or colonic GIADs that were endoscopically treated between January 2009 and November 2016. Patients that received hemoclips as monotherapy or in combination were compared to a randomly selected similar number of patients treated with APC. RESULTS We included 157 patients that underwent APC and 141 who received hemoclips. During a median follow-up of 17 months, those with hemoclips had a 32.6% rebleeding vs. 46.5% in the APC group (P = 0.017). On multivariate regression analysis, use of hemoclips was not a significant predictor of rebleeding when compared to APC; hemoclips monotherapy (HR, 0.92; 95% CI, 0.54-1.59) and hemoclips combination (HR, 0.65; 95% CI, 0.41-1.01). When the multivariate analysis was restricted to subjects that resumed antithrombotics after endoscopy, rebleeding risk was lower when hemoclips were used in combination (HR, 0.46; 95% CI, 0.25-0.84) compared to APC. We noted a similar effect in the antithrombotic subgroup even after propensity score matching (HR, 0.51; 95% CI, 0.27-0.95). CONCLUSION Treatment modality was not a significant predictor of rebleeding when studied for the entire population. However, the risk of rebleeding was lower with hemoclips combination therapy compared to APC in patients that resumed antithrombotic therapy, suggesting a potential role for a combined approach in this subgroup of patients.
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Affiliation(s)
- Bahaaeldeen Ismail
- Division of Digestive Diseases and Nutrition, University of Kentucky Chandler Medical Center, Lexington, USA
| | | | - Moaz Abdelwadoud
- Department of Pharmaceutical Health Services Research, University of Maryland, Baltimore, Maryland, USA
| | - Fernando J Castro
- Department of Gastroenterology, Cleveland Clinic Florida, Weston, Florida
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García-Compeán D, Cueto-Aguilera ÁND, González-González JA, Jáquez-Quintana JO, Borjas-Almaguer OD, Jiménez-Rodríguez AR, Muñoz-Ayala JM, Maldonado-Garza HJ. Evaluation and Validation of a New Score to Measure the Severity of Small Bowel Angiodysplasia on Video Capsule Endoscopy. Dig Dis 2022; 40:62-67. [PMID: 33780938 DOI: 10.1159/000516163] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/04/2020] [Accepted: 03/26/2021] [Indexed: 02/05/2023]
Abstract
INTRODUCTION Angiodysplasias are responsible of 50% of small bowel bleeding. An endoscopic method that allows measuring its severity is not available. AIMS The aim of the study was to validate a new endoscopic score with VCE to measure the severity of small bowel angiodysplasias (SBAD). METHODS Four endoscopists independently reviewed VCE videos of 22 patients with SBAD. The score graded 3 variables: A - extent of lesions: E1, located in one half of the intestine and E2, in both halves; B - number of lesions: N1, <5; N2, 5-10; and N3, >10 lesions; C - probability of bleeding: P1, pale red spots; P2, bright red spots; P3, bleeding stigmata; and P4, active bleeding. Capsule Endoscopy Small Bowel Angiodysplasia Activity Index (CESBAI) was calculated as follows: E × 1 + N × 2 + P × 3. Interobserver variability was analyzed by Spearman's correlation and agreement Kappa statistic tests. RESULTS The mean CESBAI scores by observers were O1= 11.6 ± 4.1; O2 = 11.3 ± 4.8; O3 = 11.1 ± 4.9; and O4 = 11.8 ± 4.2 (p > 0.05). Spearman's correlation values of CESBAI between every 2 observers were from 0.61 to 0.94 (p < 0.001) with a global correlation of 0.73 among all observers. Kappa values of CESBAI between every 2 observers ranged from 0.42 to 0.87 (p < 0.001) with a global agreement of 0.57 among all observers. All evaluators stated that the method was easy to use. CONCLUSIONS CESBAI is a reliable and reproducible score. Nevertheless, these results must be validated in other studies with larger population before assessing its power for predicting bleeding recurrence.
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Affiliation(s)
- Diego García-Compeán
- Gastroenterology Service and Department of Internal Medicine, University Hospital "Dr. José E. González" and Faculty of Medicine, Universidad Autónoma de Nuevo León, Monterrey, Mexico
| | - Ángel Noe Del Cueto-Aguilera
- Gastroenterology Service and Department of Internal Medicine, University Hospital "Dr. José E. González" and Faculty of Medicine, Universidad Autónoma de Nuevo León, Monterrey, Mexico
| | - José Alberto González-González
- Gastroenterology Service and Department of Internal Medicine, University Hospital "Dr. José E. González" and Faculty of Medicine, Universidad Autónoma de Nuevo León, Monterrey, Mexico
| | - Joel Omar Jáquez-Quintana
- Gastroenterology Service and Department of Internal Medicine, University Hospital "Dr. José E. González" and Faculty of Medicine, Universidad Autónoma de Nuevo León, Monterrey, Mexico
| | - Omar David Borjas-Almaguer
- Gastroenterology Service and Department of Internal Medicine, University Hospital "Dr. José E. González" and Faculty of Medicine, Universidad Autónoma de Nuevo León, Monterrey, Mexico
| | - Alan Rafael Jiménez-Rodríguez
- Gastroenterology Service and Department of Internal Medicine, University Hospital "Dr. José E. González" and Faculty of Medicine, Universidad Autónoma de Nuevo León, Monterrey, Mexico
| | - Juan Manuel Muñoz-Ayala
- Gastroenterology Service and Department of Internal Medicine, University Hospital "Dr. José E. González" and Faculty of Medicine, Universidad Autónoma de Nuevo León, Monterrey, Mexico
| | - Héctor Jesús Maldonado-Garza
- Gastroenterology Service and Department of Internal Medicine, University Hospital "Dr. José E. González" and Faculty of Medicine, Universidad Autónoma de Nuevo León, Monterrey, Mexico
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Mascarenhas Saraiva M, Ribeiro T, Afonso J, Andrade P, Cardoso P, Ferreira J, Cardoso H, Macedo G. Deep Learning and Device-Assisted Enteroscopy: Automatic Detection of Gastrointestinal Angioectasia. MEDICINA (KAUNAS, LITHUANIA) 2021; 57:medicina57121378. [PMID: 34946323 PMCID: PMC8706550 DOI: 10.3390/medicina57121378] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/30/2021] [Revised: 12/09/2021] [Accepted: 12/16/2021] [Indexed: 02/06/2023]
Abstract
Background and Objectives: Device-assisted enteroscopy (DAE) allows deep exploration of the small bowel and combines diagnostic and therapeutic capacities. Suspected mid-gastrointestinal bleeding is the most frequent indication for DAE, and vascular lesions, particularly angioectasia, are the most common etiology. Nevertheless, the diagnostic yield of DAE for the detection of these lesions is suboptimal. Deep learning algorithms have shown great potential for automatic detection of lesions in endoscopy. We aimed to develop an artificial intelligence (AI) model for the automatic detection of angioectasia DAE images. Materials and Methods: A convolutional neural network (CNN) was developed using DAE images. Each frame was labeled as normal/mucosa or angioectasia. The image dataset was split for the constitution of training and validation datasets. The latter was used for assessing the performance of the CNN. Results: A total of 72 DAE exams were included, and 6740 images were extracted (5345 of normal mucosa and 1395 of angioectasia). The model had a sensitivity of 88.5%, a specificity of 97.1% and an AUC of 0.988. The image processing speed was 6.4 ms/frame. Conclusions: The application of AI to DAE may have a significant impact on the management of patients with suspected mid-gastrointestinal bleeding.
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Affiliation(s)
- Miguel Mascarenhas Saraiva
- Department of Gastroenterology, São João University Hospital, Alameda Professor Hernâni Monteiro, 4200-427 Porto, Portugal; (T.R.); (J.A.); (P.A.); (P.C.); (H.C.); (G.M.)
- WGO Gastroenterology and Hepatology Training Center, 4200-427 Porto, Portugal
- Faculty of Medicine of the University of Porto, Alameda Professor Hernâni Monteiro, 4200-427 Porto, Portugal
- Correspondence:
| | - Tiago Ribeiro
- Department of Gastroenterology, São João University Hospital, Alameda Professor Hernâni Monteiro, 4200-427 Porto, Portugal; (T.R.); (J.A.); (P.A.); (P.C.); (H.C.); (G.M.)
- WGO Gastroenterology and Hepatology Training Center, 4200-427 Porto, Portugal
| | - João Afonso
- Department of Gastroenterology, São João University Hospital, Alameda Professor Hernâni Monteiro, 4200-427 Porto, Portugal; (T.R.); (J.A.); (P.A.); (P.C.); (H.C.); (G.M.)
- WGO Gastroenterology and Hepatology Training Center, 4200-427 Porto, Portugal
| | - Patrícia Andrade
- Department of Gastroenterology, São João University Hospital, Alameda Professor Hernâni Monteiro, 4200-427 Porto, Portugal; (T.R.); (J.A.); (P.A.); (P.C.); (H.C.); (G.M.)
- WGO Gastroenterology and Hepatology Training Center, 4200-427 Porto, Portugal
- Faculty of Medicine of the University of Porto, Alameda Professor Hernâni Monteiro, 4200-427 Porto, Portugal
| | - Pedro Cardoso
- Department of Gastroenterology, São João University Hospital, Alameda Professor Hernâni Monteiro, 4200-427 Porto, Portugal; (T.R.); (J.A.); (P.A.); (P.C.); (H.C.); (G.M.)
- WGO Gastroenterology and Hepatology Training Center, 4200-427 Porto, Portugal
| | - João Ferreira
- Department of Mechanical Engineering, Faculty of Engineering of the University of Porto, Rua Dr. Roberto Frias, 4200-465 Porto, Portugal;
| | - Hélder Cardoso
- Department of Gastroenterology, São João University Hospital, Alameda Professor Hernâni Monteiro, 4200-427 Porto, Portugal; (T.R.); (J.A.); (P.A.); (P.C.); (H.C.); (G.M.)
- WGO Gastroenterology and Hepatology Training Center, 4200-427 Porto, Portugal
- Faculty of Medicine of the University of Porto, Alameda Professor Hernâni Monteiro, 4200-427 Porto, Portugal
| | - Guilherme Macedo
- Department of Gastroenterology, São João University Hospital, Alameda Professor Hernâni Monteiro, 4200-427 Porto, Portugal; (T.R.); (J.A.); (P.A.); (P.C.); (H.C.); (G.M.)
- WGO Gastroenterology and Hepatology Training Center, 4200-427 Porto, Portugal
- Faculty of Medicine of the University of Porto, Alameda Professor Hernâni Monteiro, 4200-427 Porto, Portugal
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11
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Ribeiro T, Saraiva MM, Ferreira JPS, Cardoso H, Afonso J, Andrade P, Parente M, Jorge RN, Macedo G. Artificial intelligence and capsule endoscopy: automatic detection of vascular lesions using a convolutional neural network. Ann Gastroenterol 2021; 34:820-828. [PMID: 34815648 PMCID: PMC8596215 DOI: 10.20524/aog.2021.0653] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/30/2021] [Accepted: 04/07/2021] [Indexed: 12/09/2022] Open
Abstract
Background Capsule endoscopy (CE) is the first line for evaluation of patients with obscure gastrointestinal bleeding. A wide range of small intestinal vascular lesions with different hemorrhagic potential are frequently found in these patients. Nevertheless, reading CE exams is time-consuming and prone to errors. Convolutional neural networks (CNN) are artificial intelligence tools with high performance levels in image analysis. This study aimed to develop a CNN-based model for identification and differentiation of vascular lesions with distinct hemorrhagic potential in CE images. Methods The development of the CNN was based on a database of CE images. This database included images of normal small intestinal mucosa, red spots, and angiectasia/varices. The hemorrhagic risk was assessed by Saurin's classification. For CNN development, 11,588 images (9525 normal mucosa, 1026 red spots, and 1037 angiectasia/varices) were ultimately extracted. Two image datasets were created for CNN training and testing. Results The network was 91.8% sensitive and 95.9% specific for detection of vascular lesions, providing accurate predictions in 94.4% of cases. In particular, the CNN had a sensitivity and specificity of 97.1% and 95.3%, respectively, for detection of red spots. Detection of angiectasia/varices occurred with a sensitivity of 94.1% and a specificity of 95.1%. The CNN had a frame reading rate of 145 frames/sec. Conclusions The developed algorithm is the first CNN-based model to accurately detect and distinguish enteric vascular lesions with different hemorrhagic risk. CNN-assisted CE reading may improve the diagnosis of these lesions and overall CE efficiency.
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Affiliation(s)
- Tiago Ribeiro
- Department of Gastroenterology, São João University Hospital, Alameda Professor Hernâni Monteiro (Tiago Ribeiro, Miguel Mascarenhas Saraiva, Hélder Cardoso, João Afonso, Patrícia Andrade, Guilherme Macedo).,WGO Gastroenterology and Hepatology Training Center (Tiago Ribeiro, Miguel Mascarenhas Saraiva, Hélder Cardoso, João Afonso, Patrícia Andrade, Guilherme Macedo)
| | - Miguel Mascarenhas Saraiva
- Department of Gastroenterology, São João University Hospital, Alameda Professor Hernâni Monteiro (Tiago Ribeiro, Miguel Mascarenhas Saraiva, Hélder Cardoso, João Afonso, Patrícia Andrade, Guilherme Macedo).,WGO Gastroenterology and Hepatology Training Center (Tiago Ribeiro, Miguel Mascarenhas Saraiva, Hélder Cardoso, João Afonso, Patrícia Andrade, Guilherme Macedo).,Faculty of Medicine of the University of Porto, Alameda Professor Hernâni Monteiro (Miguel Mascarenhas Saraiva, Hélder Cardoso, Patrícia Andrade, Guilherme Macedo)
| | - João P S Ferreira
- Faculty of Engineering of the University of Porto (João P.S. Ferreira, Marco Parente, Renato Natal Jorge).,INEGI - Institute of Science and Innovation in Mechanical and Industrial Engineering (João P.S. Ferreira, Marco Parente, Renato Natal Jorge), Porto, Portugal
| | - Hélder Cardoso
- Department of Gastroenterology, São João University Hospital, Alameda Professor Hernâni Monteiro (Tiago Ribeiro, Miguel Mascarenhas Saraiva, Hélder Cardoso, João Afonso, Patrícia Andrade, Guilherme Macedo).,WGO Gastroenterology and Hepatology Training Center (Tiago Ribeiro, Miguel Mascarenhas Saraiva, Hélder Cardoso, João Afonso, Patrícia Andrade, Guilherme Macedo).,Faculty of Medicine of the University of Porto, Alameda Professor Hernâni Monteiro (Miguel Mascarenhas Saraiva, Hélder Cardoso, Patrícia Andrade, Guilherme Macedo)
| | - João Afonso
- Department of Gastroenterology, São João University Hospital, Alameda Professor Hernâni Monteiro (Tiago Ribeiro, Miguel Mascarenhas Saraiva, Hélder Cardoso, João Afonso, Patrícia Andrade, Guilherme Macedo).,WGO Gastroenterology and Hepatology Training Center (Tiago Ribeiro, Miguel Mascarenhas Saraiva, Hélder Cardoso, João Afonso, Patrícia Andrade, Guilherme Macedo)
| | - Patrícia Andrade
- Department of Gastroenterology, São João University Hospital, Alameda Professor Hernâni Monteiro (Tiago Ribeiro, Miguel Mascarenhas Saraiva, Hélder Cardoso, João Afonso, Patrícia Andrade, Guilherme Macedo).,WGO Gastroenterology and Hepatology Training Center (Tiago Ribeiro, Miguel Mascarenhas Saraiva, Hélder Cardoso, João Afonso, Patrícia Andrade, Guilherme Macedo).,Faculty of Medicine of the University of Porto, Alameda Professor Hernâni Monteiro (Miguel Mascarenhas Saraiva, Hélder Cardoso, Patrícia Andrade, Guilherme Macedo)
| | - Marco Parente
- Faculty of Engineering of the University of Porto (João P.S. Ferreira, Marco Parente, Renato Natal Jorge).,INEGI - Institute of Science and Innovation in Mechanical and Industrial Engineering (João P.S. Ferreira, Marco Parente, Renato Natal Jorge), Porto, Portugal
| | - Renato Natal Jorge
- Faculty of Engineering of the University of Porto (João P.S. Ferreira, Marco Parente, Renato Natal Jorge).,INEGI - Institute of Science and Innovation in Mechanical and Industrial Engineering (João P.S. Ferreira, Marco Parente, Renato Natal Jorge), Porto, Portugal
| | - Guilherme Macedo
- Department of Gastroenterology, São João University Hospital, Alameda Professor Hernâni Monteiro (Tiago Ribeiro, Miguel Mascarenhas Saraiva, Hélder Cardoso, João Afonso, Patrícia Andrade, Guilherme Macedo).,WGO Gastroenterology and Hepatology Training Center (Tiago Ribeiro, Miguel Mascarenhas Saraiva, Hélder Cardoso, João Afonso, Patrícia Andrade, Guilherme Macedo).,Faculty of Medicine of the University of Porto, Alameda Professor Hernâni Monteiro (Miguel Mascarenhas Saraiva, Hélder Cardoso, Patrícia Andrade, Guilherme Macedo)
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12
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Goltstein LCMJ, Grooteman KV, Rocco A, Holleran G, Frago S, Salgueiro PS, Aparicio T, Scaglione G, Chetcuti Zammit S, Prados-Manzano R, Benamouzig R, Nardone G, McNamara D, Benallaoua M, Michopoulos S, Sidhu R, Kievit W, Drenth JPH, van Geenen EJM. Effectiveness and predictors of response to somatostatin analogues in patients with gastrointestinal angiodysplasias: a systematic review and individual patient data meta-analysis. Lancet Gastroenterol Hepatol 2021; 6:922-932. [PMID: 34508668 DOI: 10.1016/s2468-1253(21)00262-4] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/05/2021] [Revised: 07/08/2021] [Accepted: 07/12/2021] [Indexed: 02/07/2023]
Abstract
BACKGROUND Gastrointestinal angiodysplasias are vascular malformations that often cause red blood cell transfusion-dependent anaemia. Several studies suggest that somatostatin analogues might decrease rebleeding rates, but the true effect size is unknown. We therefore aimed to investigate the efficacy of somatostatin analogues on red blood cell transfusion requirements of patients with gastrointestinal angiodysplasias and to identify subgroups that might benefit the most from somatostatin analogue therapy. METHODS We did a systematic review and individual patient data meta-analysis. We searched MEDLINE, Embase, and Cochrane on Jan 15, 2016, with an updated search on April 25, 2021. All published randomised controlled trials and cohort studies that reported on somatostatin analogue therapy in patients with gastrointestinal angiodysplasias were eligible for screening. We excluded studies without original patient data, single case reports, small case series (ie, <10 participants), studies in which patients had a specific aetiology of gastrointestinal angiodysplasias, and studies in which somatostatin analogue therapy was initiated simultaneously with other treatment modalities. Authors of eligible studies were invited to share individual patient data. Aggregated data was used if individual patient data were not provided. The primary outcome was the mean reduction in the number of red blood cell transfusions during somatostatin analogue therapy, compared with baseline, expressed as the incidence rate ratio (IRR) and absolute mean decrease. We defined patients as either good responders (≥50% reduction in the number of red blood cell transfusions) or poor responders (<50% reduction). A mixed-effects negative binomial regression was used to account for clustering of patients and skewness in data. This study was registered in the International Prospective Register of Systematic Reviews (PROSPERO), number CRD42020213985. FINDINGS We identified 11 eligible studies (one randomised controlled trial and ten cohort studies) of moderate-to-high quality and obtained individual patient data from the authors of nine (82%) studies. The remaining two (18%) studies provided sufficient information in the published manuscript to extract individual patient data. In total, we analysed data from 212 patients. Somatostatin analogues reduced the number of red blood cell transfusions with an IRR of 0·18 (95% CI 0·14-0·24; p<0·0001) during a median treatment duration of 12 months (IQR 6·0-12·0) and follow-up period of 12 months (12·0-12·0), correlating with a mean absolute decrease in the number of red blood cell transfusions from 12·8 (95% CI 10·4-15·8) during baseline to 2·3 (1·9-2·9) during follow-up-ie, a reduction of 10·5 red blood cell transfusions (p<0·0001). 177 (83%) of 212 patients had a good response to somatostatin analogue therapy (defined as at least a 50% reduction in the number of red blood cell transfusions). Heterogeneity across studies was moderate (I2=53%; p=0·02). Location of gastrointestinal angiodysplasias in the stomach compared with angiodysplasias in the small bowel and colon (IRR interaction 1·92 [95% CI 1·13-3·26]; p=0·02) was associated with worse treatment response. Octreotide was associated with a better treatment response than lanreotide therapy (IRR interaction 2·13 [95% CI 1·12-4·04]; p=0·02). The certainty of evidence was high for the randomised controlled trial and low for the ten cohort studies. Adverse events occurred in 38 (18%) of 212 patients receiving somatostatin analogue therapy, with ten (5%) discontinuing this therapy because of adverse events. The most common adverse events were loose stools (seven [3%] of 212), cholelithiasis (five [2%]), flatulence (four [2%]), and administration site reactions (erythema, five [2%]). INTERPRETATION Somatostatin analogue therapy is safe and effective in most patients with red blood cell transfusion-dependent bleeding due to gastrointestinal angiodysplasias. Somatostatin analogue therapy is more effective in patients with angiodysplasias located in the small bowel and colon, and octreotide therapy seems to be more effective than lanreotide therapy. FUNDING The Netherlands Organisation for Health Research and Development and the Radboud University Medical Center.
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Affiliation(s)
- Lia C M J Goltstein
- Department of Gastroenterology and Hepatology, Radboud University Medical Center, Nijmegen, Netherlands.
| | - Karina V Grooteman
- Department of Gastroenterology and Hepatology, Radboud University Medical Center, Nijmegen, Netherlands
| | - Alba Rocco
- Department of Clinical Medicine and Surgery, Gastroenterology Unit, University Federico II, Naples, Italy
| | - Grainne Holleran
- Department of Clinical Medicine, Trinity College Dublin, Tallaght Hospital, Dublin, Ireland
| | - Santiago Frago
- Department of Digestive Diseases, Miguel Servet University Hospital, Zaragoza, Spain
| | - Paulo S Salgueiro
- Gastroenterology Department, Centro Hospitalar Universitário do Porto-Hospital de Santo António, Porto, Portugal
| | - Thomas Aparicio
- Department of Gastroenterology, Saint-Louis, Assistance Publique-Hôpitaux de Paris, Université de Paris, Paris, France
| | | | | | - Raul Prados-Manzano
- Department of Gastroenterology, Hospital San Pedro de Alcántara, Cáceres, Spain
| | - Robert Benamouzig
- Department of Gastroenterology, Avicenne Hospital, Assistance Publique-Hôpitaux de Paris, Université de Paris, Bobigny, France
| | - Gerardo Nardone
- Department of Clinical Medicine and Surgery, Gastroenterology Unit, University Federico II, Naples, Italy
| | - Deirdre McNamara
- Department of Clinical Medicine, Trinity College Dublin, Tallaght Hospital, Dublin, Ireland
| | - Mourad Benallaoua
- Department of Gastroenterology, Avicenne Hospital, Assistance Publique-Hôpitaux de Paris, Université de Paris, Bobigny, France
| | | | - Reena Sidhu
- Academic Department of Gastroenterology, Royal Hallamshire Hospital, Sheffield, UK
| | - Wietske Kievit
- Radboud Institute for Health Science, Department of Health Evidence, Radboud University Medical Center, Nijmegen, Netherlands
| | - Joost P H Drenth
- Department of Gastroenterology and Hepatology, Radboud University Medical Center, Nijmegen, Netherlands
| | - Erwin J M van Geenen
- Department of Gastroenterology and Hepatology, Radboud University Medical Center, Nijmegen, Netherlands
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13
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Rosa B, Margalit-Yehuda R, Gatt K, Sciberras M, Girelli C, Saurin JC, Cortegoso Valdivia P, Cotter J, Eliakim R, Caprioli F, Baatrup G, Keuchel M, Ellul P, Toth E, Koulaouzidis A. Scoring systems in clinical small-bowel capsule endoscopy: all you need to know! Endosc Int Open 2021; 9:E802-E823. [PMID: 34079861 PMCID: PMC8159625 DOI: 10.1055/a-1372-4051] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/01/2020] [Accepted: 11/26/2020] [Indexed: 02/08/2023] Open
Abstract
AbstractCapsule endoscopy (CE) emerged out of the pressing clinical need to image the small bowel (SB) in cases of midgut bleeding and provide an overall comfortable and reliable gastrointestinal (GI) diagnosis 1. Since its wider adoption in clinical practice, significant progress has been made in several areas including software development, hardware features and clinical indications, while innovative applications of CE never cease to appear 2
3. Currently, several manufacturers provide endoscopic capsules with more or less similar technological features 4. Although there is engaging and continuous academic and industry-fueled R&D, promising furtherment of CE technology 4
5, the current status of clinical CE remains that of by and large an imaging modality. Clinical relevance of CE images is cornerstone in the decision-making process for medical management. In one of the larger to date SB CE studies, 4,206 abnormal images were detected in 3,280 patients 6. Thus, CE leads to the identification of a large amount of potential pathology, some of which are pertinent (or relevant) while some (probably the majority) are not.Soon artificial intelligence (AI) is likely to carry out several roles currently performed by humans; in fact, we are witnessing only the first stages of a transition in the clinical adoption of AI-based solutions in several aspects of gastroenterology including CE 7. Until then though, human-based decision-making profoundly impacts patient care and – although not suggested in the updated European Society of Gastrointestinal Endoscopy (ESGE) European curriculum 8
9 – it should be an integral part of CE training. Frequently, interpretation of CE images by experts or at least experienced readers differs. In a tandem CE reading study, expert review of discordant cases revealed a 50 % (13/25 discordant results) error rate by experienced readers, corresponding (in 5/13 cases) to ‘over-classification’ of an irrelevant abnormality 10. Another comparative study showed an ‘over-classification’ of such irrelevant abnormalities in ~10 % of CE readings 11. One thing which has been for a while on the table – in relation to optimizing and/or standardizing CE reporting and subsequent decision-making – is the need for reproducible scoring systems and for a reliable common language among clinicians responsible for further patient’s management.Over the years, several of these scoring systems were developed while others appear in the wake of software and hardware improvements aiming to replace and/or complement their predecessors. This review presents a comprehensive account of the currently available classification/scoring systems in clinical CE spanning from predicting the bleeding potential of identified SB lesions (with emphasis on vascular lesions), and the individual rebleeding risk; scoring systems for the prediction of SB lesions in patients with obscure gastrointestinal bleeding (OGlB), having the potential to improve patient selection and rationalize the use of enteroscopy, with better allocation of resources, optimized diagnostic workflow and tailored treatment. This review also includes scores for reporting the inflammatory burden, the cleansing level that underscores confidence in CE reporting and the mass or bulge question in CE. Essentially, the aim is to become a main text for reference when scoring is required and facilitate the inclusion of -through readiness of access- one of the other in the final report.
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Affiliation(s)
- Bruno Rosa
- Gastroenterology Department, Hospital da Senhora da Oliveira, Guimarães, Portugal,Life and Health Sciences Research Institute (ICVS), School of Medicine, University of Minho-Braga. Portugal,ICVS/3B’s, PT Government Associate Laboratory – Braga/Guimarães, Portugal.
| | - Reuma Margalit-Yehuda
- Department of Gastroenterology, Sheba Medical Center, Sackler School of Medicine, Tel-Aviv, Israel
| | - Kelly Gatt
- Division of Gastroenterology, Mater Dei Hospital, Msida, Malta
| | | | - Carlo Girelli
- Department of Internal Medicine, Gastroenterology & Digestive Endoscopy, Hospital of Busto Arsizio, Italy
| | - Jean-Christophe Saurin
- Hospices Civils de Lyon, Hôpital Edouard Herriot, Service d'Hépato-Gastro-Entérologie et d'Endoscopie Digestive, Lyon, France
| | - Pablo Cortegoso Valdivia
- Gastroenterology & Endoscopy Unit, University Hospital of Parma, University of Parma, Parma, Italy
| | - Jose Cotter
- Gastroenterology Department, Hospital da Senhora da Oliveira, Guimarães, Portugal,Life and Health Sciences Research Institute (ICVS), School of Medicine, University of Minho-Braga. Portugal,ICVS/3B’s, PT Government Associate Laboratory – Braga/Guimarães, Portugal.
| | - Rami Eliakim
- Department of Gastroenterology, Sheba Medical Center, Sackler School of Medicine, Tel-Aviv, Israel
| | - Flavio Caprioli
- Unit of Gastroenterology and Endoscopy, Fondazione IRCCS Cà Granda, Ospedale Policlinico di Milano, Milan, Italy
| | - Gunnar Baatrup
- Department of Clinical Research, University of Southern Denmark, Odense, Denmark
| | - Martin Keuchel
- Clinic for Internal Medicine, Bethesda Krankenhaus Bergedorf, Hamburg, Germany
| | - Pierre Ellul
- Division of Gastroenterology, Mater Dei Hospital, Msida, Malta
| | - Ervin Toth
- Skåne University Hospital, Lund University, Malmö, Sweden
| | - Anastasios Koulaouzidis
- Endoscopy Unit, The Royal Infirmary of Edinburgh, Scotland, UK,Department of Social Medicine & Public Health, Pomeranian Medical University, Szczecin, Poland
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Systemic manifestations - do not forget the small bowel. Curr Opin Gastroenterol 2021; 37:234-244. [PMID: 33606400 DOI: 10.1097/mog.0000000000000717] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/10/2022]
Abstract
PURPOSE OF REVIEW Systemic diseases can afflict the small bowel (SB) but be challenging to diagnose. In this review, we aim to provide a broad overview of these conditions and to summarise their management. RECENT FINDINGS Small bowel capsule endoscopy (SBCE) is an important modality to investigate pathology in the SB. SB imaging can be complementary to SBCE for mural and extramural involvement and detection of multiorgan involvement or lymphadenopathy. Device assisted enteroscopy provides a therapeutic arm, to SBCE enabling histology and therapeutics to be carried out. SUMMARY SB endoscopy is essential in the diagnosis, management and monitoring of these multi-system conditions. Collaboration across SB centres to combine experience will help to improve the management of some of these rarer SB conditions.
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Micic D, Sengupta N. Risk Stratification of Angioectasia as a Cause of Gastrointestinal Bleeding: Untangling the Spider's Web? Dig Dis Sci 2019; 64:2693-2695. [PMID: 31363951 DOI: 10.1007/s10620-019-05750-z] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/09/2022]
Affiliation(s)
- Dejan Micic
- Section of Gastroenterology, Hepatology and Nutrition, Department of Internal Medicine, University of Chicago Medicine, 5841 South Maryland Avenue, MC4076, Chicago, IL, 60637, USA.
| | - Neil Sengupta
- Section of Gastroenterology, Hepatology and Nutrition, Department of Internal Medicine, University of Chicago Medicine, 5841 South Maryland Avenue, MC4076, Chicago, IL, 60637, USA
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