Magnetic endoscopic imaging as a rational investment for specific colonoscopies: a systematic review and meta-analysis

Magnetic endoscopic imaging in pediatric colonoscopy: A positive impact on procedure completion rate and procedure times

OBJECTIVES

To assess the impact of magnetic endoscopic imaging (MEI) on pediatric colonoscopy.

METHODS

We analyzed demographics, procedure completion, procedure times, complications, and whether or not MEI was used for all colonoscopies between April 27, 2023, and January 18, 2024. MEI was available for every case but used at the endoscopist's discretion. Attendings were surveyed on the frequency and duration of interventions during fellow-performed colonoscopies.

RESULTS

We analyzed 310 colonoscopies, 113 (36%) of which used MEI. The average patient age was 13.8 years (range 5 months to 23 years). For the aggregate sample and attending-performed cases, there were fewer males in the groups that used MEI (p < 0.01). There were no other statistically significant differences in demographics or procedure indication when MEI was used. Terminal ileum (TI) intubation rate was higher when MEI was used in the aggregate sample (p = 0.02) and for fellow-performed cases (p = 0.04). TI intubation times and total procedure times were quicker when MEI was used in the aggregate sample and in both strata of attending-performed cases and fellow-performed cases (p < 0.001). One complication was reported in an attending-performed case that did not use MEI. Of the 145 fellow-performed procedures, 98 (68%) had completed surveys, 36 (36%) of which used MEI. There was no statistically significant difference in the number (p = 0.89) or duration (p = 0.96) of attending interventions when MEI was used.

CONCLUSION

MEI use was associated with higher TI intubation rates, faster TI intubation, and shorter total procedure times. MEI may be a valuable adjunctive tool for pediatric endoscopists.

Polyp Matching in Colon Capsule Endoscopy: Pioneering CCE-Colonoscopy Integration Towards an AI-Driven Future

Background: Colon capsule endoscopy (CCE) is becoming more widely available across Europe, but its uptake is slow due to the need for follow-up colonoscopy for therapeutic procedures and biopsies, which impacts its cost-effectiveness. One of the major factors driving the conversion to colonoscopy is the detection of excess polyps in CCE that cannot be matched during subsequent colonoscopy. The capsule's rocking motion, which can lead to duplicate reporting of the same polyp when viewed from different angles, is likely a key contributor. Objectives: This review aims to explore the types of polyp matching reported in the literature, assess matching techniques and matching accuracy, and evaluate the development of machine learning models to improve polyp matching in CCE and subsequent colonoscopy. Methods: A systematic literature search was conducted in EMBASE, MEDLINE, and PubMed. Due to the scarcity of research in this area, the search encompassed clinical trials, observational studies, reviews, case series, and editorial letters. Three directly related studies were included, and ten indirectly related studies were included for review. Results: Polyp matching in colon capsule endoscopy still needs to be developed, with only one study focused on creating criteria to match polyps within the same CCE video. Another study established that experienced CCE readers have greater accuracy, reducing interobserver variability. A machine learning algorithm was developed in one study to match polyps between initial CCE and subsequent colonoscopy. Only around 50% of polyps were successfully matched, requiring further optimisation. As Artificial Intelligence (AI) algorithms advance in CCE polyp detection, the risk of duplicate reporting may increase when clinicians are presented with polyp images or timestamps, potentially complicating the transition to AI-assisted CCE reading in the future. Conclusions: Polyp matching in CCE is a developing field with considerable challenges, especially in matching polyps within the same video. Although AI shows potential for decent accuracy, more research is needed to refine these techniques and make CCE a more reliable, non-invasive alternative to complement conventional colonoscopy for lower GI investigations.

Upskilling Pediatric Ileocolonoscopy

Upskilling in ileocolonoscopy is an important aspect of pediatric endoscopic practice as it enables endoscopists to learn additional skills through education and training to improve outcomes. With the advent of technologies, endoscopy is continuously evolving. Many devices can be applied to improve endoscopy quality and ergonomics. In addition, techniques such as dynamic position change can be employed to increase procedural efficiency and completeness. Key to upskilling is enhancing endoscopists' cognitive, technical and nontechnical skills and the concept of "training the trainer" to ensure trainers have the requisite skills to teach endoscopy effectively. This chapter details aspects of upskilling pediatric ileocolonoscopy.

Systematic review and meta-analysis of clinical outcomes of COVID-19 patients undergoing gastrointestinal endoscopy

BACKGROUND

The impact of gastrointestinal endoscopy on COVID-19 infection remains poorly investigated. We herein performed a systematic review and meta-analysis to evaluate the outcomes of COVID-19 in patients undergoing gastrointestinal endoscopy.

METHOD

Ovid Medline, Ovid EMBASE, Ovid the Cochrane Library, and other electronic databases were searched until 30 November 2020 to identify publications with confirmed COVID-19 infection in patients undergoing gastrointestinal endoscopy. The primary outcomes were SARS-CoV-2 transmission, personal protective equipment use, rates of case fatality, complications, and procedural success.

RESULTS

A total of 18 articles involving 329 patients were included in this systematic review and meta-analysis. The overall basic reproduction rate is 0.37, while the subgroup results from Asia, Europe, and North America are 0.13, 0.44, and 0.33, respectively. The differences in personal protective equipment use between the positive transmission and non-transmission group are mainly in isolation gowns, N95 or equivalent masks, and goggles or face-shields. The rate of case fatality, complication, and procedural success are 0.17 (95% confidence interval = 0.02-0.38), 0.00 (95% confidence interval = 0.00-0.02), and 0.89 (95% confidence interval = 0.50-1.00), respectively. The fatality rate in Europe was the highest (0.23, 95% confidence interval = 0.04-0.50), which is significantly different from other continents (p = 0.034).

CONCLUSION

The risk of SARS-CoV-2 transmission within gastrointestinal endoscopy units is considerably low if proper use of personal protective equipment is applied. Similarly, a low fatality and complication rate, as well as a high procedural success rate, indicated that a full recovery of endoscopic units should be considered.