Capsule Endoscopy to Detect Normally Positioned Duodenal Papilla: Performance Comparison of SB and SB2. Gastroenterol Res Pract. 2012;2012:202935. [PMID: 22548051 PMCID: PMC3324898 DOI: 10.1155/2012/202935]

Small intestinal bleeding prediction by spectral reconstruction through band selection

Significance

The identification of gastrointestinal bleeding holds significant importance in wireless capsule endoscopy examinations, primarily because bleeding is the most prevalent anomaly within the gastrointestinal tract. Moreover, gastrointestinal bleeding serves as a crucial indicator or manifestation of various other gastrointestinal disorders, including ulcers, polyps, tumors, and Crohn's disease. Gastrointestinal bleeding may be classified into two categories: active bleeding, which refers to the presence of continuing bleeding, and inactive bleeding, which can potentially manifest in any region of the gastrointestinal system. Currently, medical professionals diagnose gastrointestinal bleeding mostly by examining complete wireless capsule endoscopy images. This approach is known to be demanding in terms of labor and time.

Aim

This research used white-light images (WLIs) obtained from 100 patients using the PillCam™ SB 3 capsule endoscope to identify and label the areas of bleeding seen in the WLIs.

Approach

A total of 152 photographs depicting bleeding and 182 images depicting non-bleeding were selected for analysis. In addition, hyperspectral imaging was used to transform WLI into hyperspectral images using spectral reconstruction through band selection. These images were then categorized into WLIs and hyperspectral images. The training set consisted of seven datasets, each including six spectra. These datasets were used to train the Visual Geometry Group-16 (VGG-16) model, which was developed using a convolutional neural network. Subsequently, the model was tested, and its diagnostic accuracy was assessed.

Results

The accuracy rates for the respective measures are 83.1%, 65.8%, 66.2%, 72.2%, 73.7%, and 88%. The respective precision values are 78.5%, 47.5%, 30.6%, 59.5%, 77.7%, and 80.2%. The recall rates for the relevant data points are 83.3%, 67.9%, 86%, 74.2%, 68.6%, and 92.4%. The initial dataset comprises an image captured under white-light conditions, whereas the final dataset is the most refined spectral picture data.

Conclusions

The findings suggest that employing spectral imaging within the wavelength range of 405 to 415 nm can enhance the accuracy of detecting small intestinal bleeding.

A novel capsule endoscopy for upper and mid-GI tract: the UMGI capsule

BACKGROUNDS AND AIMS

Complete and consecutive observation of the gastrointestinal (GI) tract continues to present challenges for current endoscopy systems. We developed a novel upper and mid gastrointestinal (UMGI) capsule endoscopy using the modified detachable string magnetically controlled capsule endoscopy (DS-MCE) and inspection method and aimed to assess the clinical application.

METHODS

Patients were recruited to undergo UMGI capsule endoscopy followed by esophagogastroduodenoscopy. All capsule procedures in the upper gastrointestinal (UGI) tract were conducted under the control of magnet and string. The main outcome was technical success, and the secondary outcomes included visualization of the UMGI tract, examination time, diagnostic yield, compliance, and safety evaluation.

RESULTS

Thirty patients were enrolled and all UMGI capsule procedures realized repeated observation of the esophagus and duodenum with detection rates of 100.0%, 80.0%, and 86.7% of Z-line, duodenal papilla, and reverse side of pylorus, respectively. String detachment was succeeded in 29 patients (96.7%) and the complete examination rate of UMGI tract was 95.45% (21/22). All UMGI capsule procedures were well tolerated with low discomfort score, and had a good diagnostic yield with per-lesion sensitivity of 96.2% in UGI diseases. No adverse events occurred.

CONCLUSIONS

This new capsule endoscopy system provides an alternative screening modality for the UMGI tract, and might be indicated in cases of suspected upper and small bowel GI bleeding. Trial registration DS-MCE-UGI and SB, NCT04329468. Registered 27 March 2020, https://clinicaltrials.gov/ct2/results?cond=&term=NCT04329468 .

Capsule endoscopy for small-intestinal disorders: Current status

Small-bowel capsule endoscopy (SBCE) is used widely because of its non-invasive and patient-friendly nature. SBCE can visualize entire small-intestinal mucosa and facilitate detection of small-intestinal abnormalities. In this review article, we focus on the current status of SBCE. Several platforms for SBCE are available worldwide. Third-generation SBCE (PillCam^® SB3) has a high-resolution camera equipped with an adaptive frame rate system. Several software modes have been developed to reduce the reading time for capsule endoscopy and to minimize the possibility of missing lesions. The main complication of SBCE is capsule retention. Thus, the main contraindication for SBCE is known or suspected gastrointestinal obstruction unless intestinal patency is proven. Possible indications for SBCE are obscure gastrointestinal bleeding, Crohn's disease, small-intestinal polyps and tumors, and celiac disease. Colon capsule endoscopy (CCE) can observe inflamed colonic mucosa non-invasively, and allows for the continuous and non-invasive observation of the entire intestinal tract (pan-endoscopy). Recently, application of CCE as pan-enteric endoscopy for inflammatory bowel diseases (including Crohn's disease) has been reported. In the near future, reading for CE will be assisted by artificial intelligence, and reading CE videos for long periods will not be required.

PillCam SB3 vs. PillCam SB2: Can technologic advances in capsule endoscopy improve diagnostic yield in patients with small bowel bleeding?

INTRODUCTION AND OBJECTIVE

The SB3 capsule endoscopy system has better image resolution and the capacity to increase the number of images from 2 to 6 frames per second. Small bowel bleeding is the most common indication. The aim To determine if the advances in capsule endoscopy technology increase diagnostic yield in cases of small bowel bleeding, according to the Saurin classification.

MATERIAL AND METHODS

A retrospective, observational, analytic, cross-sectional study included 100 SB2 capsule endoscopies and 100 SB3 capsule endoscopies in patients that presented with small bowel bleeding. The findings obtained with both systems were evaluated. The lesions identified by the two capsules were categorized using the Saurin classification. The relation between the lesions identified with the SB3 and those found with the SB2 was identified through a logistic regression analysis.

RESULTS

In the SB2 capsule endoscopy group, 60% were women, patient age was 59 years (42.2, 73), and intestinal transit time was 271min (182, 353). In the SB3 group, 57% were women, patient age was 60 years (42.5, 73), and intestinal transit time was 277min (182, 352). There were no significant differences in the identification of P0 and P2 lesions between the two systems. The SB3 capsule endoscope identified more P1 lesions (p=0.020, OR: 2.35, 95% CI:1.12-4.90). There was no significant difference in relation to location of the lesions in the small bowel.

CONCLUSIONS

A greater number of P1 lesions were detected through the technologic advances made in SB3 capsule endoscopy, but the diagnostic yield for P2 lesions was not modified.

Small bowel capsule endoscopy: Indications, results, and clinical benefit in a University environment

Capsule endoscopy (CE) opened a new method for visualization of the small intestine. We here further explore its clinical implications.We retrospectively analyzed the clinical benefit of CE in view of medical history, diagnostics, and therapy. Our patient collective consisted of 203 patients. CE was investigated in the context of bleeding, anemia, abdominal pain, diarrhea, Crohn's disease, and suspected tumors.The study collective consisted of 118 male and 85 female patients with a mean age of 58 years (range 8-90 years). Complete bowel transit took place in 82% of the patients. The diagnostic yield in the detection of obscure gastrointestinal bleeding was 80% and for anemia 78%. Mucosal lesions were the most common finding (43%). Unclear abdominal pain had the lowest diagnostic yield (41%). Ensuing therapeutic interventions were mostly medical (66%), and to a minor extent surgical (4.4%) as well as endoscopic (4%).In conclusion, small intestinal CE is a secure method to clarify small intestinal diseases, especially obscure gastrointestinal bleeding, even in pre-operated patients without stenosis symptoms. Our study emphasizes in a collective of patients with extensive prior diagnostics that due to CE therapeutic measures resulted in 73%.

Capsule endoscopy: Current practice and future directions

Capsule endoscopy (CE) has transformed investigation of the small bowel providing a non-invasive, well tolerated means of accurately visualising the distal duodenum, jejunum and ileum. Since the introduction of small bowel CE thirteen years ago a high volume of literature on indications, diagnostic yields and safety profile has been presented. Inclusion in national and international guidelines has placed small bowel capsule endoscopy at the forefront of investigation into suspected diseases of the small bowel. Most commonly, small bowel CE is used in patients with suspected bleeding or to identify evidence of active Crohn’s disease (CD) (in patients with or without a prior history of CD). Typically, CE is undertaken after upper and lower gastrointestinal flexible endoscopy has failed to identify a diagnosis. Small bowel radiology or a patency capsule test should be considered prior to CE in those at high risk of strictures (such as patients known to have CD or presenting with obstructive symptoms) to reduce the risk of capsule retention. CE also has a role in patients with coeliac disease, suspected small bowel tumours and other small bowel disorders. Since the advent of small bowel CE, dedicated oesophageal and colon capsule endoscopes have expanded the fields of application to include the investigation of upper and lower gastrointestinal disorders. Oesophageal CE may be used to diagnose oesophagitis, Barrett’s oesophagus and varices but reliability in identifying gastroduodenal pathology is unknown and it does not have biopsy capability. Colon CE provides an alternative to conventional colonoscopy for symptomatic patients, while a possible role in colorectal cancer screening is a fascinating prospect. Current research is already addressing the possibility of controlling capsule movement and developing capsules which allow tissue sampling and the administration of therapy.

Small-bowel capsule endoscopy: a ten-point contemporary review

The introduction of capsule endoscopy (CE) in clinical practice increased the interest for the study of the small-bowel. Consequently, in about 10 years, an impressive quantity of literature on indications, diagnostic yield (DY), safety profile and technical evolution of CE has been published as well as several reviews. At present time, there are 5 small-bowel capsule enteroscopy (SBCE) models in the worldwide market. Head-to-head trials have showed in the great majority of studies comparable results in terms of DY, image quality and completion rate. CE meta-analyses formed the basis of national/international guidelines; these guidelines place CE in a prime position for the diagnostic work-up of patients with obscure gastrointestinal bleeding, known and/or suspected Crohn's disease and possible small-bowel neoplasia. A 2-L polyethylene glycol-based purge, administered the day before the procedure, is the most widely practiced preparation regimen. Whether this regimen can be further improved (i.e., by further decreasing its volume, changing the timing of administration, coupling it with prokinetics and/or other factors) or if it can really affect the DY, is still under discussion. Faecal calprotectin has been used in SBCE studies in two settings: in patients taking non-steroidal anti-inflammatory drugs, to evaluate the type and extent of mucosal damage and, more importantly from a clinical point of view, in patients with known or suspected Crohn's disease for assessment of inflammation activity. Although there is still a lot of debate around the exact reasons of SBCE poor performance in various small-bowel segments, it is worth to remember that the capsule progress is non-steerable, hence more rapid in the proximal than in lower segments of the small-bowel. Capsule aspiration, a relatively unexpected complication, has been reported with increasing frequency. This is probably related with the increase in the mean age of patients undergoing CE. CE video review is a time-consuming procedure. Therefore, several attempts have been made to develop technical software features, in order to make CE video analysis easier and shorter (without jeopardizing its accuracy). Suspected Blood Indicator, QuickView and Fujinon Intelligent Chromo Endoscopy are some of the software tools that have been checked in various clinical studies to date.

Detection of the ampulla of Vater in small bowel capsule endoscopy: experience with two different systems

OBJECTIVE

The aim of this study was to determine the detection rate of the ampulla of Vater (AoV) during small bowel capsule endoscopy (SBCE) examinations and compare the two SBCE systems used in our center.

METHODS

SBCE procedures performed in our center from March 2005 to June 2011 were reviewed retrospectively. A single reviewer, following a detailed protocol, analyzed 30 min of each recording to identify the AoV.

RESULTS

A total of 619 SBCE procedures were enrolled in the study, including 262 with a PillCam SB1, 148 with a PillCam SB2 and 209 with a MiroCam. AoV was identified in 59 SBCE examinations (9.5%), consisting of 28 with a PillCam SB1 (28/262, 10.7%), 13 with a PillCam SB2 (13/148, 8.8%) and 18 with a MiroCam (18/209, 8.6%) (P = 0.665). The AoV was visualized in 53.2 frames (median 12 frames, range 1-1056 frames); and the detection rate was low regardless of indication, patients' characteristics, SBCE system used or capsule transit parameters. Bile spout was associated with a higher AoV detection (P = 0.003).

CONCLUSIONS

The persistently low AoV detection rate using two different SBCE systems underlines the weakness of non-steerable capsule endoscopy. Furthermore, if AoV detection is taken as a surrogate marker of small polyp detection, it becomes obvious both that non-steerable SBCE cannot replace a side-viewing endoscope in the evaluation of periampullary polyps in familial adenomatous polyposis and that it is an infallible method in other small bowel polyposis states.