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Handa P, Goel N, Indu S, Gunjan D. A multi-label dataset and its evaluation for automated scoring system for cleanliness assessment in video capsule endoscopy. Phys Eng Sci Med 2024:10.1007/s13246-024-01441-w. [PMID: 38884670 DOI: 10.1007/s13246-024-01441-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2024] [Accepted: 05/14/2024] [Indexed: 06/18/2024]
Abstract
An automated scoring system for cleanliness assessment during video capsule endoscopy (VCE) is presently lacking. The present study focused on developing an approach to automatically assess the cleanliness in VCE frames as per the latest scoring i.e., Korea-Canada (KODA). Initially, an easy-to-use mobile application called artificial intelligence-KODA (AI-KODA) score was developed to collect a multi-label image dataset of twenty-eight patient capsule videos. Three readers (gastroenterology fellows), who had been trained in reading VCE, rated this dataset in a duplicate manner. The labels were saved automatically in real-time. Inter-rater and intra-rater reliability were checked. The developed dataset was then randomly split into train:validate:test ratio of 70:20:10 and 60:20:20. It was followed by a comprehensive benchmarking and evaluation of three multi-label classification tasks using ten machine learning and two deep learning algorithms. Reliability estimation was found to be overall good among the three readers. Overall, random forest classifier achieved the best evaluation metrics, followed by Adaboost, KNeighbours, and Gaussian naive bayes in the machine learning-based classification tasks. Deep learning algorithms outperformed the machine learning-based classification tasks for only VM labels. Thorough analysis indicates that the proposed approach has the potential to save time in cleanliness assessment and is user-friendly for research and clinical use. Further research is required for the improvement of intra-rater reliability of KODA, and the development of automated multi-task classification in this field.
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Affiliation(s)
| | - Nidhi Goel
- Department of ECE, IGDTUW, New Delhi, India
| | - S Indu
- Department of ECE, DTU, New Delhi, India
| | - Deepak Gunjan
- Department of Gastroenterology and HNU, AIIMS, Delhi, India
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Zhu Y, Li J, Gao J, Bai D, Yu Z, Jin S, Chen J, Li S, Jiang P, Ge Z, Liu M, Sun C, Su Y, Zhang Y, Zhang Y. Effect of simethicone for the management of early abdominal distension after laparoscopic cholecystectomy: a multicenter retrospective propensity score matching study. BMC Surg 2024; 24:170. [PMID: 38811935 PMCID: PMC11134702 DOI: 10.1186/s12893-024-02460-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2023] [Accepted: 05/20/2024] [Indexed: 05/31/2024] Open
Abstract
OBJECTIVE To investigate whether simethicone expediates the remission of abdominal distension after laparoscopic cholecystectomy (LC). METHODS This retrospective study involved LC patients who either received perioperative simethicone treatment or not. Propensity score matching (PSM) was employed to minimize bias. The primary endpoint was the remission rate of abdominal distension within 24 h after LC. Univariable and multivariable logistic regression analyses were conducted to identify independent risk factors affecting the early remission of abdominal distension after LC. Subsequently, a prediction model was established and validated. RESULTS A total of 1,286 patients were divided into simethicone (n = 811) and non-simethicone groups (n = 475) as 2:1 PSM. The patients receiving simethicone had better remission rates of abdominal distension at both 24 h and 48 h after LC (49.2% vs. 34.7%, 83.9% vs. 74.8%, respectively), along with shorter time to the first flatus (14.6 ± 11.1 h vs. 17.2 ± 9.1 h, P < 0.001) compared to those without. Multiple logistic regression identified gallstone (OR = 0.33, P = 0.001), cholecystic polyp (OR = 0.53, P = 0.050), preoperative abdominal distention (OR = 0.63, P = 0.002) and simethicone use (OR = 1.89, P < 0.001) as independent factors contributing to the early remission of abdominal distension following LC. The prognosis model developed for predicting remission rates of abdominal distension within 24 h after LC yielded an area under the curve of 0.643 and internal validation a value of 0.644. CONCLUSIONS Simethicone administration significantly enhanced the early remission of post-LC abdominal distension, particularly for patients who had gallstones, cholecystic polyp, prolonged anesthesia or preoperative abdominal distention. TRIAL REGISTRATION ChiCTR2200064964 (24/10/2022).
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Affiliation(s)
- Yi Zhu
- Hepatobiliary and Pancreatic Surgery, The Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, 310009, China
| | - Jinjie Li
- Hepatobiliary and Pancreatic Surgery, The 1st Affiliated Hospital of Wenzhou Medical University, Wenzhou, 325015, China
| | - Ji Gao
- Hepatobiliary Surgery, Jiangsu Province Hospital, The First Affiliated Hospital with Nanjing Medical University, Nanjing, 210029, China
| | - Dousheng Bai
- Hepatobiliary and Pancreatic Surgery, Northern Jiangsu People's Hospital, Yangzhou, 225001, China
| | - Zhengping Yu
- Hepatobiliary and Pancreatic Surgery, The 1st Affiliated Hospital of Wenzhou Medical University, Wenzhou, 325015, China
| | - Shengjie Jin
- Hepatobiliary and Pancreatic Surgery, Northern Jiangsu People's Hospital, Yangzhou, 225001, China
| | - Jianfei Chen
- Hepatobiliary Oncology Surgery Department, Beijing Shijitan Hospital, Beijing, 100000, China
| | - Shuang Li
- General Surgery Department, The First Affiliated Hospital of Dalian Medical University, Dalian, 116011, China
| | - Ping Jiang
- Hepatobiliary and Pancreatic Surgery, Zhongnan Hospital of Wuhan University, Wuhan, 430000, China
| | - Zhong Ge
- Hepatobiliary and Pancreatic Surgery, Qingdao Municipal Hospital, Qingdao, 266000, China
| | - Minchao Liu
- Hepatobiliary Hernia Surgery, Zhangzhou Affiliated Hospital of Fujian Medical University, Zhangzhou, 363000, China
| | - Chuandong Sun
- Hepatobiliary and Pancreatic Surgery, The Affiliated Hospital of Qingdao University, Qingdao, 266000, China
| | - Yongjie Su
- Hepatobiliary Surgery, Zhongshan Hospital Xiamen University, Xiamen, 361000, China
| | - Yubin Zhang
- Hepatobiliary Surgery, Shijiazhuang People's Hospital, Shijiazhuang, 050000, China
| | - Yong Zhang
- Hepatobiliary and Pancreatic Surgery, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, No. 1277 Jiefang Avenue, Wuhan, 430022, China.
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Mickenautsch S, Yengopal V. A Test Method for Identifying Selection Bias Risk in Prospective Controlled Clinical Therapy Trials Using the I2 Point Estimate. Cureus 2024; 16:e60346. [PMID: 38883024 PMCID: PMC11177798 DOI: 10.7759/cureus.60346] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/14/2024] [Indexed: 06/18/2024] Open
Abstract
OBJECTIVES A test method is proposed for identifying potential selection bias risk in single prospective controlled clinical therapy trials that can be applied by trial reviewers. METHODS The method is described in detail and was tested on eight randomised controlled trials (RCTs) with reported negative Berger-Exner test results as negative and on eight prospective, controlled cohort studies as positive controls. All 16 studies were identified by systematic literature search. RESULTS The test method yielded negative results for all RCTs and positive results for six out of the eight cohort studies. CONCLUSION All test results remained within the expected limits for both study types, suggesting a reasonably high accuracy for correctly identifying selection bias risk. However, the method does not provide the possibility to establish whether such bias risk has actually altered trial outcomes. Instead, a positive test result may provide an empirical basis for rating a trial as of high selection bias risk during trial appraisal.
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Affiliation(s)
- Steffen Mickenautsch
- Dentistry, University of the Western Cape, Cape Town, ZAF
- Community Dentistry, University of the Witwatersrand, Johannesburg, Johannesburg, ZAF
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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.
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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
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Houdeville C, Leenhardt R, Souchaud M, Velut G, Carbonell N, Nion-Larmurier I, Nuzzo A, Histace A, Marteau P, Dray X. Evaluation by a Machine Learning System of Two Preparations for Small Bowel Capsule Endoscopy: The BUBS (Burst Unpleasant Bubbles with Simethicone) Study. J Clin Med 2022; 11:2822. [PMID: 35628947 PMCID: PMC9146856 DOI: 10.3390/jcm11102822] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2022] [Revised: 05/04/2022] [Accepted: 05/12/2022] [Indexed: 11/27/2022] Open
Abstract
Background: Bubbles often mask the mucosa during capsule endoscopy (CE). Clinical scores assessing the cleanliness and the amount of bubbles in the small bowel (SB) are poorly reproducible unlike machine learning (ML) solutions. We aimed to measure the amount of bubbles with ML algorithms in SB CE recordings, and compare two polyethylene glycol (PEG)-based preparations, with and without simethicone, in patients with obscure gastro-intestinal bleeding (OGIB). Patients & Methods: All consecutive outpatients with OGIB from a tertiary care center received a PEG-based preparation, without or with simethicone, in two different periods. The primary outcome was a difference in the proportions (%) of frames with abundant bubbles (>10%) along the full-length video sequences between the two periods. SB CE recordings were analyzed by a validated computed algorithm based on a grey-level of co-occurrence matrix (GLCM), to assess the abundance of bubbles in each frame. Results: In total, 105 third generation SB CE recordings were analyzed (48 without simethicone and 57 with simethicone-added preparations). A significant association was shown between the use of a simethicone-added preparation and a lower abundance of bubbles along the SB (p = 0.04). A significantly lower proportion of “abundant in bubbles” frames was observed in the fourth quartile (30.5% vs. 20.6%, p = 0.02). There was no significant impact of the use of simethicone in terms of diagnostic yield, SB transit time and completion rate. Conclusion: An accurate and reproducible computed algorithm demonstrated significant decrease in the abundance of bubbles along SB CE recordings, with a marked effect in the last quartile, in patients for whom simethicone had been added in PEG-based preparations, compared to those without simethicone.
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Affiliation(s)
- Charles Houdeville
- Sorbonne University, Center for Digestive Endoscopy, Saint-Antoine Hospital, APHP, 75012 Paris, France; (C.H.); (R.L.); (G.V.)
- Équipes Traitement de l’Information et Systèmes, ETIS UMR 8051, CY Paris Cergy University, ENSEA, CNRS, 95000 Cergy, France; (M.S.); (A.H.)
| | - Romain Leenhardt
- Sorbonne University, Center for Digestive Endoscopy, Saint-Antoine Hospital, APHP, 75012 Paris, France; (C.H.); (R.L.); (G.V.)
- Équipes Traitement de l’Information et Systèmes, ETIS UMR 8051, CY Paris Cergy University, ENSEA, CNRS, 95000 Cergy, France; (M.S.); (A.H.)
| | - Marc Souchaud
- Équipes Traitement de l’Information et Systèmes, ETIS UMR 8051, CY Paris Cergy University, ENSEA, CNRS, 95000 Cergy, France; (M.S.); (A.H.)
| | - Guillaume Velut
- Sorbonne University, Center for Digestive Endoscopy, Saint-Antoine Hospital, APHP, 75012 Paris, France; (C.H.); (R.L.); (G.V.)
| | - Nicolas Carbonell
- Sorbonne University, Hepatology Department, Saint Antoine Hospital, APHP, Reference Center for Inflammatory Biliary Diseases and Autoimmune Hepatitis, 75012 Paris, France;
| | - Isabelle Nion-Larmurier
- Sorbonne University, Hepatology, Gastroenterology and Saint Antoine IBD NeTwork, Saint-Antoine Hospital, APHP, 75012 Paris, France;
| | - Alexandre Nuzzo
- Department of Gastroenterology, IBD and Intestinal Failure, Intestinal Stroke Center, Structure d’Urgences Vasculaires Intestinales (SURVI), Beaujon Hospital, APHP, 92110 Clichy, France;
| | - Aymeric Histace
- Équipes Traitement de l’Information et Systèmes, ETIS UMR 8051, CY Paris Cergy University, ENSEA, CNRS, 95000 Cergy, France; (M.S.); (A.H.)
| | - Philippe Marteau
- Sorbonne University, Department of Hepato-Gastroenterology, Tenon Hospital, APHP, 75020 Paris, France;
| | - Xavier Dray
- Sorbonne University, Center for Digestive Endoscopy, Saint-Antoine Hospital, APHP, 75012 Paris, France; (C.H.); (R.L.); (G.V.)
- Équipes Traitement de l’Information et Systèmes, ETIS UMR 8051, CY Paris Cergy University, ENSEA, CNRS, 95000 Cergy, France; (M.S.); (A.H.)
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O’Hara F, McNamara D. Small-Bowel Capsule Endoscopy-Optimizing Capsule Endoscopy in Clinical Practice. Diagnostics (Basel) 2021; 11:2139. [PMID: 34829486 PMCID: PMC8623858 DOI: 10.3390/diagnostics11112139] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2021] [Revised: 11/03/2021] [Accepted: 11/09/2021] [Indexed: 11/21/2022] Open
Abstract
The small bowel is the longest organ within the gastrointestinal tract. The emergence of small bowel capsule endoscopy (SBCE) over the last 20 years has revolutionized the investigation and diagnosis of small bowel pathology. Its utility as a non-invasive and well-tolerated procedure, which can be performed in an outpatient setting, has made it a valuable diagnostic tool. The indications for SBCE include obscure gastrointestinal bleeding, small bowel Crohn's disease, and, less frequently for screening in polyposis syndromes, celiac disease, or other small bowel pathology. Currently, there are several small bowel capsules on the market from different manufacturers; however, they share many technological features. The European Society of Gastrointestinal Endoscopy (ESGE) only recently developed a set of key quality indicators to guide quality standards in this area. Many of the technical aspects of capsule endoscopy still feature a degree of uncertainty in terms of optimal performance. Incomplete studies due to slow transit through the bowel, poor imaging secondary to poor preparation, and the risk of capsule retention remain frustrations in its clinical utility. Capsule review is a time-consuming process; however, artificial intelligence and machine learning offer opportunities to improve this. This narrative review examines our current standing in a number of these aspects and the potential to further the application of SBCE in order to maximize its diagnostic utility.
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Affiliation(s)
- Fintan O’Hara
- Department of Gastroenterology, Tallaght University Hospital, D24 NR0A Dublin, Ireland;
- TAGG Research Centre, School of Medicine, Trinity College, D24 NR0A Dublin, Ireland
| | - Deirdre McNamara
- Department of Gastroenterology, Tallaght University Hospital, D24 NR0A Dublin, Ireland;
- TAGG Research Centre, School of Medicine, Trinity College, D24 NR0A Dublin, Ireland
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Lavage, Simethicone, and Prokinetics-What to Swallow with a Video Capsule. Diagnostics (Basel) 2021; 11:diagnostics11091711. [PMID: 34574051 PMCID: PMC8465944 DOI: 10.3390/diagnostics11091711] [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: 08/04/2021] [Revised: 09/11/2021] [Accepted: 09/14/2021] [Indexed: 12/12/2022] Open
Abstract
The development of new capsules now allows endoscopic diagnosis in all segments of the gastrointestinal tract and comes with new needs for differentiated preparation regimens. Although the literature is steadily increasing, the results of the conducted trials on preparation are sometimes conflicting. The ingestion of simethicone before gastric and small bowel capsule endoscopy for prevention of air bubbles is established. The value of a lavage before small bowel capsule endoscopy (SBCE) is recommended, although not supported by all studies. Ingestion in the morning before the procedure seems useful for the improvement of mucosa visualization. Lavage after swallowing of the capsule seems to improve image quality, and in some studies also diagnostic yield. Prokinetics has been used with first generation capsules to shorten gastric transit time and increase the rate of complete small bowel visualization. With the massively prolonged battery capacity of the new generation small bowel capsules, prokinetics are only necessary in significantly delayed gastric emptying as documented by a real-time viewer. Lavage is crucial for an effective colon capsule or pan-intestinal capsule endoscopy. Mainly high or low volume polyethylene glycol (PEG) is used. Apart from achieving optimal cleanliness, propulsion of the capsule by ingested boosts is required to obtain a complete passage through the colon within the battery lifetime. Boosts with low volume sodium picosulfate (NaP) or diatrizoate (gastrografin) seem most effective, but potentially have more side effects than PEG. Future research is needed for more patient friendly but effective preparations, especially for colon capsule and pan-intestinal capsule endoscopy.
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