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Yaghoobi M, Tan J, Alshammari YTATA, Scandrett K, Mofrad K, Takwoingi Y. Video capsule endoscopy versus computed tomography enterography in assessing suspected small bowel bleeding: a systematic review and diagnostic test accuracy meta-analysis. Eur J Gastroenterol Hepatol 2023; 35:1253-1262. [PMID: 37773777 DOI: 10.1097/meg.0000000000002651] [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: 10/01/2023]
Abstract
Both computed tomography enterography (CTE) and video capsule endoscopy (VCE) are used in identifying small intestinal pathology in patients with suspected small bowel bleeding (SSBB) following normal upper gastrointestinal endoscopy and colonoscopy. Evidence of the comparative accuracy of these two modalities is crucial for clinical and healthcare decision-making. Comprehensive electronic searches were performed for studies on CTE and/or VCE with reference standard(s). Study selection, data extraction and quality assessment were completed by two authors independently. The QUADAS-2 and QUADAS-C tools were used to assess risk of bias, and applicability. Meta-analysis was performed using a bivariate model to obtain summary estimates of sensitivity, specificity, positive and negative likelihood ratios. Twenty-five studies involving 1986 patients with SSBB were included. Four of these were head-to-head comparison of CTE and VCE. Overall, VCE provided significantly higher sensitivity of 0.74 (95% CI: 0.61-0.83) versus 0.47 (95% CI: 0.32-0.62) for CTE, while CTE showed significantly higher specificity of 0.94 (95% CI: 0.64-0.99) versus 0.53 (95% CI: .36-0.69) for VCE. The positive likelihood ratio of CTE was 7.36 (95% CI: 0.97-56.01) versus 1.58 (95% CI: 1.15-2.15) for VCE and the negative likelihood ratio was 0.49 (95% CI: 0.33-0.72) for VCE versus 0.56 (0.40-0.79) for CTE. A secondary analysis of only head-to-head comparative studies gave results that were similar to the main analysis. Certainty of evidence was moderate. Neither VCE nor CTE is a perfect test for identifying etiology of SSBB in small intestine. VCE was more sensitive while CTE was more specific. Clinicians should choose the appropriate modality depending on whether better sensitivity or specificity is required in each clinical scenario.
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Affiliation(s)
- Mohammad Yaghoobi
- Division of Gastroenterology, McMaster University
- Department of Health Research Methods, Evidence, and Impact (HEI), McMaster University
- Cochrane GUT
- The Farncombe Family Digestive Health Research Institute, Hamilton, Ontario, Canada
| | - Julie Tan
- Division of Gastroenterology, McMaster University
| | | | - Katie Scandrett
- University of Birmingham Institute of Applied Health Research, Birmingham, UK
| | | | - Yemisi Takwoingi
- University of Birmingham Institute of Applied Health Research, Birmingham, UK
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Singla N, Inavolu P, Jagtap N, Singh AP, Kalapala R, Memon SF, Katukuri GR, Pal P, Nabi Z, Ramchandani M, Lakhtakia S, Banerjee R, Reddy PM, Tandan M, Reddy N. Small Bowel Capsule Endoscopy: Experience from a single large tertiary care centre. Endosc Int Open 2023; 11:E623-E628. [PMID: 37614640 PMCID: PMC10442921 DOI: 10.1055/a-2096-2453] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/10/2022] [Accepted: 12/20/2022] [Indexed: 08/25/2023] Open
Abstract
Background and study aims Capsule endoscopy (CE) has transformed examination of the small bowel (SB), once considered a dark continent. The present study aimed to describe the indications, diagnostic yield, practical issues and complications of CE in one of the largest tertiary center in India. Patients and methods This retrospective analysis from a prospectively maintained database, conducted from January 2013 to June 2021 included 1155 CEs performed during this period. Patient medical records were reviewed for indications, results, and complications of CE. Results A total of 1154 patients (809 males and 345 females), mean age 53 years (range 6-87 years), one capsule got stuck in the esophagus, were included in the study. Active SB bleeding had no effect on SB transit time (324.7±161 minutes, n = 137 patients with active bleed vs 310.6±166.9 minutes, n = 1017 patients without active bleed; P = 0.35). The indication and diagnostic yield (DY) of CE were potential overt SB bleed (68.6% & 43.9%), potential occult SB bleed (8.2% and 40%), chronic diarrhea (7.9% and 28.4%), abdominal pain (6.5% and 21.3%), anemia (5.9% and 57.9%), and suspected/known case of Crohn's disease (2.3% & 56.5%) respectively. The DY for patients with age ≥60 years was similar to those with age < 60 years (61.9% vs. 51.8% respectively; P = 0.4). 21 patients (1.8%) had capsule retention of which six (0.5%) had to be referred for surgery. Conclusions CE is a safe and effective investigation with ever increasing range of indications. Potential SB bleed remains the most common indication for CE with high detection rate.
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Affiliation(s)
- Neeraj Singla
- Gastroenterology, Asian Institute of Gastroenterology, Hyderabad, India
| | - Pradev Inavolu
- Gastroenterology, Asian Institute of Gastroenterology, Hyderabad, India
| | - Nitin Jagtap
- Gastroenterology, Asian Institute of Gastroenterology, Hyderabad, India
| | | | - Rakesh Kalapala
- Gastroenterology, Asian Institute of Gastroenterology, Hyderabad, India
| | | | | | - Partha Pal
- Gastroenterology, Asian Institute of Gastroenterology, Hyderabad, India
| | - Zaheer Nabi
- Gastroenterology, Asian Institute of Gastroenterology, Hyderabad, India
| | - Mohan Ramchandani
- Gastroenterology, Asian Institute of Gastroenterology, Hyderabad, India
| | - Sundeep Lakhtakia
- Gastroenterology, Asian Institute of Gastroenterology, Hyderabad, India
| | - Rupa Banerjee
- Gastroenterology, Asian Institute of Gastroenterology, Hyderabad, India
| | | | - Manu Tandan
- Gastroenterology, Asian Institute of Gastroenterology, Hyderabad, India
| | - Nageshwar Reddy
- Gastroenterology, Asian Institute of Gastroenterology, Hyderabad, India
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Yang W, Li Z, Liu R, Tong X, Wang W, Xu D, Gao S. Application of capsule endoscopy in patients with chronic and recurrent abdominal pain: Abbreviated running title: capsule endoscopy in abdominal pain. Med Eng Phys 2022; 110:103901. [PMID: 36241495 DOI: 10.1016/j.medengphy.2022.103901] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2022] [Revised: 08/15/2022] [Accepted: 10/02/2022] [Indexed: 12/24/2022]
Abstract
OBJECTIVE The incidence of chronic and recurrent abdominal pain increases every year, while the diagnosis is still unsatisfactory even after a number of check-ups. This study aimed to evaluate the diagnosis value of capsule endoscopy in patients suffering from chronic and recurrent abdominal pain. METHODS A retrospective case study was performed in 80 chronic and recurrent abdominal pain patients at Xiangyang Central Hospital from January 2013 to November 2017. Meanwhile, diagnoses by capsule endoscopy were collected for analysis. RESULTS Abnormal findings were found in 54 of 80 (67.5%) patients. The findings in chronic and recurrent abdominal pain patients include small intestinal erosion and congestion, small intestinal ulcers, small intestinal parasites, small intestinal vascular malformations, small intestinal polyps, small intestinal diverticulum, and small intestinal lymphangiectasia. There were no immediate significant side effects without being reported up to 1 month after ingestion of the capsule. The capsule was evacuated by all patients. CONCLUSIONS Capsule endoscopy has a great value in the diagnosis of chronic and recurrent abdominal pain with satisfactory safety and less pain for patients. Inflammatory lesions and ulcers in the small intestine account for the majority of positive findings in these patients.
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Affiliation(s)
- Wei Yang
- Department of Gastroenterology, Xiangyang Central Hospital, Affiliated Hospital of Hubei University of Arts and Science, Xiangyang, Hubei Province, 441021, China
| | - Zheng Li
- Department of Gastroenterology, Xiangyang Central Hospital, Affiliated Hospital of Hubei University of Arts and Science, Xiangyang, Hubei Province, 441021, China
| | - Rui Liu
- Medical School of Xiangyang Vocational and Technical College
| | - Xudong Tong
- Department of Gastroenterology, Xiangyang Central Hospital, Affiliated Hospital of Hubei University of Arts and Science, Xiangyang, Hubei Province, 441021, China
| | - Wei Wang
- Department of Gastroenterology, Xiangyang Central Hospital, Affiliated Hospital of Hubei University of Arts and Science, Xiangyang, Hubei Province, 441021, China
| | - Dongqiang Xu
- Department of Gastroenterology, Xiangyang Central Hospital, Affiliated Hospital of Hubei University of Arts and Science, Xiangyang, Hubei Province, 441021, China
| | - Shan Gao
- Department of Gastroenterology, Xiangyang Central Hospital, Affiliated Hospital of Hubei University of Arts and Science, Xiangyang, Hubei Province, 441021, China.
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Deep Learning Multi-Domain Model Provides Accurate Detection and Grading of Mucosal Ulcers in Different Capsule Endoscopy Types. Diagnostics (Basel) 2022; 12:diagnostics12102490. [PMID: 36292178 PMCID: PMC9600959 DOI: 10.3390/diagnostics12102490] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2022] [Revised: 10/06/2022] [Accepted: 10/08/2022] [Indexed: 11/17/2022] Open
Abstract
Background and Aims: The aim of our study was to create an accurate patient-level combined algorithm for the identification of ulcers on CE images from two different capsules. Methods: We retrospectively collected CE images from PillCam-SB3′s capsule and PillCam-Crohn’s capsule. ML algorithms were trained to classify small bowel CE images into either normal or ulcerated mucosa: a separate model for each capsule type, a cross-domain model (training the model on one capsule type and testing on the other), and a combined model. Results: The dataset included 33,100 CE images: 20,621 PillCam-SB3 images and 12,479 PillCam-Crohn’s images, of which 3582 were colonic images. There were 15,684 normal mucosa images and 17,416 ulcerated mucosa images. While the separate model for each capsule type achieved excellent accuracy (average AUC 0.95 and 0.98, respectively), the cross-domain model achieved a wide range of accuracies (0.569–0.88) with an AUC of 0.93. The combined model achieved the best results with an average AUC of 0.99 and average mean patient accuracy of 0.974. Conclusions: A combined model for two different capsules provided high and consistent diagnostic accuracy. Creating a holistic AI model for automated capsule reading is an essential part of the refinement required in ML models on the way to adapting them to clinical practice.
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Ogata N, Ohtsuka K, Ogawa M, Maeda Y, Ishida F, Kudo SE. Image-Enhanced Capsule Endoscopy Improves the Identification of Small Intestinal Lesions. Diagnostics (Basel) 2021; 11:diagnostics11112122. [PMID: 34829469 PMCID: PMC8621083 DOI: 10.3390/diagnostics11112122] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2021] [Revised: 11/09/2021] [Accepted: 11/13/2021] [Indexed: 12/14/2022] Open
Abstract
Image-enhanced endoscopy is useful for diagnosing and identifying lesions in the gastrointestinal tract. Recently, image-enhanced endoscopy has become a breakthrough technology that has attracted significant attention. This image enhancing technology is available for capsule endoscopy, which is an effective tool for small intestinal lesions and has been applied in flexible spectral color enhancement technology and in contrast capsule like narrow-band imaging. In this field, most researchers focus on improving the visibility and detection of small intestinal lesions. This review summarizes previous studies on image-enhanced capsule endoscopy and aims to evaluate the efficacy of this technology.
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Affiliation(s)
- Noriyuki Ogata
- Digestive Disease Center, Showa University Northern Yokohama Hospital, Yokohama 224-8503, Japan; (K.O.); (M.O.); (Y.M.); (F.I.); (S.-e.K.)
- Correspondence:
| | - Kazuo Ohtsuka
- Digestive Disease Center, Showa University Northern Yokohama Hospital, Yokohama 224-8503, Japan; (K.O.); (M.O.); (Y.M.); (F.I.); (S.-e.K.)
- Department of Endoscopy, Tokyo Medical and Dental University, Medical Hospital, Tokyo 113-0034, Japan
| | - Masataka Ogawa
- Digestive Disease Center, Showa University Northern Yokohama Hospital, Yokohama 224-8503, Japan; (K.O.); (M.O.); (Y.M.); (F.I.); (S.-e.K.)
| | - Yasuharu Maeda
- Digestive Disease Center, Showa University Northern Yokohama Hospital, Yokohama 224-8503, Japan; (K.O.); (M.O.); (Y.M.); (F.I.); (S.-e.K.)
| | - Fumio Ishida
- Digestive Disease Center, Showa University Northern Yokohama Hospital, Yokohama 224-8503, Japan; (K.O.); (M.O.); (Y.M.); (F.I.); (S.-e.K.)
| | - Shin-ei Kudo
- Digestive Disease Center, Showa University Northern Yokohama Hospital, Yokohama 224-8503, Japan; (K.O.); (M.O.); (Y.M.); (F.I.); (S.-e.K.)
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Feasibility and diagnostic yield of small-bowel capsule endoscopy in patients with surgically altered gastric anatomy: the SAGA study. Gastrointest Endosc 2021; 94:589-597.e1. [PMID: 33848508 DOI: 10.1016/j.gie.2021.03.934] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/07/2020] [Accepted: 03/30/2021] [Indexed: 02/07/2023]
Abstract
BACKGROUND AND AIMS Little is known about small-bowel (SB) capsule endoscopy (CE) in patients with a history of gastric surgery. This study aims to evaluate the feasibility and diagnostic yield (DY) of orally ingested SB-CE in patients with surgically altered gastric anatomy. METHODS Twenty-four European centers retrospectively identified patients who had SB-CE after total or subtotal gastrectomy. The primary outcome was the DY of SB-CE (intermediate P1 to highly P2 relevant findings). Secondary outcomes were gastric and SB transit times, completion, cleanliness, and adverse event rates. RESULTS Studied were 248 procedures from 243 patients (mean age, 62 years) with a history of partial gastrectomy (Billroth I, 13.1%; Billroth II, 34.6%), total gastrectomy (7.4%), Whipple procedure (12.8%), sleeve gastrectomy (7.2%), or gastric bypass surgery (24.7%). Obscure GI bleeding was the most frequent indication (85.1%). SB completion rate was 84.3%. One capsule retention in the SB was noted (adverse event rate, .4%). Median SB transit time was 286 minutes (interquartile range [235; 387]). Cleanliness was rated as adequate in 92.1% of procedures. After exclusion of abnormalities found at the upper anastomotic site, the DY was 43.6%, with inflammatory/ulcerated lesions observed more frequently (23.4%) than vascular lesions (21.0%). CONCLUSIONS SB-CE seems to be feasible and safe in selected patients with a history of major gastric surgery and comes with a high DY. The spectrum of abnormal SB findings in these patients may be different from what is known from the literature in nonoperated patients.
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Kim SH, Hwang Y, Oh DJ, Nam JH, Kim KB, Park J, Song HJ, Lim YJ. Efficacy of a comprehensive binary classification model using a deep convolutional neural network for wireless capsule endoscopy. Sci Rep 2021; 11:17479. [PMID: 34471156 PMCID: PMC8410868 DOI: 10.1038/s41598-021-96748-z] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2020] [Accepted: 08/13/2021] [Indexed: 12/22/2022] Open
Abstract
The manual reading of capsule endoscopy (CE) videos in small bowel disease diagnosis is time-intensive. Algorithms introduced to automate this process are premature for real clinical applications, and multi-diagnosis using these methods has not been sufficiently validated. Therefore, we developed a practical binary classification model, which selectively identifies clinically meaningful images including inflamed mucosa, atypical vascularity or bleeding, and tested it with unseen cases. Four hundred thousand CE images were randomly selected from 84 cases in which 240,000 images were used to train the algorithm to categorize images binarily. The remaining images were utilized for validation and internal testing. The algorithm was externally tested with 256,591 unseen images. The diagnostic accuracy of the trained model applied to the validation set was 98.067%. In contrast, the accuracy of the model when applied to a dataset provided by an independent hospital that did not participate during training was 85.470%. The area under the curve (AUC) was 0.922. Our model showed excellent internal test results, and the misreadings were slightly increased when the model was tested in unseen external cases while the classified 'insignificant' images contain ambiguous substances. Once this limitation is solved, the proposed CNN-based binary classification will be a promising candidate for developing clinically-ready computer-aided reading methods.
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Affiliation(s)
- Sang Hoon Kim
- Department of Internal Medicine, Dongguk University Ilsan Hospital, Dongguk University College of Medicine, Dongguk-ro 27 Ilsandong-gu, Goyang, 10326, Republic of Korea
| | - Youngbae Hwang
- Department of Electronics Engineering, College of Electrical and Computer Engineering, Chungbuk National University, Cheongju, Republic of Korea
| | - Dong Jun Oh
- Department of Internal Medicine, Dongguk University Ilsan Hospital, Dongguk University College of Medicine, Dongguk-ro 27 Ilsandong-gu, Goyang, 10326, Republic of Korea
| | - Ji Hyung Nam
- Department of Internal Medicine, Dongguk University Ilsan Hospital, Dongguk University College of Medicine, Dongguk-ro 27 Ilsandong-gu, Goyang, 10326, Republic of Korea
| | - Ki Bae Kim
- Department of Internal Medicine, Chungbuk National University College of Medicine, Cheongju, Republic of Korea
| | - Junseok Park
- Department of Internal Medicine, Digestive Disease Center, Institute for Digestive Research, Soonchunhyang University College of Medicine, Seoul, Republic of Korea
| | - Hyun Joo Song
- Department of Internal Medicine, Jeju National University School of Medicine, Jeju, Republic of Korea
| | - Yun Jeong Lim
- Department of Internal Medicine, Dongguk University Ilsan Hospital, Dongguk University College of Medicine, Dongguk-ro 27 Ilsandong-gu, Goyang, 10326, Republic of Korea.
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Abstract
PURPOSE OF REVIEW Artificial intelligence is becoming rapidly integrated into modern technology including medicine. Artificial intelligence has a wide range of potential in gastroenterology, particularly with endoscopy, given the required analysis of large datasets of images. The aim of this review is to summarize the advances of artificial intelligence in gastroenterology (GI) endoscopy over the past year. RECENT FINDINGS Computer-aided detection (CADe) systems during real-time colonoscopy have resulted in increased adenoma detection rate with no significant increase in procedure times. Deep learning techniques have been utilized to accurately assess bowel preparation quality, which would impact surveillance colonoscopy recommendations. For the upper GI tract, CADe systems have been developed to aid in improving the diagnosis of Barrett's neoplasia during real-time endoscopy. Artificial intelligence-assisted real-time endoscopy has been shown to reduce blind spots during EGD. SUMMARY The application of artificial intelligence in gastroenterology endoscopy remains promising. Advances over the past year include improved detection of GI neoplasia during endoscopy and characterization of lesions. Further research including randomized, multicenter trials are needed to further evaluate the use of artificial intelligence for real-time endoscopy.
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Yan JS, Yan B, Meng K. Current status and future developments of upper gastrointestinal tract capsule endoscopy. Shijie Huaren Xiaohua Zazhi 2021; 29:960-965. [DOI: 10.11569/wcjd.v29.i16.960] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
Capsule endoscopy has been widely used for the diagnosis of small bowel diseases due to its safety, noninvasiveness, and acceptability. Despite the potential benefits of capsule endoscopy, there are obvious challenges to capsule endoscopy application in the upper gastrointestinal tract, due to the fast transit speed in the esophagus and large space of the gastric cavity. With the development of innovative technologies, such as magnetic navigation and tethered capsule endoscopy, the indications for capsule endoscopy have recently been expanded. Various capsule endoscopes have been applied to clinical practice, and several state-of-the-art research-oriented designs and devices provide hope for further use in the diagnosis of upper gastrointestinal diseases. In this review, we will summarize the current status and future developments of upper gastrointestinal tract capsule endoscopy.
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Affiliation(s)
- Jing-Shuang Yan
- Department of Gastroenterology and Hepatology, The First Medical Center, Chinese PLA General Hospital, Beijing 100853, China,School of Medicine, Nankai University, Tianjin 300071, China
| | - Bin Yan
- Department of Gastroenterology and Hepatology, The First Medical Center, Chinese PLA General Hospital, Beijing 100853, China
| | - Ke Meng
- Department of Gastroenterology and Hepatology, The First Medical Center, Chinese PLA General Hospital, Beijing 100853, China
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Convolution neural network for the diagnosis of wireless capsule endoscopy: a systematic review and meta-analysis. Surg Endosc 2021; 36:16-31. [PMID: 34426876 PMCID: PMC8741689 DOI: 10.1007/s00464-021-08689-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2021] [Accepted: 08/07/2021] [Indexed: 02/07/2023]
Abstract
Background Wireless capsule endoscopy (WCE) is considered to be a powerful instrument for the diagnosis of intestine diseases. Convolution neural network (CNN) is a type of artificial intelligence that has the potential to assist the detection of WCE images. We aimed to perform a systematic review of the current research progress to the CNN application in WCE. Methods A search in PubMed, SinoMed, and Web of Science was conducted to collect all original publications about CNN implementation in WCE. Assessment of the risk of bias was performed by Quality Assessment of Diagnostic Accuracy Studies-2 risk list. Pooled sensitivity and specificity were calculated by an exact binominal rendition of the bivariate mixed-effects regression model. I2 was used for the evaluation of heterogeneity. Results 16 articles with 23 independent studies were included. CNN application to WCE was divided into detection on erosion/ulcer, gastrointestinal bleeding (GI bleeding), and polyps/cancer. The pooled sensitivity of CNN for erosion/ulcer is 0.96 [95% CI 0.91, 0.98], for GI bleeding is 0.97 (95% CI 0.93–0.99), and for polyps/cancer is 0.97 (95% CI 0.82–0.99). The corresponding specificity of CNN for erosion/ulcer is 0.97 (95% CI 0.93–0.99), for GI bleeding is 1.00 (95% CI 0.99–1.00), and for polyps/cancer is 0.98 (95% CI 0.92–0.99). Conclusion Based on our meta-analysis, CNN-dependent diagnosis of erosion/ulcer, GI bleeding, and polyps/cancer approached a high-level performance because of its high sensitivity and specificity. Therefore, future perspective, CNN has the potential to become an important assistant for the diagnosis of WCE. Supplementary Information The online version contains supplementary material available at 10.1007/s00464-021-08689-3.
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Abstract
Since its clearance for use throughout the world, capsule endoscopy (CE) has become an important diagnostic tool, helping us to understand and document both normal and abnormal findings in the small intestine, especially in children, since CE usually can be employed without sedation or radiation. The indications in children and adults are similar, though their relative frequencies are different, with evaluation of potential and known inflammatory bowel disease the most common in the pediatric population, with CE also yielding increased diagnostic certainty compared to radiographic studies and surrogate biomarkers. Newer capsules now create opportunities to expand that understanding and our practices so that we can learn when and how to employ CE and pan-enteric CE to better monitor and guide therapy. It will take further studies to determine the best uses for CE and how to select the appropriate candidates, especially with ongoing concern about capsule ingestion vs. placement, the potential for capsule retention (particularly in known Crohn's disease), still elusive optimal methods for bowel cleansing, and the most meaningful scoring for research and clinical use.
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Affiliation(s)
- Stanley A. Cohen
- Children's Center for Digestive Health Care, Atlanta, GA, United States
| | - Salvatore Oliva
- Pediatric Gastroenterology and Liver Unit, Maternal and Child Health Department, University Hospital Umberto I, Sapienza - University of Rome, Rome, Italy
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Scopel AS, Tabushi FI, Kubrusly LF, Poletti PB, Parada AA, Moreira MP, Secchi TF. PREDICTIVE FACTORS FOR COMPLETE AND INCOMPLETE EVALUATION OF SMALL INTESTINE BY ENDOSCOPIC CAPSULE. ACTA ACUST UNITED AC 2020; 33:e1532. [PMID: 33237168 PMCID: PMC7682141 DOI: 10.1590/0102-672020200002e1532] [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: 04/20/2020] [Accepted: 06/25/2020] [Indexed: 11/30/2022]
Abstract
Background:
The small-bowel is the most difficult segment to be visualized by traditional
endoscopic methods. The need for its exploration led to the development of
capsule endoscopy. The percentage of the complete examination varies and
still remains uncertain the factors that influence the complete and
incomplete examination.
Aim:
Evaluate the factors that interfere with the completeness of the endoscopic
evaluation by the capsule.
Methods:
A prospective study in which were included 939 patients divided into two
groups: complete group (CG) and incomplete group (IG). The studied variables
that could interfere were: age, gender, comorbidities, diagnosis of Crohn’s
disease, previous abdominal surgery, inadequate preparation to compare the
groups reached and did not reach the cecum.
Results:
Of the 939 patients included 879 (93.3%) reached the cecum (CG) and 63 (6.7%)
IG no. The IG was composed of 29 (46.0%) men and 34 (54.0%) women with a
mean age of 49.7 years; comorbidities this group accounted for 46% of which
15.9% was Crohn’s disease, previous abdominal surgery 22.2% and 17.5%
inadequate preparation.
Conclusion:
Factors associated with complete or incomplete outcome of the examination
with capsule endoscopy were: associated comorbidities, Crohn’s disease,
previous abdominal surgery and inadequate preparation.
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Affiliation(s)
- Andréia Sopran Scopel
- Postgraduate Program in Principles of Surgery, Mackenzie Evangelical Faculty of Paraná/Medical Research Institute, Curitiba, PR, Brazil.,Gastrointestinal Endoscopy Service, 9 of July Hospital, São Paulo, SP, Brazil
| | - Fernando Issamu Tabushi
- Postgraduate Program in Principles of Surgery, Mackenzie Evangelical Faculty of Paraná/Medical Research Institute, Curitiba, PR, Brazil
| | - Luis Fernando Kubrusly
- Postgraduate Program in Principles of Surgery, Mackenzie Evangelical Faculty of Paraná/Medical Research Institute, Curitiba, PR, Brazil
| | - Paula Bechara Poletti
- Postgraduate Program in Principles of Surgery, Mackenzie Evangelical Faculty of Paraná/Medical Research Institute, Curitiba, PR, Brazil.,Gastrointestinal Endoscopy Service, 9 of July Hospital, São Paulo, SP, Brazil
| | - Artur Adolfo Parada
- Postgraduate Program in Principles of Surgery, Mackenzie Evangelical Faculty of Paraná/Medical Research Institute, Curitiba, PR, Brazil.,Gastrointestinal Endoscopy Service, 9 of July Hospital, São Paulo, SP, Brazil
| | - Milena Perez Moreira
- Postgraduate Program in Principles of Surgery, Mackenzie Evangelical Faculty of Paraná/Medical Research Institute, Curitiba, PR, Brazil.,Gastrointestinal Endoscopy Service, 9 of July Hospital, São Paulo, SP, Brazil
| | - Thiago Festa Secchi
- Gastrointestinal Endoscopy Service, 9 of July Hospital, São Paulo, SP, Brazil
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Atsawarungruangkit A, Elfanagely Y, Asombang AW, Rupawala A, Rich HG. Understanding deep learning in capsule endoscopy: Can artificial intelligence enhance clinical practice? Artif Intell Gastrointest Endosc 2020; 1:33-43. [DOI: 10.37126/aige.v1.i2.33] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/21/2020] [Revised: 10/01/2020] [Accepted: 10/13/2020] [Indexed: 02/06/2023] Open
Abstract
Wireless capsule endoscopy (WCE) enables physicians to examine the gastrointestinal tract by transmitting images wirelessly from a disposable capsule to a data recorder. Although WCE is the least invasive endoscopy technique for diagnosing gastrointestinal disorders, interpreting a WCE study requires significant time effort and training. Analysis of images by artificial intelligence, through advances such as machine or deep learning, has been increasingly applied to medical imaging. There has been substantial interest in using deep learning to detect various gastrointestinal disorders based on WCE images. This article discusses basic knowledge of deep learning, applications of deep learning in WCE, and the implementation of deep learning model in a clinical setting. We anticipate continued research investigating the use of deep learning in interpreting WCE studies to generate predictive algorithms and aid in the diagnosis of gastrointestinal disorders.
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Affiliation(s)
- Amporn Atsawarungruangkit
- Division of Gastroenterology, Warren Alpert School of Medicine, Brown University, Providence, RI 02903, United States
| | - Yousef Elfanagely
- Department of Internal Medicine, Brown University, Providence, RI 02903, United States
| | - Akwi W Asombang
- Division of Gastroenterology, Warren Alpert School of Medicine, Brown University, Providence, RI 02903, United States
| | - Abbas Rupawala
- Division of Gastroenterology, Warren Alpert School of Medicine, Brown University, Providence, RI 02903, United States
| | - Harlan G Rich
- Division of Gastroenterology, Warren Alpert School of Medicine, Brown University, Providence, RI 02903, United States
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Deep learning for wireless capsule endoscopy: a systematic review and meta-analysis. Gastrointest Endosc 2020; 92:831-839.e8. [PMID: 32334015 DOI: 10.1016/j.gie.2020.04.039] [Citation(s) in RCA: 95] [Impact Index Per Article: 23.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/21/2019] [Accepted: 04/13/2020] [Indexed: 12/11/2022]
Abstract
BACKGROUND AND AIMS Deep learning is an innovative algorithm based on neural networks. Wireless capsule endoscopy (WCE) is considered the criterion standard for detecting small-bowel diseases. Manual examination of WCE is time-consuming and can benefit from automatic detection using artificial intelligence (AI). We aimed to perform a systematic review of the current literature pertaining to deep learning implementation in WCE. METHODS We conducted a search in PubMed for all original publications on the subject of deep learning applications in WCE published between January 1, 2016 and December 15, 2019. Evaluation of the risk of bias was performed using tailored Quality Assessment of Diagnostic Accuracy Studies-2. Pooled sensitivity and specificity were calculated. Summary receiver operating characteristic curves were plotted. RESULTS Of the 45 studies retrieved, 19 studies were included. All studies were retrospective. Deep learning applications for WCE included detection of ulcers, polyps, celiac disease, bleeding, and hookworm. Detection accuracy was above 90% for most studies and diseases. Pooled sensitivity and specificity for ulcer detection were .95 (95% confidence interval [CI], .89-.98) and .94 (95% CI, .90-.96), respectively. Pooled sensitivity and specificity for bleeding or bleeding source were .98 (95% CI, .96-.99) and .99 (95% CI, .97-.99), respectively. CONCLUSIONS Deep learning has achieved excellent performance for the detection of a range of diseases in WCE. Notwithstanding, current research is based on retrospective studies with a high risk of bias. Thus, future prospective, multicenter studies are necessary for this technology to be implemented in the clinical use of WCE.
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Lee JH, Traverso G, Ibarra-Zarate D, Boning DS, Anthony BW. Ex Vivo and In Vivo Imaging Study of Ultrasound Capsule Endoscopy. J Med Device 2020; 14:021005. [PMID: 32431763 DOI: 10.1115/1.4046352] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2019] [Revised: 01/27/2020] [Indexed: 12/22/2022] Open
Abstract
Wireless capsule endoscopy (WCE) has revolutionized the capacity for evaluation of the gastrointestinal (GI) tract, but its evaluation is limited to the mucosal surface. To overcome this, ultrasound capsule endoscopy (UCE) that can evaluate the deeper structures beyond the mucosal surface has been proposed and several studies focusing on technology development have demonstrated promising results. However, investigations of the potential for clinical utility of this technology are lacking. This work had two main goals: perform ex vivo and in vivo imaging studies in a swine model to (1) evaluate if acoustic coupling between a capsule with a specific size and GI tract can be achieved only through peristalsis autonomously without any human control and (2) identify key issues and challenges to help guide further research. The images acquired in these studies were able to visualize the wall of the GI tract as well as the structures within demonstrating that achieving adequate acoustic coupling through peristalsis is possible. Critical challenges were identified including level of visualization and area of coverage; these require further in-depth investigation before potential clinical utility of UCE technology can be concluded.
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Affiliation(s)
- John H Lee
- Division of Gastroenterology, Massachusetts Institute of Technology, 77 Massachusetts Avenue, Cambridge, MA 02139
| | - Giovanni Traverso
- Division of Gastroenterology, Massachusetts Institute of Technology, 77 Massachusetts Avenue, Cambridge, MA 02139; Brigham and Women's Hospital, 75 Francis Street, Boston, MA 02115
| | - David Ibarra-Zarate
- Tecnologico de Monterrey, Escuela de Ingenieria y Ciencias, Eugenio Garza Sada 2501 sur col. Tecnológico c.p, Monterrey, Nuevo León 64849, México
| | - Duane S Boning
- Division of Gastroenterology, Massachusetts Institute of Technology, 77 Massachusetts Avenue, Cambridge, MA 02139
| | - Brian W Anthony
- Division of Gastroenterology, Massachusetts Institute of Technology, 77 Massachusetts Avenue, Cambridge, MA 02139
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Lee SY, Lee JY, Lee YJ, Park KS. Natural elimination of a video capsule after retention for 1 year in a patient with small bowel Crohn disease: A case report. Medicine (Baltimore) 2019; 98:e17580. [PMID: 31651863 PMCID: PMC6824652 DOI: 10.1097/md.0000000000017580] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/22/2022] Open
Abstract
INTRODUCTION Video capsule endoscopy (VCE) is a useful tool to differentiate small intestinal bleeding, inflammatory bowel disease, and other small bowel disease. The most common adverse effect of VCE is capsule retention; the incidence varies greatly depending on the underlying disease, which is known to increase from 1.5% in healthy individuals to 21% in patients with small bowel Crohn disease. We report this case on a patient who had asymptomatic capsule retention for 12 months and experienced natural elimination with medication. PATIENT CONCERNS A 21-year-old woman presented to the hospital with chronic abdominal pain and persistent diarrhea for 2 years. DIAGNOSES The patient was diagnosed with small bowel Crohn disease using VCE, and radiography revealed capsule retention. INTERVENTION Symptoms of obstruction were not distinctive, it was decided to increase the dosages of azathioprine and infliximab to 50 and 500 mg (10 mg/kg), at 5 months after VCE. And at month 11 of capsule retention, she was admitted and started on a regimen of hydrocortisol 300 mg for 4 days and hydrocortisol injection 200 mg for 10 days. OUTCOMES At month 12, abdominal radiography in the clinic confirmed that the capsule had been naturally retrieved. LESSONS Capsule retention could be initially treated conservatively with medication and if the treatment fails, it is recommended to remove the capsule surgically. But in the case of the clinical condition of the patient is favorable without symptoms of bowel obstruction, the medication should be continued and the patient followed up.
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Double-balloon enteroscopy (DBE) in patients presenting with obscure gastrointestinal bleeding (OGIB). Arab J Gastroenterol 2018; 18:228-233. [PMID: 29325750 DOI: 10.1016/j.ajg.2017.11.001] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/31/2017] [Revised: 08/07/2017] [Accepted: 11/12/2017] [Indexed: 12/22/2022]
Abstract
BACKGROUND AND STUDY AIMS Obscure gastrointestinal bleeding (OGIB) is defined as bleeding of unknown origin that persists or recurs after an initial negative investigation. Identifying the source of OGIB represents a diagnostic challenge that is frequently focused on visualizing the small intestine. Conventional diagnostic methods, such as push enteroscopy, small-bowel follow-through, radionuclide scanning, and angiography, each exhibit inherent limitations. Double balloon enteroscopy (DBE) was designed specifically to evaluate the entire small bowel. DBE allows for better visualization, biopsy of the identified lesions and application of therapeutic techniques. This study sought to assess the role of DBE in the diagnosis and management of patients with OGIB. PATIENTS AND METHODS This prospective study was conducted to analyse data from 31 patients presenting with OGIB referred for DBE in the Endoscopy Unit at the Internal Medicine Department of the Faculty of Medicine, Cairo University. RESULTS Five patients had lesions in locations other than the small intestine that accounted for GI bleeding. Thus, the potential source of OGIB was defined as the small intestine in 18 of 26 patients (69.2%), and negative DBE findings were noted in eight patients (30.8%). Major findings included small intestinal tumours in eight patients, vascular bleeding lesions in 8 patients and ulcerations in 2 patients. Endoscopic haemostasis was performed in eight patients with vascular lesions. The three patients with Petuz-Jegher syndrome underwent polypectomy of their major polyps. Patients with gastrointestinal tumours were referred for surgery. CONCLUSION DBE is an excellent endoscopic procedure that has a relatively high diagnostic and therapeutic yield. The procedure is feasible and exhibits a high safety profile with a low complication rate when performed by an experienced endoscopist.
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Noujaim MG, Green J, Min M, Schlieve CR, Patel K, Cahan M, Cave D. Carcinoids and Capsules: A Case Series Highlighting the Utility of Capsule Endoscopy in Patients With Small Bowel Carcinoids. Gastroenterology Res 2018; 10:347-351. [PMID: 29317942 PMCID: PMC5755636 DOI: 10.14740/gr937w] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/20/2017] [Accepted: 12/12/2017] [Indexed: 12/21/2022] Open
Abstract
Background Neuroendocine tumors (NETs) or carcinoids arise at many different sites of the gastrointestinal tract. The small intestine is the most common site for NETs. Diagnosing small bowel carcinoids remains challenging given their non-specific presentations and the overall low incidence of small bowel tumors. Video capsule endoscopy (VCE) has significanly improved our ability to detect small bowel malignancies. We explore the value of VCE in the initial workup and management of a series of small bowel carcinoid patients. Methods We retrospectively analyzed adult patients undergoing surgical management for small bowel lesions from July 2005 to September 2015 at a tertiary care center. Patient characteristics, presenting symptomatology, diagnostic workup and surgical management were analyzed among patients with histologically confirmed small bowel carcinoid tumors. Results Our study identified 16 patients treated surgically for small bowel carcinoids. The majority of patients (87.5%) presented with either occult gastrointestinal bleeding or anemia. Most patients (87.5%) were initially evaluated with various endoscopic and imaging modalities before all ultimately undergoing surgery. Seventy-five percent of patients had a VCE, with 83.3% (10/12) having positive findings that correlated with intraoperative findings compared to 62.5% (5/8) with computed tomography scan, 21.4% (3/14) with colonoscopy, 44% (4/9) with deep enteroscopy, and 0% (0/9) with esophagogastroduodenoscopy (EGD). Conclusions In the absence of any contraindications, VCE is an effective endoscopic modality in the diagnostic workup of small bowel NETs. Furthermore, positive VCE findings appear to highly correlate with surgical findings, thus suggesting a valuable role for VCE in the initial surgical assessment of patients with small bowel NETs.
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Affiliation(s)
- Michael G Noujaim
- Department of Internal Medicine, Duke University Medical Center, Durham, NC, USA.,These authors contributed equally to this work
| | - Jonathan Green
- Department of Surgery, University of Massachusetts Medical School, Worcester, MA, USA.,These authors contributed equally to this work
| | - May Min
- Department of Internal Medicine, University of Massachusetts Medical School, Worcester, MA, USA
| | | | - Krunal Patel
- Department of Internal Medicine, University of Massachusetts Medical School, Worcester, MA, USA.,Division of Gastroenterology, University of Massachusetts Medical School, Worcester, MA, USA
| | - Mitchell Cahan
- Department of Surgery, University of Massachusetts Medical School, Worcester, MA, USA
| | - David Cave
- Department of Internal Medicine, University of Massachusetts Medical School, Worcester, MA, USA.,Division of Gastroenterology, University of Massachusetts Medical School, Worcester, MA, USA
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Egea Valenzuela J, Pereñíguez López A, Pérez Fernández V, Alberca de Las Parras F, Carballo Álvarez F. Fecal calprotectin and C-reactive protein are associated with positive findings in capsule endoscopy in suspected small bowel Crohn's disease. REVISTA ESPANOLA DE ENFERMEDADES DIGESTIVAS 2017; 108:394-400. [PMID: 27312194 DOI: 10.17235/reed.2016.4318/2016] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
Abstract
BACKGROUND AND AIM Capsule endoscopy is an extended tool for the diagnosis of small bowel Crohn's disease. However, factors associated with positive findings of this technique have not been well established. Our aim is to asses which factors are associated with a better diagnostic yield of capsule endoscopy in suspected small bowel Crohn's disease. MATERIAL AND METHODS This was a retrospective study including patients under capsule endoscopy because of suspected small bowel Crohn's disease. Demographic data of these patients, as well as symptoms and laboratory data including hemoglobin levels, count of leucocytes and platelets, and levels of C-reactive protein, erythrocyte sedimentation rate and fecal calprotectin were collected. Capsule endoscopy studies were classified as negative (no lesions) or positive (lesions suggestive of Crohn's disease). Descriptive, univariate and multivariate analysis were done, as well as diagnostic yield tests of the different markers for predicting lesions in capsule studies. RESULTS One hundred and twenty-four patients were included (85 women and 39 men). The average age was 38.21 years. Levels of C-reactive protein and fecal calprotectin were the markers more frequently associated with positive findings in capsule endoscopy. Calprotectin presented the best sensitivity as isolated marker. The association of altered levels of C-reactive protein and calprotectin showed the best specificity and predictive values. CONCLUSIONS C-reactive protein and fecal calprotectin are appropriate biomarkers for selecting patients with suspected Crohn's disease of the small bowel for capsule endoscopy studies.
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Affiliation(s)
- Juan Egea Valenzuela
- Unidad de Gestión Clínica de Digestivo, Hospital Clínico Universitario Virgen de la Arrixa, España
| | - Ana Pereñíguez López
- Unidad Gestión Clínica Aparato Digestivo, Hospital Universitario Virgen de la Arrixaca
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Campisano F, Gramuglia F, Dawson IR, Lyne CT, Izmaylov ML, Misra S, De Momi E, Morgan DR, Obstein KL, Valdastri P. Gastric Cancer Screening in Low?-Income Countries: System Design, Fabrication, and Analysis for an Ultralow-Cost Endoscopy Procedure. IEEE ROBOTICS & AUTOMATION MAGAZINE 2017; 24:73-81. [PMID: 28959118 PMCID: PMC5613747 DOI: 10.1109/mra.2017.2673852] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/17/2023]
Affiliation(s)
- Federico Campisano
- STORM Lab USA, Dept. of Mechanical Engineering, Vanderbilt University, Nashville, TN 37212, USA
| | - Francesco Gramuglia
- Dept. of Electronics, Information and Bioengineering, Politecnico di Milano, Milano 20100, Italy
| | - Imro R Dawson
- Surgical Robotics Lab, Dept. of Biomechanical Engineering, University of Twente, Enschede, The Netherlands
| | - Christopher T Lyne
- STORM Lab USA, Dept. of Mechanical Engineering, Vanderbilt University, Nashville, TN 37212, USA
| | - Michelle L Izmaylov
- Division of Gastroenterology, Hepatology and Nutrition, Vanderbilt University Medical Center, Nashville, TN 37212, USA
| | - Sarthak Misra
- Surgical Robotics Lab, Dept. of Biomechanical Engineering, University of Twente, Enschede, The Netherlands
- Department of Biomedical Engineering, University Medical Center Groningen and University of Groningen, Groningen, The Netherlands
| | - Elena De Momi
- Dept. of Electronics, Information and Bioengineering, Politecnico di Milano, Milano 20100, Italy
| | - Douglas R Morgan
- Division of Gastroenterology, Hepatology and Nutrition, Vanderbilt University Medical Center, Nashville, TN 37212, USA
| | - Keith L Obstein
- Division of Gastroenterology, Hepatology and Nutrition, Vanderbilt University Medical Center, Nashville, TN 37212, USA
- STORM Lab USA, Dept. of Mechanical Engineering, Vanderbilt University, Nashville, TN 37212, USA
| | - Pietro Valdastri
- STORM Lab UK, School of Electronic and Electrical Engineering, University of Leeds, Leeds, UK
- STORM Lab USA, Dept. of Mechanical Engineering, Vanderbilt University, Nashville, TN 37212, USA
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Hirao M, Komori M, Nishida T, Iijima H, Yamaguchi S, Ishihara R, Yasunaga Y, Kobayashi I, Kishida O, Oshita M, Hagiwara H, Ito T, Suzuki K, Hayashi Y, Inoue T, Tsujii M, Yoshihara H, Takehara T. Clinical use of molecular targeted agents for primary small bowel adenocarcinoma: A multicenter retrospective cohort study by the Osaka Gut Forum. Oncol Lett 2017; 14:1628-1636. [PMID: 28789389 DOI: 10.3892/ol.2017.6290] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2016] [Accepted: 03/03/2017] [Indexed: 01/05/2023] Open
Abstract
Primary small bowel adenocarcinoma (SBA) is a rare cancer for which effective treatment strategies have not yet been established. The results of previous retrospective studies suggest that chemotherapy contributes to a longer survival time in patients with SBA. However, there are few case reports about the efficacy of molecular targeted agent-containing chemotherapy for SBA. In the present study, the treatment and follow-up data of patients with SBA who received chemotherapy with or without molecular targeted agents were retrospectively analyzed. Each patient was treated in one of ten hospitals participating in the Osaka Gut Forum between April 2006 and March 2014. The following factors were evaluated: Age, sex, Eastern Cooperative Oncology Group performance status (PS), tumor location, tumor differentiation, chemotherapy regimen, resection of primary tumor, tumor biomarker expression, distant metastasis, best response under chemotherapy, time to disease progression, subsequent treatments, survival status and treatment toxicity. A total of 27 patients (17 males and 10 females; mean age, 63.4 years old; range, 36-83 years old) received chemotherapy due to non-curative tumor resection, unresectable tumor or post-operative recurrence. The median overall survival time was 14.8 months (range, 2-58 months). A univariate analysis revealed a PS of 0 (P=0.0228) and treatment with platinum-based chemotherapy (P=0.0048) were significant factors for an improved prognosis. An age-adjusted multivariate analysis also revealed that a platinum-based regimen was a significant positive prognostic factor (P=0.0373). Molecular targeted agents were administered to 8 patients, for whom it was their first- or second-line therapy. Among the 17 patients who received oxaliplatin-based chemotherapy as a first-line chemotherapy, a PS of 0 (P=0.0255) and treatment with bevacizumab (P=0.0121) were significant positive prognostic factors. Toxicities higher than Grade 3 occurred in 8/27 patients with SBA; however, serious side effects due to the molecular targeted agents were not experienced. The results of the present study indicate that chemotherapy containing molecular targeted agents is a well-tolerated and effective treatment option for SBA.
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Affiliation(s)
- Motohiro Hirao
- Department of Gastroenterology, Osaka Rosai Hospital, Sakai, Osaka 591-8025, Japan
| | - Masato Komori
- Department of Gastroenterology, Osaka Rosai Hospital, Sakai, Osaka 591-8025, Japan
| | - Tsutomu Nishida
- Department of Gastroenterology, Toyonaka Municipal Hospital, Toyonaka, Osaka 560-8565, Japan
| | - Hideki Iijima
- Department of Gastroenterology and Hepatology, Osaka University, Suita, Osaka 565-0871, Japan
| | - Shinjiro Yamaguchi
- Department of Gastroenterology, Kansai Rosai Hospital, Amagasaki, Hyogo 660-8511, Japan
| | - Ryu Ishihara
- Department of Gastroenterology, Osaka Medical Center for Cancer and Cardiovascular Diseases, Higashinari-ku, Osaka 537-8511, Japan
| | - Yuichi Yasunaga
- Department of Gastroenterology, Hyogo Prefectural Nishinomiya Hospital, Nishinomiya, Hyogo 662-0918, Japan
| | - Ichizo Kobayashi
- Department of Gastroenterology, Higashiosaka City General Hospital, Higashiosaka, Osaka 578-8588, Japan
| | - Osamu Kishida
- Department of Gastroenterology, Sumitomo Hospital, Nakanoshima, Osaka 530-0005, Japan
| | - Masahide Oshita
- Department of Gastroenterology, Osaka Police Hospital, Osaka 543-0035, Japan
| | - Hideki Hagiwara
- Department of Gastroenterology, Kansai Rosai Hospital, Amagasaki, Hyogo 660-8511, Japan
| | - Toshifumi Ito
- Department of Internal Medicine, Japan Community Healthcare Organization Osaka Hospital, Osaka 553-0003, Japan
| | - Kunio Suzuki
- Department of Gastroenterology, Saiseikai Senri Hospital, Suita, Osaka 565-0862, Japan
| | - Yoshito Hayashi
- Department of Gastroenterology and Hepatology, Osaka University, Suita, Osaka 565-0871, Japan
| | - Takahiro Inoue
- Department of Gastroenterology and Hepatology, Osaka University, Suita, Osaka 565-0871, Japan
| | - Masahiko Tsujii
- Department of Gastroenterology, Higashiosaka City General Hospital, Higashiosaka, Osaka 578-8588, Japan
| | - Harumasa Yoshihara
- Department of Gastroenterology, Kaizuka City Hospital, Kaizuka, Osaka 597-0015, Japan
| | - Tetsuo Takehara
- Department of Gastroenterology and Hepatology, Osaka University, Suita, Osaka 565-0871, Japan
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Análisis histórico de la experiencia en cápsula endoscópica de intestino delgado en un hospital terciario español. GASTROENTEROLOGIA Y HEPATOLOGIA 2017; 40:70-79. [DOI: 10.1016/j.gastrohep.2016.04.005] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/09/2016] [Revised: 03/05/2016] [Accepted: 04/05/2016] [Indexed: 12/21/2022]
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Abstract
BACKGROUND Small bowel (SB) capsule endoscopy (CE) studies provide data on both gastric and SB transit times (GTT and SBTT, respectively). AIMS This study aimed to evaluate the influence of demographic and clinical parameters on the GTT and SBTT. Transit times for two generations of capsules (Pillcam SB2 and SB3) were also compared. METHODS Consecutive adult patients undergoing CE were included. GTT, SBTT, and cecum arrival rates were calculated and correlated to demographics and clinical characteristics. RESULTS A total of 332 CE studies were analyzed. Neither GTT nor SBTT were impacted by age or sex. SBTT was prolonged in newly diagnosed Crohn's disease (CD) patients compared with all other patients (303.1±90.3 vs. 243.6±83.6 min, P=0.02 for SB2, 267.8±63 vs. 228.6±72.3, P=0.01 for SB3, respectively). Moreover, CD patients had higher incomplete study rates compared with patients with all other diagnoses (29.4 vs. 7.3%, respectively, P=0.0116) in the SB2 subgroup. Higher cecum arrival rates were achieved by the SB3 capsule compared with SB2 (97 vs. 91%, P=0.04). Patients with prolonged gastric time or patients with incomplete studies had similar demographic and clinical characteristics as others. CONCLUSION Age and sex apparently do not influence intestinal kinetics. Newly diagnosed CD patients have relatively prolonged SBTTs. Demographic and clinical parameters cannot predict prolonged GTT or cecum nonarrival.
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Castañeda-Ortiz RA, Espinosa-Rosas P, Rodriguez-Izaguirre RA, Anzo-Osorio A, Almanza-Miranda E, Waller-Gónzalez LA, Gómez-Navarro G, Jimenez-Urueta PS. Experiencia de cápsula endoscópica en sangrado de origen obscuro y dolor abdominal crónico recurrente en Pediatría del CMN «20 de Noviembre» del ISSSTE. ENDOSCOPIA 2016. [DOI: 10.1016/j.endomx.2016.07.005] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
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Kim JH, Moon W. Optimal Diagnostic Approaches for Patients with Suspected Small Bowel Disease. Clin Endosc 2016; 49:364-9. [PMID: 27334413 PMCID: PMC4977738 DOI: 10.5946/ce.2016.074] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/11/2016] [Accepted: 06/02/2016] [Indexed: 12/16/2022] Open
Abstract
While the domain of gastrointestinal endoscopy has made great strides over the last several decades, endoscopic assessment of the small bowel continues to be challenging. Recently, with the development of new technology including video capsule endoscopy, device-assisted enteroscopy, and computed tomography/magnetic resonance enterography, a more thorough investigation of the small bowel is possible. In this article, we review the systematic approach for patients with suspected small bowel disease based on these advanced endoscopic and imaging systems.
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Affiliation(s)
- Jae Hyun Kim
- Department of Internal Medicine, Kosin University College of Medicine, Busan, Korea
| | - Won Moon
- Department of Internal Medicine, Kosin University College of Medicine, Busan, Korea
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Velayos Jiménez B, Alcaide Suárez N, González Redondo G, Fernández Salazar L, Aller de la Fuente R, Del Olmo Martínez L, Ruiz Rebollo L, González Hernández JM. Impact of the endoscopist's experience on the negative predictive value of capsule endoscopy. GASTROENTEROLOGIA Y HEPATOLOGIA 2016; 40:10-15. [PMID: 27085915 DOI: 10.1016/j.gastrohep.2016.03.003] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/05/2015] [Revised: 03/06/2016] [Accepted: 03/07/2016] [Indexed: 02/08/2023]
Abstract
INTRODUCTION The impact of the accumulated experience of the capsule endoscopy (CE) reader on the accuracy of this test is discussed. AIM To determine whether the negative predictive value of CE findings changes along the learning curve. METHODS We reviewed the first 900 CE read by 3 gastroenterologists experienced in endoscopy over 8 years. These 900 CE were divided into 3 groups (300 CE each): group 1 consisted of the sum of the first 100 CE read by each of the 3 endoscopists; group 2, the sum of the second 100 and groups 3, the sum of the third 100. Patients with normal CE were monitored for at least 28 months to estimate the negative predictive value. RESULTS A total of 54 (18%) CE in group 1, 58 (19.3%) in group 2 and 47 (15.6%) in group 3 were normal, although only 34 patients in group 1, 38 in group 2 and 36 in group 3 with normal CE completed follow up and were eventually studied. The negative predictive value was 88.2% in group 1, 89.5% in group 2 and 97% in group 3 (P>.05). CONCLUSION The negative predictive value tended to increase, but remained high and did not change significantly after the first 100 when readers are experienced in conventional endoscopy and have preliminary specific training.
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Affiliation(s)
| | | | | | | | | | | | - Lourdes Ruiz Rebollo
- Servicio de Aparato Digestivo, Hospital Clínico de Valladolid, Valladolid, España
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Diagnostic Role of Colon Capsule Endoscopy in Patients with Optimal Colon Cleaning. Gastroenterol Res Pract 2016; 2016:2738208. [PMID: 27066070 PMCID: PMC4811092 DOI: 10.1155/2016/2738208] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/16/2016] [Accepted: 02/21/2016] [Indexed: 12/22/2022] Open
Abstract
Background. Colon capsule endoscopy (CCE) is a diagnostic test with relatively rare usage. In this study, we aimed to evaluate both the optimal cleaning regimen for CCE and the diagnostic value of test in the study group. Methods. A total of 62 patients were enrolled in this study. In the first step, 3 different colon preparing regimens were given to 30 patients [Group A: 3 days of liquid diet, sodium phosphate (NaP) (90 mL), and NaP enema; Group B: 3 days of liquid diet, 4 L of polyethylene glycol (PEG), and metoclopramide; Group C: 3 days of liquid diet, 4 L of PEG, NaP (45 mL), and bisacodyl after capsule ingestion] (10 patients in each group). The other consecutive 32 patients were cleaned with the best regimen which was NaP + PEG and CCE was performed. The results of CCE were controlled with colonoscopy in 28 patients. Results. Group C had the highest cleaning score, compared with the other groups (2.2 ± 0.4 versus 2.7 ± 0.4 versus 3.7 ± 0.4, p value = 0.000). The CCE findings were as follows in 28 patients who were also examined with colonoscopy: polyp (range: 5–10 mm) in 6 patients, internal hemorrhoids in 3 patients, angiodysplasia in 1 patient, diverticula in 1 patient, and ulcerative colitis in 1 patient. The sensitivity, specificity, PPV, and NPV of CCE were 100%, 92%, 93%, and 100%, respectively. Conclusions. Low dosage NaP combined with PEG provides optimal bowel preparation for CCE. CCE appears to be a highly sensitive diagnostic modality for detecting colonic pathologies.
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Song HJ, Shim KN. Current status and future perspectives of capsule endoscopy. Intest Res 2016; 14:21-9. [PMID: 26884731 PMCID: PMC4754518 DOI: 10.5217/ir.2016.14.1.21] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/08/2015] [Revised: 09/15/2015] [Accepted: 09/17/2015] [Indexed: 02/06/2023] Open
Abstract
Small bowel capsule endoscopy (CE) was first introduced 15 years ago, and a large amount of literature has since been produced, focused on its indication, diagnostic yields, and safety. Guidelines that have made CE the primary diagnostic tool for small bowel disease have been created. Since its initial use in the small bowel, CE has been used for the esophagus, stomach, and colon. The primary indications for small bowel CE are obscure gastrointestinal bleeding, unexplained iron deficiency anemia, suspected Crohn's disease, small bowel tumors, nonsteroidal anti-inflammatory drug enteropathy, portal hypertensive enteropathy, celiac disease, etc. Colon CE provides an alternative to conventional colonoscopy, with possible use in colorectal cancer screening. Guidelines for optimal bowel preparation of CE have been suggested. The main challenges in CE are the development of new devices with the ability to provide therapy, air inflation for better visualization of the small bowel, biopsy sampling systems attached to the capsule, and the possibility of guiding and moving the capsule by an external motion controller. We review the current status and future directions of CE, and address all aspects of clinical practice, including the role of CE and long-term clinical outcomes.
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Affiliation(s)
- Hyun Joo Song
- Department of Internal Medicine, Jeju National University School of Medicine, Jeju, Korea
| | - Ki-Nam Shim
- Department of Internal Medicine, Ewha Womans University School of Medicine, Seoul, Korea
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Urgesi R, Cianci R, Pagliari D, Newton EE, Rizzo G, Costamagna G, Riccioni ME. Is capsule endoscopy appropriate for elderly patients? The influence of ageing on findings and diagnostic yield: An Italian retrospective study. Dig Liver Dis 2015; 47:1086-8. [PMID: 26514739 DOI: 10.1016/j.dld.2015.09.004] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/20/2015] [Revised: 08/31/2015] [Accepted: 09/16/2015] [Indexed: 12/11/2022]
Abstract
BACKGROUND Few data are available on the use of capsule endoscopy in the elderly. METHODS We performed a retrospective study on 1008 consecutive patients referred to our centre between December 1, 2002 and January 30, 2014 who underwent capsule endoscopy for various indications. Patients were enrolled and divided into 3 sub-groups according to their age (Group A: <50 years; Group B: 50-69 years; Group C: >70 years). The Pillcam diagnostic yield, clinically significant findings and post-treatment outcomes were compared between groups. RESULTS Diagnostic yield was significantly higher in Group C vs. Groups A and B (65.2% vs. 42.3% and 47.5%, respectively; p<0.05). The most common diagnosis in the elderly was angiodysplasia (42.5%). In 84.5% of elderly patients (Group C) capsule endoscopy results modified patient management. CONCLUSIONS Capsule endoscopy has a high diagnostic yield and positive impact on management in patients aged >70 years.
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Affiliation(s)
- Riccardo Urgesi
- Department of Internal Medicine and Gastroenterology, 'Columbus Hospital', Catholic University of the Sacred Heart, Rome Italy
| | - Rossella Cianci
- Department of Internal Medicine, 'A. Gemelli Hospital', Catholic University of the Sacred Heart, Rome Italy
| | - Danilo Pagliari
- Department of Internal Medicine, 'A. Gemelli Hospital', Catholic University of the Sacred Heart, Rome Italy
| | | | - Gianluca Rizzo
- Department of Surgery, 'Columbus Hospital', Catholic University of the Sacred Heart, Rome, Italy
| | - Guido Costamagna
- Department of Surgery, Surgical Endoscopy Unit, 'A. Gemelli Hospital', Catholic University of the Sacred Heart, Rome, Italy
| | - Maria Elena Riccioni
- Department of Surgery, Surgical Endoscopy Unit, 'A. Gemelli Hospital', Catholic University of the Sacred Heart, Rome, Italy.
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Retained Capsule Endoscopy in a Large Tertiary Care Academic Practice and Radiologic Predictors of Retention. Inflamm Bowel Dis 2015; 21:2158-64. [PMID: 26284295 DOI: 10.1097/mib.0000000000000482] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
BACKGROUND Capsule retention reported rates range between 1% and 13%. This study aims to determine the incidence of, risk factors for, and clinical outcomes of capsule retention in a large heterogenous cohort of patients and define cross-sectional imaging findings predictive of capsule retention. METHODS A retrospective review of all capsule endoscopy (CE) examinations performed at our center from January 2002 to January 2013 was undertaken. Data on patient demographics, CE indication, findings, and details of management were analyzed. Radiologic images of patients with computed tomography scan performed 6 months before CE for patients with CE retention and for controls without CE retention but at high risk based on clinical computed tomography reports were examined by a gastrointestinal radiologist, blinded to history, and classified as worrisome based on the presence of stricture, partial obstruction, or small bowel (SB) anastomosis. RESULTS Seventeen CE retentions (0.3%) occurred in 15 patients. Obscure gastrointestinal bleeding (47%) was the most common indication. Outcomes included surgical intervention (n = 10), endoscopic retrieval (n = 2), passing of capsule after treatment of inflammation (n = 3), passage after conservative measures for SB obstruction (n = 1), and loss to follow-up (n = 1). Patients with CE retention were more likely to have SB anastomoses (88% versus 23%) and partial obstruction (63% versus 38%) than patients with high-risk features for capsule retention who passed the capsule. CONCLUSIONS In a tertiary care population without obstructive symptoms, capsule retention occurred in only 0.3% of cases. Review of surgical history and prior imaging for obstruction or SB anastomoses may help to reduce retention.
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ACG Clinical Guideline: Diagnosis and Management of Small Bowel Bleeding. Am J Gastroenterol 2015; 110:1265-87; quiz 1288. [PMID: 26303132 DOI: 10.1038/ajg.2015.246] [Citation(s) in RCA: 381] [Impact Index Per Article: 42.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/07/2015] [Accepted: 06/01/2015] [Indexed: 02/06/2023]
Abstract
Bleeding from the small intestine remains a relatively uncommon event, accounting for ~5-10% of all patients presenting with gastrointestinal (GI) bleeding. Given advances in small bowel imaging with video capsule endoscopy (VCE), deep enteroscopy, and radiographic imaging, the cause of bleeding in the small bowel can now be identified in most patients. The term small bowel bleeding is therefore proposed as a replacement for the previous classification of obscure GI bleeding (OGIB). We recommend that the term OGIB should be reserved for patients in whom a source of bleeding cannot be identified anywhere in the GI tract. A source of small bowel bleeding should be considered in patients with GI bleeding after performance of a normal upper and lower endoscopic examination. Second-look examinations using upper endoscopy, push enteroscopy, and/or colonoscopy can be performed if indicated before small bowel evaluation. VCE should be considered a first-line procedure for small bowel investigation. Any method of deep enteroscopy can be used when endoscopic evaluation and therapy are required. VCE should be performed before deep enteroscopy if there is no contraindication. Computed tomographic enterography should be performed in patients with suspected obstruction before VCE or after negative VCE examinations. When there is acute overt hemorrhage in the unstable patient, angiography should be performed emergently. In patients with occult hemorrhage or stable patients with active overt bleeding, multiphasic computed tomography should be performed after VCE or CTE to identify the source of bleeding and to guide further management. If a source of bleeding is identified in the small bowel that is associated with significant ongoing anemia and/or active bleeding, the patient should be managed with endoscopic therapy. Conservative management is recommended for patients without a source found after small bowel investigation, whereas repeat diagnostic investigations are recommended for patients with initial negative small bowel evaluations and ongoing overt or occult bleeding.
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Ustundag Y, Shorbagi A, Dindar G. Double balloon enteroscopy for removal of retained video capsules. Dig Endosc 2015; 27:531-532. [PMID: 25604075 DOI: 10.1111/den.12440] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Affiliation(s)
- Yucel Ustundag
- Department of Internal Medicine, Gastroenterology Clinics, Bulent Ecevit University, Zonguldak, Turkey
| | - Ali Shorbagi
- Gastroenterology Division, Department of Internal Medicine, Near East University, Lefkosia, Cyprus
| | - Gokhan Dindar
- Department of Internal Medicine, Gastroenterology Clinics, Bulent Ecevit University, Zonguldak, Turkey
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Magalhães-Costa P, Bispo M, Santos S, Couto G, Matos L, Chagas C. Re-bleeding events in patients with obscure gastrointestinal bleeding after negative capsule endoscopy. World J Gastrointest Endosc 2015; 7:403-410. [PMID: 25901220 PMCID: PMC4400630 DOI: 10.4253/wjge.v7.i4.403] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/01/2014] [Revised: 11/27/2014] [Accepted: 01/20/2015] [Indexed: 02/05/2023] Open
Abstract
AIM: To investigate long-term re-bleeding events after a negative capsule endoscopy in patients with obscure gastrointestinal bleeding (OGIB) and the risk factors associated with the procedure.
METHODS: Patients referred to Hospital Egas Moniz (Lisboa, Portugal) between January 2006 and October 2012 with OGIB and a negative capsule endoscopy were retrospectively analyzed. The following study variables were included: demographic data, comorbidities, bleeding-related drug use, hemoglobin level, indication for capsule endoscopy, post procedure details, work-up and follow-up. Re-bleeding rates and associated factors were assessed using a Cox proportional hazard analysis. The Kaplan-Meier method was used to estimate the cumulative incidence of re-bleeding at 1, 3 and 5 years, and the differences between factors were evaluated.
RESULTS: The study population consisted of 640 patients referred for OGIB investigation. Wireless capsule endoscopy was deemed negative in 113 patients (17.7%). A total of 64.6% of the population was female, and the median age was 69 years. The median follow-up was forty-eight months (interquartile range 24-60). Re-bleeding occurred in 27.4% of the cases. The median time to re-bleeding was fifteen months (interquartile range 2-33). In 22.6% (n = 7) of the population, small-bowel angiodysplasia was identified as the culprit lesion. A univariate analysis showed that age > 65 years old, chronic kidney disease, aortic stenosis, anticoagulant use and overt OGIB were risk factors for re-bleeding; however, on a multivariate analysis, there were no risk factors for re-bleeding. The cumulative risk of re-bleeding at 1, 3 and 5 years of follow-up was 12.9%, 25.6% and 31.5%, respectively. Patients who presented with overt OGIB tended to re-bleed sooner (median time for re-bleeding: 8.5 mo vs 22 mo).
CONCLUSION: Patients with OGIB despite a negative capsule endoscopy have a significant re-bleeding risk; therefore, these patients require an extended follow-up strategy.
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The Utility of Capsule Endoscopy in Patients under 50 Years of Age with Recurrent Iron Deficiency Anaemia: Is the Juice Worth the Squeeze? Gastroenterol Res Pract 2015; 2015:948574. [PMID: 25922603 PMCID: PMC4397481 DOI: 10.1155/2015/948574] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/10/2014] [Accepted: 03/16/2015] [Indexed: 12/22/2022] Open
Abstract
Background and Aims. The role of capsule endoscopy (CE) in the <50 years of age patients with iron deficiency anaemia (IDA) remains unclear. We aim to assess its utility in this cohort. Methods. All patients referred for CE for recurrent IDA were included retrospectively. Patients were divided into Group 1 (<50 years) and Group 2 (≥50 years). Results. There were 971 patients with recurrent IDA and 28% belonged to Group 1. The mean age was 40 years in this group with a DY of 28% (n = 76). Significant diagnoses included erosions and ulcers (26%; n = 71), small bowel (SB) angioectasia (AE) (10%; n = 27), SB tumours (3%; n = 7), Crohn's disease (3%; n = 7), SB bowel strictures (1%; n = 3), and SB varices (1%; n = 2). On logistic regression, the presence of diabetes (P = 0.02) and the use of warfarin (P = 0.049) was associated with increased DY. The DY in Group 2 was 38% which was significantly higher than in Group 1 (P = 0.02). While SB tumours were equally common in both groups, AE was commoner in Group 2 (P < 0.001). Conclusion. A significant proportion of patients <50 years are referred for CE. Although the DY is lower compared to those ≥50 years, significant pathology is found in this age group. CE is advisable in patients <50 years old with recurrent IDA and negative bidirectional endoscopies.
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Schlag C, Menzel C, Nennstiel S, Neu B, Phillip V, Schuster T, Schmid RM, von Delius S. Emergency video capsule endoscopy in patients with acute severe GI bleeding and negative upper endoscopy results. Gastrointest Endosc 2015; 81:889-95. [PMID: 25432532 DOI: 10.1016/j.gie.2014.09.035] [Citation(s) in RCA: 34] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/20/2014] [Accepted: 09/10/2014] [Indexed: 02/08/2023]
Abstract
BACKGROUND In mid-GI bleeding, video capsule endoscopy (VCE) shows the best diagnostic yield for ongoing overt bleeding. To date, the utility of VCE in acute severe GI bleeding has been analyzed rarely. OBJECTIVE To evaluate the impact of VCE when performed on patients with acute severe GI bleeding immediately after an initial negative upper endoscopy result. DESIGN Prospective study. SETTING Tertiary-care center. PATIENTS Patients with melena, dark-red or maroon stool, hemodynamic instability, drop of hemoglobin level ≥2 g/dL/day, and/or need of transfusion ≥2 units of packed red blood cells per day were included. INTERVENTIONS After a negative upper endoscopy result, emergency VCE was performed by immediate endoscopic placement of the video capsule into the duodenum. MAIN OUTCOME MEASUREMENTS Rate of patients in whom emergency VCE correctly guided further diagnostic and therapeutic procedures. RESULTS Upper endoscopy showed the source of bleeding in 68 of 88 patients (77%). In the remaining 20 patients (23%), emergency VCE was performed, which was feasible in 19 of 20 patients (95%; 95% confidence interval [CI], 75%-99%). Emergency VCE correctly guided further diagnostic and therapeutic procedures in 17 of 20 patients (85%; 95% CI, 62%-97%) and showed a diagnostic yield of 75% (95% CI, 51%-91%). LIMITATIONS Single-center study, small sample size. CONCLUSION In patients with acute severe GI bleeding and negative upper endoscopy results, emergency VCE can be useful for the immediate detection of the bleeding site and is able to guide further therapy. (Clinical trial registration number: NCT01584869.)
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Tan W, Ge ZZ, Gao YJ, Li XB, Dai J, Fu SW, Zhang Y, Xue HB, Zhao YJ. Long-term outcome in patients with obscure gastrointestinal bleeding after capsule endoscopy. J Dig Dis 2015; 16:125-34. [PMID: 25495855 DOI: 10.1111/1751-2980.12222] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
OBJECTIVE This study aimed to identify the risk factors associated with rebleeding and long-term outcomes after capsule endoscopy (CE) for obscure gastrointestinal bleeding (OGIB) in a follow-up study. METHODS Data of consecutive patients who underwent CE due to OGIB from June 2002 to January 2012 were retrospectively reviewed. The Cox proportional hazard model was used to evaluate the risk factors associated with rebleeding, while Kaplan-Meier survival curves and the log-rank test were used to analyze cumulative rebleeding rates. RESULTS The overall rebleeding rate after CE in patients with OGIB was 28.6% (97/339) during a median follow-up of 48 months (range 12-112 months). Multivariate analysis showed that age ≥60 years (hazard ratio [HR] 2.473, 95% confidence interval [CI] 1.576-3.881, P = 0.000), positive CE findings (HR 3.393, 95% CI 1.931-5.963, P = 0.000), hemoglobin ≤70 g/L before CE (HR 2.010, 95% CI 1.261-3.206, P = 0.003), nonspecific treatments (HR 2.500, 95% CI 1.625-3.848, P = 0.000) and the use of anticoagulants, antiplatelet or non-steroidal anti-inflammatory drugs after CE (HR 2.851, 95% CI 1.433-5.674, P = 0.003) were independent risk factors associated with rebleeding. Univariate analysis showed that chronic hepatitis was independently associated with rebleeding in CE-negative patients (P = 0.021). CONCLUSIONS CE has a significant impact on the long-term outcome of patients with OGIB. Further investigation and close follow-up in patients with OGIB and those with negative CE findings are necessary.
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Affiliation(s)
- Wei Tan
- Key Laboratory of Gastroenterology & Hepatology, Ministry of Health, Division of Gastroenterology and Hepatology, Ren Ji Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai Institute of Digestive Disease, Shanghai, China
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Koulaouzidis A, Iakovidis DK, Karargyris A, Plevris JN. Optimizing lesion detection in small-bowel capsule endoscopy: from present problems to future solutions. Expert Rev Gastroenterol Hepatol 2015; 9:217-35. [PMID: 25169106 DOI: 10.1586/17474124.2014.952281] [Citation(s) in RCA: 49] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
This review presents issues pertaining to lesion detection in small-bowel capsule endoscopy (SBCE). The use of prokinetics, chromoendoscopy, diagnostic yield indicators, localization issues and the use of 3D reconstruction are presented. The authors also review the current status (and future expectations) in automatic lesion detection software development. Automatic lesion detection and reporting, and development of an accurate lesion localization system are the main software challenges of our time. The 'smart', selective and judicious use (before as well as during SBCE) of prokinetics in combination with other modalities (such as real time and/or purge) improves the completion rate of SBCE. The tracking of the capsule within the body is important for the localization of abnormal findings and planning of further therapeutic interventions. Currently, localization is based on transit time. Recently proposed software and hardware solutions are proposed herein. Moreover, the feasibility of software-based 3D representation (attempt for 3D reconstruction) is examined.
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Capsule endoscopy in pediatrics: A growing experience. TECHNIQUES IN GASTROINTESTINAL ENDOSCOPY 2015. [DOI: 10.1016/j.tgie.2015.01.002] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
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Caprara R, Obstein KL, Scozzarro G, Di Natali C, Beccani M, Morgan DR, Valdastri P. A platform for gastric cancer screening in low- and middle-income countries. IEEE Trans Biomed Eng 2014; 62:1324-32. [PMID: 25561586 DOI: 10.1109/tbme.2014.2386309] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
Gastric cancer is the second leading cause of cancer death worldwide and screening programs have had a significant impact on reducing mortality. The majority of cases occur in low- and middle-income countries (LMIC), where endoscopy resources are traditionally limited. In this paper, we introduce a platform designed to enable inexpensive gastric screening to take place in remote areas of LMIC. The system consists of a swallowable endoscopic capsule connected to an external water distribution system by a multichannel soft tether. Pressurized water is ejected from the capsule to orient the view of the endoscopic camera. After completion of a cancer screening procedure, the outer shell of the capsule and the soft tether can be disposed, while the endoscopic camera is reclaimed without needing further reprocessing. The capsule, measuring 12 mm in diameter and 28 mm in length, is able to visualize the inside of the gastric cavity by combining waterjet actuation and the adjustment of the tether length. Experimental assessment was accomplished through a set of bench trials, ex vivo analysis, and in vivo feasibility validation. During the ex vivo trials, the platform was able to visualize the main landmarks that are typically observed during a gastric cancer screening procedure in less than 8 min. Given the compact footprint, the minimal cost of the disposable parts, and the possibility of running on relatively available and inexpensive resources, the proposed platform can potentially widen gastric cancer screening programs in LMIC.
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Niv E, Fishman S, Kachman H, Arnon R, Dotan I. Sequential capsule endoscopy of the small bowel for follow-up of patients with known Crohn's disease. J Crohns Colitis 2014; 8:1616-23. [PMID: 24666976 DOI: 10.1016/j.crohns.2014.03.003] [Citation(s) in RCA: 50] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/29/2013] [Revised: 02/25/2014] [Accepted: 03/03/2014] [Indexed: 02/08/2023]
Abstract
BACKGROUND AND AIMS The aim of this study was to perform sequential small bowel (SB) capsule endoscopy (CE) studies in patients with known active Crohn's disease (CD) during different treatments, to characterize the changes in the SB mucosa over time, and to correlate the CE findings with clinical and laboratory parameters of inflammation. METHODS Consecutive patients with known moderately active CD were prospectively recruited. After proven patency with Agile capsule, CE studies were performed at baseline and after 4, 12 and 24 weeks. CE parameters and a Lewis score were calculated. Clinical and laboratory parameters were correlated. A control group of 178 non-CD patients was used for comparisons. RESULTS Thirty-one CD patients were recruited and 19 met the inclusion criteria. A total of 43 CE studies were performed over the time. There was no capsule retention despite a high rate of previous SB surgery. The mean baseline CDAI, IBDQ and Lewis scores were 306±56, 135±26.6 and 1730±1780, respectively. There was no correlation at the baseline between clinical and laboratory parameters (CDAI, CRP, IBDQ) and mucosal disease (Lewis scores). CDAI and IBDQ changes over a period of 4 and 12 weeks did not correlate with the Lewis score. The cecum arrival rate of the CD patients was significantly lower (p=0.0047) and the SB transit time was significantly longer (p=0.005) compared to those of the controls. CONCLUSIONS Sequential CE studies are feasible and safe in CD patients. In patients with complete CE studies, they provide reliable information on mucosal changes in CD and should be considered as an independent and objective follow-up tool in known CD patients.
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Affiliation(s)
- Eva Niv
- IBD Center, The Department of Gastroenterology and Liver Diseases, Tel-Aviv Sourasky Medical Center, Tel-Aviv, Israel(1).
| | - Sigal Fishman
- IBD Center, The Department of Gastroenterology and Liver Diseases, Tel-Aviv Sourasky Medical Center, Tel-Aviv, Israel(1)
| | - Helena Kachman
- IBD Center, The Department of Gastroenterology and Liver Diseases, Tel-Aviv Sourasky Medical Center, Tel-Aviv, Israel(1)
| | - Ruth Arnon
- Department of Immunology, Weizmann Institute of Science, Tel-Aviv, Israel
| | - Iris Dotan
- IBD Center, The Department of Gastroenterology and Liver Diseases, Tel-Aviv Sourasky Medical Center, Tel-Aviv, Israel(1)
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Sakai E, Endo H, Taguri M, Kawamura H, Taniguchi L, Hata Y, Ezuka A, Nagase H, Kessoku T, Ishii K, Arimoto J, Yamada E, Ohkubo H, Higurashi T, Koide T, Nonaka T, Takahashi H, Nakajima A. Frequency and risk factors for rebleeding events in patients with small bowel angioectasia. BMC Gastroenterol 2014; 14:200. [PMID: 25430814 PMCID: PMC4262995 DOI: 10.1186/s12876-014-0200-3] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/18/2014] [Accepted: 11/10/2014] [Indexed: 12/19/2022] Open
Abstract
BACKGROUND Small bowel angioectasia is reported as the most common cause of bleeding in patients with obscure gastrointestinal bleeding. Although the safety and efficacy of endoscopic treatment have been demonstrated, rebleeding rates are relatively high. To establish therapeutic and follow-up guidelines, we investigated the long-term outcomes and clinical predictors of rebleeding in patients with small bowel angioectasia. METHODS A total of 68 patients were retrospectively included in this study. All the patients had undergone CE examination, and subsequent control of bleeding, where needed, was accomplished by endoscopic argon plasma coagulation. Based on the follow-up data, the rebleeding rate was compared between patients who had/had not undergone endoscopic treatment. Multivariate analysis was performed using Cox proportional hazard regression model to identify the predictors of rebleeding. We defined the OGIB as controlled if there was no further overt bleeding within 6 months and the hemoglobin level had not fallen below 10 g/dl by the time of the final examination. RESULTS The overall rebleeding rate over a median follow-up duration of 30.5 months (interquartile range 16.5-47.0) was 33.8% (23/68 cases). The cumulative risk of rebleeding tended to be lower in the patients who had undergone endoscopic treatment than in those who had not undergone endoscopic treatment, however, the difference did not reach statistical significance (P = 0.14). In the majority of patients with rebleeding (18/23, 78.3%), the bleeding was controlled by the end of the follow-up period. Multiple regression analysis identified presence of multiple lesions (≥3) (OR 3.82; 95% CI 1.30-11.3, P = 0.02) as the only significant independent predictor of rebleeding. CONCLUSION In most cases, bleeding can be controlled by repeated endoscopic treatment. Careful follow-up is needed for patients with multiple lesions, presence of which is considered as a significant risk factor for rebleeding.
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Affiliation(s)
- Eiji Sakai
- Department of Gastroenterology and Hepatology, Yokohama City University School of Medicine, 3-9 Fuku-ura, Kanazawa-ku, Yokohama, 236-0004, Japan.
| | - Hiroki Endo
- Department of Gastroenterology and Hepatology, Yokohama City University School of Medicine, 3-9 Fuku-ura, Kanazawa-ku, Yokohama, 236-0004, Japan. .,Department of Endoscopy Center, Yokohama City University School of Medicine, Yokohama, Japan.
| | - Masataka Taguri
- Department of Biostatistics and Epidemiology, Yokohama City University School of Medicine, Yokohama, Japan.
| | - Harunobu Kawamura
- Gastroenterology Division, Odawara Municipal Hospital, Odawara, Japan.
| | - Leo Taniguchi
- Gastroenterology Division, Chigasaki Municipal Hospital, Chigasaki, Japan.
| | - Yasuo Hata
- Gastroenterology Division, Chigasaki Municipal Hospital, Chigasaki, Japan.
| | - Akiko Ezuka
- Gastroenterology Division, Yokohama Rosai Hospital, Yokohama, Japan.
| | - Hajime Nagase
- Gastroenterology Division, Yokohama Rosai Hospital, Yokohama, Japan.
| | - Takaomi Kessoku
- Department of Gastroenterology and Hepatology, Yokohama City University School of Medicine, 3-9 Fuku-ura, Kanazawa-ku, Yokohama, 236-0004, Japan. .,Gastroenterology Division, Hiratsuka City Hospital, Hiratsuka, Japan.
| | - Ken Ishii
- Department of Gastroenterology and Hepatology, Yokohama City University School of Medicine, 3-9 Fuku-ura, Kanazawa-ku, Yokohama, 236-0004, Japan.
| | - Jun Arimoto
- Department of Gastroenterology and Hepatology, Yokohama City University School of Medicine, 3-9 Fuku-ura, Kanazawa-ku, Yokohama, 236-0004, Japan.
| | - Eiji Yamada
- Department of Endoscopy Center, Yokohama City University School of Medicine, Yokohama, Japan.
| | - Hidenori Ohkubo
- Department of Endoscopy Center, Yokohama City University School of Medicine, Yokohama, Japan.
| | - Takuma Higurashi
- Department of Gastroenterology and Hepatology, Yokohama City University School of Medicine, 3-9 Fuku-ura, Kanazawa-ku, Yokohama, 236-0004, Japan.
| | - Tomoko Koide
- Department of Gastroenterology and Hepatology, Yokohama City University School of Medicine, 3-9 Fuku-ura, Kanazawa-ku, Yokohama, 236-0004, Japan.
| | - Takashi Nonaka
- Department of Gastroenterology and Hepatology, Yokohama City University School of Medicine, 3-9 Fuku-ura, Kanazawa-ku, Yokohama, 236-0004, Japan.
| | - Hirokazu Takahashi
- Department of Endoscopy Center, Yokohama City University School of Medicine, Yokohama, Japan.
| | - Atsushi Nakajima
- Department of Gastroenterology and Hepatology, Yokohama City University School of Medicine, 3-9 Fuku-ura, Kanazawa-ku, Yokohama, 236-0004, Japan. .,Department of Endoscopy Center, Yokohama City University School of Medicine, Yokohama, Japan.
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Royall NA, Fiscina CD. Report of video-capsule endoscopy disruption producing episodic small bowel obstruction after prolonged retention. Int J Surg Case Rep 2014; 5:1001-4. [PMID: 25460458 PMCID: PMC4276273 DOI: 10.1016/j.ijscr.2014.10.073] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2014] [Accepted: 10/20/2014] [Indexed: 11/21/2022] Open
Abstract
We report a case of a patient who developed intermittent small bowel obstruction secondary to a retained video-capsule endoscopy with capsule disruption. Wireless video-capsule endoscopy is associated with elevated risk for capsule retention and intestinal obstruction in the setting of Crohn's disease. Prolonged video-capsule endoscopy retention may predispose to capsule fragmentation and intestinal perforation. Early intervention is indicated for retained video-capsule endoscopy without excellent patient compliance and follow-up.
INTRODUCTION Wireless video-capsule endoscopy is a procedure which provides direct visualization of the gastrointestinal tract, particularly the jejunum and ileum. Capsule retention is the main risk associated with capsule endoscopy, occurring at a significantly elevated incidence in patients with known or suspected Crohn's disease. PRESENTATION OF CASE A case of a prolonged retained capsule with subsequent fragmentation producing a multicentric complete small bowel obstruction in a 39 year old male patient who had undergone wireless video capsule-endoscopy approximately three years prior. Management required surgical resection of the strictured jejunum and removal of retained capsule fragments under fluoroscopic guidance. DISCUSSION Although capsule endoscopy is capable of diagnosis, evaluation, and monitoring inflammatory bowel disease, understanding the elevated risk for capsule retention is important in this population. Specifically, prolonged capsule retention appears to increase the risk of capsule disruption, and likely the potential for intestinal perforation. CONCLUSION Patients should therefore be carefully selected for monitoring based upon treatment compliance and offered early endoscopic or surgical intervention in the setting of questionable compliance due to the risk for capsule disruption and subsequent intestinal perforation.
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Affiliation(s)
- Nelson A Royall
- Department of Surgery, Orlando Health, 1414 Kuhl Avenue, Orlando, FL 32806, USA.
| | - Creighton D Fiscina
- Advanced Surgical Care Specialists, Florida Hospital Medical Group, 4106 West Lake Mary Boulevard, Suite 330, Lake Mary, FL 32746, USA
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Neumann H, Fry LC, Nägel A, Neurath MF. Wireless capsule endoscopy of the small intestine: a review with future directions. Curr Opin Gastroenterol 2014; 30:463-71. [PMID: 25029549 DOI: 10.1097/mog.0000000000000101] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
PURPOSE OF REVIEW Here, we review the clinical applications of small bowel capsule endoscopy. Moreover, we provide an outlook on the exceptional future developments of small bowel capsule endoscopy. We discuss clinical algorithms for diagnosis of small bowel diseases. Multiple studies have shown the potential of capsule endoscopy for identification of the bleeding source located in the small bowel and the increased diagnostic yield over radiographic studies. Capsule endoscopy could detect villous atrophy and severe complications in patients with nonresponsive celiac disease. In addition, small bowel capsule endoscopy was proven as a valid tool to diagnose polyps and tumors and Crohn's disease. SUMMARY Major current clinical indications of capsule endoscopy in the small bowel include evaluation of obscure gastrointestinal bleeding, diagnosis and surveillance of small bowel polyps and tumors, celiac disease and Crohn's disease. Recent developments have also passed the way for small bowel capsule endoscopy to become a therapeutic instrument.
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Affiliation(s)
- Helmut Neumann
- aDepartment of Medicine I, University of Erlangen-Nürnberg, Erlangen bLudwig Demling Endoscopic Center of Excellence, University Hospital Erlangen, Erlangen, Germany cDivision of Gastroenterology and Hepatology, Basil Hirschowitz Endoscopic Center of Excellence, University of Alabama at Birmingham, Birmingham, Alabama, USA
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Muhammad A, Vidyarthi G, Brady P. Role of small bowel capsule endoscopy in the diagnosis and management of iron deficiency anemia in elderly: A comprehensive review of the current literature. World J Gastroenterol 2014; 20:8416-8423. [PMID: 25024599 PMCID: PMC4093694 DOI: 10.3748/wjg.v20.i26.8416] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/04/2013] [Revised: 01/30/2014] [Accepted: 03/13/2014] [Indexed: 02/06/2023] Open
Abstract
Iron deficiency anemia (IDA) is common and often under recognized problem in the elderly. It may be the result of multiple factors including a bleeding lesion in the gastrointestinal tract. Twenty percent of elderly patients with IDA have a negative upper and lower endoscopy and two-thirds of these have a lesion in the small bowel (SB). Capsule endoscopy (CE) provides direct visualization of entire SB mucosa, which was not possible before. It is superior to push enteroscopy, enteroclysis and barium radiography for diagnosing clinically significant SB pathology resulting in IDA. Angioectasia is one of the commonest lesions seen on the CE in elderly with IDA. The diagnostic yield of CE for IDA progressively increases with advancing age, and is highest among patients over 85 years of age. Balloon assisted enteroscopy is used to treat the lesions seen on CE. CE has some limitations mainly lack of therapeutic capability, inability to provide precise location of the lesion and false positive results. Overall CE is a very safe and effective procedure for the evaluation of IDA in elderly.
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Laurain A, de Leusse A, Gincul R, Vanbiervliet G, Bramli S, Heyries L, Martane G, Amrani N, Serraj I, Saurin JC, Borentain P, Filoche B, Duburque C, Gaudric M, Sogni P, Dumortier J. Oesophageal capsule endoscopy versus oesophago-gastroduodenoscopy for the diagnosis of recurrent varices: a prospective multicentre study. Dig Liver Dis 2014; 46:535-40. [PMID: 24631032 DOI: 10.1016/j.dld.2014.02.002] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/20/2013] [Revised: 01/22/2014] [Accepted: 02/04/2014] [Indexed: 12/11/2022]
Abstract
BACKGROUND Oesophago-gastroduodenoscopy is the standard method for the diagnosis of recurrent oesophago-gastric varices after endoscopic treatment and eradication. The aim of this study was to evaluate the PillCam Eso capsule endoscopy in this setting. METHODS Prospective, multicentre study in which patients with history of oesophageal varices treated by band ligation underwent PillCam Eso capsule and oesophago-gastroduodenoscopy. Capsule recordings were blindly read by two endoscopists. Indication for a new prophylactic treatment and patient satisfaction were determined for both procedures. RESULTS 80 patients (80% males, mean age: 57±12 years) were included, after a median delay of 16 months from last endoscopic treatment. Recurrent oesophageal varices requiring a new prophylactic treatment were detected in 26 patients (32.5%). The mean oesophageal transit time of the capsule was 153 s (range 2-930 s). Capsule sensitivity, specificity, negative and positive predictive values for indication of new prophylactic treatments were 65%, 83%, 83%, and 65%, respectively. Capsule adequately classified 77.5% of the patients for prophylaxis indication. Inter-observer concordance for capsule readings was 88% for the prophylaxis indication. CONCLUSION This study demonstrates that accuracy of PillCam Eso capsule for the diagnosis of recurrent oesophageal varices after endoscopic eradication is suboptimal. PillCam Eso capsule might therefore be proposed in patients unable or unwilling to undergo oesophago-gastroduodenoscopy.
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Affiliation(s)
- Anne Laurain
- Edouard Herriot Hospital - HCL, Department of Digestive Diseases, Claude Bernard Lyon 1 University, Lyon, France
| | - Antoine de Leusse
- Edouard Herriot Hospital - HCL, Department of Digestive Diseases, Claude Bernard Lyon 1 University, Lyon, France; Jean Mermoz Hospital, Lyon, France; Société Française d'Endoscopie Digestive, Paris, France
| | - Rodica Gincul
- Edouard Herriot Hospital - HCL, Department of Digestive Diseases, Claude Bernard Lyon 1 University, Lyon, France; Société Française d'Endoscopie Digestive, Paris, France
| | - Geoffroy Vanbiervliet
- Archet II Hospital, Department of Digestive Diseases, Nice, France; Société Française d'Endoscopie Digestive, Paris, France
| | - Slim Bramli
- Avignon Hospital, Department of Digestive Diseases, Avignon, France; Société Française d'Endoscopie Digestive, Paris, France
| | - Laurent Heyries
- Conception Hospital - AP-HM, Department of Digestive Diseases, Marseille, France; Société Française d'Endoscopie Digestive, Paris, France
| | - Gabriel Martane
- Avignon Hospital, Department of Digestive Diseases, Avignon, France; Société Française d'Endoscopie Digestive, Paris, France
| | - Naima Amrani
- Ibn Sina Hospital, Department of Digestive Diseases, Rabat, Morocco; Société Française d'Endoscopie Digestive, Paris, France
| | - Ilham Serraj
- Ibn Sina Hospital, Department of Digestive Diseases, Rabat, Morocco
| | - Jean-Christophe Saurin
- Edouard Herriot Hospital - HCL, Department of Digestive Diseases, Claude Bernard Lyon 1 University, Lyon, France; Lyon Sud Hospital, Department of Digestive Diseases, Pierre Benite, France; Société Française d'Endoscopie Digestive, Paris, France
| | - Patrick Borentain
- Conception Hospital - AP-HM, Department of Digestive Diseases, Marseille, France
| | - Bernard Filoche
- Saint Philibert Hospital, Department of Digestive Diseases, Lomme, France; Société Française d'Endoscopie Digestive, Paris, France
| | - Clotilde Duburque
- Saint Philibert Hospital, Department of Digestive Diseases, Lomme, France
| | - Marianne Gaudric
- Cochin Hospital - AP-HP, Department of Digestive Endoscopy, Paris, France; Société Française d'Endoscopie Digestive, Paris, France
| | - Philippe Sogni
- Cochin Hospital - AP-HP, Department of Digestive Endoscopy, Paris, France
| | - Jérôme Dumortier
- Edouard Herriot Hospital - HCL, Department of Digestive Diseases, Claude Bernard Lyon 1 University, Lyon, France.
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Koulaouzidis A. Technology status evaluation report on wireless capsule endoscopy. Gastrointest Endosc 2014; 79:872-3. [PMID: 24721630 DOI: 10.1016/j.gie.2013.12.033] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/22/2013] [Accepted: 12/30/2013] [Indexed: 02/08/2023]
Affiliation(s)
- Anastasios Koulaouzidis
- The Centre for Liver & Digestive Disorders, The Royal Infirmary of Edinburgh, Edinburgh, United Kingdom
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Tontini GE, Vecchi M, Neurath MF, Neumann H. Advanced endoscopic imaging techniques in Crohn's disease. J Crohns Colitis 2014; 8:261-9. [PMID: 24080247 DOI: 10.1016/j.crohns.2013.09.004] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/04/2013] [Revised: 09/05/2013] [Accepted: 09/05/2013] [Indexed: 12/12/2022]
Abstract
BACKGROUND Endoscopy is of pivotal importance in Crohn's disease (CD) patients for diagnosis, surveillance and assessment of disease activity and extent. Device-assisted enteroscopy (DAE) and small-bowel capsule endoscopy (SBCE) have recently changed our endoscopic approach to small-bowel imaging. Furthermore, new advanced endoscopic imaging techniques have been implemented into clinical practice to improve both characterization of mucosal inflammation and detection of dysplastic lesions. AIM To provide readers with a review about the concept of advanced endoscopic imaging for the diagnosis and characterization of CD. METHODS A literature search on the use of advanced endoscopy techniques in IBD patients was performed. RESULTS DAE and SBCE allow for deep enteroscopy with high diagnostic yields and low complication's rate but their collocation in the diagnostic algorithm is still not clearly defined. Dye-based chromoendoscopy (DBC) and magnification chromoendoscopy improved dysplasia's detection in long standing colitis and prediction of inflammatory activity and extent. Dye-less chromoendoscopy (DLC) might offer the potential to replace conventional DBC for surveillance. However, both narrow band imaging and i-scan have already shown to significantly improve activity and extent assessment in comparison to white-light endoscopy. Confocal laser endomicroscopy (CLE) can detect more dysplastic lesions in surveillance colonoscopy and predict neoplastic and inflammatory changes with high accuracy compared to histology. Moreover, CLE-based molecular imaging may anticipate the therapeutic responses to biological therapy. Endocytoscopy can identify in vivo inflammatory mucosal cells harboring a new method to assess the mucosal activity. CONCLUSIONS Recent progresses in small-bowel enteroscopy offer several potential benefits to improve both diagnosis and characterization of CD. New advanced endoscopic imaging techniques can improve detection of dysplasia and refine mucosal healing assessment, even looking beyond the morphological parameters revealed by conventional endoscopic imaging.
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Affiliation(s)
- Gian Eugenio Tontini
- Department of Medicine I, University of Erlangen-Nuremberg, Germany; Gastroenterology and Digestive Endoscopy Unit, IRCCS Policlinico San Donato, San Donato Milanese, Italy.
| | - Maurizio Vecchi
- Gastroenterology and Digestive Endoscopy Unit, IRCCS Policlinico San Donato, San Donato Milanese, Italy; Department of Medical Science for Health, University of Milan, Italy
| | - Markus F Neurath
- Department of Medicine I, University of Erlangen-Nuremberg, Germany
| | - Helmut Neumann
- Department of Medicine I, University of Erlangen-Nuremberg, Germany.
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Is it possible to predict the presence of intestinal angioectasias? DIAGNOSTIC AND THERAPEUTIC ENDOSCOPY 2014; 2014:461602. [PMID: 24771990 PMCID: PMC3977092 DOI: 10.1155/2014/461602] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 12/08/2013] [Revised: 01/25/2014] [Accepted: 02/13/2014] [Indexed: 12/18/2022]
Abstract
Background and Aim. Angioectasias are the most common vascular anomalies found in the gastrointestinal tract. In small bowel (SB), they can cause obscure gastrointestinal bleeding (OGIB) and in this setting, small bowel capsule endoscopy (SBCE) is an important diagnostic tool. This study aimed to identify predictive factors for the presence of SB angioectasias, detected by SBCE. Methods. We retrospectively analyzed the results of 284 consecutive SBCE procedures between April 2006 and December 2012, whose indication was OGIB, of which 47 cases with SB angioectasias and 53 controls without vascular lesions were selected to enter the study. Demographic and clinical data were collected. Results. The mean age of subjects with angioectasias (70.9 ± 14.7) was significantly higher than in controls (53.1 ± 18.6; P < 0.001). The presence of SB angioectasias was significantly higher when the indication for the exam was overt OGIB versus occult OGIB (13/19 versus 34/81, P = 0.044). Hypertension and hypercholesterolemia were significantly associated with the presence of SB angioectasias (38/62 versus 9/38, P < 0.001 and 28/47 versus 19/53, P = 0.027, resp.). Other studied factors were not associated with small bowel angioectasias. Conclusions. In patients with OGIB, overt bleeding, older age, hypercholesterolemia, and hypertension are predictive of the presence of SB angioectasias detected by SBCE, which may be used to increase the diagnostic yield of the SBCE procedure and to reduce the proportion of nondiagnostic examinations.
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Abstract
Acute gastrointestinal (GI) bleeding is a common cause of hospitalization, resulting in about 400,000 hospital admissions annually, with a mortality rate of 5-10%. It is estimated that 5% of acute GI bleedings are of obscure origin with a normal esophagogastroduodenoscopy and ileocolonoscopy. Capsule endoscopy is the state-of-the-art procedure for inspection of the entire small bowel with a high sensitivity for the detection of causes of bleeding. In recent years, many studies have addressed the sensitivity and outcome of capsule-endoscopy procedures in patients with acute GI bleeding. This review looks at the role of capsule endoscopy in the evaluation of patients with acute GI bleeding from either the upper GI tract or small bowel.
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Affiliation(s)
- Moshe Nadler
- Department of Gastroenterology, Sheba Medical Center and Sackler School of Medicine, Tel-Aviv University, Tel-Aviv, Israel
| | - Rami Eliakim
- Department of Gastroenterology, Sheba Medical Center, Tel Hashomer, 5265601, Israel
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Saruta M, Papadakis KA. Capsule endoscopy in the evaluation and management of inflammatory bowel disease: a future perspective. Expert Rev Mol Diagn 2014; 9:31-6. [DOI: 10.1586/14737159.9.1.31] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
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