1
|
Sahafi A, Koulaouzidis A, Lalinia M. Polypoid Lesion Segmentation Using YOLO-V8 Network in Wireless Video Capsule Endoscopy Images. Diagnostics (Basel) 2024; 14:474. [PMID: 38472946 DOI: 10.3390/diagnostics14050474] [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: 12/12/2023] [Revised: 01/26/2024] [Accepted: 02/19/2024] [Indexed: 03/14/2024] Open
Abstract
Gastrointestinal (GI) tract disorders are a significant public health issue. They are becoming more common and can cause serious health problems and high healthcare costs. Small bowel tumours (SBTs) and colorectal cancer (CRC) are both becoming more prevalent, especially among younger adults. Early detection and removal of polyps (precursors of malignancy) is essential for prevention. Wireless Capsule Endoscopy (WCE) is a procedure that utilises swallowable camera devices that capture images of the GI tract. Because WCE generates a large number of images, automated polyp segmentation is crucial. This paper reviews computer-aided approaches to polyp detection using WCE imagery and evaluates them using a dataset of labelled anomalies and findings. The study focuses on YOLO-V8, an improved deep learning model, for polyp segmentation and finds that it performs better than existing methods, achieving high precision and recall. The present study underscores the potential of automated detection systems in improving GI polyp identification.
Collapse
Affiliation(s)
- Ali Sahafi
- Department of Mechanical and Electrical Engineering, Digital and High-Frequency Electronics Section, University of Southern Denmark, 5230 Odense, Denmark
| | - Anastasios Koulaouzidis
- Surgical Research Unit, Odense University Hospital, 5000 Svendborg, Denmark
- Department of Clinical Research, University of Southern Denmark, 5230 Odense, Denmark
- Department of Medicine, OUH Svendborg Sygehus, 5700 Svendborg, Denmark
- Department of Social Medicine and Public Health, Pomeranian Medical University, 70204 Szczecin, Poland
| | - Mehrshad Lalinia
- Department of Mechanical and Electrical Engineering, Digital and High-Frequency Electronics Section, University of Southern Denmark, 5230 Odense, Denmark
| |
Collapse
|
2
|
Aoki T, Yamada A, Oka S, Tsuboi M, Kurokawa K, Togo D, Tanino F, Teshima H, Saito H, Suzuki R, Arai J, Abe S, Kondo R, Yamashita A, Tsuboi A, Nakada A, Niikura R, Tsuji Y, Hayakawa Y, Matsuda T, Nakahori M, Tanaka S, Kato Y, Tada T, Fujishiro M. Comparison of clinical utility of deep learning-based systems for small-bowel capsule endoscopy reading. J Gastroenterol Hepatol 2024; 39:157-164. [PMID: 37830487 DOI: 10.1111/jgh.16369] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/16/2023] [Revised: 09/01/2023] [Accepted: 09/17/2023] [Indexed: 10/14/2023]
Abstract
BACKGROUND AND AIM Convolutional neural network (CNN) systems that automatically detect abnormalities from small-bowel capsule endoscopy (SBCE) images are still experimental, and no studies have directly compared the clinical usefulness of different systems. We compared endoscopist readings using an existing and a novel CNN system in a real-world SBCE setting. METHODS Thirty-six complete SBCE videos, including 43 abnormal lesions (18 mucosal breaks, 8 angioectasia, and 17 protruding lesions), were retrospectively prepared. Three reading processes were compared: (A) endoscopist readings without CNN screening, (B) endoscopist readings after an existing CNN screening, and (C) endoscopist readings after a novel CNN screening. RESULTS The mean number of small-bowel images was 14 747 per patient. Among these images, existing and novel CNN systems automatically captured 24.3% and 9.4% of the images, respectively. In this process, both systems extracted all 43 abnormal lesions. Next, we focused on the clinical usefulness. The detection rates of abnormalities by trainee endoscopists were not significantly different across the three processes: A, 77%; B, 67%; and C, 79%. The mean reading time of the trainees was the shortest during process C (10.1 min per patient), followed by processes B (23.1 min per patient) and A (33.6 min per patient). The mean psychological stress score while reading videos (scale, 1-5) was the lowest in process C (1.8) but was not significantly different between processes B (2.8) and A (3.2). CONCLUSIONS Our novel CNN system significantly reduced endoscopist reading time and psychological stress while maintaining the detectability of abnormalities. CNN performance directly affects clinical utility and should be carefully assessed.
Collapse
Affiliation(s)
- Tomonori Aoki
- Department of Gastroenterology, Graduate School of Medicine, University of Tokyo, Tokyo, Japan
- Division of Next-Generation Endoscopic Computer Vision, Graduate School of Medicine, University of Tokyo, Tokyo, Japan
| | - Atsuo Yamada
- Department of Gastroenterology, Graduate School of Medicine, University of Tokyo, Tokyo, Japan
| | - Shiro Oka
- Department of Endoscopy, Hiroshima University Hospital, Hiroshima, Japan
| | - Mayo Tsuboi
- Department of Gastroenterology, Graduate School of Medicine, University of Tokyo, Tokyo, Japan
| | - Ken Kurokawa
- Department of Gastroenterology, Graduate School of Medicine, University of Tokyo, Tokyo, Japan
| | - Daichi Togo
- Department of Gastroenterology, Sendai Kousei Hospital, Sendai, Japan
| | - Fumiaki Tanino
- Department of Endoscopy, Hiroshima University Hospital, Hiroshima, Japan
| | - Hajime Teshima
- Department of Endoscopy, Hiroshima University Hospital, Hiroshima, Japan
| | - Hiroaki Saito
- Department of Gastroenterology, Sendai Kousei Hospital, Sendai, Japan
| | - Ryuta Suzuki
- Department of Gastroenterology, Sendai Kousei Hospital, Sendai, Japan
| | - Junya Arai
- Department of Gastroenterology, Graduate School of Medicine, University of Tokyo, Tokyo, Japan
| | - Sohei Abe
- Department of Gastroenterology, Graduate School of Medicine, University of Tokyo, Tokyo, Japan
| | - Ryo Kondo
- Department of Gastroenterology, Graduate School of Medicine, University of Tokyo, Tokyo, Japan
| | - Aya Yamashita
- Department of Gastroenterology, Graduate School of Medicine, University of Tokyo, Tokyo, Japan
| | - Akiyoshi Tsuboi
- Department of Endoscopy, Hiroshima University Hospital, Hiroshima, Japan
| | - Ayako Nakada
- Department of Gastroenterology, Graduate School of Medicine, University of Tokyo, Tokyo, Japan
| | - Ryota Niikura
- Department of Gastroenterology, Graduate School of Medicine, University of Tokyo, Tokyo, Japan
- Department of Gastroenterological Endoscopy, Tokyo Medical University, Tokyo, Japan
| | - Yosuke Tsuji
- Department of Gastroenterology, Graduate School of Medicine, University of Tokyo, Tokyo, Japan
- Division of Next-Generation Endoscopic Computer Vision, Graduate School of Medicine, University of Tokyo, Tokyo, Japan
| | - Yoku Hayakawa
- Department of Gastroenterology, Graduate School of Medicine, University of Tokyo, Tokyo, Japan
| | - Tomoki Matsuda
- Department of Gastroenterology, Sendai Kousei Hospital, Sendai, Japan
| | - Masato Nakahori
- Department of Gastroenterology, Sendai Kousei Hospital, Sendai, Japan
| | - Shinji Tanaka
- Department of Endoscopy, Hiroshima University Hospital, Hiroshima, Japan
| | | | - Tomohiro Tada
- AI Medical Service Inc, Tokyo, Japan
- Department of Surgical Oncology, Graduate School of Medicine, University of Tokyo, Tokyo, Japan
- Tada Tomohiro Institute of Gastroenterology and Proctology, Saitama, Japan
| | - Mitsuhiro Fujishiro
- Department of Gastroenterology, Graduate School of Medicine, University of Tokyo, Tokyo, Japan
| |
Collapse
|
3
|
Singeap AM, Sfarti C, Girleanu I, Huiban L, Muzica C, Timofeiov S, Stanciu C, Trifan A. Reclassification of Inflammatory Bowel Disease Type Unclassified by Small Bowel Capsule Endoscopy. MEDICINA (KAUNAS, LITHUANIA) 2023; 59:2064. [PMID: 38138167 PMCID: PMC10744735 DOI: 10.3390/medicina59122064] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/17/2023] [Revised: 11/03/2023] [Accepted: 11/22/2023] [Indexed: 12/24/2023]
Abstract
Background and Objectives: Ulcerative colitis (UC) and Crohn's disease (CD) are idiopathic inflammatory bowel diseases (IBDs) without a unique, gold standard diagnostic test. UC and Crohn's colitis are impossible to distinguish in approximately 10% of cases. The term IBD type unclassified (IBD-U) is recommended for cases of chronic colitis showing overlapping endoscopic, radiological, and biopsy histological features between UC and CD, while indetermined colitis is reserved for colectomy specimens. Our aim was to assess the role of small-bowel capsule endoscopy (SBCE) in the diagnostic work-up of IBD-U. Materials and Methods: We retrospectively studied the cases of IBD-U explored by SBCE in a tertiary referral gastroenterology center. Patients were investigated using SBCE after contraindications were excluded. Diagnostic criteria for small bowel CD consisted in more than three ulcerations, irregular ulcers, or stenosis, and the Lewis score was used for the quantification of inflammation. The immediate impact of reclassification and outcome data was recorded over a follow-up period of more than one year. Results: Twenty-eight patients with IBD-U were examined using SBCE. Nine patients had small bowel lesions that met the diagnostic criteria for CD, resulting in a reclassification rate of 32.1%. In five of these cases, the treatment was subsequently changed. In the remaining nineteen examinations, no significant findings were observed. There were no complications associated with SBCE. Median follow-up time was 32.5 months (range 12-60). During follow-up, twelve patients were classified as having UC, and seven remained as having an unclassified type; one case of colectomy, for medically refractory UC, was recorded. Conclusions: SBCE is a useful safe tool in the work-up of IBD-U, allowing reclassification in about one third of cases, with subsequent treatment modifications. SBCE may provide a definite diagnosis, enhance the comprehension of the disease's progression, and optimize the short- and long-term management strategy.
Collapse
Affiliation(s)
- Ana-Maria Singeap
- Department of Gastroenterology, Faculty of Medicine, “Grigore T. Popa” University of Medicine and Pharmacy, 700115 Iasi, Romania; (A.-M.S.); (I.G.); (L.H.); (C.M.); (C.S.); (A.T.)
- Institute of Gastroenterology, “St. Spiridon” University Hospital, 700111 Iasi, Romania
| | - Catalin Sfarti
- Department of Gastroenterology, Faculty of Medicine, “Grigore T. Popa” University of Medicine and Pharmacy, 700115 Iasi, Romania; (A.-M.S.); (I.G.); (L.H.); (C.M.); (C.S.); (A.T.)
- Institute of Gastroenterology, “St. Spiridon” University Hospital, 700111 Iasi, Romania
| | - Irina Girleanu
- Department of Gastroenterology, Faculty of Medicine, “Grigore T. Popa” University of Medicine and Pharmacy, 700115 Iasi, Romania; (A.-M.S.); (I.G.); (L.H.); (C.M.); (C.S.); (A.T.)
- Institute of Gastroenterology, “St. Spiridon” University Hospital, 700111 Iasi, Romania
| | - Laura Huiban
- Department of Gastroenterology, Faculty of Medicine, “Grigore T. Popa” University of Medicine and Pharmacy, 700115 Iasi, Romania; (A.-M.S.); (I.G.); (L.H.); (C.M.); (C.S.); (A.T.)
- Institute of Gastroenterology, “St. Spiridon” University Hospital, 700111 Iasi, Romania
| | - Cristina Muzica
- Department of Gastroenterology, Faculty of Medicine, “Grigore T. Popa” University of Medicine and Pharmacy, 700115 Iasi, Romania; (A.-M.S.); (I.G.); (L.H.); (C.M.); (C.S.); (A.T.)
- Institute of Gastroenterology, “St. Spiridon” University Hospital, 700111 Iasi, Romania
| | - Sergiu Timofeiov
- Department of Surgery, Faculty of Medicine, “Grigore T. Popa” University of Medicine and Pharmacy, 700115 Iasi, Romania
- Department of Surgery, “St. Spiridon” University Hospital, 700111 Iasi, Romania
| | - Carol Stanciu
- Department of Gastroenterology, Faculty of Medicine, “Grigore T. Popa” University of Medicine and Pharmacy, 700115 Iasi, Romania; (A.-M.S.); (I.G.); (L.H.); (C.M.); (C.S.); (A.T.)
- Institute of Gastroenterology, “St. Spiridon” University Hospital, 700111 Iasi, Romania
| | - Anca Trifan
- Department of Gastroenterology, Faculty of Medicine, “Grigore T. Popa” University of Medicine and Pharmacy, 700115 Iasi, Romania; (A.-M.S.); (I.G.); (L.H.); (C.M.); (C.S.); (A.T.)
- Institute of Gastroenterology, “St. Spiridon” University Hospital, 700111 Iasi, Romania
| |
Collapse
|
4
|
O'Hara FJ, Mc Namara D. Capsule endoscopy with artificial intelligence-assisted technology: Real-world usage of a validated AI model for capsule image review. Endosc Int Open 2023; 11:E970-E975. [PMID: 37828977 PMCID: PMC10567136 DOI: 10.1055/a-2161-1816] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/31/2023] [Accepted: 08/25/2023] [Indexed: 10/14/2023] Open
Abstract
Background and study aims Capsule endoscopy is a time-consuming procedure with a significance error rate. Artificial intelligence (AI) can potentially reduce reading time significantly by reducing the number of images that need human review. An OMOM Artificial Intelligence-enabled small bowel capsule has been recently trained and validated for small bowel capsule endoscopy video review. This study aimed to assess its performance in a real-world setting in comparison with standard reading methods. Patients and methods In this single-center retrospective study, 40 patient studies performed using the OMOM capsule were analyzed first with standard reading methods and later using AI-assisted reading. Reading time, pathology identified, intestinal landmark identification and bowel preparation assessment (Brotz Score) were compared. Results Overall diagnosis correlated 100% between the two reading methods. In a per-lesion analysis, 1293 images of significant lesions were identified combining standard and AI-assisted reading methods. AI-assisted reading captured 1268 (98.1%, 95% CI 97.15-98.7) of these findings while standard reading mode captured 1114 (86.2%, 95% confidence interval 84.2-87.9), P < 0.001. Mean reading time went from 29.7 minutes with standard reading to 2.3 minutes with AI-assisted reading ( P < 0.001), for an average time saving of 27.4 minutes per study. Time of first cecal image showed a wide discrepancy between AI and standard reading of 99.2 minutes (r = 0.085, P = 0.68). Bowel cleansing evaluation agreed in 97.4% (r = 0.805 P < 0.001). Conclusions AI-assisted reading has shown significant time savings without reducing sensitivity in this study. Limitations remain in the evaluation of other indicators.
Collapse
Affiliation(s)
- Fintan John O'Hara
- Gastroenterology, Tallaght University Hospital, Dublin, Ireland
- Medicine, Trinity College Dublin School of Medicine, Dublin, Ireland
| | - Deirdre Mc Namara
- Gastroenterology, Tallaght University Hospital, Dublin, Ireland
- Medicine, Trinity College Dublin School of Medicine, Dublin, Ireland
| |
Collapse
|
5
|
Pezzoli A, Guarino M, Fusetti N, Pizzo E, Simoni M, Simone L, Cifalà V, Solimando R, Perna B, Testino G, Pellicano R, Caio G, Lungaro L, Caputo F, Zoli G, Merighi A, DE Giorgio R. Efficacy and safety of capsule endoscopy in octogenarian patients: a retrospective study. Minerva Gastroenterol (Torino) 2023; 69:388-395. [PMID: 35708039 DOI: 10.23736/s2724-5985.22.03220-x] [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: 08/31/2023]
Abstract
BACKGROUND Life expectancy and the number of ultra-octogenarians increased significantly, thus making crucial the appropriateness of several endoscopic procedures in elderly patients. The aim of our study was to provide a retrospective analysis of the efficacy and safety of capsule endoscopy (CE) in patients aged over 80 years. METHODS In this single-centre study, 900 patients underwent capsule endoscopy between 2002 and 2015 for different indications; of these 106 patients aged ≥80 years (group A) and 99 patients aged 40-60 years (control group B) were retrospectively selected. RESULTS Occult gastrointestinal bleeding accounted for 62.1% of all indications for capsule endoscopy in group B, compared to 95.2% in group A (P<0.001). Although not statistically significant, the diagnostic yield was higher in group A (71%) vs. group B (62%). The percentages of reaching the cecum and the median gastric transit time were uniform within the two groups. In contrast, small bowel transit time was longer in group A vs. B. Small bowel preparation was similar in the two groups. The exam was generally well tolerated in both groups, with capsule aspiration being one of the main adverse events, which occurred in two elderly patients. CONCLUSIONS Our data expand previous findings confirming that capsule endoscopy can be performed safely even in very old patients and show that the diagnostic yield is similar to that of younger patients.
Collapse
Affiliation(s)
- Alessandro Pezzoli
- Department of Gastroenterology and Gastrointestinal Endoscopy, University Hospital of Ferrara, Ferrara, Italy
| | - Matteo Guarino
- Department of Translational Medicine, University Hospital of Ferrara, Ferrara, Italy
| | - Nadia Fusetti
- Department of Gastroenterology and Gastrointestinal Endoscopy, University Hospital of Ferrara, Ferrara, Italy
| | - Elena Pizzo
- Department of Applied Health Research, University College of London, London, UK
| | - Marzia Simoni
- Epidemiological Unit of CNR Institute of Clinical Physiology, Pisa, Italy
| | - Loredana Simone
- Department of Gastroenterology and Gastrointestinal Endoscopy, University Hospital of Ferrara, Ferrara, Italy
| | - Viviana Cifalà
- Department of Gastroenterology and Gastrointestinal Endoscopy, University Hospital of Ferrara, Ferrara, Italy
| | - Riccardo Solimando
- Department of Gastroenterology and Gastrointestinal Endoscopy, University Hospital of Ferrara, Ferrara, Italy
| | - Benedetta Perna
- Department of Translational Medicine, University Hospital of Ferrara, Ferrara, Italy
| | - Gianni Testino
- Unit of Addiction and Hepatology, Regional Centre on Alcohol, ASL3 San Martino Hospital, Genoa, Italy
| | | | - Giacomo Caio
- Department of Translational Medicine, University Hospital of Ferrara, Ferrara, Italy
| | - Lisa Lungaro
- Department of Translational Medicine, University Hospital of Ferrara, Ferrara, Italy
| | - Fabio Caputo
- Department of Translational Medicine, University Hospital of Ferrara, Ferrara, Italy
| | - Giorgio Zoli
- Department of Translational Medicine, University Hospital of Ferrara, Ferrara, Italy
| | - Alberto Merighi
- Department of Gastroenterology and Gastrointestinal Endoscopy, University Hospital of Ferrara, Ferrara, Italy
| | - Roberto DE Giorgio
- Department of Translational Medicine, University Hospital of Ferrara, Ferrara, Italy
| |
Collapse
|
6
|
Chu Y, Huang F, Gao M, Zou DW, Zhong J, Wu W, Wang Q, Shen XN, Gong TT, Li YY, Wang LF. Convolutional neural network-based segmentation network applied to image recognition of angiodysplasias lesion under capsule endoscopy. World J Gastroenterol 2023; 29:879-889. [PMID: 36816625 PMCID: PMC9932427 DOI: 10.3748/wjg.v29.i5.879] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/25/2022] [Revised: 11/26/2022] [Accepted: 01/12/2023] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Small intestinal vascular malformations (angiodysplasias) are common causes of small intestinal bleeding. While capsule endoscopy has become the primary diagnostic method for angiodysplasia, manual reading of the entire gastrointestinal tract is time-consuming and requires a heavy workload, which affects the accuracy of diagnosis.
AIM To evaluate whether artificial intelligence can assist the diagnosis and increase the detection rate of angiodysplasias in the small intestine, achieve automatic disease detection, and shorten the capsule endoscopy (CE) reading time.
METHODS A convolutional neural network semantic segmentation model with a feature fusion method, which automatically recognizes the category of vascular dysplasia under CE and draws the lesion contour, thus improving the efficiency and accuracy of identifying small intestinal vascular malformation lesions, was proposed. Resnet-50 was used as the skeleton network to design the fusion mechanism, fuse the shallow and depth features, and classify the images at the pixel level to achieve the segmentation and recognition of vascular dysplasia. The training set and test set were constructed and compared with PSPNet, Deeplab3+, and UperNet.
RESULTS The test set constructed in the study achieved satisfactory results, where pixel accuracy was 99%, mean intersection over union was 0.69, negative predictive value was 98.74%, and positive predictive value was 94.27%. The model parameter was 46.38 M, the float calculation was 467.2 G, and the time length to segment and recognize a picture was 0.6 s.
CONCLUSION Constructing a segmentation network based on deep learning to segment and recognize angiodysplasias lesions is an effective and feasible method for diagnosing angiodysplasias lesions.
Collapse
Affiliation(s)
- Ye Chu
- Department of Gastroenterology, Shanghai Jiao Tong University School of Medicine, Ruijin Hospital, Shanghai 200025, China
| | - Fang Huang
- Technology Platform Department, Jinshan Science & Technology (Group) Co., Ltd., Chongqing 401120, China
| | - Min Gao
- Technology Platform Department, Jinshan Science & Technology (Group) Co., Ltd., Chongqing 401120, China
| | - Duo-Wu Zou
- Department of Gastroenterology, Shanghai Jiao Tong University School of Medicine, Ruijin Hospital, Shanghai 200025, China
| | - Jie Zhong
- Department of Gastroenterology, Shanghai Jiao Tong University School of Medicine, Ruijin Hospital, Shanghai 200025, China
| | - Wei Wu
- Department of Gastroenterology, Shanghai Jiao Tong University School of Medicine, Ruijin Hospital, Shanghai 200025, China
| | - Qi Wang
- Department of Gastroenterology, Shanghai Jiao Tong University School of Medicine, Ruijin Hospital, Shanghai 200025, China
| | - Xiao-Nan Shen
- Department of Gastroenterology, Shanghai Jiao Tong University School of Medicine, Ruijin Hospital, Shanghai 200025, China
| | - Ting-Ting Gong
- Department of Gastroenterology, Shanghai Jiao Tong University School of Medicine, Ruijin Hospital, Shanghai 200025, China
| | - Yuan-Yi Li
- Technology Platform Department, Jinshan Science & Technology (Group) Co., Ltd., Chongqing 401120, China
| | - Li-Fu Wang
- Department of Gastroenterology, Shanghai Jiao Tong University School of Medicine, Ruijin Hospital, Shanghai 200025, China
| |
Collapse
|
7
|
Mascarenhas Saraiva M, Afonso J, Ribeiro T, Ferreira J, Cardoso H, Andrade P, Gonçalves R, Cardoso P, Parente M, Jorge R, Macedo G. Artificial intelligence and capsule endoscopy: automatic detection of enteric protruding lesions using a convolutional neural network. REVISTA ESPANOLA DE ENFERMEDADES DIGESTIVAS 2023; 115:75-79. [PMID: 34517717 DOI: 10.17235/reed.2021.7979/2021] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
BACKGROUND AND AIMS capsule endoscopy (CE) revolutionized the study of the small intestine. Nevertheless, reviewing CE images is time-consuming and prone to error. Artificial intelligence algorithms, particularly convolutional neural networks (CNN), are expected to overcome these drawbacks. Protruding lesions of the small intestine exhibit enormous morphological diversity in CE images. This study aimed to develop a CNN-based algorithm for the automatic detection small bowel protruding lesions. METHODS a CNN was developed using a pool of CE images containing protruding lesions or normal mucosa from 1,229 patients. A training dataset was used for the development of the model. The performance of the network was evaluated using an independent dataset, by calculating its sensitivity, specificity, accuracy, positive and negative predictive values. RESULTS a total of 18,625 CE images (2,830 showing protruding lesions and 15,795 normal mucosa) were included. Training and validation datasets were built with an 80 %/20 % distribution, respectively. After optimizing the architecture of the network, our model automatically detected small-bowel protruding lesions with an accuracy of 92.5 %. CNN had a sensitivity and specificity of 96.8 % and 96.5 %, respectively. The CNN analyzed the validation dataset in 53 seconds, at a rate of approximately 70 frames per second. CONCLUSIONS we developed an accurate CNN for the automatic detection of enteric protruding lesions with a wide range of morphologies. The development of these tools may enhance the diagnostic efficiency of CE.
Collapse
Affiliation(s)
| | - João Afonso
- Gastroenterology, Centro Hospitalar Universitário de São João
| | - Tiago Ribeiro
- Gastroenterology, Centro Hospitalar Universitário de São João
| | | | - Hélder Cardoso
- Gastroenterology, Centro Hospitalar Universitário de São João
| | | | | | - Pedro Cardoso
- Gastroenterology, Centro Hospitalar Universitário de São João
| | | | | | | |
Collapse
|
8
|
Brodersen JB, Kjeldsen J, Knudsen T, Jensen MD. Endoscopic severity and classification of lesions with pan-enteric capsule endoscopy and ileocolonoscopy in ileocolonic Crohn's disease. Endosc Int Open 2023; 11:E32-E38. [PMID: 36618875 PMCID: PMC9812649 DOI: 10.1055/a-1978-6586] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/20/2022] [Accepted: 11/11/2022] [Indexed: 11/17/2022] Open
Abstract
Background and study aims Recent evidence supports the use of pan-enteric capsule endoscopy (CE) for the diagnosis and follow-up of Crohn's disease (CD). The aim of this study was to examine the agreement between CE and ileocolonoscopy (IC) for determining the severity and classification of lesions in ileocolonic CD. Patients and methods In a prospective blinded multicenter study, patients with suspected CD were examined with CE and IC within 2 weeks. Ninety-nine participants with a full IC and CE were included in the analysis. The ileocolonic disease severity was assessed with the Simple Endoscopic Score for Crohn's Disease (SES-CD). Results CD was diagnosed in 30 patients with IC and CE. The mean SES-CD was 9.8 (CI 7.9-11.8) and 10.6 (CI 8.2-13.1), respectively ( P = 0.69). There was a substantial agreement (ICC 0.83, CI 0.68-0.92) and a strong correlation between SES-CD assessed with IC and CE (r s = 0.78, P < 0.001). 55 bowel segments had ulcerations with both modalities (terminal ileum 24, right colon 12, transverse colon eight, left colon eight and rectum three). Mean sub-scores for ulcer size, area of ulcerated surface and area of affected surface did not differ between modalities. The inter-modality agreement (κ) was 0.46, 0.34 and 0.43, respectively ( P < 0.001). Conclusions There is a strong correlation between IC and CE for the severity of ileocolonic CD. The agreement for SES-CD sub-scores is fair to moderate. CE could be an alternative to IC for the assessment of endoscopic severity in selected patients with suspected CD.
Collapse
Affiliation(s)
- Jacob Broder Brodersen
- Department of Internal Medicine, Section of Gastroenterology, Hospital of South West Jutland, Esbjerg, Denmark,Department of Regional Health Research, University of Southern Denmark, Denmark
| | - Jens Kjeldsen
- Department of Medical Gastroenterology, Odense University Hospital, Odense, Denmark,Research Unit of Medical Gastroenterology, Department of Clinical Research, University of Southern Denmark, Odense, Denmark,OPEN Odense Patient data Explorative Network, Odense University Hospital, Odense, Denmark
| | - Torben Knudsen
- Department of Internal Medicine, Section of Gastroenterology, Hospital of South West Jutland, Esbjerg, Denmark,Department of Regional Health Research, University of Southern Denmark, Denmark
| | - Michael Dam Jensen
- Department of Regional Health Research, University of Southern Denmark, Denmark,Department of Internal Medicine, Section of Gastroenterology, Lillebaelt Hospital, Vejle, Denmark
| |
Collapse
|
9
|
Sorge A, Elli L, Rondonotti E, Pennazio M, Spada C, Cadoni S, Cannizzaro R, Calabrese C, de Franchis R, Girelli CM, Marmo R, Riccioni ME, Marmo C, Oliva S, Scarpulla G, Soncini M, Vecchi M, Tontini GE. Enteroscopy in diagnosis and treatment of small bowel bleeding: A Delphi expert consensus. Dig Liver Dis 2023; 55:29-39. [PMID: 36100515 DOI: 10.1016/j.dld.2022.08.021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/29/2022] [Accepted: 08/14/2022] [Indexed: 12/31/2022]
Abstract
BACKGROUND Enteroscopy plays an important role in the management of small bowel bleeding. However, current guidelines are not specifically designed for small bowel bleeding and recommendations from different international societies do not always align. Consequently, there is heterogeneity in the definitions of clinical entities, clinical practice policies, and adherence to guidelines among clinicians. This represents an obstacle to providing the best patient care and to obtain homogeneous data for clinical research. AIMS The aims of the study were to establish a consensus on the definitions of bleeding entities and on the role of enteroscopy in the management of small bowel bleeding using a Delphi process. METHODS A core group of eight experts in enteroscopy identified five main topics of small bowel bleeding management and drafted statements on each topic. An expert panel of nine gastroenterologists participated in three rounds of the Delphi process, together with the core group. RESULTS A total of 33 statements were approved after three rounds of Delphi voting. CONCLUSION This Delphi consensus proposes clear definitions and a unifying strategy to standardize the management of small bowel bleeding. Furthermore, it provides a useful guide in daily practice for both clinical and technical issues of enteroscopy.
Collapse
Affiliation(s)
- Andrea Sorge
- Gastroenterology and Endoscopy Unit, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy; Department of Pathophysiology and Transplantation, University of Milan, Milan, Italy.
| | - Luca Elli
- Gastroenterology and Endoscopy Unit, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
| | | | - Marco Pennazio
- University Division of Gastroenterology, City of Health and Science University Hospital, Turin, Italy
| | - Cristiano Spada
- Digestive Endoscopy Unit, Catholic University of Rome, Rome, Italy; Digestive Endoscopy Unit, Fondazione Poliambulanza, Brescia, Italy
| | - Sergio Cadoni
- Digestive Endoscopy Unit, Centro Traumatologico Ortopedico, Iglesias, Italy
| | - Renato Cannizzaro
- Experimental Oncological Gastroenterology Unit, Centro di Riferimento Oncologico di Aviano (CRO), Istituto Nazionale Tumori IRCCS, Aviano, Italy
| | - Carlo Calabrese
- University of Bologna Alma Mater - School of Medicine, Department of Medical and Surgical Sciences - Regional Referral Center for IBD, Bologna, Italy
| | | | | | | | - Maria Elena Riccioni
- Digestive Endoscopy Unit, IRCCS Fondazione Policlinico Universitario A. Gemelli, Rome, Italy
| | - Clelia Marmo
- Digestive Endoscopy Unit, IRCCS Fondazione Policlinico Universitario A. Gemelli, Rome, Italy
| | - Salvatore Oliva
- Gastroenterology and Paeditric Hepatology Unit, Università La Sapienza, Rome, Italy
| | | | - Marco Soncini
- Department of Internal Medicine, "A. Manzoni" Hospital, ASST Lecco, Italy
| | - Maurizio Vecchi
- Gastroenterology and Endoscopy Unit, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy; Department of Pathophysiology and Transplantation, University of Milan, Milan, Italy
| | - Gian Eugenio Tontini
- Gastroenterology and Endoscopy Unit, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy; Department of Pathophysiology and Transplantation, University of Milan, Milan, Italy
| | | |
Collapse
|
10
|
Otani K, Shimada S, Watanabe T, Nadatani Y, Higashimori A, Ominami M, Fukunaga S, Hosomi S, Kamata N, Tanaka F, Nagami Y, Taira K, Fujiwara Y. Long-term rebleeding rate and predictive factors of rebleeding after capsule endoscopy in patients with obscure GI bleeding. Gastrointest Endosc 2022; 96:956-969.e3. [PMID: 35850171 DOI: 10.1016/j.gie.2022.07.012] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/30/2022] [Revised: 07/04/2022] [Accepted: 07/08/2022] [Indexed: 02/08/2023]
Abstract
BACKGROUND AND AIMS The incidence of rebleeding in obscure GI bleeding (OGIB) remains unclear. This study used capsule endoscopy (CE) to determine the long-term rebleeding rate and predictive factors for rebleeding in patients with OGIB. METHODS This single-center, observational study enrolled consecutive patients with OGIB who underwent CE as the first small intestinal examination between March 2004 and December 2015 and were followed up through medical records or letters. RESULTS Three hundred eighty-nine patients were included in the analysis. Survival curve analysis showed that the overall cumulative rebleeding rate in OGIB during the 5 years was 41.7%. Multivariate analysis using the Cox proportional hazards model revealed that overt OGIB (hazard ratio [HR], 2.017; 95% confidence interval [CI], 1.299-3.131; P = .002), anticoagulants (HR, 1.930; 95% CI, 1.093-3.410; P = .023), positive balloon-assisted enteroscopy findings after CE (HR, 2.927; 95% CI, 1.791-4.783; P < .001), and iron supplements without therapeutic intervention (HR, 2.202; 95% CI, 1.386-3.498; P = .001) were associated with rebleeding, whereas a higher minimum hemoglobin level (HR, .902; 95% CI, .834-.975; P = .009) and therapeutic intervention (HR, .288; 95% CI, .145-.570; P < .001) significantly reduced the risk of rebleeding. Among the Charlson Comorbidity Index components, liver cirrhosis was an independent predictor associated with rebleeding in patients with OGIB (HR, 4.362; 95% CI, 2.622-7.259; P < .001) and in patients with negative CE findings (HR, 8.961; 95% CI, 4.424-18.150; P < .001). CONCLUSIONS Rebleeding is common during the long-term follow-up of patients with OGIB. Careful follow-up is required for patients with liver cirrhosis or previous massive bleeding.
Collapse
Affiliation(s)
- Koji Otani
- Department of Gastroenterology, Osaka Metropolitan University Graduate School of Medicine, Osaka, Japan
| | - Sunao Shimada
- Department of Gastroenterology, Osaka City Juso Hospital, Osaka, Japan
| | - Toshio Watanabe
- Department of Premier Preventive Medicine, Osaka Metropolitan University Graduate School of Medicine, Osaka, Japan
| | - Yuji Nadatani
- Department of Premier Preventive Medicine, Osaka Metropolitan University Graduate School of Medicine, Osaka, Japan
| | - Akira Higashimori
- Department of Gastroenterology, Osaka Metropolitan University Graduate School of Medicine, Osaka, Japan
| | - Masaki Ominami
- Department of Gastroenterology, Osaka Metropolitan University Graduate School of Medicine, Osaka, Japan
| | - Shusei Fukunaga
- Department of Gastroenterology, Osaka Metropolitan University Graduate School of Medicine, Osaka, Japan
| | - Shuhei Hosomi
- Department of Gastroenterology, Osaka Metropolitan University Graduate School of Medicine, Osaka, Japan
| | - Noriko Kamata
- Department of Gastroenterology, Osaka Metropolitan University Graduate School of Medicine, Osaka, Japan
| | - Fumio Tanaka
- Department of Gastroenterology, Osaka Metropolitan University Graduate School of Medicine, Osaka, Japan
| | - Yasuaki Nagami
- Department of Gastroenterology, Osaka Metropolitan University Graduate School of Medicine, Osaka, Japan
| | - Koichi Taira
- Department of Gastroenterology, Osaka Metropolitan University Graduate School of Medicine, Osaka, Japan
| | - Yasuhiro Fujiwara
- Department of Gastroenterology, Osaka Metropolitan University Graduate School of Medicine, Osaka, Japan
| |
Collapse
|
11
|
Quality indicators for capsule endoscopy and deep enteroscopy. Gastrointest Endosc 2022; 96:693-711. [PMID: 36175176 DOI: 10.1016/j.gie.2022.08.039] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/31/2022] [Accepted: 08/31/2022] [Indexed: 12/11/2022]
Abstract
BACKGROUND AND AIMS Capsule endoscopy (CE) and deep enteroscopy (DE) can be useful for diagnosing and treating suspected small-bowel disease. Guidelines and detailed recommendations exist for the use of CE/DE, but comprehensive quality indicators are lacking. The goal of this task force was to develop quality indicators for appropriate use of CE/DE by using a modified RAND/UCLA Appropriateness Method. METHODS An expert panel of 7 gastroenterologists with diverse practice experience was assembled to identify quality indicators. A literature review was conducted to develop a list of proposed quality indicators applicable to preprocedure, intraprocedure, and postprocedure periods. The panelists reviewed the literature; identified and modified proposed quality indicators; rated them on the basis of scientific evidence, validity, and necessity; and determined proposed performance targets. Agreement and consensus with the proposed indicators were verified using the RAND/UCLA Appropriateness Method. RESULTS The voting procedure to prioritize metrics emphasized selecting measures to improve quality and overall patient care. Panelists rated indicators on the perceived appropriateness and necessity for clinical practice. After voting and discussion, 2 quality indicators ranked as inappropriate or uncertain were excluded. Each quality indicator was categorized by measure type, performance target, and summary of evidence. The task force identified 13 quality indicators for CE and DE. CONCLUSIONS Comprehensive quality indicators have not existed for CE or DE. The task force identified quality indicators that can be incorporated into clinical practice. The panel also addressed existing knowledge gaps and posed research questions to better inform future research and quality guidelines for these procedures.
Collapse
|
12
|
Quality Indicators for Capsule Endoscopy and Deep Enteroscopy. Am J Gastroenterol 2022; 117:1780-1796. [PMID: 36155365 DOI: 10.14309/ajg.0000000000001903] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/06/2022] [Indexed: 12/11/2022]
Abstract
INTRODUCTION Capsule endoscopy (CE) and deep enteroscopy (DE) can be useful for diagnosing and treating suspected small-bowel disease. Guidelines and detailed recommendations exist for the use of CE/DE, but comprehensive quality indicators are lacking. The goal of this task force was to develop quality indicators for appropriate use of CE/DE by using a modified RAND/UCLA Appropriateness Method. METHODS An expert panel of 7 gastroenterologists with diverse practice experience was assembled to identify quality indicators. A literature review was conducted to develop a list of proposed quality indicators applicable to preprocedure, intraprocedure, and postprocedure periods. The panelists reviewed the literature; identified and modified proposed quality indicators; rated them on the basis of scientific evidence, validity, and necessity; and determined proposed performance targets. Agreement and consensus with the proposed indicators were verified using the RAND/UCLA Appropriateness Method. RESULTS The voting procedure to prioritize metrics emphasized selecting measures to improve quality and overall patient care. Panelists rated indicators on the perceived appropriateness and necessity for clinical practice. After voting and discussion, 2 quality indicators ranked as inappropriate or uncertain were excluded. Each quality indicator was categorized by measure type, performance target, and summary of evidence. The task force identified 13 quality indicators for CE and DE. DISCUSSION Comprehensive quality indicators have not existed for CE or DE. The task force identified quality indicators that can be incorporated into clinical practice. The panel also addressed existing knowledge gaps and posed research questions to better inform future research and quality guidelines for these procedures.
Collapse
|
13
|
Elli L, Marinoni B, Sidhu R, Bojarski C, Branchi F, Tontini GE, Chetcuti Zammit S, Khater S, Eliakim R, Rondonotti E, Saurin JC, Bruno M, Buchkremer J, Cadoni S, Cavallaro F, Dray X, Ellul P, Urien IF, Keuchel M, Kopylov U, Koulaouzidis A, Leenhardt R, Baltes P, Beaumont H, Marmo C, McNamara D, Mussetto A, Nemeth A, Cuadrado Robles EP, Perrod G, Rahmi G, Riccioni ME, Robertson A, Spada C, Toth E, Triantafyllou K, Wurm Johansson G, Rimondi A. Nomenclature and Definition of Atrophic Lesions in Small Bowel Capsule Endoscopy: A Delphi Consensus Statement of the International CApsule endoscopy REsearch (I-CARE) Group. Diagnostics (Basel) 2022; 12:diagnostics12071704. [PMID: 35885608 PMCID: PMC9325291 DOI: 10.3390/diagnostics12071704] [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: 05/29/2022] [Revised: 06/25/2022] [Accepted: 07/07/2022] [Indexed: 11/16/2022] Open
Abstract
(1) Background: Villous atrophy is an indication for small bowel capsule endoscopy (SBCE). However, SBCE findings are not described uniformly and atrophic features are sometimes not recognized; (2) Methods: The Delphi technique was employed to reach agreement among a panel of SBCE experts. The nomenclature and definitions of SBCE lesions suggesting the presence of atrophy were decided in a core group of 10 experts. Four images of each lesion were chosen from a large SBCE database and agreement on the correspondence between the picture and the definition was evaluated using the Delphi method in a broadened group of 36 experts. All images corresponded to histologically proven mucosal atrophy; (3) Results: Four types of atrophic lesions were identified: mosaicism, scalloping, folds reduction, and granular mucosa. The core group succeeded in reaching agreement on the nomenclature and the descriptions of these items. Consensus in matching the agreed definitions for the proposed set of images was met for mosaicism (88.9% in the first round), scalloping (97.2% in the first round), and folds reduction (94.4% in the first round), but granular mucosa failed to achieve consensus (75.0% in the third round); (4) Conclusions: Consensus among SBCE experts on atrophic lesions was met for the first time. Mosaicism, scalloping, and folds reduction are the most reliable signs, while the description of granular mucosa remains uncertain.
Collapse
Affiliation(s)
- Luca Elli
- Department of Pathophysiology and Transplantation, Università degli Studi di Milano, 20122 Milan, Italy;
- Gastroenterology and Endoscopy Unit, Fondazione IRCCS Ca’ Granda Ospedale Maggiore Policlinico, 20122 Milan, Italy; (B.M.); (F.C.); (A.R.)
- Correspondence: ; Tel.: +39-02-55-03-33-64
| | - Beatrice Marinoni
- Gastroenterology and Endoscopy Unit, Fondazione IRCCS Ca’ Granda Ospedale Maggiore Policlinico, 20122 Milan, Italy; (B.M.); (F.C.); (A.R.)
- Postgraduate Specialization in Gastrointestinal Diseases, Università degli Studi di Milano, 20122 Milan, Italy
| | - Reena Sidhu
- Department of Infection, Immunity and Cardiovascular Diseases, Royal Hallamshire Hospital, University of Sheffield, Sheffield S10 2TN, UK;
| | - Christian Bojarski
- Charité-Universitätsmedizin Berlin, Campus Benjamin Franklin, 10117 Berlin, Germany; (C.B.); (F.B.); (J.B.)
| | - Federica Branchi
- Charité-Universitätsmedizin Berlin, Campus Benjamin Franklin, 10117 Berlin, Germany; (C.B.); (F.B.); (J.B.)
| | - Gian Eugenio Tontini
- Department of Pathophysiology and Transplantation, Università degli Studi di Milano, 20122 Milan, Italy;
- Gastroenterology and Endoscopy Unit, Fondazione IRCCS Ca’ Granda Ospedale Maggiore Policlinico, 20122 Milan, Italy; (B.M.); (F.C.); (A.R.)
| | - Stefania Chetcuti Zammit
- Department of Medicine, Division of Gastroenterology, Mater Dei Hospital, MSD 2090 Msida, Malta; (S.C.Z.); (P.E.)
| | - Sherine Khater
- Department of Gastroenterology, Georges-Pompidou European Hospital, 75015 Paris, France; (S.K.); (E.P.C.R.); (G.P.); (G.R.)
| | - Rami Eliakim
- Gastroenterology Department, Sheba Medical Center, Tel Aviv University, Tel Aviv 52621, Israel; (R.E.); (U.K.)
| | | | - Jean Cristhophe Saurin
- Gastroenterology Department, Hospices Civils de Lyon-Centre Hospitalier Universitaire, 69002 Lyon, France;
| | - Mauro Bruno
- University Division of Gastroenterology, City of Health and Science University Hospital, 10126 Turin, Italy;
| | - Juliane Buchkremer
- Charité-Universitätsmedizin Berlin, Campus Benjamin Franklin, 10117 Berlin, Germany; (C.B.); (F.B.); (J.B.)
| | - Sergio Cadoni
- Digestive Endoscopy Unit, CTO Hospital, 09016 Iglesias, Italy;
| | - Flaminia Cavallaro
- Gastroenterology and Endoscopy Unit, Fondazione IRCCS Ca’ Granda Ospedale Maggiore Policlinico, 20122 Milan, Italy; (B.M.); (F.C.); (A.R.)
| | - Xavier Dray
- Centre for Digestive Endoscopy, Sorbonne University, Saint Antoine Hospital, APHP, 75012 Paris, France; (X.D.); (R.L.)
| | - Pierre Ellul
- Department of Medicine, Division of Gastroenterology, Mater Dei Hospital, MSD 2090 Msida, Malta; (S.C.Z.); (P.E.)
| | | | - Martin Keuchel
- Clinic for Internal Medicine, Agaplesion Bethesda Krankenhaus Bergedorf, Academic Teaching Hospital of the University of Hamburg, 21029 Hamburg, Germany; (M.K.); (P.B.)
| | - Uri Kopylov
- Gastroenterology Department, Sheba Medical Center, Tel Aviv University, Tel Aviv 52621, Israel; (R.E.); (U.K.)
| | - Anastasios Koulaouzidis
- Department of Medicine, Odense University Hospital (OUH)-Svendborg Sygehus, 5700 Svendborg, Denmark;
- Department of Clinical Research, University of Southern Denmark (SDU), 5230 Odense, Denmark
- Surgical Research Unit, OUH, 5000 Odense, Denmark
| | - Romain Leenhardt
- Centre for Digestive Endoscopy, Sorbonne University, Saint Antoine Hospital, APHP, 75012 Paris, France; (X.D.); (R.L.)
| | - Peter Baltes
- Clinic for Internal Medicine, Agaplesion Bethesda Krankenhaus Bergedorf, Academic Teaching Hospital of the University of Hamburg, 21029 Hamburg, Germany; (M.K.); (P.B.)
| | - Hanneke Beaumont
- Department of Gastroenterology and Hepatology, Amsterdam University Medical Center, Location VU, 1118 Amsterdam, The Netherlands;
| | - Clelia Marmo
- Fondazione Policlinico Universitario Agostino Gemelli, IRCCS, Università Cattolica del Sacro Cuore, 00168 Roma, Italy; (C.M.); (M.E.R.); (C.S.)
| | - Deirdre McNamara
- Trinity College Dublin, Tallaght University Hospital, D24 NR0A Dublin, Ireland;
| | - Alessandro Mussetto
- Gastroenterology Unit, Santa Maria delle Croci Hospital, 48121 Ravenna, Italy;
| | - Artur Nemeth
- Skåne University Hospital Malmö, Lund University, 221 00 Lund, Sweden; (A.N.); (E.T.); (G.W.J.)
| | - Enrique Perez Cuadrado Robles
- Department of Gastroenterology, Georges-Pompidou European Hospital, 75015 Paris, France; (S.K.); (E.P.C.R.); (G.P.); (G.R.)
- Small Bowel Unit, Morales Meseguer Hospital, 30008 Murcia, Spain
| | - Guillame Perrod
- Department of Gastroenterology, Georges-Pompidou European Hospital, 75015 Paris, France; (S.K.); (E.P.C.R.); (G.P.); (G.R.)
| | - Gabriel Rahmi
- Department of Gastroenterology, Georges-Pompidou European Hospital, 75015 Paris, France; (S.K.); (E.P.C.R.); (G.P.); (G.R.)
| | - Maria Elena Riccioni
- Fondazione Policlinico Universitario Agostino Gemelli, IRCCS, Università Cattolica del Sacro Cuore, 00168 Roma, Italy; (C.M.); (M.E.R.); (C.S.)
| | - Alexander Robertson
- Department of Gastroenterology, Western General Hospital, Edinburgh EH4 2XU, UK;
| | - Cristiano Spada
- Fondazione Policlinico Universitario Agostino Gemelli, IRCCS, Università Cattolica del Sacro Cuore, 00168 Roma, Italy; (C.M.); (M.E.R.); (C.S.)
- Digestive Endoscopy and Gastroenterology Unit, Poliambulanza Foundation, 25124 Brescia, Italy
| | - Ervin Toth
- Skåne University Hospital Malmö, Lund University, 221 00 Lund, Sweden; (A.N.); (E.T.); (G.W.J.)
| | - Konstantinos Triantafyllou
- Hepatogastroenterology Unit, 2nd Department of Propaedeutic Internal Medicine, Medical School, Attikon University General Hospital, National and Kapodistrian University, 157 72 Athens, Greece;
| | - Gabriele Wurm Johansson
- Skåne University Hospital Malmö, Lund University, 221 00 Lund, Sweden; (A.N.); (E.T.); (G.W.J.)
| | - Alessandro Rimondi
- Gastroenterology and Endoscopy Unit, Fondazione IRCCS Ca’ Granda Ospedale Maggiore Policlinico, 20122 Milan, Italy; (B.M.); (F.C.); (A.R.)
- Postgraduate Specialization in Gastrointestinal Diseases, Università degli Studi di Milano, 20122 Milan, Italy
| |
Collapse
|
14
|
Xie X, Xiao YF, Zhao XY, Li JJ, Yang QQ, Peng X, Nie XB, Zhou JY, Zhao YB, Yang H, Liu X, Liu E, Chen YY, Zhou YY, Fan CQ, Bai JY, Lin H, Koulaouzidis A, Yang SM. Development and Validation of an Artificial Intelligence Model for Small Bowel Capsule Endoscopy Video Review. JAMA Netw Open 2022; 5:e2221992. [PMID: 35834249 PMCID: PMC9284338 DOI: 10.1001/jamanetworkopen.2022.21992] [Citation(s) in RCA: 16] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/17/2022] Open
Abstract
IMPORTANCE Reading small bowel capsule endoscopy (SBCE) videos is a tedious task for clinicians, and a new method should be applied to solve the situation. OBJECTIVES To develop and evaluate the performance of a convolutional neural network algorithm for SBCE video review in real-life clinical care. DESIGN, SETTING, AND PARTICIPANTS In this multicenter, retrospective diagnostic study, a deep learning neural network (SmartScan) was trained and validated for the SBCE video review. A total of 2927 SBCE examinations from 29 medical centers were used to train SmartScan to detect 17 types of CE structured terminology (CEST) findings from January 1, 2019, to June 30, 2020. SmartScan was later validated with conventional reading (CR) and SmartScan-assisted reading (SSAR) in 2898 SBCE examinations collected from 22 medical centers. Data analysis was performed from January 25 to December 31, 2021. EXPOSURE An artificial intelligence-based tool for interpreting clinical images of SBCE. MAIN OUTCOMES AND MEASURES The detection rate and efficiency of CEST findings detected by SSAR and CR were compared. RESULTS A total of 5825 SBCE examinations were retrospectively collected; 2898 examinations (1765 male participants [60.9%]; mean [SD] age, 49.8 [15.5] years) were included in the validation phase. From a total of 6084 CEST-classified SB findings, SSAR detected 5834 findings (95.9%; 95% CI, 95.4%-96.4%), significantly higher than CR, which detected 4630 findings (76.1%; 95% CI, 75.0%-77.2%). SmartScan-assisted reading achieved a higher per-patient detection rate (79.3% [2298 of 2898]) for CEST findings compared with CR (70.7% [2048 of 2298]; 95% CI, 69.0%-72.3%). With SSAR, the mean (SD) number of images (per SBCE video) requiring review was reduced to 779.2 (337.2) compared with 27 910.8 (12 882.9) with CR, for a mean (SD) reduction rate of 96.1% (4.3%). The mean (SD) reading time with SSAR was shortened to 5.4 (1.5) minutes compared with CR (51.4 [11.6] minutes), for a mean (SD) reduction rate of 89.3% (3.1%). CONCLUSIONS AND RELEVANCE This study suggests that a convolutional neural network-based algorithm is associated with an increased detection rate of SBCE findings and reduced SBCE video reading time.
Collapse
Affiliation(s)
- Xia Xie
- Department of Gastroenterology, The Second Affiliated Hospital, the Third Military Medical University, Chongqing, China
| | - Yu-Feng Xiao
- Department of Gastroenterology, The Second Affiliated Hospital, the Third Military Medical University, Chongqing, China
| | - Xiao-Yan Zhao
- Department of Gastroenterology, The Second Affiliated Hospital, the Third Military Medical University, Chongqing, China
| | - Jian-Jun Li
- Department of Gastroenterology, The Second Affiliated Hospital, the Third Military Medical University, Chongqing, China
| | - Qiang-Qiang Yang
- Department of Gastroenterology, The Second Affiliated Hospital, the Third Military Medical University, Chongqing, China
| | - Xue Peng
- Department of Gastroenterology, The Second Affiliated Hospital, the Third Military Medical University, Chongqing, China
| | - Xu-Biao Nie
- Department of Gastroenterology, The Second Affiliated Hospital, the Third Military Medical University, Chongqing, China
| | - Jian-Yun Zhou
- Department of Gastroenterology, The Second Affiliated Hospital, the Third Military Medical University, Chongqing, China
| | - Yong-Bing Zhao
- Department of Gastroenterology, The Second Affiliated Hospital, the Third Military Medical University, Chongqing, China
| | - Huan Yang
- Department of Gastroenterology, The Second Affiliated Hospital, the Third Military Medical University, Chongqing, China
| | - Xi Liu
- Department of Gastroenterology, The Second Affiliated Hospital, the Third Military Medical University, Chongqing, China
| | - En Liu
- Department of Gastroenterology, The Second Affiliated Hospital, the Third Military Medical University, Chongqing, China
| | - Yu-Yang Chen
- Department of Gastroenterology, The Second Affiliated Hospital, the Third Military Medical University, Chongqing, China
| | - Yuan-Yuan Zhou
- Department of Gastroenterology, The Second Affiliated Hospital, the Third Military Medical University, Chongqing, China
| | - Chao-Qiang Fan
- Department of Gastroenterology, The Second Affiliated Hospital, the Third Military Medical University, Chongqing, China
| | - Jian-Ying Bai
- Department of Gastroenterology, The Second Affiliated Hospital, the Third Military Medical University, Chongqing, China
| | - Hui Lin
- Department of Gastroenterology, The Second Affiliated Hospital, the Third Military Medical University, Chongqing, China
- Department of Epidemiology, the Third Military Medical University, Chongqing, China
| | | | - Shi-Ming Yang
- Department of Gastroenterology, The Second Affiliated Hospital, the Third Military Medical University, Chongqing, China
| |
Collapse
|
15
|
Sey M. Artificial Intelligence and the Promise of Expediting and Standardizing the Reviewing and Reporting of Capsule Endoscopy Videos. JAMA Netw Open 2022; 5:e2222006. [PMID: 35834257 DOI: 10.1001/jamanetworkopen.2022.22006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Affiliation(s)
- Michael Sey
- Schulich School of Medicine, Western University, London, Ontario, Canada
- Gastroenterology and Therapeutic Endoscopy, London Health Sciences Centre, London, Ontario, Canada
- Lawson Health Research Institute, London Health Sciences Centre, London, Ontario, Canada
| |
Collapse
|
16
|
Afonso J, Mascarenhas M, Ribeiro T, Cardoso H, Andrade P, Ferreira JP, Saraiva MM, Macedo G. Deep Learning for Automatic Identification and Characterization of the Bleeding Potential of Enteric Protruding Lesions in Capsule Endoscopy. GASTRO HEP ADVANCES 2022; 1:835-843. [PMID: 39131843 PMCID: PMC11307543 DOI: 10.1016/j.gastha.2022.04.008] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/05/2021] [Accepted: 04/12/2022] [Indexed: 08/13/2024]
Abstract
Background and Aims Capsule endoscopy (CE) revolutionized the study of the small intestine, overcoming the limitations of conventional endoscopy. Nevertheless, reviewing CE images is time-consuming. Convolutional Neural Networks (CNNs) are an artificial intelligence architecture with high performance levels for image analysis. Protruding lesions of the small intestine exhibit enormous morphologic diversity in CE images. We aimed to develop a CNN-based algorithm for automatic detection of varied small-bowel protruding lesions. Methods A CNN was developed using a pool of CE images containing protruding lesions or normal mucosa/other findings. A total of 2565 patients were included. These images were inserted into a CNN model with transfer learning. We evaluated the performance of the network by calculating its sensitivity, specificity, accuracy, positive predictive value, and negative predictive value. Results A CNN was developed based on a total of 21,320 CE images. Training and validation data sets comprising 80% and 20% of the total pool of images, respectively, were constructed for development and testing of the network. The algorithm automatically detected small-bowel protruding lesions with an accuracy of 97.1%. Our CNN had a sensitivity, specificity, positive, and negative predictive values of 95.9%, 97.1%, 83.0%, and 95.7%, respectively. The CNN operated at a rate of approximately 355 frames per second. Conclusion We developed an accurate CNN for automatic detection of enteric protruding lesions with a wide range of morphologies. The development of these tools may enhance the diagnostic efficiency of CE.
Collapse
Affiliation(s)
- João Afonso
- Department of Gastroenterology, São João University Hospital, Porto, Portugal
- WGO Gastroenterology and Hepatology Training Center, Porto, Portugal
| | - Miguel Mascarenhas
- Department of Gastroenterology, São João University Hospital, Porto, Portugal
- WGO Gastroenterology and Hepatology Training Center, Porto, Portugal
- Faculty of Medicine of the University of Porto, Porto, Portugal
| | - Tiago Ribeiro
- Department of Gastroenterology, São João University Hospital, Porto, Portugal
- WGO Gastroenterology and Hepatology Training Center, Porto, Portugal
| | - Hélder Cardoso
- Department of Gastroenterology, São João University Hospital, Porto, Portugal
- WGO Gastroenterology and Hepatology Training Center, Porto, Portugal
- Faculty of Medicine of the University of Porto, Porto, Portugal
| | - Patrícia Andrade
- Department of Gastroenterology, São João University Hospital, Porto, Portugal
- WGO Gastroenterology and Hepatology Training Center, Porto, Portugal
- Faculty of Medicine of the University of Porto, Porto, Portugal
| | - João P.S. Ferreira
- Department of Mechanical Engineering, Faculty of Engineering of the University of Porto, Porto, Portugal
| | | | - Guilherme Macedo
- Department of Gastroenterology, São João University Hospital, Porto, Portugal
- WGO Gastroenterology and Hepatology Training Center, Porto, Portugal
- Faculty of Medicine of the University of Porto, Porto, Portugal
| |
Collapse
|
17
|
Brodersen JB, Andersen KW, Jensen MD. Adherence to the bowel cleansing regimen for pan-enteric capsule endoscopy in patients with suspected Crohn's disease and factors affecting the image quality. Scand J Gastroenterol 2022; 57:501-506. [PMID: 34915794 DOI: 10.1080/00365521.2021.2016945] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
OBJECTIVE Pan-enteric capsule endoscopy (CE) is an attractive diagnostic approach in patients examined for Crohn's disease (CD). The aim of this study was to examine the adherence to the recommended bowel cleansing regimen and determine clinical factors affecting the image quality. METHODS In a prospective blinded trial, patients with suspected CD were examined with the PillCam Crohn's capsule after bowel preparation with 2 + 2 L of polyethylene glycol (PEG) and sodium phosphate booster. The image quality was graded on a four-point scale. A good or excellent image quality defined a diagnostic procedure. RESULTS Fifty-nine patients participated. The mean volume of PEG was 2.5 L (CI 2.3-2.8). Ten patients (17%) were able to drink all 4 L of PEG, and 44 patients (75%) ingested ≥2 L. The image quality was poor, fair, good or excellent in 0%, 29.3%, 29.3% and 41.4%, respectively. The mean volume of PEG was 1.9 L (CI 1.4-2.4), 2.2 L (CI 1.8-2.7) and 3.2 L (CI 2.8-3.5) in patients with a fair, good or excellent image quality (p < .001). In a regression analysis, only the volume of PEG was associated with the obtained image quality (rs=0.52; p < .001). The diagnostic yield was equal in patients with a diagnostic or non-diagnostic procedure (43.9% and 47.1%, respectively). CONCLUSIONS In patients examined with pan-enteric CE for suspected CD, the volume of PEG is the major factor affecting the image quality. Although few patients are able to ingest the recommended volume, the diagnostic yield is not affected.
Collapse
Affiliation(s)
- Jacob Broder Brodersen
- Department of Internal Medicine, Section of Gastroenterology, Hospital of South West Jutland, Esbjerg, Denmark.,Department of Regional Health Research, University of Southern Denmark, Odense, Denmark
| | - Karina Winther Andersen
- Department of Internal Medicine, Section of Gastroenterology, Lillebaelt Hospital, Vejle, Denmark
| | - Michael Dam Jensen
- Department of Internal Medicine, Section of Gastroenterology, Lillebaelt Hospital, Vejle, Denmark
| |
Collapse
|
18
|
Romeo S, Neri B, Mossa M, Riccioni ME, Scucchi L, Sena G, Potenza S, Petruzziello C, Biancone L. Diagnostic yield of small bowel capsule endoscopy in obscure gastrointestinal bleeding: a real-world prospective study. Intern Emerg Med 2022; 17:349-358. [PMID: 34176039 PMCID: PMC8964573 DOI: 10.1007/s11739-021-02791-z] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/18/2021] [Accepted: 06/05/2021] [Indexed: 12/22/2022]
Abstract
Small bowel capsule endoscopy (SBCE) visualizes the small bowel (SB) mucosa. Gastrointestinal (GI) bleeding from SB accounts for the majority of SBCE indications. We aimed to assess, in a "real-world" prospective study, the diagnostic yield of SBCE in a cohort of consecutive patients with obscure gastrointestinal bleeding (OGIB). Secondary end point was to assess the frequency of adverse events and the role of SBCE in determining the diagnostic work-up and clinical outcome. From 2016 to 2018, all patients referred for SBCE examination were enrolled. Indication for SBCE was re-assessed by 2 dedicated gastroenterologists. Inclusion criteria: (1) age ≥ 18 and ≤ 85 years; (2) diagnosis of OGIB; 3) non-diagnostic standard bidirectional endoscopy; (4) informed consent. Exclusion criteria: (1) deglutition impairment; (2) SBCE contraindications; (3) pregnancy. The cohort included 50 patients [males 18 (36%), age 68 (27-83)]. SBCE indication: patients with ongoing overt OGIB (Group A) (n = 11; 22%), previous overt OGIB (Group B) (n = 14; 28%), occult bleeding (with Iron Deficiency Anaemia) (Group C) (n = 25; 50%). SBCE detected clinically relevant lesions in 46 (92%) cases. Clinically relevant lesions were more frequent in Group C (24/25; 96%), followed by Group A (10/11; 91%) and Group B (12/14; 85.5%). After SBCE, treatment was medical (60%); endoscopic (14%), surgical (36%) or conservative (18%). Clinical follow-up showed complete resolution in 63.2%, partial/absent resolution in 18.4% of cases. In a prospective study, the high diagnostic yield of SBCE supports its role as first-line investigation in patients with OGIB. However, this achievement requires an accurate and timely assessment by dedicated gastroenterologists.
Collapse
Affiliation(s)
- Samanta Romeo
- Department of Systems Medicine, University "Tor Vergata" of Rome, Vie Montpellier, 1, 00133, Rome, Italy
- GI Unit, ASST, Hospital Maggiore of Crema, Crema, Italy
| | - Benedetto Neri
- Department of Systems Medicine, University "Tor Vergata" of Rome, Vie Montpellier, 1, 00133, Rome, Italy
| | - Michelangela Mossa
- Department of Systems Medicine, University "Tor Vergata" of Rome, Vie Montpellier, 1, 00133, Rome, Italy
| | - Maria Elena Riccioni
- Department of Traslational Medicine, Università Cattolica del Sacro Cuore, Rome, Italy
| | - Ludovica Scucchi
- Department of Systems Medicine, University "Tor Vergata" of Rome, Vie Montpellier, 1, 00133, Rome, Italy
| | - Giorgia Sena
- Department of Systems Medicine, University "Tor Vergata" of Rome, Vie Montpellier, 1, 00133, Rome, Italy
| | - Saverio Potenza
- Department of Biomedicine and Prevention, University "Tor Vergata" of Rome, Rome, Italy
| | - Carmelina Petruzziello
- Department of Systems Medicine, University "Tor Vergata" of Rome, Vie Montpellier, 1, 00133, Rome, Italy
| | - Livia Biancone
- Department of Systems Medicine, University "Tor Vergata" of Rome, Vie Montpellier, 1, 00133, Rome, Italy.
| |
Collapse
|
19
|
Blanco-Velasco G, Pinho R, Solórzano-Pineda OM, Martínez-Camacho C, García-Contreras LF, Murcio-Pérez E, Hernández-Mondragón OV. Assessment of the Role of a Second Evaluation of Capsule Endoscopy Recordings to Improve Diagnostic Yield and Patient Management. GE PORTUGUESE JOURNAL OF GASTROENTEROLOGY 2022; 29:106-110. [PMID: 35497672 PMCID: PMC8995631 DOI: 10.1159/000516947] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/16/2021] [Accepted: 04/25/2021] [Indexed: 09/02/2023]
Abstract
INTRODUCTION The diagnostic yield (DY) of small-bowel capsule endoscopy (SBCE) varies considerably according to its indication. Some strategies have been used to increase DY with varying results. The intention of this study was to identify whether evaluation of the SBCE recordings by a second reviewer can increase DY and change patient management. METHODS One hundred SBCEs with different indications, already read by an endoscopist were read by a second blinded endoscopist. When the results of the 2 readings were different, the images were discussed by the endoscopists; if no consensus was reached, they took the opinion of a third endoscopist into account. All the participating endoscopists had experience in reading SBCEs (i.e., >50 per year). The SBCE findings were divided into positive (vascular lesions, ulcers, and tumors), equivocal (erosions or red spots), and negative. The interobserver agreement and the increase in DY were assessed as well as the percentage of false-negatives (FNs) in the first evaluation. RESULTS The indications for SBCE were small-bowel bleeding (SBB) in 48 cases, Crohn's disease (CD) in 30, and other causes (iron-deficiency anemia, small-bowel tumors, and diarrhea) in 22. There was substantial interobserver agreement between evaluations (κ = 0.79). The findings in the first evaluation were positive in 60%, equivocal in 20% and, negative in 20%. In the second evaluation, 66% were positive, 18% were equivocal, and 16% were negative. The increase in DY with the second reading was 6% (p = 0.380), i.e., 6.3% for SBB, 4.4% for CD and 9.2% for other indications, resulting in a change in management of 4% of the patients. FNs in the first SBCE reading were found in 4% of the SBCEs. DISCUSSION A second evaluation of the SBCE recordings identified significant pathology that the first evaluation had missed, resulting in a nonsignificant 6% increase in DY and a change in the management of 4% of the patients.
Collapse
Affiliation(s)
- Gerardo Blanco-Velasco
- Endoscopy Service, Hospital de Especialidades, Centro Médico Nacional Siglo XXI, Instituto Mexicano del Seguro Social, Ciudad de México, Mexico
| | - Rolando Pinho
- Department of Gastroenterology, Centro Hospitalar Vila Nova de Gaia/Espinho, Vila Nova de Gaia, Portugal
| | - Omar Michel Solórzano-Pineda
- Endoscopy Service, Hospital de Especialidades, Centro Médico Nacional Siglo XXI, Instituto Mexicano del Seguro Social, Ciudad de México, Mexico
| | - Claudia Martínez-Camacho
- Endoscopy Service, Hospital de Especialidades, Centro Médico Nacional Siglo XXI, Instituto Mexicano del Seguro Social, Ciudad de México, Mexico
| | - Luis Fernando García-Contreras
- Endoscopy Service, Hospital de Especialidades, Centro Médico Nacional Siglo XXI, Instituto Mexicano del Seguro Social, Ciudad de México, Mexico
| | - Enrique Murcio-Pérez
- Endoscopy Service, Hospital de Especialidades, Centro Médico Nacional Siglo XXI, Instituto Mexicano del Seguro Social, Ciudad de México, Mexico
| | - Oscar Victor Hernández-Mondragón
- Endoscopy Service, Hospital de Especialidades, Centro Médico Nacional Siglo XXI, Instituto Mexicano del Seguro Social, Ciudad de México, Mexico
| |
Collapse
|
20
|
Leenhardt R, Koulaouzidis A, McNamara D, Keuchel M, Sidhu R, McAlindon ME, Saurin JC, Eliakim R, Fernandez-Urien Sainz I, Plevris JN, Rahmi G, Rondonotti E, Rosa B, Spada C, Toth E, Houdeville C, Li C, Robaszkiewicz M, Marteau P, Dray X. A guide for assessing the clinical relevance of findings in small bowel capsule endoscopy: analysis of 8064 answers of international experts to an illustrated script questionnaire. Clin Res Hepatol Gastroenterol 2021; 45:101637. [PMID: 33662785 DOI: 10.1016/j.clinre.2021.101637] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/26/2020] [Revised: 06/10/2020] [Accepted: 09/10/2020] [Indexed: 02/04/2023]
Abstract
BACKGROUND AND AIM Although recommended, the P-score used for assessing the pertinence / relevance of findings seen in small bowel (SB) capsule endoscopy (CE) is based on a low level of knowledge. The aim of this study was to evaluate the clinical relevance of the most frequent SBCE findings through an illustrated script questionnaire. MATERIALS AND METHODS Sixteen types of SBCE findings were illustrated four times each in three different settings (occult and overt obscure gastrointestinal bleeding and suspected Crohn's disease), and with a variable number (n = 1/n = 2-5/n ≥ 6), thus providing a questionnaire with 192 scenarios and 576 illustrated questions. Fifteen international experts were asked to rate the finding's relevance for each question as very unlikely (-2) / unlikely (-1) / doubtful (0) / likely (+1) / very likely (+2). The median score (≤-0.75, between -0.75 and 0.75, or ≥0.75) obtained for each scenario determined a low (P0), intermediate (P1) or high (P2) relevance, respectively. RESULTS 8064 answers were analyzed. Participation and completion rates were 93% and 100%, respectively. In overt or occult OGIB, resultant P2 findings were 'typical angiectasia', 'deep ulceration', 'stenosis', and'blood', whatever their numbers, and 'superficial ulcerations' when multiple. While in suspected CD, consensus P2 lesions were 'deep ulceration' and 'stenosis' whatever their numbers, and 'aphthoid erosions' and 'superficial ulcerations' when multiple. CONCLUSION This study establishes a guide for the evaluation of relevance of SBCE findings. It represents a step forward for SB-CE interpretation and is intended to be used as a tool for teaching and academic research.
Collapse
Affiliation(s)
- R Leenhardt
- Sorbonne Université, Endoscopy Unit, Hôpital Saint-Antoine, APHP, Paris, France
| | - A Koulaouzidis
- The Royal Infirmary of Edinburgh, Centre For Liver & Digestive Disorders, Edinburgh, United Kingdom
| | - D McNamara
- TAGG Research Centre, Department of Clinical Medicine Tallaght Hospital, Trinity College Dublin, Ireland
| | - M Keuchel
- Bethesda Krankenhaus Bergedorf, Klinik für Innere Medizin, Hamburg, Germany
| | - R Sidhu
- Dept. of Gastroenterology, Royal Hallamshire Hospital, Sheffield, United Kingdom
| | - M E McAlindon
- Dept. of Gastroenterology, Royal Hallamshire Hospital, Sheffield, United Kingdom
| | - J C Saurin
- Gastroenterology and Endoscopy Unit, Edouard Herriot Hospital, Lyon, France
| | - R Eliakim
- Dept. of Gastroenterology, Sheba Medical Center, Ramat Gan, and Sackler School of Medicine, Tel-Aviv University, Tel-Aviv, Israel
| | | | - J N Plevris
- The Royal Infirmary of Edinburgh, Centre For Liver & Digestive Disorders, Edinburgh, United Kingdom
| | - G Rahmi
- Université de Paris, Department of Gastroenterology and Digestive Endoscopy, Georges-Pompidou European Hospital, Paris, France
| | - E Rondonotti
- Gastroenterology Unit, Valduce Hospital, Como, Italy
| | - B Rosa
- Universidade do Minho, Hospital Senhora da Oliveira, Departamento de Gastroenterologia, Guimarães, Portugal
| | - C Spada
- Digestive Endoscopy Unit and Gastroenterology, Fondazione Poliambulanza, Brescia, Italy; Digestive Endoscopy Unit, Universita Cattolica del Sacro Cuore, Roma, Italy
| | - E Toth
- Department of Gastroenterology, Skåne University Hospital, Lund University, Malmö, Sweden
| | - C Houdeville
- Sorbonne Université, Endoscopy Unit, Hôpital Saint-Antoine, APHP, Paris, France
| | - C Li
- Sorbonne Université, Endoscopy Unit, Hôpital Saint-Antoine, APHP, Paris, France; Drexel University, College of Arts & Sciences, Philadelphia, USA
| | - M Robaszkiewicz
- La Cavale Blanche University Hospital, Endoscopy Unit, Brest, France
| | - P Marteau
- Sorbonne Université, Endoscopy Unit, Hôpital Saint-Antoine, APHP, Paris, France
| | - X Dray
- Sorbonne Université, Endoscopy Unit, Hôpital Saint-Antoine, APHP, Paris, France.
| |
Collapse
|
21
|
Pérez de Arce E, Quera R, Núñez F P, Araya R. Role of capsule endoscopy in inflammatory bowel disease: Anything new? Artif Intell Gastrointest Endosc 2021; 2:136-148. [DOI: 10.37126/aige.v2.i4.136] [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: 05/01/2021] [Revised: 06/21/2021] [Accepted: 08/16/2021] [Indexed: 02/06/2023] Open
Abstract
Capsule endoscopy (CE) is a recently developed diagnostic method for diseases of the small bowel that is non-invasive, safe, and highly tolerable. Its role in patients with inflammatory bowel disease has been widely validated in suspected and established Crohn’s disease (CD) due to its ability to assess superficial lesions not detected by cross-sectional imaging and proximal lesions of the small bowel not evaluable by ileocolonoscopy. Because CE is a highly sensitive but less specific technique, differential diagnoses that can simulate CD must be considered, and its interpretation should be supported by other clinical and laboratory indicators. The use of validated scoring systems to characterize and estimate lesion severity (Lewis score, Capsule Endoscopy Crohn’s Disease Activity Index), as well as the standardization of the language used to define the lesions (Delphi Consensus), have reduced the interobserver variability in CE reading observed in clinical practice, allowing for the optimization of diagnoses and clinical management strategies. The appearance of the panenteric CE, the incorporation of artificial intelligence, magnetically-guided capsules, and tissue biopsies are elements that contribute to CE being a promising, unique diagnostic tool in digestive tract diseases.
Collapse
Affiliation(s)
- Edith Pérez de Arce
- Department of Gastroenterology, Hospital Clínico Universidad de Chile, Santiago 8380456, Chile
| | - Rodrigo Quera
- Digestive Disease Center, Inflammatory Bowel Disease Program, Clínica Universidad de los Andes, Santiago 7620157, Chile
| | - Paulina Núñez F
- Digestive Disease Center, Inflammatory Bowel Disease Program, Clínica Universidad de los Andes, Santiago 7620157, Chile
- Department of Gastroenterology, Hospital San Juan De Dios, Santiago 8350488, Chile
| | - Raúl Araya
- Digestive Disease Center, Inflammatory Bowel Disease Program, Clínica Universidad de los Andes, Santiago 7620157, Chile
| |
Collapse
|
22
|
A Current and Newly Proposed Artificial Intelligence Algorithm for Reading Small Bowel Capsule Endoscopy. Diagnostics (Basel) 2021; 11:diagnostics11071183. [PMID: 34209948 PMCID: PMC8306692 DOI: 10.3390/diagnostics11071183] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2021] [Revised: 06/26/2021] [Accepted: 06/28/2021] [Indexed: 12/09/2022] Open
Abstract
Small bowel capsule endoscopy (SBCE) is one of the most useful methods for diagnosing small bowel mucosal lesions. However, it takes a long time to interpret the capsule images. To solve this problem, artificial intelligence (AI) algorithms for SBCE readings are being actively studied. In this article, we analyzed several studies that applied AI algorithms to SBCE readings, such as automatic lesion detection, automatic classification of bowel cleanliness, and automatic compartmentalization of small bowels. In addition to automatic lesion detection using AI algorithms, a new direction of AI algorithms related to shorter reading times and improved lesion detection accuracy should be considered. Therefore, it is necessary to develop an integrated AI algorithm composed of algorithms with various functions in order to be used in clinical practice.
Collapse
|
23
|
Tai FWD, Parker C, Sidhu R, McAlindon M, Davison C, Smith GV, Panter S. Training pathway for small bowel capsule endoscopy in the UK. Frontline Gastroenterol 2021; 13:206-210. [PMID: 35493627 PMCID: PMC8996098 DOI: 10.1136/flgastro-2021-101810] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/04/2023] Open
Abstract
The demand for small bowel (SB) capsule endoscopy (CE) is increasing in the UK. However, there remains a wide variation in the number of CE procedures performed in different centres. Across the UK there is a lack of a clear training pathway or certification process. A standardised national Joint Advisory Group (JAG) on Gastrointestinal Endoscopy approved a 1-year training and accreditation programme accessible to all professional groups that may wish to train in SB CE. Structured training is delivered using JAG-accredited CE courses and an electronic learning module. Prior to setting a knowledge-based assessment, a minimum of 50 SB CE cases are recommended to be read in tandem with a trainer at a local centre, with proficiency documented using Direct Observation of Procedural Skill (DOPS) assessments.
Collapse
Affiliation(s)
- Foong Way David Tai
- Academic Unit of Gastroenterology, Royal Hallamshire Hospital, Sheffield, UK
| | - Clare Parker
- Department of Gastroenterology, South Tyneside District Hospital, South Tyneside and Sunderland NHS Foundation Trust, South Shields, UK
| | - Reena Sidhu
- Academic Unit of Gastroenterology, Royal Hallamshire Hospital, Sheffield, UK
| | - Mark McAlindon
- Academic Unit of Gastroenterology, Royal Hallamshire Hospital, Sheffield, UK
| | - Carolyn Davison
- Department of Gastroenterology, South Tyneside District Hospital, South Tyneside and Sunderland NHS Foundation Trust, South Shields, UK
| | | | - Simon Panter
- Department of Gastroenterology, South Tyneside District Hospital, South Tyneside and Sunderland NHS Foundation Trust, South Shields, UK
| |
Collapse
|
24
|
Abstract
Video capsule endoscopy (VCE) is an established modality for examining the small bowel. Formal training in interpretation and reporting of VCE examinations, along with assessment of performance metrics, is advocated for all gastroenterology fellowship programs. This review provides an overview of VCE minimum training requirements and competency assessment, cognitive and technical aspects of interpretation, and standardized reporting of findings. In order to optimize and advance the clinical utility of VCE, efforts must continue to promote and encourage consensus and standardization of training, definition and assessment of competence, enhancements of VCE reading tools, and use of appropriate nomenclature in VCE reports.
Collapse
|
25
|
Koulaouzidis A, Dabos K, Philipper M, Toth E, Keuchel M. How should we do colon capsule endoscopy reading: a practical guide. Ther Adv Gastrointest Endosc 2021; 14:26317745211001983. [PMID: 33817637 PMCID: PMC7992771 DOI: 10.1177/26317745211001983] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/24/2021] [Accepted: 02/15/2021] [Indexed: 12/11/2022] Open
Abstract
In this article, we aim to provide general principles as well as personal views for colonic capsule endoscopy. To allow an in-depth understanding of the recommendations, we also present basic technological characteristics and specifications, with emphasis on the current as well as the previous version of colonic capsule endoscopy and relevant software. To date, there is no scientific proof to support the optimal way of reading a colonic capsule endoscopy video, or any standards or guidelines exist. Hence, any advice is a mixture of recommendations by the capsule manufacturer and experts’ opinion. Furthermore, there is a paucity of data regarding the use of term(s) (pre-reader/reader-validator) in colonic capsule endoscopy. We also include a couple of handy tables in order to get info at a glance.
Collapse
Affiliation(s)
- Anastasios Koulaouzidis
- Department of Social Medicine and Public Health, Faculty of Health Sciences, Pomeranian Medical University, Szczecin, Poland
| | | | | | - Ervin Toth
- Department of Gastroenterology, Skåne University Hospital, Lund University, Malmö, Sweden
| | - Martin Keuchel
- Clinic for Internal Medicine, Agaplesion Bethesda Krankenhaus Bergedorf, 21029 Hamburg, Germany
| |
Collapse
|
26
|
Aoki T, Yamada A, Koike K. The exceptional performance of deep learning for capsule endoscopy: Will such quality be maintained in clinical scenarios? Gastrointest Endosc 2021; 93:365-366. [PMID: 33478661 DOI: 10.1016/j.gie.2020.08.014] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/05/2020] [Accepted: 08/15/2020] [Indexed: 02/07/2023]
Affiliation(s)
- Tomonori Aoki
- Department of Gastroenterology, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
| | - Atsuo Yamada
- Department of Gastroenterology, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
| | - Kazuhiko Koike
- Department of Gastroenterology, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
| |
Collapse
|
27
|
Marquès Camí M, Serracarbasa A, D'Haens G, Löwenberg M. Characterization of Mucosal Lesions in Crohn's Disease Scored With Capsule Endoscopy: A Systematic Review. Front Med (Lausanne) 2021; 7:600095. [PMID: 33521017 PMCID: PMC7840780 DOI: 10.3389/fmed.2020.600095] [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: 08/28/2020] [Accepted: 11/26/2020] [Indexed: 12/22/2022] Open
Abstract
Background and Aims: There is little agreement on the nomenclature and description of Crohn's disease (CD) lesions that can be found in the small and large bowel using capsule endoscopy (CE). We performed a systematic review to identify mucosal lesions that have been described using CE in CD, in both the small bowel and colon, with the aim to make propositions to homogenize such descriptions. Methods: A systematic literature search was conducted using Embase, Medline (OvidSP), and Cochrane Central on August 6, 2019. Clinical studies providing nomenclature and descriptions for small bowel and colonic inflammatory lesions using CE in CD were selected for data collection. Results: In total, 851 articles were included for abstract screening out of which 219 were analyzed for full-text review. Twenty-two articles were selected for data extraction. Seven items, accompanied by clear descriptions, were found for the small bowel: i.e., ulcer, erosion, aphthoid lesion, edema, fissure, cobblestone appearance, and villous atrophy. No studies were found describing inflammatory items using CE in colonic CD. Conclusions: The most frequently described CD lesions using CE were ulcers and erosions. Subjective interpretation of CE inflammatory findings plays an important role. Based on our findings, a range of suggestions regarding items and descriptions is made that might form the basis of a pan-enteric CE activity index.
Collapse
Affiliation(s)
- Miquel Marquès Camí
- Servei d'Aparell Digestiu, Hospital Universitari Arnau de Vilanova, Lleida, Spain
| | - Alba Serracarbasa
- Servei d'Aparell Digestiu, Hospital Universitari de Bellvitge, Hospitalet de Llobregat, Spain
| | - Geert D'Haens
- Department of Gastroenterology and Hepatology, Amsterdam University Medical Centre, Location Academic Medical Centre, Amsterdam, Netherlands
| | - Mark Löwenberg
- Department of Gastroenterology and Hepatology, Amsterdam University Medical Centre, Location Academic Medical Centre, Amsterdam, Netherlands
| |
Collapse
|
28
|
Dray X, Iakovidis D, Houdeville C, Jover R, Diamantis D, Histace A, Koulaouzidis A. Artificial intelligence in small bowel capsule endoscopy - current status, challenges and future promise. J Gastroenterol Hepatol 2021; 36:12-19. [PMID: 33448511 DOI: 10.1111/jgh.15341] [Citation(s) in RCA: 36] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/16/2020] [Revised: 11/05/2020] [Accepted: 11/05/2020] [Indexed: 12/24/2022]
Abstract
Neural network-based solutions are under development to alleviate physicians from the tedious task of small-bowel capsule endoscopy reviewing. Computer-assisted detection is a critical step, aiming to reduce reading times while maintaining accuracy. Weakly supervised solutions have shown promising results; however, video-level evaluations are scarce, and no prospective studies have been conducted yet. Automated characterization (in terms of diagnosis and pertinence) by supervised machine learning solutions is the next step. It relies on large, thoroughly labeled databases, for which preliminary "ground truth" definitions by experts are of tremendous importance. Other developments are under ways, to assist physicians in localizing anatomical landmarks and findings in the small bowel, in measuring lesions, and in rating bowel cleanliness. It is still questioned whether artificial intelligence will enter the market with proprietary, built-in or plug-in software, or with a universal cloud-based service, and how it will be accepted by physicians and patients.
Collapse
Affiliation(s)
- Xavier Dray
- Sorbonne Université, Centre d'Endoscopie Digestive, Hôpital Saint-Antoine, APHP, Paris, France.,ETIS UMR 8051 (CY Paris Cergy University, ENSEA, CNRS), Cergy, France
| | - Dimitris Iakovidis
- Department of Computer Science and Biomedical Informatics, University of Thessaly, Lamia, Greece
| | - Charles Houdeville
- Sorbonne Université, Centre d'Endoscopie Digestive, Hôpital Saint-Antoine, APHP, Paris, France
| | - Rodrigo Jover
- Servicio de Medicina Digestiva, Hospital General Universitario de Alicante, Instituto de Investigación Biomédica ISABIAL, Alicante, Spain
| | - Dimitris Diamantis
- Department of Computer Science and Biomedical Informatics, University of Thessaly, Lamia, Greece
| | - Aymeric Histace
- ETIS UMR 8051 (CY Paris Cergy University, ENSEA, CNRS), Cergy, France
| | | |
Collapse
|
29
|
Automatic detection of various abnormalities in capsule endoscopy videos by a deep learning-based system: a multicenter study. Gastrointest Endosc 2021; 93:165-173.e1. [PMID: 32417297 DOI: 10.1016/j.gie.2020.04.080] [Citation(s) in RCA: 31] [Impact Index Per Article: 10.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/10/2020] [Accepted: 04/27/2020] [Indexed: 12/11/2022]
Abstract
BACKGROUND AND AIMS A deep convolutional neural network (CNN) system could be a high-level screening tool for capsule endoscopy (CE) reading but has not been established for targeting various abnormalities. We aimed to develop a CNN-based system and compare it with the existing QuickView mode in terms of their ability to detect various abnormalities. METHODS We trained a CNN system using 66,028 CE images (44,684 images of abnormalities and 21,344 normal images). The detection rate of the CNN for various abnormalities was assessed per patient, using an independent test set of 379 consecutive small-bowel CE videos from 3 institutions. Mucosal breaks, angioectasia, protruding lesions, and blood content were present in 94, 29, 81, and 23 patients, respectively. The detection capability of the CNN was compared with that of QuickView mode. RESULTS The CNN picked up 1,135,104 images (22.5%) from the 5,050,226 test images, and thus, the sampling rate of QuickView mode was set to 23% in this study. In total, the detection rate of the CNN for abnormalities per patient was significantly higher than that of QuickView mode (99% vs 89%, P < .001). The detection rates of the CNN for mucosal breaks, angioectasia, protruding lesions, and blood content were 100% (94 of 94), 97% (28 of 29), 99% (80 of 81), and 100% (23 of 23), respectively, and those of QuickView mode were 91%, 97%, 80%, and 96%, respectively. CONCLUSIONS We developed and tested a CNN-based detection system for various abnormalities using multicenter CE videos. This system could serve as an alternative high-level screening tool to QuickView mode.
Collapse
|
30
|
Small intestinal mucosal injury and its risk factors in patients with gastrointestinal cancer who developed complicated fluoropyrimidine-induced diarrhea. BMC Gastroenterol 2020; 20:355. [PMID: 33109089 PMCID: PMC7590606 DOI: 10.1186/s12876-020-01507-5] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/01/2020] [Accepted: 10/19/2020] [Indexed: 12/22/2022] Open
Abstract
Background Diarrhea is a common adverse event of fluoropyrimidine-based chemotherapy. However, limited data are available on the frequency and risk factors of complicated chemotherapy-induced diarrhea (CID) and small intestinal mucosal damage. In this current study, we aimed to determine the incidence of complicated CID and mucosal injury among patients with complicated CID receiving fluoropyrimidine via small bowel capsule endoscopy (CE) and determined baseline risk factors associated with complicated CID. Methods In total, 536 patients with advanced or recurrent gastrointestinal cancer who received fluoropyrimidine-based chemotherapy were retrospectively analyzed. Diarrhea was evaluated using the Common Terminology Criteria for Adverse Events version 4. Complicated CID was defined according to the American Society of Clinical Oncology guidelines. To evaluate small intestinal mucosal injury in patients with complicated CID, CE was performed. Multivariate analysis was performed to identify risk factors for complicated CID. Results Total number of 32 (6%) patients developed complicated CID. Complicating symptoms were noted in 25 (78%) patients, with cramping, vomiting, and sepsis being observed in 15 (60%), 8 (32%), and 3 (12%) patients, respectively. Among the 13 patients who underwent CE, 11 (85%) showed abnormal findings. Multivariate analysis revealed that oral fluoropyrimidine administration was a risk factor for complicated CID (odds ratio 2.95; 95% confidence interval 1.06–8.19). Conclusions Despite the relatively low incidence of complicated CID, mucosal injury of small intestine was common in patients with complicated fluoropyrimidine-induced diarrhea and oral fluoropyrimidine was an independent risk factor.
Collapse
|
31
|
Saito H, Aoki T, Aoyama K, Kato Y, Tsuboi A, Yamada A, Fujishiro M, Oka S, Ishihara S, Matsuda T, Nakahori M, Tanaka S, Koike K, Tada T. Automatic detection and classification of protruding lesions in wireless capsule endoscopy images based on a deep convolutional neural network. Gastrointest Endosc 2020; 92:144-151.e1. [PMID: 32084410 DOI: 10.1016/j.gie.2020.01.054] [Citation(s) in RCA: 91] [Impact Index Per Article: 22.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/31/2019] [Accepted: 01/31/2020] [Indexed: 02/08/2023]
Abstract
BACKGROUND AND AIMS Protruding lesions of the small bowel vary in wireless capsule endoscopy (WCE) images, and their automatic detection may be difficult. We aimed to develop and test a deep learning-based system to automatically detect protruding lesions of various types in WCE images. METHODS We trained a deep convolutional neural network (CNN), using 30,584 WCE images of protruding lesions from 292 patients. We evaluated CNN performance by calculating the area under the receiver operating characteristic curve (AUC), sensitivity, and specificity, using an independent set of 17,507 test images from 93 patients, including 7507 images of protruding lesions from 73 patients. RESULTS The developed CNN analyzed 17,507 images in 530.462 seconds. The AUC for detection of protruding lesions was 0.911 (95% confidence interval [Cl], 0.9069-0.9155). The sensitivity and specificity of the CNN were 90.7% (95% CI, 90.0%-91.4%) and 79.8% (95% CI, 79.0%-80.6%), respectively, at the optimal cut-off value of 0.317 for probability score. In a subgroup analysis of the category of protruding lesions, the sensitivities were 86.5%, 92.0%, 95.8%, 77.0%, and 94.4% for the detection of polyps, nodules, epithelial tumors, submucosal tumors, and venous structures, respectively. In individual patient analyses (n = 73), the detection rate of protruding lesions was 98.6%. CONCLUSION We developed and tested a new computer-aided system based on a CNN to automatically detect various protruding lesions in WCE images. Patient-level analyses with larger cohorts and efforts to achieve better diagnostic performance are necessary in further studies.
Collapse
Affiliation(s)
- Hiroaki Saito
- Department of Gastroenterology, Sendai Kousei Hospital, Miyagi, Japan.
| | - Tomonori Aoki
- Department of Gastroenterology, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
| | | | | | - Akiyoshi Tsuboi
- Department of Endoscopy, Hiroshima University Hospital, Hiroshima, Japan
| | - Atsuo Yamada
- Department of Gastroenterology, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
| | - Mitsuhiro Fujishiro
- Department of Gastroenterology and Hepatology, Nagoya University Graduate School of Medicine, Aichi, Japan
| | - Shiro Oka
- Department of Endoscopy, Hiroshima University Hospital, Hiroshima, Japan
| | - Soichiro Ishihara
- Department of Surgical Oncology, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan; Tada Tomohiro Institute of Gastroenterology and Proctology, Saitama, Japan
| | - Tomoki Matsuda
- Department of Gastroenterology, Sendai Kousei Hospital, Miyagi, Japan
| | - Masato Nakahori
- Department of Gastroenterology, Sendai Kousei Hospital, Miyagi, Japan
| | - Shinji Tanaka
- Department of Endoscopy, Hiroshima University Hospital, Hiroshima, Japan
| | - Kazuhiko Koike
- Department of Gastroenterology, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
| | - Tomohiro Tada
- AI Medical Service Inc., Tokyo, Japan; Department of Surgical Oncology, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan; Tada Tomohiro Institute of Gastroenterology and Proctology, Saitama, Japan
| |
Collapse
|
32
|
Leenhardt R, Buisson A, Bourreille A, Marteau P, Koulaouzidis A, Li C, Keuchel M, Rondonotti E, Toth E, Plevris JN, Eliakim R, Rosa B, Triantafyllou K, Elli L, Wurm Johansson G, Panter S, Ellul P, Pérez-Cuadrado Robles E, McNamara D, Beaumont H, Spada C, Cavallaro F, Cholet F, Fernandez-Urien Sainz I, Kopylov U, McAlindon ME, Németh A, Tontini GE, Yung DE, Niv Y, Rahmi G, Saurin JC, Dray X. Nomenclature and semantic descriptions of ulcerative and inflammatory lesions seen in Crohn's disease in small bowel capsule endoscopy: An international Delphi consensus statement. United European Gastroenterol J 2020; 8:99-107. [PMID: 32213061 PMCID: PMC7005999 DOI: 10.1177/2050640619895864] [Citation(s) in RCA: 28] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/31/2019] [Accepted: 11/24/2019] [Indexed: 12/21/2022] Open
Abstract
BACKGROUND In the medical literature, the nomenclature and descriptions (ND) of small bowel (SB) ulcerative and inflammatory (U-I) lesions in capsule endoscopy (CE) are scarce and inconsistent. Inter-observer variability in interpreting these findings remains a major limitation in the assessment of the severity of mucosal lesions, which can impact negatively on clinical care, training and research on SB-CE. OBJECTIVE Focusing on SB-CE in Crohn's disease (CD), our aim is to establish a consensus on the ND of U-I lesions. METHODS An international panel of experienced SB-CE readers was formed during the 2016 United European Gastroenterology Week meeting. A core group of five CE and inflammatory bowel disease (IBD) experts established an Internet-based, three-round Delphi consensus but did not participate in the voting process. The core group built illustrated questionnaires, including SB-CE still frames of U-I lesions from patients with documented CD. Twenty-seven other experts were asked to rate and comment on the different proposals for the ND of the most frequent SB U-I lesions. For each round, we used a 6-point rating scale (varying from 'strongly disagree' to 'strongly agree'). The consensus was reached when at least 80 % of the voting members scored the statement within the 'agree' or 'strongly agree' categories. RESULTS A 100% participation rate was obtained for all the rounds. Consensual ND were reached for the following seven U-I lesions: aphthoid erosion, deep ulceration, superficial ulceration, stenosis, edema, hyperemia and denudation. CONCLUSION Considering the most frequent SB U-I lesions seen in CE in CD, a consensual ND was reached by the international group of experts. These descriptions and names are useful not only for daily practice and medical education, but also for medical research.
Collapse
Affiliation(s)
- Romain Leenhardt
- Sorbonne Université, Endoscopy Unit, Hôpital Saint-Antoine, AP-HP, Paris, France
| | - Anthony Buisson
- Dept. of Gastroenterology, CHU Estaing Clermont-Ferrand, Clermont-ferrand, France
| | - Arnaud Bourreille
- Institut des Maladies de l’Appareil Digestif (IMAD), Dept of Gastroenterology, CHU Nantes, University of Nantes, Nantes, France
| | - Philippe Marteau
- Sorbonne Université, Endoscopy Unit, Hôpital Saint-Antoine, AP-HP, Paris, France
| | - Anastasios Koulaouzidis
- Centre For Liver & Digestive Disorders, The Royal Infirmary of Edinburgh, Edinburgh, United Kingdom
| | - Cynthia Li
- Sorbonne Université, Endoscopy Unit, Hôpital Saint-Antoine, AP-HP, Paris, France
- College of Arts & Sciences, Drexel University, Philadelphia, USA
| | - Martin Keuchel
- Klinik für Innere Medizin, Bethesda Krankenhaus Bergedorf, Hamburg, Germany
| | | | - Ervin Toth
- Department of Gastroenterology, Skåne University Hospital, Lund University, Malmö, Sweden
| | - John N Plevris
- Centre For Liver & Digestive Disorders, The Royal Infirmary of Edinburgh, Edinburgh, United Kingdom
| | - Rami Eliakim
- Dept. of Gastroenterology, Sheba Medical Center, Ramat Gan, and Sackler School of Medicine, Tel-Aviv University, Tel-Aviv, Israel
| | - Bruno Rosa
- Departamento de Gastroenterologia, Universidade do Minho, Hospital Senhora da Oliveira, Guimarães, Portugal
| | - Konstantinos Triantafyllou
- Hepatogastroenterology Unit, Second Department of Internal Medicine - Propaedeutic Research Institute and Diabetes Center, National and Kapodistrian University of Athens, Medical School, Attikon University General Hospital, Athens, Greece
| | - Luca Elli
- Center for Prevention and Diagnosis of Celiac Disease, Fondazione IRCCS Ca Granda, Milano, Italy
| | | | - Simon Panter
- Gastroenterology, South Tyneside Hospital, South Shields, United Kingdom
| | - Pierre Ellul
- Department of Medicine, Mater Dei Hospital, Msida, Malta
| | - Enrique Pérez-Cuadrado Robles
- Department of Gastroenterology, Cliniques Universitaires Saint-Luc, Bruxelles, Belgium
- Department of Gastroenterology and Digestive Endoscopy, Georges-Pompidou European hospital, Paris, France
| | - Deirdre McNamara
- Trinity Academic Gastroenterology Group, Departement of Clinical Medicine, Tallaght Hospital, Trinity College Dublin, Ireland
| | - Hanneke Beaumont
- Department of Gastroenterology, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
| | - Cristiano Spada
- Digestive Endoscopy Unit and Gastroenterology, Fondazione Poliambulanza, Brescia, Italia; Digestive Endoscopy Unit, Università Cattolica del Sacro Cuore, Roma, Italia
| | - Flaminia Cavallaro
- Gastroenterology and Endoscopy Unit, IRCCS Policlinico San Donato, San Donato Milanese, Milan, Italy
| | - Franck Cholet
- Endoscopy unit, CHU La Cavale Blanche, Brest, France
| | | | - Uri Kopylov
- Dept. of Gastroenterology, Sheba Medical Center, Ramat Gan, and Sackler School of Medicine, Tel-Aviv University, Tel-Aviv, Israel
| | - Mark E McAlindon
- Dept. of Gastroenterology, Royal Hallamshire Hospital, Sheffield, United Kingdom
| | - Artur Németh
- Department of Gastroenterology, Skåne University Hospital, Lund University, Malmö, Sweden
| | - Gian Eugenio Tontini
- Department of Pathophysiology and Transplantation, University of Milan - Gastroenterology and Endoscopy Unit, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Diana E Yung
- Centre For Liver & Digestive Disorders, The Royal Infirmary of Edinburgh, Edinburgh, United Kingdom
| | - Yaron Niv
- Rabin Medical Center, Dept. of Gastroenterology, Petach Tikva, Israel, and Sackler School of Medicine, Tel-Aviv University, Tel-Aviv, Israel
| | - Gabriel Rahmi
- Department of Gastroenterology and Digestive Endoscopy, Georges-Pompidou European hospital, Paris, France
| | | | - Xavier Dray
- Sorbonne Université, Endoscopy Unit, Hôpital Saint-Antoine, AP-HP, Paris, France
| |
Collapse
|
33
|
Koffas A, Laskaratos FM, Epstein O. Training in video capsule endoscopy: Current status and unmet needs. World J Gastrointest Endosc 2019; 11:395-402. [PMID: 31236192 PMCID: PMC6580306 DOI: 10.4253/wjge.v11.i6.395] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/12/2019] [Revised: 05/19/2019] [Accepted: 06/10/2019] [Indexed: 02/06/2023] Open
Abstract
Since its introduction to clinical practice nearly 20 years ago, wireless capsule endoscopy has revolutionized the landscape in the diagnosis and management of small bowel diseases. Over the past 10 years, capsule endoscopy has evolved beyond the small intestine and a range of capsules are now available to examine the esophagus, stomach and colon. Because of its ease of use, tolerability, paucity of complications and ability to visualize the entire gastrointestinal tract, capsule endoscopy has entered the mainstream of clinical practice. This review of the literature summarizes the current state of capsule training and highlights the limited data available to assess reader competence and standards expected of an independent practitioner. There are neither standardized teaching strategies nor national or international metrics for accreditation of physicians and non-physicians interested in mastering this examination. Summating the few publications, there appears to be consensus that diagnostic expertise improves with experience, and that trainees should be fully supervised for at least 20 full case studies. Formative and summative assessment is advisable and the number of taught cases should not be the sole determinant of competence. The review also highlights differences in recommendations from major national gastroenterology societies. Finally, the authors discuss areas of unmet needs in teaching and learning for capsule endoscopy.
Collapse
Affiliation(s)
- Apostolos Koffas
- Gastroenterology Department, University Hospital of Larisa, Mezourlo, Larisa 41110, Greece
| | | | - Owen Epstein
- Centre for Gastroenterology, Royal Free Hospital, Pond St, London NW3 2QG, United Kingdom
| |
Collapse
|
34
|
Spada C, McNamara D, Despott EJ, Adler S, Cash BD, Fernández-Urién I, Ivekovic H, Keuchel M, McAlindon M, Saurin JC, Panter S, Bellisario C, Minozzi S, Senore C, Bennett C, Bretthauer M, Dinis-Ribeiro M, Domagk D, Hassan C, Kaminski MF, Rees CJ, Valori R, Bisschops R, Rutter MD. Performance measures for small-bowel endoscopy: A European Society of Gastrointestinal Endoscopy (ESGE) Quality Improvement Initiative. United European Gastroenterol J 2019; 7:614-641. [PMID: 31210941 DOI: 10.1177/2050640619850365] [Citation(s) in RCA: 49] [Impact Index Per Article: 9.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/11/2019] [Accepted: 04/24/2019] [Indexed: 12/17/2022] Open
Abstract
The European Society of Gastrointestinal Endoscopy (ESGE) together with the United European Gastroenterology (UEG) recently developed a short list of performance measures for small-bowel endoscopy (i.e. small-bowel capsule endoscopy and device-assisted enteroscopy) with the final goal of providing endoscopy services across Europe with a tool for quality improvement. Six key performance measures both for small-bowel capsule endoscopy and for device-assisted enteroscopy were selected for inclusion, with the intention being that practice at both a service and endoscopist level should be evaluated against them. Other performance measures were considered to be less relevant, based on an assessment of their overall importance, scientific acceptability, and feasibility. Unlike lower and upper gastrointestinal endoscopy, for which performance measures had already been identified, this is the first time small-bowel endoscopy quality measures have been proposed.
Collapse
Affiliation(s)
- Cristiano Spada
- Digestive Endoscopy Unit and Gastroenterology, Fondazione Poliambulanza, Brescia, Italy.,Digestive Endoscopy Unit, Fondazione Policlinico Universitario A. Gemelli - IRCCS, Rome, Italy
| | - Deirdre McNamara
- TAGG Research Centre, Department of Clinical Medicine, Tallaght Hospital, Trinity College Dublin, Ireland
| | - Edward J Despott
- Royal Free Unit for Endoscopy, The Royal Free Hospital and UCL Institute for Liver and Digestive Health, London, UK
| | - Samuel Adler
- Division of Gastroenterology, Shaare Zedek Medical Center, Jerusalem, Israel
| | - Brooks D Cash
- Department of Gastroenterology, Hepatology, and Nutrition, UT Health Science Center at Houston/Memorial Hermann, Houston, TX, USA.,McGovern Medical School, Department of Internal Medicine, Houston, TX, USA
| | | | - Hrvoje Ivekovic
- Department of Gastroenterology and Hepatology, University Hospital Centre, Zagreb, Croatia
| | - Martin Keuchel
- Clinic for Internal Medicine, Bethesda Krankenhaus Bergedorf, Hamburg, Germany
| | - Mark McAlindon
- Academic Department of Gastroenterology and Hepatology, Sheffield Teaching Hospitals NHS Trust, Sheffield, UK
| | - Jean-Christophe Saurin
- Gastroenterology and Endoscopy Unit, Hospices Civils de Lyon, Hôpital E. Herriot, Lyon, France
| | - Simon Panter
- Department of Gastroenterology, South Tyneside NHS Foundation Trust, South Shields, UK
| | | | - Silvia Minozzi
- CPO Piemonte, AOU Città della Salute e della Scienza, Turin, Italy
| | - Carlo Senore
- CPO Piemonte, AOU Città della Salute e della Scienza, Turin, Italy
| | - Cathy Bennett
- Office of Research and Innovation, Royal College of Surgeons in Ireland Coláiste Ríoga na Máinleá in Éirinn, Dublin, Ireland
| | - Michael Bretthauer
- Clinical Effectiveness Research Group, University of Oslo and Oslo University Hospital, Oslo, Norway
| | - Mario Dinis-Ribeiro
- Servicio de Gastroenterologia, Instituto Portugues de Oncologia Francisco Gentil, Porto, Portugal
| | - Dirk Domagk
- Department of Medicine I, Josephs-Hospital Warendorf, Academic Teaching Hospital, University of Muenster, Warendorf, Germany
| | - Cesare Hassan
- Endoscopy Unit, Nuovo Regina Margherita Hospital, Rome, Italy
| | - Michal F Kaminski
- Department of Gastroenterology, Hepatology and Oncology, Medical Center for Postgraduate Education, Warsaw, Poland.,Department of Gastroenterological Oncology and Department of Cancer Prevention, The Maria Sklodowska-Curie Memorial Cancer Center and Institute of Oncology, Warsaw, Poland.,Department of Health Management and Health Economics, University of Oslo, Oslo, Norway
| | - Colin J Rees
- Northern Institute for Cancer Research, Newcastle University, Newcastle, UK
| | - Roland Valori
- Department of Gastroenterology, Gloucestershire Hospitals NHS Foundation Trust, Gloucestershire, UK
| | - Raf Bisschops
- Department of Gastroenterology and Hepatology. University Hospital Leuven, Leuven, Belgium
| | - Matthew D Rutter
- Northern Institute for Cancer Research, Newcastle University, Newcastle, UK.,Department of Gastroenterology, University Hospital of North Tees, Stockton-on-Tees, Cleveland, UK
| |
Collapse
|
35
|
Abstract
Celiac disease predominantly involves the proximal small bowel, but villus atrophy can be patchy, spare the duodenum, and be present more distally. Video capsule endoscopy is more sensitive than standard endoscopy to detect villus atrophy, and can define extent of disease, though it cannot obtain biopsies. Duodenal biopsy is the gold standard for diagnosis. Video capsule endoscopy assists in special circumstances when biopsy is not possible, and in equivocal diagnosis. Video capsule endoscopy and enteroscopy are recommended for evaluating complicated celiac disease, especially refractory celiac disease type II. Future developments include computer-assisted capsule programs and advanced capsule and enteroscope design.
Collapse
Affiliation(s)
- Suzanne K Lewis
- Division of Digestive Diseases, Celiac Disease Center at Columbia University, Columbia University, 180 Fort Washington Avenue, New York, NY 10032, USA.
| | - Carol E Semrad
- The University of Chicago, 5841 South Maryland Avenue, MC 4080 S401, Chicago, IL 60637, USA
| |
Collapse
|
36
|
Leenhardt R, Li C, Koulaouzidis A, Cavallaro F, Cholet F, Eliakim R, Fernandez-Urien I, Kopylov U, McAlindon M, Németh A, Plevris JN, Rahmi G, Rondonotti E, Saurin JC, Tontini GE, Toth E, Yung D, Marteau P, Dray X. Nomenclature and semantic description of vascular lesions in small bowel capsule endoscopy: an international Delphi consensus statement. Endosc Int Open 2019; 7:E372-E379. [PMID: 30834297 PMCID: PMC6395173 DOI: 10.1055/a-0761-9742] [Citation(s) in RCA: 30] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/07/2018] [Accepted: 08/09/2018] [Indexed: 12/22/2022] Open
Abstract
Background and study aims Nomenclature and descriptions of small bowel (SB) vascular lesions in capsule endoscopy (CE) are scarce in the medical literature. They are mostly based on the reader's opinion and thus differ between experts, with a potential negative impact on clinical care, teaching and research regarding SBCE. Our aim was to better define a nomenclature and to give a description of the most frequent vascular lesions in SBCE. Methods A panel of 18 European expert SBCE readers was formed during the UEGW 2016 meeting. Three experts constructed an Internet-based four-round Delphi consensus, but did not participate in the voting process. They built questionnaires that included various still frames of vascular lesions obtained with a third-generation SBCE system. The 15 remaining participants were asked to rate different proposals and description of the most common SB vascular lesions. A 6-point rating scale (varying from 'strongly disagree' to 'strongly agree') was used successive rounds. The consensus was reached when at least 80 % voting members scored the statement within the 'agree' or 'strongly agree'. Results Consensual terms and descriptions were reached for angiectasia/angiodysplasia, erythematous patch, red spot/dot, and phlebectasia. A consensual description was reached for more subtle vascular lesions tentatively named "diminutive angiectasia" but no consensus was reached for this term. Conclusion An international group has reached a consensus on the nomenclature and descriptions of the most frequent and relevant SB vascular lesions in CE. These terms and descriptions are useful in daily practice, for teaching and for medical research purposes.
Collapse
Affiliation(s)
- Romain Leenhardt
- Sorbonne Université & Department of Hepatogastroenterology, APHP, Saint Antoine Hospital, Paris, France,Corresponding author Leenhardt Romain Hopital Saint-Antoine – Gastroenterology and Endoscopic Department184 Rue du Faubourg Saint-AntoineParis 75012France+0033149282000
| | - Cynthia Li
- Sorbonne Université & Department of Hepatogastroenterology, APHP, Saint Antoine Hospital, Paris, France,Drexel University, College of Arts & Sciences, Philadelphia, Pennsylvania, United States
| | - Anastasios Koulaouzidis
- Centre for Liver and Digestive Disorders, The Royal Infirmary of Edinburgh, Edinburgh, United Kingdom
| | - Flaminia Cavallaro
- Gastroenterology & Digestive Endoscopy Unit, IRCCS Policlinico San Donato, San Donato Milanese, Milan, Italy
| | - Franck Cholet
- Department of Gastrointestinal Endoscopy, Brest Teaching Hospital, Brest, France
| | - Rami Eliakim
- Department of Gastroenterology, Chaim Sheba Medical Center, Sackler School of Medicine, Tel-Aviv University, Tel-Aviv, Israel
| | | | - Uri Kopylov
- Department of Gastroenterology, Chaim Sheba Medical Center, Sackler School of Medicine, Tel-Aviv University, Tel-Aviv, Israel
| | - Mark McAlindon
- Academic Unit of Gastroenterology and Hepatology, Sheffield Teaching Hospitals NHS Trust, Sheffield, UK
| | - Artur Németh
- Department of Gastroenterology, Skåne University Hospital, Malmö, Lund University, Sweden
| | - John N. Plevris
- Centre for Liver and Digestive Disorders, The Royal Infirmary of Edinburgh, Edinburgh, United Kingdom
| | - Gabriel Rahmi
- Department of Gastroenterology and Digestive Endoscopy, Georges-Pompidou European Hospital, Paris, France
| | | | | | - Gian Eugenio Tontini
- Gastroenterology & Endoscopy Unit, Fondazione IRCCS Ca’ Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Ervin Toth
- Department of Gastroenterology, Skåne University Hospital, Malmö, Lund University, Sweden
| | - Diana Yung
- Centre for Liver and Digestive Disorders, The Royal Infirmary of Edinburgh, Edinburgh, United Kingdom
| | - Philippe Marteau
- Sorbonne Université & Department of Hepatogastroenterology, APHP, Saint Antoine Hospital, Paris, France
| | - Xavier Dray
- Sorbonne Université & Department of Hepatogastroenterology, APHP, Saint Antoine Hospital, Paris, France
| |
Collapse
|
37
|
Goran L, Negreanu AM, Stemate A, Negreanu L. Capsule endoscopy: Current status and role in Crohn’s disease. World J Gastrointest Endosc 2018; 10:184-192. [PMID: 30283601 PMCID: PMC6162247 DOI: 10.4253/wjge.v10.i9.184] [Citation(s) in RCA: 12] [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: 04/07/2018] [Revised: 07/01/2018] [Accepted: 08/05/2018] [Indexed: 02/06/2023] Open
Abstract
Capsule endoscopy (CE) has proved to be an important non-invasive tool for diagnosis and monitoring Crohn’s disease patients. It has the advantage of excellent visualization of digestive tract mucosa, a good tolerability and safety in well-selected patients. The risk of retention can be diminished by good selection of patients using imaging techniques and by the use of patency capsule. The aim of a capsule examination is not only an early diagnosis but also a very good stratification of prognosis, thus directing the treatment strategy for either a step up or top-down approach and also permitting the optimization of the treatment depending on the findings. When symptoms and biomarkers point to a change in the disease’s activity we can either adjust the treatment directly as recommended in CALM study or choose in selected patients to visualize the digestive mucosa through a CE and take a decision afterwards. The appearance of the new capsule from Medtronic-the Pillcam Crohn’s might be an important step forward in diagnosis, evaluating disease extent, the severity of the disease, prognosis, management in a treat to target approach, with treatment modifications according to the data from CE examination. Serial examinations in the same patient can be compared and a more objective evaluation of the lesions modification from one exam to another can be performed. We present the latest developments and current status and evidence that in selected patients capsule can be a tool in a treat to target approach.
Collapse
Affiliation(s)
- Loredana Goran
- Internal Medicine 2-Gastroenterology Department, University Hospital, Carol Davila University, Bucharest 050098, Romania
| | - Ana Maria Negreanu
- Internal Medicine 2-Gastroenterology Department, University Hospital, Carol Davila University, Bucharest 050098, Romania
| | - Ana Stemate
- Internal Medicine 2-Gastroenterology Department, University Hospital, Carol Davila University, Bucharest 050098, Romania
| | - Lucian Negreanu
- Internal Medicine 2-Gastroenterology Department, University Hospital, Carol Davila University, Bucharest 050098, Romania
| |
Collapse
|
38
|
Mitselos IV, Christodoulou DK. What defines quality in small bowel capsule endoscopy. ANNALS OF TRANSLATIONAL MEDICINE 2018; 6:260. [PMID: 30094246 DOI: 10.21037/atm.2018.05.28] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
Small bowel capsule endoscopy is considered a first-line diagnostic tool for the investigation of small bowel diseases. Gastroenterological and endoscopic societies have proposed and established measures known as quality indicators, quality measures or performance measures for the majority of endoscopic procedures, in order to ensure competence, healthcare quality and define areas requiring improvement. However, there is a paucity of publications describing small bowel capsule endoscopy quality indicators. Hereby, we attempt to identify and describe a number of pre-procedure, intra-procedure and post-procedure quality indicators, regarding process measures in small bowel capsule endoscopy, after a comprehensive review of the literature.
Collapse
Affiliation(s)
- Ioannis V Mitselos
- Department of Gastroenterology, School of Health Sciences, University Hospital of Ioannina, Faculty of Medicine, University of Ioannina, Ioannina, Greece
| | - Dimitrios K Christodoulou
- Department of Gastroenterology, School of Health Sciences, University Hospital of Ioannina, Faculty of Medicine, University of Ioannina, Ioannina, Greece
| |
Collapse
|
39
|
Abstract
A search of the internet today to quantify the estimated value of capsules from a global perspective, easily delivers figures stating around $200 million in 2014 to about $400 million by 2020, which would be approximately 10% of the gastrointestinal endoscopic market. Is this a steep rise within just six years or could the capsule market do even better? What chances does this offer and what are the key aspects for future success? By 2020, more than 1 billion people are aged sixty or older and around one third of them will live in what the UN calls "more developed regions". Naturally, this brings an increased demand for colorectal cancer screening and surgery. But keeping in mind that basically every healthcare system, in any country, is already operating at its limits, how do we secure future treatment for a growing community? Surely more competition will steadily bring down prices for capsules. However, that does not ease the amount of time that is spent to properly read any video and issue a valid diagnosis for every patient. This article intends to give an overview about the current global market for capsule endoscopy (CE) with a perspective on typical patients, their indications, and how the capsules are used and by whom. Further aspects, such as standardization of training, reading and future trends will also be elaborated on.
Collapse
Affiliation(s)
- Tanja Nowak
- Master Program MHMM (Health and Medical Management), Friedrich-Alexander-University Erlangen-Nuremberg, Germany.,Consultant Medical Affairs, Hamburg, Germany
| |
Collapse
|
40
|
Yung DE, Rondonotti E, Sykes C, Pennazio M, Plevris JN, Koulaouzidis A. Systematic review and meta-analysis: is bowel preparation still necessary in small bowel capsule endoscopy? Expert Rev Gastroenterol Hepatol 2017; 11:979-993. [PMID: 28737439 DOI: 10.1080/17474124.2017.1359540] [Citation(s) in RCA: 40] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
INTRODUCTION Optimal bowel preparation for small bowel capsule endoscopy(SBCE) is controversial. This meta-analysis aimed to investigate the effects of laxatives in SBCE. METHODS A comprehensive literature search was conducted for studies investigating the use of laxatives in SBCE. The primary outcome was diagnostic yield(DY) for SB findings; secondary outcomes SB visualization quality(SBVQ) and completion rate(CR). Pooled odds ratios(ORs) with 95% confidence intervals(CIs) and number needed to treat(NNT) were calculated. RESULTS Forty studies (4380 patients with laxatives, 2185 without) were included. Laxative use did not improve DY of SB findings overall (OR 1.11 (95%CI 0.85-1.44)) or for significant SB findings (OR 1.10 (95%CI 0.76-1.60)). However, SBVQ improved with the use of laxatives (OR 1.60 (95%CI 1.08-2.06)), NNT 14. The OR for completed SBCE was 1.30 (95%CI 0.95-1.78). Patients given polyethylene glycol(PEG) had lower DY than sodium phosphate(NaP). SBVQ improved more with NaP (NNT 7) than PEG (NNT 53). CONCLUSIONS Laxatives do not significantly improve DY or CR in SBCE, but do improve SBQV. The use of laxatives may be beneficial in patients likely to have subtle findings. There are significant differences in methodology/definitions between studies, hence the need for standardized visualization scoring and recording of SBCE findings.
Collapse
Affiliation(s)
- Diana E Yung
- a Centre for Liver & Digestive Disorders , The Royal Infirmary of Edinburgh , Edinburgh , UK
| | | | - Catherine Sykes
- a Centre for Liver & Digestive Disorders , The Royal Infirmary of Edinburgh , Edinburgh , UK
| | - Marco Pennazio
- c Division of Gastroenterology U , San Giovanni AS University-Teaching Hospital , Torino , Italy
| | - John N Plevris
- a Centre for Liver & Digestive Disorders , The Royal Infirmary of Edinburgh , Edinburgh , UK
| | | |
Collapse
|
41
|
Fernandez-Urien I, Panter S, Carretero C, Davison C, Dray X, Fedorov E, Makins R, Mascarenhas M, McAlindon M, McNamara D, Palmer H, Rey JF, Saurin JC, Seitz U, Spada C, Toth E, Wiedbrauck F, Keuchel M. International core curriculum for capsule endoscopy training courses. Endosc Int Open 2017; 5:E526-E538. [PMID: 28596986 PMCID: PMC5462604 DOI: 10.1055/s-0043-106181] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/06/2017] [Accepted: 02/10/2017] [Indexed: 12/19/2022] Open
Abstract
Capsule endoscopy (CE) has become a first-line noninvasive tool for visualisation of the small bowel (SB) and is being increasingly used for investigation of the colon. The European Society of Gastrointestinal Endoscopy (ESGE) guidelines have specified requirements for the clinical applications of CE. However, there are no standardized recommendations yet for CE training courses in Europe. The following suggestions in this curriculum are based on the experience of European CE training courses directors. It is suggested that 12 hours be dedicated for either a small bowel capsule endoscopy (SBCE) or a colon capsule endoscopy (CCE) course with 4 hours for an introductory CCE course delivered in conjunction with SBCE courses. SBCE courses should include state-of-the-art lectures on indications, contraindications, complications, patient management and hardware and software use. Procedural issues require approximately 2 hours. For CCE courses 2.5 hours for theoretical lessons and 3.5 hours for procedural issued are considered appropriate. Hands-on training on reading and interpretation of CE cases using a personal computer (PC) for 1 or 2 delegates is recommended for both SBCE and CCE courses. A total of 6 hours hands-on session- time should be allocated. Cases in a SBCE course should cover SB bleeding, inflammatory bowel diseases (IBD), tumors and variants of normal and cases with various types of polyps covered in CCE courses. Standardization of the description of findings and generation of high-quality reports should be essential parts of the training. Courses should be followed by an assessment of trainees' skills in order to certify readers' competency.
Collapse
Affiliation(s)
- Ignacio Fernandez-Urien
- Department of Gastroenterology – CHN, Pamplona, Spain,Corresponding author Ignacio Fernandez-Urien MD, PhD Department of Gastroenterology – CHN, Pamplona (España)c/ Irunlarrea 3 – 31008 Pamplona (Navarra)
| | - Simon Panter
- Department of Gastroenterology – South Tyneside NHS, South Tyneside, United Kingdom
| | | | - Carolyn Davison
- Department of Gastroenterology – South Tyneside NHS, South Tyneside, United Kingdom
| | - Xavier Dray
- Department of Hepatology and Gastroenterology – Saint-Antoine Hospital, Pierre et Marie Curie University & APHP, Paris, France
| | - Evgeny Fedorov
- Department of Abdominal Surgery, Gastroenterology and Endoscopy – Pirogov Russia National Medical University, Moscow University Hospital, Moscow, Russia
| | - Richard Makins
- Department of Gastroenterology – Gloucestershire Hospitals, Gloucester, United Kingdom
| | | | - Mark McAlindon
- Department of Gastroenterology – Royal Hallamshire Hospital, Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield, United Kingdom
| | - Deirdre McNamara
- Department of Clinical Medicine – Tallaght Hospital, Trinity College, Dublin, Ireland
| | - Hansa Palmer
- Digestive Endoscopy Unit – Royal Free Hampstead NHS Trust, London, United Kingdom
| | | | | | - Uwe Seitz
- Department of Internal Medicine 1 – Bergstrasse Medical Center, University Hospital Heidelberg, Heppenheim, Germany
| | - Cristiano Spada
- Digestive Endoscopy Unit, Fondazione Policlinico Universitario Gemelli, Rome, Italy
| | - Ervin Toth
- Department of Gastroenterology – Skåne University Hospital, Lund University, Malmö, Sweden
| | - Felix Wiedbrauck
- Department of Gastroenterology – Allgemeines Krankenhaus Celle, Celle, Germany
| | - Martin Keuchel
- Clinic for Internal Medicine, Bethesda Hospital Bergedorf, Hamburg, Germany
| |
Collapse
|
42
|
Koulaouzidis A, Iakovidis DK, Yung DE, Rondonotti E, Kopylov U, Plevris JN, Toth E, Eliakim A, Wurm Johansson G, Marlicz W, Mavrogenis G, Nemeth A, Thorlacius H, Tontini GE. KID Project: an internet-based digital video atlas of capsule endoscopy for research purposes. Endosc Int Open 2017; 5:E477-E483. [PMID: 28580415 PMCID: PMC5452962 DOI: 10.1055/s-0043-105488] [Citation(s) in RCA: 44] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/07/2016] [Accepted: 02/06/2017] [Indexed: 12/22/2022] Open
Abstract
BACKGROUND AND AIMS Capsule endoscopy (CE) has revolutionized small-bowel (SB) investigation. Computational methods can enhance diagnostic yield (DY); however, incorporating machine learning algorithms (MLAs) into CE reading is difficult as large amounts of image annotations are required for training. Current databases lack graphic annotations of pathologies and cannot be used. A novel database, KID, aims to provide a reference for research and development of medical decision support systems (MDSS) for CE. METHODS Open-source software was used for the KID database. Clinicians contribute anonymized, annotated CE images and videos. Graphic annotations are supported by an open-access annotation tool (Ratsnake). We detail an experiment based on the KID database, examining differences in SB lesion measurement between human readers and a MLA. The Jaccard Index (JI) was used to evaluate similarity between annotations by the MLA and human readers. RESULTS The MLA performed best in measuring lymphangiectasias with a JI of 81 ± 6 %. The other lesion types were: angioectasias (JI 64 ± 11 %), aphthae (JI 64 ± 8 %), chylous cysts (JI 70 ± 14 %), polypoid lesions (JI 75 ± 21 %), and ulcers (JI 56 ± 9 %). CONCLUSION MLA can perform as well as human readers in the measurement of SB angioectasias in white light (WL). Automated lesion measurement is therefore feasible. KID is currently the only open-source CE database developed specifically to aid development of MDSS. Our experiment demonstrates this potential.
Collapse
Affiliation(s)
- Anastasios Koulaouzidis
- Centre for Liver and Digestive Disorders, The Royal Infirmary of Edinburgh,
Edinburgh, UK,Corresponding author Anastasios Koulaouzidis, MD, FECG, FACG, FASGE The Royal Infirmary of EdinburghEndoscopy Unit51 Little France CrescentEdinburgh EH16 4SAUK
| | - Dimitris K. Iakovidis
- University of Thessaly, Department of Computer Science and Biomedical
Informatics, Volos, Thessaly, Greece
| | - Diana E. Yung
- Centre for Liver and Digestive Disorders, The Royal Infirmary of Edinburgh,
Edinburgh, UK
| | | | - Uri Kopylov
- Department of Gastroenterology, Sheba Medical Center, Tel Hashomer, and Sackler
School of Medicine, Tel Aviv University, Tel-Aviv, Israel
| | - John N. Plevris
- Centre for Liver and Digestive Disorders, The Royal Infirmary of Edinburgh,
Edinburgh, UK
| | - Ervin Toth
- Department of Gastroenterology, Skåne University Hospital, Lund University,
Malmö, Sweden
| | - Abraham Eliakim
- Department of Gastroenterology, Sheba Medical Center, Tel Hashomer, and Sackler
School of Medicine, Tel Aviv University, Tel-Aviv, Israel
| | | | - Wojciech Marlicz
- Department of Gastroenterology, Pomeranian Medical University, Szezecin,
Poland
| | | | - Artur Nemeth
- Department of Gastroenterology, Skåne University Hospital, Lund University,
Malmö, Sweden
| | | | - Gian Eugenio Tontini
- Gastroenterology and Digestive Endoscopy Unit, IRCCS Policlinico San Donato,
Milan, Italy
| |
Collapse
|
43
|
Nennstiel S, Machanek A, von Delius S, Neu B, Haller B, Abdelhafez M, Schmid RM, Schlag C. Predictors and characteristics of angioectasias in patients with obscure gastrointestinal bleeding identified by video capsule endoscopy. United European Gastroenterol J 2017; 5:1129-1135. [PMID: 29238592 DOI: 10.1177/2050640617704366] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/11/2016] [Accepted: 03/12/2017] [Indexed: 12/13/2022] Open
Abstract
Background In obscure gastrointestinal bleeding, angioectasias are common findings in video capsule endoscopy (VCE). Objective The objective of this study was to identify predictors and characteristics of small bowel angioectasias. Methods Video capsule examinations between 1 July 2001 and 31 July 2011 were retrospectively reviewed. Patients with obscure gastrointestinal bleeding were identified, and those with small bowel angioectasia were compared with patients without a definite bleeding source. Univariate and multivariable statistical analyses for possible predictors of small bowel angioectasia were performed. Results From a total of 717 video capsule examinations, 512 patients with obscure gastrointestinal bleeding were identified. Positive findings were reported in 350 patients (68.4%) and angioectasias were documented in 153 of these patients (43.7%). These angioectasias were mostly located in the proximal small intestine (n = 86, 56.6%). Patients' age >65 years (odds ratio (OR) 2.15, 95% confidence interval (CI) 1.36-3.38, p = .001) and overt bleeding type (OR 1.89, 95% CI 1.22-2.94, p = .004) were identified as significant independent predictors of small bowel angioectasia. Conclusion Angioectasias are the most common finding in VCE in patients with obscure gastrointestinal bleeding. They are mostly located in the proximal small bowel and are associated with higher age and an overt bleeding type.
Collapse
Affiliation(s)
- Simon Nennstiel
- Klinik und Poliklinik für Innere Medizin II, Klinikum rechts der Isar der Technischen Universität München, Munich, Germany
| | - Annkathrin Machanek
- Klinik und Poliklinik für Innere Medizin II, Klinikum rechts der Isar der Technischen Universität München, Munich, Germany
| | - Stefan von Delius
- Klinik und Poliklinik für Innere Medizin II, Klinikum rechts der Isar der Technischen Universität München, Munich, Germany
| | - Bruno Neu
- Medizinische Klinik II, Krankenhaus Landshut-Achdorf, Academic Teaching Hospital, Technische Universität München, Landshut, Germany
| | - Bernhard Haller
- Institut für Medizinische Statistik und Epidemiologie, Klinikum rechts der Isar der Technischen Universität München, Munich, Germany
| | - Mohamed Abdelhafez
- Klinik und Poliklinik für Innere Medizin II, Klinikum rechts der Isar der Technischen Universität München, Munich, Germany
| | - Roland M Schmid
- Klinik und Poliklinik für Innere Medizin II, Klinikum rechts der Isar der Technischen Universität München, Munich, Germany
| | - Christoph Schlag
- Klinik und Poliklinik für Innere Medizin II, Klinikum rechts der Isar der Technischen Universität München, Munich, Germany
| |
Collapse
|
44
|
Shim KN, Jeon SR, Jang HJ, Kim J, Lim YJ, Kim KO, Song HJ, Lee HS, Park JJ, Kim JH, Chun J, Park SJ, Yang DH, Min YW, Keum B, Lee BI. Quality Indicators for Small Bowel Capsule Endoscopy. Clin Endosc 2017; 50:148-160. [PMID: 28391667 PMCID: PMC5398361 DOI: 10.5946/ce.2017.030] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/09/2017] [Revised: 03/14/2017] [Accepted: 03/16/2017] [Indexed: 02/06/2023] Open
Abstract
Capsule endoscopy (CE) enables evaluation of the entire mucosal surface of the small bowel (SB), which is one of the most important steps for evaluating obscure gastrointestinal bleeding. Although the diagnostic yield of SB CE depends on many clinical factors, there are no reports on quality indicators. Thus, the Korean Gut Image Study Group (KGISG) publishes an article titled, “Quality Indicators for Small Bowel Capsule Endoscopy” under approval from the Korean Society of Gastrointestinal Endoscopy (KSGE). Herein, we initially identified process quality indicators, while the structural and outcome indicators are reserved until sufficient clinical data are accumulated. We believe that outcomes of SB CE can be improved by trying to meet our proposed quality indicators.
Collapse
Affiliation(s)
- Ki-Nam Shim
- Department of Internal Medicine, Ewha Womans University School of Medicine, Seoul, Korea
| | - Seong Ran Jeon
- Department of Internal Medicine,Soonchunhyang University College of Medicine, Seoul, Korea
| | - Hyun Joo Jang
- Department of Internal Medicine, Hallym University College of Medicine, Hwaseong, Korea
| | - Jinsu Kim
- Department of Internal Medicine, The Catholic University of Korea, Seoul, Korea
| | - Yun Jeong Lim
- Department of Internal Medicine, Dongguk University College of Medicine, Goyang, Korea
| | - Kyeong Ok Kim
- Department of Internal Medicine, Yeungnam University College of Medicine, Daegu, Korea
| | - Hyun Joo Song
- Department of Internal Medicine, Jeju National University School of Medicine, Jeju, Korea
| | - Hyun Seok Lee
- Department of Internal Medicine, Kyungpook National University School of Medicine, Daegu, Korea
| | - Jae Jun Park
- Department of Internal Medicine, Yonsei University College of Medicine, Seoul, Korea
| | - Ji Hyun Kim
- Department of Internal Medicine, Inje University College of Medicine, Busan, Korea
| | - Jaeyoung Chun
- Department of Internal Medicine, Seoul National University College of Medicine, Seoul, Korea
| | - Soo Jung Park
- Department of Internal Medicine, Yonsei University College of Medicine, Seoul, Korea
| | - Dong-Hoon Yang
- Department of Internal Medicine, University of Ulsan College of Medicine, Seoul, Korea
| | - Yang Won Min
- Department of Internal Medicine, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Bora Keum
- Department of Internal Medicine, Korea University College of Medicine, Seoul, Korea
| | - Bo-In Lee
- Department of Internal Medicine, The Catholic University of Korea, Seoul, Korea
| | | |
Collapse
|
45
|
Enns RA, Hookey L, Armstrong D, Bernstein CN, Heitman SJ, Teshima C, Leontiadis GI, Tse F, Sadowski D. Clinical Practice Guidelines for the Use of Video Capsule Endoscopy. Gastroenterology 2017; 152:497-514. [PMID: 28063287 DOI: 10.1053/j.gastro.2016.12.032] [Citation(s) in RCA: 242] [Impact Index Per Article: 34.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
BACKGROUND & AIMS Video capsule endoscopy (CE) provides a noninvasive option to assess the small intestine, but its use with respect to endoscopic procedures and cross-sectional imaging varies widely. The aim of this consensus was to provide guidance on the appropriate use of CE in clinical practice. METHODS A systematic literature search identified studies on the use of CE in patients with Crohn's disease, celiac disease, gastrointestinal bleeding, and anemia. The quality of evidence and strength of recommendations were rated using the Grading of Recommendation Assessment, Development, and Evaluation (GRADE) approach. RESULTS The consensus includes 21 statements focused on the use of small-bowel CE and colon capsule endoscopy. CE was recommended for patients with suspected, known, or relapsed Crohn's disease when ileocolonoscopy and imaging studies were negative if it was imperative to know whether active Crohn's disease was present in the small bowel. It was not recommended in patients with chronic abdominal pain or diarrhea, in whom there was no evidence of abnormal biomarkers typically associated with Crohn's disease. CE was recommended to assess patients with celiac disease who have unexplained symptoms despite appropriate treatment, but not to make the diagnosis. In patients with overt gastrointestinal bleeding, and negative findings on esophagogastroduodenoscopy and colonoscopy, CE should be performed as soon as possible. CE was recommended only in selected patients with unexplained, mild, chronic iron-deficiency anemia. CE was suggested for surveillance in patients with polyposis syndromes or other small-bowel cancers, who required small-bowel studies. Colon capsule endoscopy should not be substituted routinely for colonoscopy. Patients should be made aware of the potential risks of CE including a failed procedure, capsule retention, or a missed lesion. Finally, standardized criteria for training and reporting in CE should be defined. CONCLUSIONS CE generally should be considered a complementary test in patients with gastrointestinal bleeding, Crohn's disease, or celiac disease, who have had negative or inconclusive endoscopic or imaging studies.
Collapse
Affiliation(s)
- Robert A Enns
- Division of Gastroenterology, Department of Medicine, University of British Columbia, Vancouver, British Columbia, Canada.
| | - Lawrence Hookey
- Division of Gastroenterology, Department of Medicine, Queen's University, Kingston, Ontario, Canada
| | - David Armstrong
- Division of Gastroenterology, Department of Medicine, McMaster University, Hamilton, Ontario, Canada
| | - Charles N Bernstein
- Section of Gastroenterology, Department of Medicine, University of Manitoba, Winnipeg, Manitoba, Canada
| | - Steven J Heitman
- Division of Gastroenterology and Hepatology, Department of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Christopher Teshima
- Division of Gastroenterology, Department of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Grigorios I Leontiadis
- Division of Gastroenterology, Department of Medicine, McMaster University, Hamilton, Ontario, Canada
| | - Frances Tse
- Division of Gastroenterology, Department of Medicine, McMaster University, Hamilton, Ontario, Canada
| | - Daniel Sadowski
- Division of Gastroenterology, Royal Alexandria Hospital, Edmonton, Alberta, Canada
| |
Collapse
|
46
|
Rodrigues-Pinto E, Cardoso H, Rosa B, Santos-Antunes J, Rodrigues S, Marques M, Lopes S, Albuquerque A, Carvalho P, Moreira M, Cotter J, Macedo G. Development of a predictive model of Crohn's disease proximal small bowel involvement in capsule endoscopy evaluation. Endosc Int Open 2016; 4:E631-6. [PMID: 27556069 PMCID: PMC4993902 DOI: 10.1055/s-0042-106961] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/05/2015] [Accepted: 04/11/2016] [Indexed: 12/22/2022] Open
Abstract
BACKGROUND AND STUDY AIMS One of the indications for capsule endoscopy (CE) is the detection of proximal small bowel (SB) involvement in Crohn's disease (CD) patients. Our aim was to assess clinical, laboratory and endoscopic predictors associated with proximal SB involvement in CD patients submitted to CE. PATIENTS AND METHODS Retrospective multicenter study in which Lewis score (LS) was systematically determined in 190 CE of patients diagnosed with CD between 2003 and 2014. RESULTS Significant inflammatory activity (LS > 135) was present in 23 % of the patients in the first tertile and in 31 % of the patients in the second tertile. Albumin, haemoglobin, and total proteins were significantly lower in patients with a LS > 790 compared to patients with a LS < 135, while white blood cell counts and C-reactive protein were significantly higher. In the univariable analysis, a higher risk for proximal SB involvement at CE was associated with ileal involvement at ileocolonoscopy (OR 2.858, P = 0.006), higher platelets levels (OR 1.005, P = 0.004) and significant weight loss (OR 2.450, P = 0.006). In logistic regression, ileal involvement at ileocolonoscopy (OR 6.817, P = 0.003), stricturing behavior (OR 8.653, P = 0.011) and significant weight loss (OR 3.629, P = 0.028) were independently associated with proximal SB involvement at CE. Considering the ROC curve of this model, a cut-off > 0.249 predicts proximal SB involvement with 90 % sensitivity and 40 % specificity (AUROC 0.732). CONCLUSIONS One-third of patients had proximal SB involvement. Predictive factors were significant weight loss, stricturing behaviour, and ileal involvement at ileocolonoscopy. These data help to select CD patients that benefit the most from performing a CE.
Collapse
Affiliation(s)
- Eduardo Rodrigues-Pinto
- Gastroenterology Department, Centro Hospitalar São João, Porto, Portugal,Corresponding author Eduardo Rodrigues-Pinto, MD Gastroenterology DepartmentCentro Hospitalar São JoãoPorto. Al. Prof. Hernâni Monteiro 4200 - 319 PortoPortugal+351 919657386+351 22 551 3601
| | - Helder Cardoso
- Gastroenterology Department, Centro Hospitalar São João, Porto, Portugal
| | - Bruno Rosa
- Gastroenterology Department, Centro Hospitalar do Alto Ave, Guimarães, Portugal
| | | | - Susana Rodrigues
- Gastroenterology Department, Centro Hospitalar São João, Porto, Portugal
| | - Margarida Marques
- Gastroenterology Department, Centro Hospitalar São João, Porto, Portugal
| | - Susana Lopes
- Gastroenterology Department, Centro Hospitalar São João, Porto, Portugal
| | | | - Pedro Carvalho
- Gastroenterology Department, Centro Hospitalar do Alto Ave, Guimarães, Portugal
| | - Maria Moreira
- Gastroenterology Department, Centro Hospitalar do Alto Ave, Guimarães, Portugal
| | - José Cotter
- Gastroenterology Department, Centro Hospitalar do Alto Ave, Guimarães, Portugal
| | - Guilherme Macedo
- Gastroenterology Department, Centro Hospitalar São João, Porto, Portugal
| |
Collapse
|
47
|
Hosoe N, Matsukawa S, Kanno Y, Naganuma M, Imaeda H, Ida Y, Tsuchiya Y, Hibi T, Ogata H, Kanai T. Cross-sectional small intestinal surveillance of maintenance hemodialysis patients using video capsule endoscopy: SCHEMA study. Endosc Int Open 2016; 4:E589-96. [PMID: 27227120 PMCID: PMC4874804 DOI: 10.1055/s-0042-105203] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/01/2015] [Accepted: 02/21/2016] [Indexed: 12/22/2022] Open
Abstract
BACKGROUND AND STUDY AIMS Small intestinal pathology in hemodialysis (HD) patients has been studied in only a small number of retrospective case series. One method for noninvasively surveying small intestinal disorders is video capsule endoscopy (VCE). The primary aim of this study was to investigate the prevalence of small intestinal abnormalities among asymptomatic maintenance HD outpatients using VCE. The secondary aim was to assess the clinical impact of these abnormalities. PATIENTS AND METHODS This study consisted of two phases. In phase I, a cross-sectional study, a cohort of patients who received maintenance HD three times weekly at an outpatient hemodialysis clinic were studied using VCE. Phase II was a prospective cohort study with follow up for 1 year after VCE. RESULTS Fifty-six patients were enrolled in this study, and two were excluded from analysis due to capsule retention in the stomach. The prevalence of small bowel abnormalities in HD patients was 64.8 % (35/54) (95 % confidential interval 52.1 % - 77.6 %). Of 54 patients, 21 (38.9 %) had mucosal lesions, 10 (18.5 %) had vascular lesions, and 4 (7.4 %) had both lesion types. During the 1-year follow-up period, events occurred in four patients. A small bowel-associated event was observed in one patient, who underwent laparoscopy-assisted small intestinal partial resection 3 months after diagnosis by VCE. All patients in whom events were seen had small bowel abnormalities; no events were observed in the VCE-negative group. CONCLUSIONS Although asymptomatic maintenance HD patients had a high prevalence of small bowel abnormalities (64.8 %), they did not have a high incidence of small bowel-associated events during the 1-year follow-up.
Collapse
Affiliation(s)
- Naoki Hosoe
- Center for Diagnostic and Therapeutic Endoscopy, School of Medicine, Keio University, 35 Shinanomachi, Shinjuku, Tokyo 160-8582, Japan.,Corresponding author Naoki Hosoe, MD, PhD Center for Diagnostic and Therapeutic EndoscopySchool of MedicineKeio University35 ShinanomachiShinjuku, Tokyo 160-8582Japan+81-3-3357-2778
| | - Shigeaki Matsukawa
- Keishinkai Tama Nagayama Jin-Naika Clinic, 1-4 Nagayama, Tama city, Tokyo 206-0025, Japan
| | - Yoshihiko Kanno
- Department of Nephrology, Tokyo Medical University, 6-7-1 Nishi-Shinjuku, Shinjuku, Tokyo 160-0023, Japan
| | - Makoto Naganuma
- Division of Gastroenterology and Hepatology, Department of Internal Medicine, School of Medicine, Keio University, 35 Shinanomachi, Shinjuku, Tokyo 160-8582, Japan
| | - Hiroyuki Imaeda
- Department of General Internal Medicine, Saitama Medical University, 38 Morohongo, Moroyama-machi, Iruma-gun, Saitama, 350-0495, Japan
| | - Yosuke Ida
- Division of Gastroenterology and Hepatology, Department of Internal Medicine, School of Medicine, Keio University, 35 Shinanomachi, Shinjuku, Tokyo 160-8582, Japan
| | - Yoshitsugu Tsuchiya
- Keishinkai Tama Nagayama Jin-Naika Clinic, 1-4 Nagayama, Tama city, Tokyo 206-0025, Japan
| | - Toshifumi Hibi
- Division of Gastroenterology and Hepatology, Department of Internal Medicine, School of Medicine, Keio University, 35 Shinanomachi, Shinjuku, Tokyo 160-8582, Japan ,Center for Advanced IBD Research and Treatment, Kitasato University Kitasato Institute Hospital, 5-9-1 Shirokane, Minato-ku, Tokyo 108-8642, Japan.
| | - Haruhiko Ogata
- Center for Diagnostic and Therapeutic Endoscopy, School of Medicine, Keio University, 35 Shinanomachi, Shinjuku, Tokyo 160-8582, Japan.
| | - Takanori Kanai
- Division of Gastroenterology and Hepatology, Department of Internal Medicine, School of Medicine, Keio University, 35 Shinanomachi, Shinjuku, Tokyo 160-8582, Japan
| |
Collapse
|
48
|
Analysis of Non-Small Bowel Lesions Detected by Capsule Endoscopy in Patients with Potential Small Bowel Bleeding. DIAGNOSTIC AND THERAPEUTIC ENDOSCOPY 2016; 2016:9063293. [PMID: 27092029 PMCID: PMC4820590 DOI: 10.1155/2016/9063293] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/26/2016] [Accepted: 03/13/2016] [Indexed: 02/07/2023]
Abstract
Gastrointestinal (GI) bleeding cases in whom source cannot be identified after conventional upper and lower GI endoscopy are defined as potential small bowel bleeding. We aimed to search for lesions in the reach of conventional endoscopy in patients to whom video capsule endoscopy (VCE) had been applied for potential small bowel bleeding. 114 patients who had VCE evaluation for potential small bowel bleeding between January 2009 and August 2015 were retrospectively evaluated. Mean age of the patients was 55 ± 17 years. Female/male ratio is 39/75. In 58 patients (50.9%) bleeding lesion could be determined. Among these 58 patients 8 patients' lesions were in the reach of conventional endoscopes. Overall these 8 patients comprised 7% of patients in whom VCE was performed for potential small bowel bleeding. Among these 8 patients 5 had colonic lesions (4 angiodysplasia, 1 ulcerated polypoid cecal lesion), 2 had gastric lesions (1 GAVE, 1 anastomotic bleeding), and 1 patient had a bleeding lesion in the duodenal bulbus. Although capsule endoscopy is usually performed for potential small bowel bleeding gastroenterologists should always keep in mind that these patients may be suffering from bleeding from non-small bowel segments and should carefully review images captured from non-small bowel areas.
Collapse
|
49
|
Rosa B, Pinho R, de Ferro SM, Almeida N, Cotter J, Saraiva MM. Endoscopic Scores for Evaluation of Crohn's Disease Activity at Small Bowel Capsule Endoscopy: General Principles and Current Applications. GE-PORTUGUESE JOURNAL OF GASTROENTEROLOGY 2015; 23:36-41. [PMID: 28868428 PMCID: PMC5580095 DOI: 10.1016/j.jpge.2015.08.004] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/21/2015] [Accepted: 08/27/2015] [Indexed: 12/14/2022]
Abstract
The small bowel is affected in the vast majority of patients with Crohn's Disease (CD). Small bowel capsule endoscopy (SBCE) has a very high sensitivity for the detection of CD-related pathology, including early mucosal lesions and/or those located in the proximal segments of the small bowel, which is a major advantage when compared with other small bowel imaging modalities. The recent guidelines of European Society of Gastrointestinal Endoscopy (ESGE) and European Crohn's and Colitis Organisation (ECCO) advocate the use of validated endoscopic scoring indices for the classification of inflammatory activity in patients with CD undergoing SBCE, such as the Lewis Score or the Capsule Endoscopy Crohn's Disease Activity Index (CECDAI). These scores aim to standardize the description of lesions and capsule endoscopy reports, contributing to increase inter-observer agreement and enabling a stratification of the severity of the disease. On behalf of the Grupo de Estudos Português do Intestino Delgado (GEPID) - Portuguese Small Bowel Study Group, we aimed to summarize the general principles and clinical applications of current endoscopic scoring systems for SBCE in the setting of CD, covering the topic of suspected CD as well as the evaluation of disease extent (with potential prognostic and therapeutic impact), evaluation of mucosal healing in response to treatment and evaluation of post-surgical recurrence in patients with previously established diagnosis of CD.
Collapse
Affiliation(s)
- Bruno Rosa
- Gastroenterology Department, Centro Hospitalar do Alto Ave, Guimarães, Portugal
- Corresponding author.
| | - Rolando Pinho
- Gastroenterology Department, Centro Hospitalar de Vila Nova de Gaia/Espinho, Vila Nova de Gaia, Portugal
- Gastroenterology Center, ManopH, Instituto CUF, Porto, Portugal
| | - Susana Mão de Ferro
- Gastroenterology Department, Instituto Português de Oncologia de Lisboa Francisco Gentil, Lisbon, Portugal
| | - Nuno Almeida
- Faculdade de Medicina, Universidade de Coimbra, Coimbra, Portugal
- Gastroenterology Department, Centro Hospitalar e Universitário de Coimbra, Coimbra, Portugal
| | - José Cotter
- Gastroenterology Department, Centro Hospitalar do Alto Ave, Guimarães, Portugal
- Instituto de Investigação em Ciências da Vida e Saúde (ICVS), Escola de Ciências da Saúde, Universidade do Minho, Braga, Portugal
- Laboratório Associado ICVS/3B's, Braga, Portugal
| | - Miguel Mascarenhas Saraiva
- Gastroenterology Center, ManopH, Instituto CUF, Porto, Portugal
- ManopH – Laboratório de Endoscopia e Motilidade Digestiva, Porto, Portugal
| |
Collapse
|
50
|
Albert JG, Humbla O, McAlindon ME, Davison C, Seitz U, Fraser C, Hagenmüller F, Noetzel E, Spada C, Riccioni ME, Barnert J, Filmann N, Keuchel M. A Simple Evaluation Tool (ET-CET) Indicates Increase of Diagnostic Skills From Small Bowel Capsule Endoscopy Training Courses: A Prospective Observational European Multicenter Study. Medicine (Baltimore) 2015; 94:e1941. [PMID: 26512623 PMCID: PMC4985436 DOI: 10.1097/md.0000000000001941] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/15/2022] Open
Abstract
Small bowel capsule endoscopy (SBCE) has become a first line diagnostic tool. Several training courses with a similar format have been established in Europe; however, data on learning curve and training in SBCE remain sparse.Between 2008 and 2011, different basic SBCE training courses were organized internationally in UK (n = 2), Italy (n = 2), Germany (n = 2), Finland (n = 1), and nationally in Germany (n = 10), applying similar 8-hour curricula with 50% lectures and 50% hands-on training. The Given PillCam System was used in 12 courses, the Olympus EndoCapsule system in 5, respectively. A simple evaluation tool for capsule endoscopy training (ET-CET) was developed using 10 short SBCE videos including relevant lesions and normal or irrelevant findings. For each video, delegates were required to record a diagnosis (achievable total score from 0 to 10) and the clinical relevance (achievable total score 0 to 10). ET-CET was performed at baseline before the course and repeated, with videos in altered order, after the course.Two hundred ninety-four delegates (79.3% physicians, 16.3% nurses, 4.4% others) were included for baseline analysis, 268 completed the final evaluation. Forty percent had no previous experience in SBCE, 33% had performed 10 or less procedures. Median scores for correct diagnosis improved from 4.0 (IQR 3) to 7.0 (IQR 3) during the courses (P < 0.001, Wilcoxon), and for correct classification of relevance of the lesions from 5.0 (IQR 3) to 7.0 (IQR 3) (P < 0.001), respectively. Improvement was not dependent on experience, profession, SBCE system, or course setting. Previous experience in SBCE was associated with higher baseline scores for correct diagnosis (P < 0.001; Kruskal-Wallis). Additionally, independent nonparametric partial correlation with experience in gastroscopy (rho 0.33) and colonoscopy (rho 0.27) was observed (P < 0.001).A simple ET-CET demonstrated significant improvement of diagnostic skills on completion of formal basic SBCE courses with hands-on training, regardless of preexisting experience, profession, and course setting. Baseline scores for correct diagnoses show a plateau after interpretation of 25 SBCE before courses, supporting this number as a compromise for credentialing. Experience in flexible endoscopy may be useful before attending an SBCE course.
Collapse
Affiliation(s)
- J G Albert
- From the Department of Internal Medicine I, JW Goethe Universität, Frankfurt, Germany (JGA); Department of Internal Medicine, Bethesda Krankenhaus Bergedorf, Hamburg, Germany (OH, MK); Department of Gastroenterology, University Hospital, Sheffield, United Kingdom (MEM); Department of Gastroenterology, South Tyneside NHS Trust, South Tyneside, United Kingdom (CD); Department of Gastroenterology, Kreiskrankenhaus Bergstrasse, Heppenheim, Germany (US); Wolfson Unit, St. Marks's Hospital, London, United Kingdom (CF); 1st Medical Department, Asklepios Klinik Altona, Hamburg, Germany (FH, MK); Department of Gastroenterology, Sana Klinikum Lichtenberg, Berlin, Germany (EN); Endoscopy Unit, Università Cattolica, Roma, Italy (CS, MER); Department of Gastroenterology, Klinikum, Augsburg, Germany (JB); Institute of Biostatistics and Mathematical Modeling, JW Goethe Universität, Frankfurt, Germany (NF)
| | | | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|