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Lima Capela T, Arieira C, Xavier S, Cúrdia Gonçalves T, Boal Carvalho P, Rosa B, Cotter J. TOP 100 and detection of colorectal lesions in colon capsule endoscopy: more than meets the eye. Eur J Gastroenterol Hepatol 2024; 36:1087-1092. [PMID: 38916233 DOI: 10.1097/meg.0000000000002809] [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: 06/26/2024]
Abstract
Colon capsule endoscopy (CCE) is a well-known method for the detection of colorectal lesions. Nevertheless, there are no studies reporting the accuracy of TOP 100, a CCE software tool, for the automatic detection of colorectal lesions in CCE. We aimed to evaluate the performance of TOP 100 in detecting colorectal lesions in patients submitted to CCE for incomplete colonoscopy compared with classic reading. A retrospective cohort study including adult patients submitted to CCE (PillCam COLON 2; Medtronic) for incomplete colonoscopy. Blinded for each other's evaluation, one experienced reader analyzed the TOP 100 images and the other performed classic reading to identify colorectal lesions. Detection of colorectal lesions, namely polyps, angioectasia, blood, diverticula, erosions/ulcers, neoplasia, and subepithelial lesions was assessed and TOP 100 performance was evaluated compared with the gold standard (classic reading). A total of 188 CCEs were included. Prevalence of colorectal lesions, polyps, angioectasia, blood, diverticula, erosions/ulcers, neoplasia, and subepithelial lesions were 77.7, 54.3, 8.5, 1.6, 50.0, 0.5, 0.5, and 1.1%, respectively. TOP 100 had a sensitivity of 92.5%, specificity of 69.1%, negative predictive value of 72.5%, positive predictive value of 91.2%, and accuracy of 87.2% for detecting colorectal lesions. TOP 100 had a sensitivity of 89.2%, specificity of 84.9%, negative predictive value of 86.9%, positive predictive value of 87.5%, and accuracy of 87.2% in detecting polyps. All colorectal lesions other than polyps were identified with 100% accuracy by TOP 100. TOP 100 has been shown to be a simple and useful tool in assisting the reader in the prompt identification of colorectal lesions in CCE.
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Affiliation(s)
- Tiago Lima Capela
- Gastroenterology Department, Hospital da Senhora da Oliveira - Guimarães, Guimarães
- Life and Health Sciences Research Institute (ICVS), School of Medicine, University of Minho, Braga
- ICVS/3B's, PT Government Associate Laboratory, Guimarães/Braga, Portugal
| | - Cátia Arieira
- Gastroenterology Department, Hospital da Senhora da Oliveira - Guimarães, Guimarães
- Life and Health Sciences Research Institute (ICVS), School of Medicine, University of Minho, Braga
- ICVS/3B's, PT Government Associate Laboratory, Guimarães/Braga, Portugal
| | - Sofia Xavier
- Gastroenterology Department, Hospital da Senhora da Oliveira - Guimarães, Guimarães
- Life and Health Sciences Research Institute (ICVS), School of Medicine, University of Minho, Braga
- ICVS/3B's, PT Government Associate Laboratory, Guimarães/Braga, Portugal
| | - Tiago Cúrdia Gonçalves
- Gastroenterology Department, Hospital da Senhora da Oliveira - Guimarães, Guimarães
- Life and Health Sciences Research Institute (ICVS), School of Medicine, University of Minho, Braga
- ICVS/3B's, PT Government Associate Laboratory, Guimarães/Braga, Portugal
| | - Pedro Boal Carvalho
- Gastroenterology Department, Hospital da Senhora da Oliveira - Guimarães, Guimarães
- Life and Health Sciences Research Institute (ICVS), School of Medicine, University of Minho, Braga
- ICVS/3B's, PT Government Associate Laboratory, Guimarães/Braga, Portugal
| | - Bruno Rosa
- Gastroenterology Department, Hospital da Senhora da Oliveira - Guimarães, Guimarães
- Life and Health Sciences Research Institute (ICVS), School of Medicine, University of Minho, Braga
- ICVS/3B's, PT Government Associate Laboratory, Guimarães/Braga, Portugal
| | - José Cotter
- Gastroenterology Department, Hospital da Senhora da Oliveira - Guimarães, Guimarães
- Life and Health Sciences Research Institute (ICVS), School of Medicine, University of Minho, Braga
- ICVS/3B's, PT Government Associate Laboratory, Guimarães/Braga, Portugal
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2
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Moreels TG. Changing the paradigm of capsule endoscopy: tempting… but no (not yet). Endoscopy 2024. [PMID: 38670138 DOI: 10.1055/a-2304-3160] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 04/28/2024]
Affiliation(s)
- Tom G Moreels
- Department of Gastroenterology and Hepatology, Cliniques universitaires Saint-Luc, Brussels, Belgium
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3
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Rosa B, Andrade P, Lopes S, Gonçalves AR, Serrazina J, Marílio Cardoso P, Silva A, Macedo Silva V, Cotter J, Macedo G, Figueiredo PN, Chagas C. Pan-Enteric Capsule Endoscopy: Current Applications and Future Perspectives. GE PORTUGUESE JOURNAL OF GASTROENTEROLOGY 2024; 31:89-100. [PMID: 38572440 PMCID: PMC10987171 DOI: 10.1159/000533960] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/02/2023] [Accepted: 08/13/2023] [Indexed: 04/05/2024]
Abstract
Background The role of capsule endoscopy in the evaluation of the small bowel is well established, and current guidelines position it as a first-line test in a variety of clinical scenarios. The advent of double-headed capsules further enabled the endoscopic assessment of colonic mucosa and the opportunity for a one-step noninvasive examination of the entire bowel (pan-enteric capsule endoscopy [PCE]). Summary We reviewed the technical procedure and preparation of patients for PCE, as well as its current clinical applications and future perspectives. In non-stricturing and non-penetrating Crohn's disease affecting the small bowel and colon, PCE monitors disease activity by assessing mucosal healing, a major treatment outcome, with a higher diagnostic yield than cross-sectional imaging or conventional colonoscopy. Also in ulcerative colitis, double-headed capsules have been used to monitor disease activity noninvasively. Currently, validated scoring systems have been specifically devised for these double-headed capsules and permit a standardized assessment of the inflammatory burden. In suspected mid-lower digestive bleeding, some exploratory studies have demonstrated the feasibility and high diagnostic yield of PCE, which may work as a filter indicating which patients may benefit of further invasive procedures, namely, for planned hemostatic procedures. The possibility of using PCE is also discussed in the context of polyposis syndromes with simultaneous involvement of the small intestine and colon. Key Messages PCE is a feasible, effective, and safe diagnostic procedure to evaluate the small bowel and colon. It has been increasingly explored in the setting of inflammatory bowel diseases and, more recently, in suspected mid-lower digestive bleeding. PCE is expected to reduce the demand for invasive procedures and expand the scope of noninvasive intestinal evaluation in the coming future.
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Affiliation(s)
- Bruno Rosa
- Gastroenterology Department, Hospital da Senhora da Oliveira, Guimarães, Portugal
- Life and Health Sciences Research Institute (ICVS), School of Medicine, University of Minho, Braga, Portugal
- ICVS/3B’s, PT Government Associate Laboratory, Braga/Guimarães, Portugal
| | - Patrícia Andrade
- Gastroenterology Department, Centro Hospitalar Universitário de São João, Porto, Portugal
- WGO Gastroenterology and Hepatology Training Center Porto, Porto, Portugal
| | - Sandra Lopes
- Gastroenterology Department, Centro Hospitalar e Universitário de Coimbra, Coimbra, Portugal
| | - Ana Rita Gonçalves
- Gastroenterology Department, Hospital de Santa Maria, Centro Hospitalar Lisboa Norte, Lisboa, Portugal
| | - Juliana Serrazina
- Gastroenterology Department, Hospital de Santa Maria, Centro Hospitalar Lisboa Norte, Lisboa, Portugal
| | - Pedro Marílio Cardoso
- Gastroenterology Department, Centro Hospitalar Universitário de São João, Porto, Portugal
- WGO Gastroenterology and Hepatology Training Center Porto, Porto, Portugal
| | - Andrea Silva
- Gastroenterology Department, Centro Hospitalar e Universitário de Coimbra, Coimbra, Portugal
| | - Vítor Macedo Silva
- Gastroenterology Department, Hospital da Senhora da Oliveira, Guimarães, Portugal
- Life and Health Sciences Research Institute (ICVS), School of Medicine, University of Minho, Braga, Portugal
- ICVS/3B’s, PT Government Associate Laboratory, Braga/Guimarães, Portugal
| | - José Cotter
- Gastroenterology Department, Hospital da Senhora da Oliveira, Guimarães, Portugal
- Life and Health Sciences Research Institute (ICVS), School of Medicine, University of Minho, Braga, Portugal
- ICVS/3B’s, PT Government Associate Laboratory, Braga/Guimarães, Portugal
| | - Guilherme Macedo
- Gastroenterology Department, Centro Hospitalar Universitário de São João, Porto, Portugal
- WGO Gastroenterology and Hepatology Training Center Porto, Porto, Portugal
| | - Pedro Narra Figueiredo
- Gastroenterology Department, Centro Hospitalar e Universitário de Coimbra, Coimbra, Portugal
- Faculty of Medicine, University of Coimbra, Coimbra, Portugal
| | - Cristina Chagas
- Gastroenterology Department, Centro Hospitalar de Lisboa Ocidental, Lisboa, Portugal
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Rosa B, Cotter J. Capsule endoscopy and panendoscopy: A journey to the future of gastrointestinal endoscopy. World J Gastroenterol 2024; 30:1270-1279. [PMID: 38596501 PMCID: PMC11000081 DOI: 10.3748/wjg.v30.i10.1270] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/26/2023] [Revised: 01/22/2024] [Accepted: 02/21/2024] [Indexed: 03/14/2024] Open
Abstract
In 2000, the small bowel capsule revolutionized the management of patients with small bowel disorders. Currently, the technological development achieved by the new models of double-headed endoscopic capsules, as miniaturized devices to evaluate the small bowel and colon [pan-intestinal capsule endoscopy (PCE)], makes this non-invasive procedure a disruptive concept for the management of patients with digestive disorders. This technology is expected to identify which patients will require conventional invasive endoscopic procedures (colonoscopy or balloon-assisted enteroscopy), based on the lesions detected by the capsule, i.e., those with an indication for biopsies or endoscopic treatment. The use of PCE in patients with inflammatory bowel diseases, namely Crohn's disease, as well as in patients with iron deficiency anaemia and/or overt gastrointestinal (GI) bleeding, after a non-diagnostic upper endoscopy (esophagogastroduodenoscopy), enables an effective, safe and comfortable way to identify patients with relevant lesions, who should undergo subsequent invasive endoscopic procedures. The recent development of magnetically controlled capsule endoscopy to evaluate the upper GI tract, is a further step towards the possibility of an entirely non-invasive assessment of all the segments of the digestive tract, from mouth-to-anus, meeting the expectations of the early developers of capsule endoscopy.
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Affiliation(s)
- Bruno Rosa
- Department of Gastroenterology, Hospital da Senhora da Oliveira, Guimarães 4835-044, Portugal
- Life and Health Sciences Research Institute, School of Medicine, University of Minho, Braga 4710-057, Portugal
- ICVS/3B's, PT Government Associate Laboratory, Braga 4710-057, Portugal
| | - José Cotter
- Department of Gastroenterology, Hospital da Senhora da Oliveira, Guimarães 4835-044, Portugal
- Life and Health Sciences Research Institute, School of Medicine, University of Minho, Braga 4710-057, Portugal
- ICVS/3B's, PT Government Associate Laboratory, Braga 4710-057, Portugal
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Rane K, Kukreja G, Deshmukh S, Kakad U, Jadhav P, Patole V. Robotic Pills as Innovative Personalized Medicine Tools: A Mini Review. RECENT ADVANCES IN DRUG DELIVERY AND FORMULATION 2024; 18:2-11. [PMID: 38841731 DOI: 10.2174/0126673878265457231205114925] [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: 08/02/2023] [Revised: 11/13/2023] [Accepted: 11/17/2023] [Indexed: 06/07/2024]
Abstract
The most common route for drug administration is the oral route due to the various advantages offered by this route, such as ease of administration, controlled and sustained drug delivery, convenience, and non-invasiveness. In spite of this, oral drug absorption faces challenges due to various issues related to its stability, permeability and solubility in the GI tract. Biologic drugs generally face problems when administered by oral route as they are readily degradable and thus required to be injected. To overcome these issues in oral absorption, different approaches like novel drug delivery systems and newer pharmaceutical technologies have been adopted. With a combined knowledge of drug delivery and pharmaceutical technology, robotic pills can be designed and used successfully to enhance the adhesion and permeation of drugs through the mucus membrane of the GI tract to achieve drug delivery at the target site. The potential application of robotic pills in diagnosis and drug dispensing is also discussed. The review highlights recent developments in robotic pill drug-device technology and discusses its potential applications to solve the problems and challenges in oral drug delivery.
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Affiliation(s)
- Komal Rane
- Department of Pharmacy Practice, Dr. D.Y. Patil Institute of Pharmaceutical Sciences and Research, Pimpri, Pune - 411018, Maharashtra, India
| | - Garima Kukreja
- Department of Pharmacy Practice, Dr. D.Y. Patil Institute of Pharmaceutical Sciences and Research, Pimpri, Pune - 411018, Maharashtra, India
| | - Siddhi Deshmukh
- Department of Pharmacy Practice, Dr. D.Y. Patil Institute of Pharmaceutical Sciences and Research, Pimpri, Pune - 411018, Maharashtra, India
| | - Urmisha Kakad
- Department of Pharmacy Practice, Dr. D.Y. Patil Institute of Pharmaceutical Sciences and Research, Pimpri, Pune - 411018, Maharashtra, India
| | - Pranali Jadhav
- Department of Pharmaceutical Chemistry, Dr. D.Y. Patil Institute of Pharmaceutical Sciences and Research, Pimpri, Pune - 411018, Maharashtra, India
| | - Vinita Patole
- Department of Pharmaceutics, Dr. D.Y. Patil Institute of Pharmaceutical Sciences and Research, Pimpri, Pune - 411018, Maharashtra, India
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Ukashi O, Soffer S, Klang E, Eliakim R, Ben-Horin S, Kopylov U. Capsule Endoscopy in Inflammatory Bowel Disease: Panenteric Capsule Endoscopy and Application of Artificial Intelligence. Gut Liver 2023; 17:516-528. [PMID: 37305947 PMCID: PMC10352070 DOI: 10.5009/gnl220507] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/01/2022] [Revised: 01/23/2023] [Accepted: 01/30/2023] [Indexed: 06/13/2023] Open
Abstract
Video capsule endoscopy (VCE) of the small-bowel has been proven to accurately diagnose small-bowel inflammation and to predict future clinical flares among patients with Crohn's disease (CD). In 2017, the panenteric capsule (PillCam Crohn's system) was introduced for the first time, enabling a reliable evaluation of the whole small and large intestines. The great advantage of visualization of both parts of the gastrointestinal tract in a feasible and single procedure, holds a significant promise for patients with CD, enabling determination of the disease extent and severity, and potentially optimize disease management. In recent years, applications of machine learning, for VCE have been well studied, demonstrating impressive performance and high accuracy for the detection of various gastrointestinal pathologies, among them inflammatory bowel disease lesions. The use of artificial neural network models has been proven to accurately detect/classify and grade CD lesions, and shorten the VCE reading time, resulting in a less tedious process with a potential to minimize missed diagnosis and better predict clinical outcomes. Nevertheless, prospective, and real-world studies are essential to precisely examine artificial intelligence applications in real-life inflammatory bowel disease practice.
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Affiliation(s)
- Offir Ukashi
- Gastroenterology Institute, Sheba Medical Center, Tel Hashomer, Israel
- Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
- Department of Internal Medicine A, Sheba Medical Center, Tel Hashomer, Israel
| | - Shelly Soffer
- Deep Vision Lab, Sheba Medical Center, Tel Hashomer, Israel
- Internal Medicine B, Assuta Medical Center, Ashdod, Israel
- Faculty of Health Sciences, Ben Gurion University of the Negev, Beer Sheva, Israel
| | - Eyal Klang
- Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
- Deep Vision Lab, Sheba Medical Center, Tel Hashomer, Israel
- Department of Diagnostic Imaging, Sheba Medical Center, Tel Hashomer, Israel
| | - Rami Eliakim
- Gastroenterology Institute, Sheba Medical Center, Tel Hashomer, Israel
- Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Shomron Ben-Horin
- Gastroenterology Institute, Sheba Medical Center, Tel Hashomer, Israel
- Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Uri Kopylov
- Gastroenterology Institute, Sheba Medical Center, Tel Hashomer, Israel
- Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
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7
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Ribeiro T, Mascarenhas M, Afonso J, Cardoso H, Andrade P, Lopes S, Ferreira J, Mascarenhas Saraiva M, Macedo G. Artificial intelligence and colon capsule endoscopy: Automatic detection of ulcers and erosions using a convolutional neural network. J Gastroenterol Hepatol 2022; 37:2282-2288. [PMID: 36181257 DOI: 10.1111/jgh.16011] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/22/2022] [Revised: 09/12/2022] [Accepted: 09/25/2022] [Indexed: 12/13/2022]
Abstract
BACKGROUND AND AIM Colon capsule endoscopy (CCE) has become a minimally invasive alternative for conventional colonoscopy. Nevertheless, each CCE exam produces between 50 000 and 100 000 frames, making its analysis time-consuming and prone to errors. Convolutional neural networks (CNNs) are a type of artificial intelligence (AI) architecture with high performance in image analysis. This study aims to develop a CNN model for the identification of colonic ulcers and erosions in CCE images. METHODS A CNN model was designed using a database of CCE images. A total of 124 CCE exams performed between 2010 and 2020 in two centers were reviewed. For CNN development, a total of 37 319 images were extracted, 33 749 showing normal colonic mucosa and 3570 showing colonic ulcers and erosions. Datasets for CNN training, validation, and testing were created. The performance of the algorithm was evaluated regarding its sensitivity, specificity, positive and negative predictive values, accuracy, and area under the curve. RESULTS The network had a sensitivity of 96.9% and a specificity of 99.9% specific for the detection of colonic ulcers and erosions. The algorithm had an overall accuracy of 99.6%. The area under the curve was 1.00. The CNN had an image processing capacity of 90 frames per second. CONCLUSIONS The developed algorithm is the first CNN-based model to accurately detect ulcers and erosions in CCE images, also providing a good image processing performance. The development of these AI systems may contribute to improve both the diagnostic and time efficiency of CCE exams, facilitating CCE adoption to routine clinical practice.
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Affiliation(s)
- Tiago Ribeiro
- Department of Gastroenterology, São João University Hospital, Porto, Portugal.,World Gastroenterology Organisation Gastroenterology and Hepatology Training Center, Porto, Portugal
| | - Miguel Mascarenhas
- Department of Gastroenterology, São João University Hospital, Porto, Portugal.,World Gastroenterology Organisation Gastroenterology and Hepatology Training Center, Porto, Portugal.,Faculty of Medicine of the University of Porto, Porto, Portugal
| | - João Afonso
- Department of Gastroenterology, São João University Hospital, Porto, Portugal.,World Gastroenterology Organisation Gastroenterology and Hepatology Training Center, Porto, Portugal
| | - Hélder Cardoso
- Department of Gastroenterology, São João University Hospital, Porto, Portugal.,World Gastroenterology Organisation 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.,World Gastroenterology Organisation Gastroenterology and Hepatology Training Center, Porto, Portugal.,Faculty of Medicine of the University of Porto, Porto, Portugal
| | - Susana Lopes
- Department of Gastroenterology, São João University Hospital, Porto, Portugal.,World Gastroenterology Organisation Gastroenterology and Hepatology Training Center, Porto, Portugal.,Faculty of Medicine of the University of Porto, Porto, Portugal
| | - João Ferreira
- Faculty of Engineering of the University of Porto, Porto, Portugal.,INEGI-Institute of Science and Innovation in Mechanical and Industrial Engineering, Porto, Portugal
| | | | - Guilherme Macedo
- Department of Gastroenterology, São João University Hospital, Porto, Portugal.,World Gastroenterology Organisation Gastroenterology and Hepatology Training Center, Porto, Portugal.,Faculty of Medicine of the University of Porto, Porto, Portugal
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8
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Leenhardt R, Koulaouzidis A, Histace A, Baatrup G, Beg S, Bourreille A, de Lange T, Eliakim R, Iakovidis D, Dam Jensen M, Keuchel M, Margalit Yehuda R, McNamara D, Mascarenhas M, Spada C, Segui S, Smedsrud P, Toth E, Tontini GE, Klang E, Dray X, Kopylov U. Key research questions for implementation of artificial intelligence in capsule endoscopy. Therap Adv Gastroenterol 2022; 15:17562848221132683. [PMID: 36338789 PMCID: PMC9629556 DOI: 10.1177/17562848221132683] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/22/2022] [Accepted: 09/27/2022] [Indexed: 11/29/2022] Open
Abstract
BACKGROUND Artificial intelligence (AI) is rapidly infiltrating multiple areas in medicine, with gastrointestinal endoscopy paving the way in both research and clinical applications. Multiple challenges associated with the incorporation of AI in endoscopy are being addressed in recent consensus documents. OBJECTIVES In the current paper, we aimed to map future challenges and areas of research for the incorporation of AI in capsule endoscopy (CE) practice. DESIGN Modified three-round Delphi consensus online survey. METHODS The study design was based on a modified three-round Delphi consensus online survey distributed to a group of CE and AI experts. Round one aimed to map out key research statements and challenges for the implementation of AI in CE. All queries addressing the same questions were merged into a single issue. The second round aimed to rank all generated questions during round one and to identify the top-ranked statements with the highest total score. Finally, the third round aimed to redistribute and rescore the top-ranked statements. RESULTS Twenty-one (16 gastroenterologists and 5 data scientists) experts participated in the survey. In the first round, 48 statements divided into seven themes were generated. After scoring all statements and rescoring the top 12, the question of AI use for identification and grading of small bowel pathologies was scored the highest (mean score 9.15), correlation of AI and human expert reading-second (9.05), and real-life feasibility-third (9.0). CONCLUSION In summary, our current study points out a roadmap for future challenges and research areas on our way to fully incorporating AI in CE reading.
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Affiliation(s)
| | - Anastasios Koulaouzidis
- Department of Social Medicine and Public Health, Pomeranian Medical University, Szczecin, Poland,Department of Surgery, Odense University Hospital, Odense, Denmark,Department of Clinical research, University of Southern Denmark, Odense, Denmark
| | - Aymeric Histace
- ETIS UMR 8051 (CY Paris Cergy University, ENSEA, CNRS), Cergy, France
| | - Gunnar Baatrup
- Department of Surgery, Odense University Hospital, Odense, Denmark,Department of Clinical research, University of Southern Denmark, Odense, Denmark
| | - Sabina Beg
- Department of Gastroenterology, Imperial College NHS Healthcare Trust, London, UK
| | - Arnaud Bourreille
- Nantes Université, CHU Nantes, Institut des maladies de l’appareil digestif (IMAD), Hépato-gastroentérologie, Nantes, France
| | - Thomas de Lange
- Department of Medicine and emergencies-Mölndal, Region Västra Götaland, Sahlgrenska University Hospital, Gothenburg, Sweden,Department of Molecular and Clinical and Medicine, University of Gothenburg, Sahlgrenska Academy, Gothenburg, Sweden
| | - Rami Eliakim
- Department of Gastroenterology, Sheba Medical Center and Sackler School of Medicine, Tel Aviv University, Tel-Aviv, Israel
| | - Dimitris Iakovidis
- Department of Computer Science and Biomedical Informatics, University of Thessaly, Lamia, Greece
| | - Michael Dam Jensen
- Department of Internal Medicine, Section of Gastroenterology, Lillebaelt Hospital, Vejle, Denmark
| | - Martin Keuchel
- Clinic for Internal Medicine, Agaplesion Bethesda Krankenhaus Bergedorf, Hamburg, Germany
| | - Reuma Margalit Yehuda
- Department of Gastroenterology, Sheba Medical Center and Sackler School of Medicine, Tel Aviv University, Tel-Aviv, Israel
| | - Deirdre McNamara
- Trinity Academic Gastroenterology Group, Department of Clinical Medicine, Tallaght Hospital, Trinity College Dublin, Dublin, Ireland
| | - Miguel Mascarenhas
- Department of Gastroenterology, Centro Hospitalar São João, Porto, Portugal
| | - Cristiano Spada
- Digestive Endoscopy Unit and Gastroenterology, Fondazione Poliambulanza, Brescia, Italy,Digestive Endoscopy Unit, Università Cattolica del Sacro Cuore, Rome, Italy
| | - Santi Segui
- Department of Mathematics and Computer Science, Universitat de Barcelona, Barcelona, Spain
| | - Pia Smedsrud
- Simula Metropolitan Centre for Digital Engineering, University of Oslo, Augere Medical AS, Oslo, Norway
| | - Ervin Toth
- Department of Gastroenterology, Skåne University Hospital, Lund University, Malmö, Sweden
| | - Gian Eugenio Tontini
- Department of Pathophysiology and Transplantation, University of Milan and Gastroenterology and Endoscopy Unit, Fondazione IRCCS Ca’Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Eyal Klang
- Sheba ARC, Sheba Medical Center and Sackler School of Medicine, Tel Aviv University, Tel-Aviv, Israel
| | - Xavier Dray
- Sorbonne Université, Centre of Digestive Endoscopy, Hôpital Saint-Antoine, AP-HP, Paris, France,ETIS UMR 8051 (CY Paris Cergy University, ENSEA, CNRS), Cergy, France
| | - Uri Kopylov
- Department of Gastroenterology, Sheba Medical Center and Sackler School of Medicine, Tel Aviv University, Tel-Aviv, Israel
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9
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de Sousa Magalhães R, Chálim Rebelo C, Sousa-Pinto B, Pereira J, Boal Carvalho P, Rosa B, Moreira MJ, Duarte MA, Cotter J. CC-CLEAR (Colon Capsule Cleansing Assessment and Report): the novel scale to evaluate the clinical impact of bowel preparation in capsule colonoscopy - a multicentric validation study. Scand J Gastroenterol 2022; 57:625-632. [PMID: 35068293 DOI: 10.1080/00365521.2022.2026463] [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
BACKGROUND Colon Capsule Cleansing Assessment and Report (CC-CLEAR) is a novel quantitative bowel preparation scale for colon capsule. AIM The aim of this study is to validate the association between CC-CLEAR's classification and major CC outcomes: lesion detection rate, surveillance recommendations and post-CC endoscopic treatment. METHODS Multicentric cohort of consecutive CCs. An expert's panel decided post-CC recommendations. Data included CC-CLEAR and Leighton-REX scales. Major CC outcomes were associated with the different cleansing grades. RESULTS From 168 CC's included, findings were reported in 123 (73.2%), 67 (54.4%) of those being colorectal polyps. CC-CLEAR influenced CC's lesion detection (OR 1.25 95% IC [1.07-1.46], p-value .004) and polyp detection rate (OR 1.22 95% IC [1.04-1.43], p-value.014). Thirty-two (19%) post-CC colonoscopies were recommended, including 22 (68.75%) with at least one polypectomy. CC-CLEAR was associated with post-CC colonoscopy treatment (OR 1.40 95% IC [1.07-1.84], p-value .015). Regarding surveillance, CC-CLEAR influenced the decision for immediate CC repetition (OR 0.21 95% IC [0.12-0.36], p-value < .001) and the recommendation for CC in 3-5 years' time (OR 1.47 95% IC [1.50-1.86], p-value < .002). The Leighton-Rex scale was not correlated with major CC outcomes. CONCLUSION CC-CLEAR impacts major CC outcomes: lesion detection, surveillance recommendations and post-CC endoscopic treatment.
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Affiliation(s)
- Rui de Sousa Magalhães
- Department of Gastroenterology, Hospital Senhora da Oliveira, Guimarães, Portugal.,Life and Health Sciences Research Institute (ICVS), School of Medicine, University of Minho, Braga, Portugal.,ICVS/3B's, PT Government Associate Laboratory, Guimarães/Braga, Portugal
| | - Carolina Chálim Rebelo
- Department of Gastroenterology, Hospital do Divino Espírito Santo de Ponta Delgada, EPER, Ponta Delgada, Portugal
| | - Bernardo Sousa-Pinto
- MEDCIDS - Department of Community Medicine, Information and Health Decision Sciences, Faculty of Medicine, University of Porto, Porto, Portugal.,CINTESIS - Centre for Health Technology and Services Research, University of Porto, Porto, Portugal
| | - José Pereira
- Department of Gastroenterology, Hospital do Divino Espírito Santo de Ponta Delgada, EPER, Ponta Delgada, Portugal
| | - Pedro Boal Carvalho
- Department of Gastroenterology, Hospital Senhora da Oliveira, Guimarães, Portugal.,Life and Health Sciences Research Institute (ICVS), School of Medicine, University of Minho, Braga, Portugal.,ICVS/3B's, PT Government Associate Laboratory, Guimarães/Braga, Portugal
| | - Bruno Rosa
- Department of Gastroenterology, Hospital Senhora da Oliveira, Guimarães, Portugal.,Life and Health Sciences Research Institute (ICVS), School of Medicine, University of Minho, Braga, Portugal.,ICVS/3B's, PT Government Associate Laboratory, Guimarães/Braga, Portugal
| | - Maria J Moreira
- Department of Gastroenterology, Hospital Senhora da Oliveira, Guimarães, Portugal.,Life and Health Sciences Research Institute (ICVS), School of Medicine, University of Minho, Braga, Portugal.,ICVS/3B's, PT Government Associate Laboratory, Guimarães/Braga, Portugal
| | - Maria A Duarte
- Department of Gastroenterology, Hospital do Divino Espírito Santo de Ponta Delgada, EPER, Ponta Delgada, Portugal
| | - José Cotter
- Department of Gastroenterology, Hospital Senhora da Oliveira, Guimarães, Portugal.,Life and Health Sciences Research Institute (ICVS), School of Medicine, University of Minho, Braga, Portugal.,ICVS/3B's, PT Government Associate Laboratory, Guimarães/Braga, Portugal
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10
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Limpias Kamiya KJ, Hosoe N, Hayashi Y, Kawaguchi T, Takabayashi K, Ogata H, Kanai T. Video capsule endoscopy in inflammatory bowel disease. DEN OPEN 2022; 2:e26. [PMID: 35310695 PMCID: PMC8828198 DOI: 10.1002/deo2.26] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 04/19/2021] [Accepted: 04/30/2021] [Indexed: 12/22/2022]
Affiliation(s)
- Kenji J.L. Limpias Kamiya
- Division of Gastroenterology and Hepatology Department of Internal Medicine Keio University School of Medicine Tokyo Japan
| | - Naoki Hosoe
- Center for Diagnostic and Therapeutic Endoscopy Keio University School of Medicine Tokyo Japan
| | - Yukie Hayashi
- Division of Gastroenterology and Hepatology Department of Internal Medicine Keio University School of Medicine Tokyo Japan
| | - Takaaki Kawaguchi
- Division of Gastroenterology and Hepatology Department of Internal Medicine Keio University School of Medicine Tokyo Japan
| | - Kaoru Takabayashi
- Center for Diagnostic and Therapeutic Endoscopy Keio University School of Medicine Tokyo Japan
| | - Haruhiko Ogata
- Center for Diagnostic and Therapeutic Endoscopy Keio University School of Medicine Tokyo Japan
| | - Takanori Kanai
- Division of Gastroenterology and Hepatology Department of Internal Medicine Keio University School of Medicine Tokyo Japan
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11
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Volkers A, Bossuyt P, de Jong J, Pouillon L, Gecse K, Duijvestein M, Ponsioen C, D'Haens G, Löwenberg M. Assessment of endoscopic response using pan-enteric capsule endoscopy in Crohn's disease; the Sensitivity to Change (STOC) study. Scand J Gastroenterol 2022; 57:439-445. [PMID: 34968158 DOI: 10.1080/00365521.2021.2018491] [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
BACKGROUND The potential use of pan-enteric capsule endoscopy (pan-CE) to evaluate mucosal changes during treatment has not been evaluated. We aimed to assess the ability of pan-CE to measure changes in mucosal disease activity before and after starting biologic treatment in Crohn's disease patients. METHODS In this two-center prospective study, patients with clinical and biochemical signs of active Crohn's disease underwent pan-CE before and 8 to 12 weeks after treatment initiation with infliximab, adalimumab or vedolizumab. Endoscopic disease activity was assessed using the simple endoscopic score for Crohn's disease (SES-CD) and the Crohn's disease endoscopic index of severity (CDEIS), expanded with two segments (i.e., the jejunum and pre-terminal ileum). Occurrence of endoscopic remission (i.e., absence of ulcers) and endoscopic response (i.e., 50% decrease in SES-CD and CDEIS scores compared to baseline) was assessed and the standardized effect size was calculated. RESULTS Twenty-two patients (50% females) completed the study. Endoscopic remission was observed in 6 out of 22 (27%) patients and 13/22 patients (59%) showed an endoscopic response for both the SES-CD and CDEIS score. Median SES-CD and CDEIS scores decreased from 16.0 (IQR 10.0 - 24.0) to 6.0 (IQR 2.8 - 12.0, p = .001) and from 7.1 (IQR 4.6 - 11.2) to 3.0 (IQR 0.9 - 6.0, p = .001), respectively. The standardized effect size was 1.44 and 1.24 for the SES-CD and CDEIS, respectively. No adverse events related to pan-CE were reported. CONCLUSION Pan-CE was a useful technique to assess changes in mucosal disease activity in Crohn's disease patients.
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Affiliation(s)
- Adriaan Volkers
- Department of Gastroenterology and Hepatology, Amsterdam UMC, Amsterdam, Netherlands
| | - Peter Bossuyt
- Imelda GI clinical research center, Imelda general hospital, Bonheiden, Belgium
| | - Jitteke de Jong
- Department of Gastroenterology and Hepatology, Amsterdam UMC, Amsterdam, Netherlands
| | - Lieven Pouillon
- Imelda GI clinical research center, Imelda general hospital, Bonheiden, Belgium
| | - Krisztina Gecse
- Department of Gastroenterology and Hepatology, Amsterdam UMC, Amsterdam, Netherlands
| | - Marjolijn Duijvestein
- Department of Gastroenterology and Hepatology, Amsterdam UMC, Amsterdam, Netherlands
| | - Cyriel Ponsioen
- Department of Gastroenterology and Hepatology, Amsterdam UMC, Amsterdam, Netherlands
| | - Geert D'Haens
- Department of Gastroenterology and Hepatology, Amsterdam UMC, Amsterdam, Netherlands
| | - Mark Löwenberg
- Department of Gastroenterology and Hepatology, Amsterdam UMC, Amsterdam, Netherlands
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12
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Review: Colon Capsule Endoscopy in Inflammatory Bowel Disease. Diagnostics (Basel) 2022; 12:diagnostics12010149. [PMID: 35054315 PMCID: PMC8775260 DOI: 10.3390/diagnostics12010149] [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: 12/01/2021] [Revised: 12/25/2021] [Accepted: 01/04/2022] [Indexed: 11/19/2022] Open
Abstract
The COVID-19 pandemic has caused considerable disruption in healthcare services and has had a substantial impact on the care of patients with chronic diseases, such as inflammatory bowel disease. Endoscopy services were significantly restricted, resulting in long waiting lists. There has been a growing interest in the use of capsule endoscopy in the diagnostic pathway and management of these patients. This review explores the published literature on the role of colon capsule endoscopy in ulcerative colitis and Crohn’s disease as a method for mucosal assessment of extent, severity, and response to treatment. Colon capsule preparation regimens and scoring systems are reported. The studies indicate that, despite inherent limitations of minimally invasive capsule endoscopy, there is increasing evidence to support the use of the second-generation colon capsule in inflammatory bowel disease evaluation, providing an additional pathway to expedite investigation of appropriate patients especially during and after the pandemic.
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13
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Panintestinal capsule endoscopy in patients with celiac disease. Eur J Gastroenterol Hepatol 2021; 33:e1022-e1026. [PMID: 34138763 DOI: 10.1097/meg.0000000000002205] [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] [Indexed: 12/10/2022]
Abstract
INTRODUCTION Capsule endoscopy has proven its utility in diagnosing villous atrophy and lymphoma in patients with celiac disease. Recently, a novel capsule endoscopy system was introduced which enables the examination of the small and large bowel. So far, it has not been evaluated in patients with celiac disease. OBJECTIVE The primary objective of this study was to evaluate the novel panintestinal capsule endoscopy system in patients with celiac disease. METHODS Eleven patients with histologically proven celiac disease (Marsh 0-IV), who underwent a panintestinal capsule endoscopy between March 2018 and April 2019 at our institution, were included in this retrospective single-center study. All patients performed standard bowel preparation prior to the examination. Diagnostic yield, safety and therapeutic impact were analyzed. In addition, the correlation between capsule endoscopy findings and the histology of the duodenal mucosa was assessed. RESULTS Panintestinal capsule endoscopy was feasible and produced an acceptable visualization quality in all cases. Concordance of capsule endoscopy findings with the Marsh classification showed a good correlation (r = 0.8). No lymphomas were detected. Evaluation of the colon revealed diminutive polyps (median size 4 mm) in 18% of patients. CONCLUSIONS The novel panintestinal capsule endoscopy system shows a fair correlation with the Marsh classification in patients with celiac disease. It is also capable of identifying colon polyps. Therefore, the novel panintestinal capsule endoscopy system can be considered for patients with celiac disease and an indication for capsule endoscopy.
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14
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Papalia I, Tjandra D, Quah S, Tan C, Gorelik A, Sivanesan S, Macrae F. Colon Capsule Endoscopy in the Assessment of Mucosal Healing in Crohn's Disease. Inflamm Bowel Dis 2021; 27:S25-S32. [PMID: 34791289 PMCID: PMC8690064 DOI: 10.1093/ibd/izab180] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/04/2021] [Indexed: 12/13/2022]
Abstract
BACKGROUND Patients with Crohn's disease (CD) undergo frequent endoscopic procedures, with visualization of the gastrointestinal mucosa central to treatment decision-making. Subsequently, a noninvasive alternative to optical colonoscopy (OC) would be welcomed. One such technology is capsule endoscopy, including the PillCam COLON 2 (PCC2), though research validating its use in ileocolonic CD is limited. This study aims to compare PCC2 with ileocolonoscopy (OC) in assessing mucosal CD through use of a standardized scoring system. METHODS At an Australian tertiary hospital, same-day PCC2 and ileocolonoscopy results of 47 CD patients, with known nonstricturing disease, were prospectively collected and analyzed for correlation and agreement. Deidentified recordings were reported by a single expert gastroenterologist. Mucosal disease was quantified using the Simple Endoscopic Score for Crohn's Disease (SES-CD). The SES-CD results of paired endoscopic modalities were compared in total per bowel segment and per SES-CD variable. RESULTS Of 47 PCC2 recordings, 68% were complete, fully assessing terminal ileum to rectum, and OC was complete in 89%. Correlation (r) between total SES-CD scores was strongest in the terminal ileum (r = 0.77, P < .001), with the SES-CD variable of "ulcer detection" showing the strongest agreement. The PCC2 (vs OC) identified additional ulcers in the terminal ileum; ascending, transverse, and descending colon; and rectum; scores were 5 (1), 5 (3), 1 (1), 2 (1), and 2 (2), respectively. CONCLUSIONS The PCC2 shows promise in assessing ileocolonic mucosa, especially in proximal bowel segments, with greater reach of visualization in the small bowel. Given the resource and safety considerations raised by the Coronavirus disease 2019 pandemic, capsule endoscopy has particular significance.This article aims to contribute to the limited body of research surrounding the validity of capsule endoscopy technology in assessing ileocolonic mucosa in Crohn's Disease patients. In doing so, an alternative option for patients enduring frequent endoscopies is given potential.
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Affiliation(s)
- Isabella Papalia
- The University of Melbourne, Parkville, VIC, Australia,Department of Colorectal Medicine and Genetics, The Royal Melbourne Hospital, Parkville, VIC, Australia,Address correspondence to: Isabella Papalia, MD, Department of Colorectal Medicine and Genetics, PO Box 2010, The Royal Melbourne Hospital, Parkville, VIC 3050, Australia ()
| | - Douglas Tjandra
- Department of Colorectal Medicine and Genetics, The Royal Melbourne Hospital, Parkville, VIC, Australia
| | - Stephanie Quah
- Department of Colorectal Medicine and Genetics, The Royal Melbourne Hospital, Parkville, VIC, Australia
| | - Christina Tan
- Department of Colorectal Medicine and Genetics, The Royal Melbourne Hospital, Parkville, VIC, Australia
| | - Alexandra Gorelik
- Department of Colorectal Medicine and Genetics, The Royal Melbourne Hospital, Parkville, VIC, Australia
| | - Suresh Sivanesan
- Department of Colorectal Medicine and Genetics, The Royal Melbourne Hospital, Parkville, VIC, Australia
| | - Finlay Macrae
- The University of Melbourne, Parkville, VIC, Australia,Department of Colorectal Medicine and Genetics, The Royal Melbourne Hospital, Parkville, VIC, Australia
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15
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Bjoersum-Meyer T, Skonieczna-Zydecka K, Cortegoso Valdivia P, Stenfors I, Lyutakov I, Rondonotti E, Pennazio M, Marlicz W, Baatrup G, Koulaouzidis A, Toth E. Efficacy of bowel preparation regimens for colon capsule endoscopy: a systematic review and meta-analysis. Endosc Int Open 2021; 9:E1658-E1673. [PMID: 34790528 PMCID: PMC8589531 DOI: 10.1055/a-1529-5814] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/25/2021] [Accepted: 06/04/2021] [Indexed: 12/11/2022] Open
Abstract
Background and study aims Colon capsule endoscopy (CCE) is an alternative to conventional colonoscopy (CC) in specific clinical settings. High completion rates (CRs) and adequate cleanliness rates (ACRs) are fundamental quality parameters if CCE is to be widely implemented as a CC equivalent diagnostic modality. We conducted a systematic review and meta-analysis to investigate the efficacy of different bowel preparations regimens on CR and ACR in CCE. Patients and methods We performed a systematic literature search in PubMed, Embase, CINAHL, Web of Science, and the Cochrane Library. Data were independently extracted per the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA). The primary outcome measures (CR, ACR) were retrieved from the individual studies and pooled event rates were calculated. Results Thirty-four observational (OBS) studies (n = 3,789) and 12 randomized clinical trials (RCTs) (n = 1,214) comprising a total 5,003 patients were included. The overall CR was 0.798 (95 % CI, 0.764-0.828); the highest CRs were observed with sodium phosphate (NaP) + gastrografin booster (n = 2, CR = 0.931, 95 % CI, 0.820-0.976). The overall ACR was 0.768 (95 % CI, 0.735-0.797); the highest ACRs were observed with polyethylene glycol (PEG) + magnesium citrate (n = 4, ER = 0.953, 95 % CI, 0.896-0.979). Conclusions In the largest meta-analysis on CCE bowel preparation regimens, we found that both CRs and ACRs are suboptimal compared to the minimum recommended standards for CC. PEG laxative and NaP booster were the most commonly used but were not associated with higher CRs or ACRs. Well-designed studies on CCE should be performed to find the optimal preparation regimen.
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Affiliation(s)
| | | | - Pablo Cortegoso Valdivia
- Gastroenterology and Endoscopy Unit, University Hospital of Parma, University of Parma, Parma, Italy.
| | - Irene Stenfors
- Department of Gastroenterology, Skåne University Hospital, Malmö, Lund University, Sweden
| | - Ivan Lyutakov
- Department of Gastroenterology, University Hospital “Tsaritsa Yoanna – ISUL”, Medical University Sofia, Bulgaria
| | | | - Marco Pennazio
- University Division of Gastroenterology, City of Health and Science University Hospital, Turin, Italy
| | - Wojciech Marlicz
- Department of Gastroenterology, Pomeranian Medical University, Szczecin, Poland,The Centre for Digestive Diseases, Endoklinika, Szczecin, Poland
| | - Gunnar Baatrup
- Department of Surgery, Odense University Hospital, Odense Denmark
| | - Anastasios Koulaouzidis
- Department of Social Medicine & Public Health, Pomeranian Medical University, Szczecin, Poland
| | - Ervin Toth
- Department of Gastroenterology, Skåne University Hospital, Malmö, Lund University, Sweden
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16
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Otsuka H, Nakamura M, Yamamura T, Maeda K, Sawada T, Mizutani Y, Ishikawa E, Ishikawa T, Kakushima N, Furukawa K, Ohno E, Kawashima H, Honda T, Ishigami M, Fujishiro M. Feasibility of patency capsule and colon capsule endoscopy in patients with suspected gastrointestinal stenosis: a prospective study. NAGOYA JOURNAL OF MEDICAL SCIENCE 2021; 83:419-430. [PMID: 34552280 PMCID: PMC8438001 DOI: 10.18999/nagjms.83.3.419] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/03/2020] [Accepted: 11/19/2020] [Indexed: 11/30/2022]
Abstract
Patency capsule (PC) can evaluate the patency of gastrointestinal (GI) tract. We hypothesized preceding patient selection using PC would improve the successful rate of colon capsule endoscopy (CCE). Therefore, a prospective single-arm study using PC followed by CCE was conducted with a control group of CCE alone. Patients with suspected or known GI stenosis scheduled for CCE were enrolled. CCE was performed only when the PC was excreted out of the body within 33 hours of ingestion. Primary endpoint was the rate of observation of the entire GI tract within the duration of examination. The secondary endpoints were complications and CCE findings. Twenty-three patients (17 men) were enrolled. The mean age was 50.5±19.8 years. Suspected stenotic sites were 8, 5, and 10 in the small, large, and small and large bowel, respectively. Sixteen, 12, and 10 patients had abdominal pain, active inflammatory bowel disease, and history of surgery for suspected stenosis, respectively. Patency of GI tract was confirmed in 96% (22/23) of the patients by administered PC. Of the 22 patients who underwent CCE, the entire GI tract was observed in 86% (19/22). No complications were observed. The median transit times in the small bowel and colon were 99 (21–682) and 160 (5–328) minutes, respectively. CCE findings revealed ulcers, erosions, and diverticula in 5, 9, and 4 patients, respectively. In conclusion, CCE with PC might be a safer and useful modality to observe the large colon for patients with suspected GI stenosis.
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Affiliation(s)
- Hiroyuki Otsuka
- Department of Gastroenterology and Hepatology, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Masanao Nakamura
- Department of Gastroenterology and Hepatology, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Takeshi Yamamura
- Department of Gastroenterology and Hepatology, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Keiko Maeda
- Department of Endoscopy, Nagoya University Hospital, Nagoya, Japan
| | - Tsunaki Sawada
- Department of Endoscopy, Nagoya University Hospital, Nagoya, Japan
| | - Yasuyuki Mizutani
- Department of Gastroenterology and Hepatology, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Eri Ishikawa
- Department of Gastroenterology and Hepatology, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Takuya Ishikawa
- Department of Gastroenterology and Hepatology, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Naomi Kakushima
- Department of Gastroenterology and Hepatology, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Kazuhiro Furukawa
- Department of Gastroenterology and Hepatology, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Eizaburo Ohno
- Department of Gastroenterology and Hepatology, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Hiroki Kawashima
- Department of Endoscopy, Nagoya University Hospital, Nagoya, Japan
| | - Takashi Honda
- Department of Gastroenterology and Hepatology, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Masatoshi Ishigami
- Department of Gastroenterology and Hepatology, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Mitsuhiro Fujishiro
- Department of Gastroenterology and Hepatology, Nagoya University Graduate School of Medicine, Nagoya, Japan
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17
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de Sousa Magalhães R, Boal Carvalho P, Rosa B, Moreira MJ, Cotter J. The Prediction of Inadequate Colon Capsule Cleansing: A Cohort Selection Guided by CC-CLEAR. GE-PORTUGUESE JOURNAL OF GASTROENTEROLOGY 2021; 29:311-321. [PMID: 36159193 PMCID: PMC9485925 DOI: 10.1159/000518588] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/22/2021] [Accepted: 07/09/2021] [Indexed: 11/19/2022]
Abstract
Introduction In order to optimize the rate of adequate cleansing in colon capsule, it may be important to identify risk factors that can predict a suboptimal colon preparation. Aim To define predictive factors for inadequate bowel preparation in colon capsule, according to CC-CLEAR (Colon Capsule CLEansing Assessment and Report). Methods Retrospective, single center, cohort study. Patients' demographics, data, and quality of bowel preparation, according to CC-CLEAR, were collected retrospectively. A univariate analysis tested the association between covariables and the outcome, inadequate cleansing. The statistically significant variables were included in multivariable logistic binary regression, and a receiver operating characteristic curve (ROC) assessment was performed. Results We included 167 consecutive colon capsules. Sixty-eight percent (n = 114) of patients were female, with a mean age of 64 years. The main indication for colon capsule was previous incomplete colonoscopy, in 158 patients (94.6%). The colon capsules cleansing was graded as good or excellent in 96 patients (57.5%) and as inadequate in 71 (42.5%), according to CC-CLEAR. The variables inadequate previous colon cleansing (OR adjusted 41.72 [95% CI 12.57–138.57], p value < 0.001); chronic laxative (OR adjusted 4.86 [95% CI 1.08–21.79], p value = 0.039); antidepressant (OR adjusted 5.00 [95% CI 1.65–15.16], p value = 0.004), and impaired mobility (OR adjusted 5.54 [95% CI 1.17–26.31], p value = 0.031) were independently associated with the outcome inadequate cleansing, after adjusting for confoundment. The model presented an excellent discriminative power towards the outcome variable (AUC ROC 0.937 [CI 95% 0.899–0.975], p value < 0.001). Conclusion A previous inadequate colon cleansing, the use of chronic laxative and antidepressant, or impaired mobility are predictors of inadequate colon capsule cleansing, as assessed by the CC-CLEAR. These 4 predictors come together as a model enabling an accurate categorization of the patients at major risk of inadequate bowel preparation for capsule colonoscopy, with an excellent discriminative power and performance, which seems useful for the selection of patients for tailored optimization of the colon cleansing protocol.
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Affiliation(s)
- Rui de Sousa Magalhães
- Gastroenterology Department, Hospital Senhora da Oliveira, Guimarães, Portugal
- Life and Health Sciences Research Institute (ICVS), School of Medicine, University of Minho, Braga, Portugal
- ICVS/3B's, PT Government Associate Laboratory, Guimarães/Braga, Portugal
- * Rui de Sousa Magalhães,
| | - Pedro Boal Carvalho
- Gastroenterology Department, Hospital Senhora da Oliveira, Guimarães, Portugal
- Life and Health Sciences Research Institute (ICVS), School of Medicine, University of Minho, Braga, Portugal
- ICVS/3B's, PT Government Associate Laboratory, Guimarães/Braga, Portugal
| | - Bruno Rosa
- Gastroenterology Department, Hospital Senhora da Oliveira, Guimarães, Portugal
- Life and Health Sciences Research Institute (ICVS), School of Medicine, University of Minho, Braga, Portugal
- ICVS/3B's, PT Government Associate Laboratory, Guimarães/Braga, Portugal
| | - Maria João Moreira
- Gastroenterology Department, Hospital Senhora da Oliveira, Guimarães, Portugal
- Life and Health Sciences Research Institute (ICVS), School of Medicine, University of Minho, Braga, Portugal
- ICVS/3B's, PT Government Associate Laboratory, Guimarães/Braga, Portugal
| | - José Cotter
- Gastroenterology Department, Hospital Senhora da Oliveira, Guimarães, Portugal
- Life and Health Sciences Research Institute (ICVS), School of Medicine, University of Minho, Braga, Portugal
- ICVS/3B's, PT Government Associate Laboratory, Guimarães/Braga, Portugal
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18
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Cortegoso Valdivia P, Elosua A, Houdeville C, Pennazio M, Fernández-Urién I, Dray X, Toth E, Eliakim R, Koulaouzidis A. Clinical feasibility of panintestinal (or panenteric) capsule endoscopy: a systematic review. Eur J Gastroenterol Hepatol 2021; 33:949-955. [PMID: 34034282 DOI: 10.1097/meg.0000000000002200] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
In recent years, panintestinal capsule endoscopy (PCE) with double-headed capsules has been used to perform complete, single-sitting exploration of both small bowel and colon in different clinical conditions. Double-headed capsules for colonic examination (CCE) have been exploited first in this setting, followed by newer generations of capsules (i.e. PillCam Crohn, PCC) specifically engineered for this purpose. The aim of this study was to evaluate the feasibility of PCE in the form of a systematic review. We performed a comprehensive literature search to identify papers in which CE was specifically used for a PCE of the gastrointestinal tract. Data on CE, bowel preparation regimen, rate of cleanliness and completeness, and data on transit times were analyzed. The primary outcome was to assess the feasibility of a whole-gut exploration with CE. Sixteen (n = 16) studies including 915 CE procedures with CCE1 (n = 134), CCE2 (n = 357) and PCC (n = 424) were included. 13/16 studies were performed in the setting of Crohn's disease. Cleanliness and completeness rates were acceptable in all studies, ranging from 63.9% and 68.6% to 100%, respectively. In conclusion, PCE is a feasible technique, although further structured studies are needed to explore its full potential.
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Affiliation(s)
- Pablo Cortegoso Valdivia
- Gastroenterology and Endoscopy Unit, University Hospital of Parma, University of Parma, Parma, Italy
| | - Alfonso Elosua
- Gastroenterology Unit, Hospital Garcia Orcoyen, Estella, Spain
| | - Charles Houdeville
- Sorbonne Université, Centre d'Endoscopie Digestive, Hôpital Saint-Antoine, APHP, Paris, France
| | - Marco Pennazio
- University Division of Gastroenterology, AOU Città della Salute e della Scienza, University of Turin, Turin, Italy
| | | | - Xavier Dray
- Sorbonne Université, Centre d'Endoscopie Digestive, Hôpital Saint-Antoine, APHP, Paris, France
| | - Ervin Toth
- Department of Gastroenterology, Skåne University Hospital, Lund University, Malmö, Sweden
| | - Rami Eliakim
- Department of Gastroenterology, Chaim Sheba Medical Center, Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Anastasios Koulaouzidis
- Department of Social Medicine & Public Health, Pomeranian Medical University, Szczecin, Poland
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19
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Shimozaki K, Hirata K, Horie S, Chida A, Tsugaru K, Hayashi Y, Kawasaki K, Miyanaga R, Hayashi H, Mizuno R, Funakoshi T, Hosoe N, Hamamoto Y, Kanai T. The Entire Intestinal Tract Surveillance Using Capsule Endoscopy after Immune Checkpoint Inhibitor Administration: A Prospective Observational Study. Diagnostics (Basel) 2021; 11:diagnostics11030543. [PMID: 33803735 PMCID: PMC8003297 DOI: 10.3390/diagnostics11030543] [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: 02/13/2021] [Revised: 03/15/2021] [Accepted: 03/16/2021] [Indexed: 12/19/2022] Open
Abstract
BACKGROUND Despite the proven efficacy of immune checkpoint inhibitors (ICIs) against various types of malignancies, they have been found to induce immune-related adverse events, such as enterocolitis; however, the clinical features of ICI-induced enterocolitis remain to be sufficiently elucidated, which is significant, considering the importance of early detection in the appropriate management and treatment of ICI-induced enterocolitis. Therefore, the current study aimed to determine the utility of capsule endoscopy as a screening tool for ICI-induced enterocolitis. METHODS This single-center, prospective, observational study was conducted on patients with malignancy who received any ICI between April 2016 and July 2020 at Keio University Hospital. Next, second-generation capsule endoscopy (CCE-2) was performed on day 60 after ICI initiation to explore the entire gastrointestinal tract. RESULTS Among the 30 patients enrolled herein, 23 underwent CCE-2. Accordingly, a total of 23 findings were observed in 14 (60.8%) patients at any portion of the gastrointestinal tract (7 patients in the colon, 4 patients in the small intestine, 2 patients in both the colon and the small intestine, and 1 patient in the stomach). After capsule endoscopy, 2 patients (8.7%) developed ICI-induced enterocolitis: both had significantly higher Capsule Scoring of Ulcerative Colitis than those who had not developed ICI-induced enterocolitis (p = 0.0455). No adverse events related to CCE-2 were observed. CONCLUSIONS CCE-2 might be a safe and useful entire intestinal tract screening method for the early detection of ICI-induced enterocolitis in patients with malignancies.
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Affiliation(s)
- Keitaro Shimozaki
- Division of Gastroenterology and Hepatology, Department of Internal Medicine, Keio University School of Medicine, Tokyo 160-8582, Japan; (K.S.); (S.H.); (A.C.); (K.T.); (Y.H.); (K.K.); (R.M.); (T.K.)
| | - Kenro Hirata
- Division of Gastroenterology and Hepatology, Department of Internal Medicine, Keio University School of Medicine, Tokyo 160-8582, Japan; (K.S.); (S.H.); (A.C.); (K.T.); (Y.H.); (K.K.); (R.M.); (T.K.)
- Correspondence: ; Tel.: +81-3-3353-1211
| | - Sara Horie
- Division of Gastroenterology and Hepatology, Department of Internal Medicine, Keio University School of Medicine, Tokyo 160-8582, Japan; (K.S.); (S.H.); (A.C.); (K.T.); (Y.H.); (K.K.); (R.M.); (T.K.)
| | - Akihiko Chida
- Division of Gastroenterology and Hepatology, Department of Internal Medicine, Keio University School of Medicine, Tokyo 160-8582, Japan; (K.S.); (S.H.); (A.C.); (K.T.); (Y.H.); (K.K.); (R.M.); (T.K.)
| | - Kai Tsugaru
- Division of Gastroenterology and Hepatology, Department of Internal Medicine, Keio University School of Medicine, Tokyo 160-8582, Japan; (K.S.); (S.H.); (A.C.); (K.T.); (Y.H.); (K.K.); (R.M.); (T.K.)
| | - Yukie Hayashi
- Division of Gastroenterology and Hepatology, Department of Internal Medicine, Keio University School of Medicine, Tokyo 160-8582, Japan; (K.S.); (S.H.); (A.C.); (K.T.); (Y.H.); (K.K.); (R.M.); (T.K.)
| | - Kenta Kawasaki
- Division of Gastroenterology and Hepatology, Department of Internal Medicine, Keio University School of Medicine, Tokyo 160-8582, Japan; (K.S.); (S.H.); (A.C.); (K.T.); (Y.H.); (K.K.); (R.M.); (T.K.)
| | - Ryoichi Miyanaga
- Division of Gastroenterology and Hepatology, Department of Internal Medicine, Keio University School of Medicine, Tokyo 160-8582, Japan; (K.S.); (S.H.); (A.C.); (K.T.); (Y.H.); (K.K.); (R.M.); (T.K.)
| | - Hideyuki Hayashi
- Keio Cancer Center, Keio University School of Medicine, Tokyo 160-8582, Japan; (H.H.); (Y.H.)
| | - Ryuichi Mizuno
- Department of Urology, Keio University School of Medicine, Tokyo 160-8582, Japan;
| | - Takeru Funakoshi
- Department of Dermatology, Keio University School of Medicine, Tokyo 160-8582, Japan;
| | - Naoki Hosoe
- Center for Diagnostic and Therapeutic Endoscopy, Keio University School of Medicine, Tokyo 160-8582, Japan;
| | - Yasuo Hamamoto
- Keio Cancer Center, Keio University School of Medicine, Tokyo 160-8582, Japan; (H.H.); (Y.H.)
| | - Takanori Kanai
- Division of Gastroenterology and Hepatology, Department of Internal Medicine, Keio University School of Medicine, Tokyo 160-8582, Japan; (K.S.); (S.H.); (A.C.); (K.T.); (Y.H.); (K.K.); (R.M.); (T.K.)
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20
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Yamada K, Nakamura M, Yamamura T, Maeda K, Sawada T, Mizutani Y, Ishikawa E, Ishikawa T, Kakushima N, Furukawa K, Ohno E, Kawashima H, Honda T, Ishigami M, Fujishiro M. Diagnostic yield of colon capsule endoscopy for Crohn's disease lesions in the whole gastrointestinal tract. BMC Gastroenterol 2021; 21:75. [PMID: 33593297 PMCID: PMC7888071 DOI: 10.1186/s12876-021-01657-0] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/01/2020] [Accepted: 01/18/2021] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Crohn's disease (CD) can involve the upper gastrointestinal (GI) tract as well as the small and large bowel. PillCam colon capsule endoscopy (PCCE-2) enables observation of the whole GI tract, but its diagnostic yield for CD lesions in the whole GI tract remains unknown. AIM To elucidate the diagnostic yield of PCCE-2 in patients with CD. METHODS Patients with CD who underwent PCCE-2 and double-balloon endoscopy (DBE) using oral and anal approaches were evaluated for CD lesions in the whole GI tract. We divided the small bowel into three segments (jejunum, ileum, and terminal ileum), and the large bowel into four segments (right colon, transverse colon, left colon, rectum). Detection of ulcer scars, erosion, ulcers, bamboo joint-like appearance, and notch-like appearance was assessed in each segment. The diagnostic yield of PCCE-2 was analyzed based on the DBE results as the gold standard. RESULTS Of the total 124 segments, the sensitivities of PCCE-2 for ulcer scars, erosion, and ulcers were 83.3%, 93.8%, and 88.5%, respectively, and the specificities were 76.0%, 78.3%, and 81.6%, respectively. For the 60 small bowel segments, the sensitivities were 84.2%, 95.5%, and 90.0%, respectively, and the specificities were 63.4%, 86.8%, and 87.5%, respectively. For the 64 large bowel segments, the sensitivities were 80.0%, 90.0%, and 83.3%, respectively, and the specificities were 84.7%, 72.2%, and 77.6%, respectively. CONCLUSION PCCE-2 provides a high diagnostic yield for lesions in the whole GI tract of patients with CD. Thus, we recommend its use as a pan-enteric tool in clinical settings.
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Affiliation(s)
- Keisaku Yamada
- Department of Gastroenterology and Hepatology, Nagoya University Graduate School of Medicine, 65 Tsurumai-cho, Syowa-ku, Nagoya City, Aichi, Japan
| | - Masanao Nakamura
- Department of Gastroenterology and Hepatology, Nagoya University Graduate School of Medicine, 65 Tsurumai-cho, Syowa-ku, Nagoya City, Aichi, Japan.
| | - Takeshi Yamamura
- Department of Gastroenterology and Hepatology, Nagoya University Graduate School of Medicine, 65 Tsurumai-cho, Syowa-ku, Nagoya City, Aichi, Japan
| | - Keiko Maeda
- Department of Endoscopy, Nagoya University Hospital, 65 Tsurumai-cho, Showa-ku, Nagoya, 466-8550, Japan
| | - Tsunaki Sawada
- Department of Endoscopy, Nagoya University Hospital, 65 Tsurumai-cho, Showa-ku, Nagoya, 466-8550, Japan
| | - Yasuyuki Mizutani
- Department of Gastroenterology and Hepatology, Nagoya University Graduate School of Medicine, 65 Tsurumai-cho, Syowa-ku, Nagoya City, Aichi, Japan
| | - Eri Ishikawa
- Department of Gastroenterology and Hepatology, Nagoya University Graduate School of Medicine, 65 Tsurumai-cho, Syowa-ku, Nagoya City, Aichi, Japan
| | - Takuya Ishikawa
- Department of Gastroenterology and Hepatology, Nagoya University Graduate School of Medicine, 65 Tsurumai-cho, Syowa-ku, Nagoya City, Aichi, Japan
| | - Naomi Kakushima
- Department of Gastroenterology and Hepatology, Nagoya University Graduate School of Medicine, 65 Tsurumai-cho, Syowa-ku, Nagoya City, Aichi, Japan
| | - Kazuhiro Furukawa
- Department of Gastroenterology and Hepatology, Nagoya University Graduate School of Medicine, 65 Tsurumai-cho, Syowa-ku, Nagoya City, Aichi, Japan
| | - Eizaburo Ohno
- Department of Gastroenterology and Hepatology, Nagoya University Graduate School of Medicine, 65 Tsurumai-cho, Syowa-ku, Nagoya City, Aichi, Japan
| | - Hiroki Kawashima
- Department of Endoscopy, Nagoya University Hospital, 65 Tsurumai-cho, Showa-ku, Nagoya, 466-8550, Japan
| | - Takashi Honda
- Department of Gastroenterology and Hepatology, Nagoya University Graduate School of Medicine, 65 Tsurumai-cho, Syowa-ku, Nagoya City, Aichi, Japan
| | - Masatoshi Ishigami
- Department of Gastroenterology and Hepatology, Nagoya University Graduate School of Medicine, 65 Tsurumai-cho, Syowa-ku, Nagoya City, Aichi, Japan
| | - Mitsuhiro Fujishiro
- Department of Gastroenterology and Hepatology, Nagoya University Graduate School of Medicine, 65 Tsurumai-cho, Syowa-ku, Nagoya City, Aichi, Japan
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21
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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.
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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
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22
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de Sousa Magalhães R, Arieira C, Boal Carvalho P, Rosa B, Moreira MJ, Cotter J. Colon Capsule CLEansing Assessment and Report (CC-CLEAR): a new approach for evaluation of the quality of bowel preparation in capsule colonoscopy. Gastrointest Endosc 2021; 93:212-223. [PMID: 32534054 DOI: 10.1016/j.gie.2020.05.062] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/11/2020] [Accepted: 05/25/2020] [Indexed: 02/08/2023]
Abstract
BACKGROUND AND AIMS Current colon capsule (CC) cleansing grading scales rely on subjective parameters and lack proper interobserver agreement. We should strive for higher intra- and interobserver agreement for the evaluation of the cleansing quality of CCs. Here we sought to validate a new grading scale for the evaluation of CC cleansing. METHODS For the new grading scale, named Colon Capsule CLEansing Assessment and Report (CC-CLEAR), the colon was divided in 3 segments: right-sided, transverse, and left-sided colon. Each segment was scored according to an estimation of the percentage of visualized mucosa (0, <50%; 1, 50%-75%; 2, >75%; 3, >90%). The overall cleansing classification was a sum of each segment score, grading between excellent (8-9), good (6-7), and inadequate (0-5). Any segment scoring ≤1 resulted in inadequate overall classification. Videos were reviewed and scored using CC-CLEAR and the Leighton-Rex grading scale by 2 experienced operators blinded to each other. Kendall's coefficient evaluated inter- and intraobserver agreement. RESULTS We included 58 consecutive CCs, corresponding to 75.9% women, with a mean age of 65 years. Overall cleansing CC-CLEAR classifications were as follows: reader A, 22.4% (n = 13) excellent, 31% (n = 18) good, and 46.5% (n = 27) inadequate; and reader B, 24.1% (n = 14) excellent, 22.4% (n = 13) good, and 53.4% (n = 31) inadequate. CC-CLEAR interobserver agreement was superior to the Leighton-Rex scale (Kendall's W .911 vs .806, respectively; P < .01). The intraobserver agreement for CC-CLEAR was excellent for both readers (P > .01). CONCLUSIONS CC-CLEAR is a new practical and reliable grading scale for the evaluation of bowel preparation quality using a CC, with excellent inter- and intraobserver agreement.
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Affiliation(s)
- Rui de Sousa Magalhães
- Gastroenterology Department, Hospital Senhora da Oliveira, Guimarães, Portugal; Life and Health Sciences Research Institute, School of Medicine, University of Minho, Braga, Portugal; ICVS/3B's, PT Government Associate Laboratory, Guimarães/Braga, Portugal
| | - Cátia Arieira
- Gastroenterology Department, Hospital Senhora da Oliveira, Guimarães, Portugal; Life and Health Sciences Research Institute, School of Medicine, University of Minho, Braga, Portugal; ICVS/3B's, PT Government Associate Laboratory, Guimarães/Braga, Portugal
| | - Pedro Boal Carvalho
- Gastroenterology Department, Hospital Senhora da Oliveira, Guimarães, Portugal; Life and Health Sciences Research Institute, School of Medicine, University of Minho, Braga, Portugal; ICVS/3B's, PT Government Associate Laboratory, Guimarães/Braga, Portugal
| | - Bruno Rosa
- Gastroenterology Department, Hospital Senhora da Oliveira, Guimarães, Portugal; Life and Health Sciences Research Institute, School of Medicine, University of Minho, Braga, Portugal; ICVS/3B's, PT Government Associate Laboratory, Guimarães/Braga, Portugal
| | - Maria João Moreira
- Gastroenterology Department, Hospital Senhora da Oliveira, Guimarães, Portugal; Life and Health Sciences Research Institute, School of Medicine, University of Minho, Braga, Portugal; ICVS/3B's, PT Government Associate Laboratory, Guimarães/Braga, Portugal
| | - José Cotter
- Gastroenterology Department, Hospital Senhora da Oliveira, Guimarães, Portugal; Life and Health Sciences Research Institute, School of Medicine, University of Minho, Braga, Portugal; ICVS/3B's, PT Government Associate Laboratory, Guimarães/Braga, Portugal
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23
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The Use of Capsule Endoscopy to Determine Tablet Disintegration In Vivo. Pharmaceutics 2020; 12:pharmaceutics12060498. [PMID: 32486088 PMCID: PMC7355699 DOI: 10.3390/pharmaceutics12060498] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2020] [Revised: 05/26/2020] [Accepted: 05/27/2020] [Indexed: 12/22/2022] Open
Abstract
The preferred delivery route for drugs targeted for systemic effect is by oral administration. Following oral administration, a solid dosage form must disintegrate and the drug dissolve, thereafter permeating the intestinal mucosa. Several different in vitro methods are used to investigate these processes, i.e., disintegration tests, dissolution tests, and permeability models. However, the actual behavior of oral dosage forms in the environment of the gastro-intestinal tract is not very well elucidated using these conventional methods. In this study, the use of capsule endoscopy to determine tablet disintegration in vivo was assessed. Panadol and Panadol Rapid (acetaminophen/paracetamol) were used as the test material. The in vivo tablet disintegration behavior in beagle dogs was assessed by the use of capsule endoscopy. The in vitro tablet disintegration behavior was assessed using the European Pharmacopeia (Ph. Eur.) disintegration test. The study showed that the in vivo disintegration times of Panadol and Panadol Rapid were 24.7 and 16.5 min, respectively, when determined by capsule endoscopy, which corresponded to the pharmacokinetic data. By contrast, the in vitro disintegration times of the same formulations were 5.5 and 4.0 min, respectively, when determined by the Ph. Eur. disintegration test. In conclusion, capsule endoscopy can be used to determine the in vivo tablet disintegration behavior. By contrast, the in vitro methods appear to not be predictive of the disintegration behavior in vivo but may be used to rank the order the formulations with respect to disintegration time.
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24
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Tontini GE, Rizzello F, Cavallaro F, Bonitta G, Gelli D, Pastorelli L, Salice M, Vecchi M, Gionchetti P, Calabrese C. Usefulness of panoramic 344°-viewing in Crohn's disease capsule endoscopy: a proof of concept pilot study with the novel PillCam™ Crohn's system. BMC Gastroenterol 2020; 20:97. [PMID: 32264831 PMCID: PMC7140388 DOI: 10.1186/s12876-020-01231-0] [Citation(s) in RCA: 19] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/03/2019] [Accepted: 03/24/2020] [Indexed: 02/07/2023] Open
Abstract
BACKGROUND A new capsule endoscopy (CE) system featuring two advanced optics for 344°-viewing and a prolonged operative time has been recently developed for Crohn's disease (CD) patients. Hence, we evaluated, for the first time, the performance of this novel CE and the add-on value of the 344°-viewing in a multi-center real-life setting. METHODS Consecutive patients with suspected or established CD received the PillCam™ Crohn's System as supplementary diagnostic work-up focused on the small-bowel between June 2017 and June 2018. Technical and clinical data, including the panenteric CE diagnostic yield, the Lewis score and the impact of small-bowel findings on clinical management during a 6-months follow-up (new diagnosis, staging or treatment upgrade) were collected, thereby evaluating the added value of the 344° panoramic-view (lesions detected by camera A and B) over the standard 172°-view (lesions detected by one camera only). RESULTS Among 41 patients (aged 43 ± 20 years), 73% underwent CE for suspected CD and 27% for established CD. The rate of complete enteroscopy was 90%. No technical failure or retention occurred. Compared to the standard 172° view, the panoramic 344°-view revealed a greater number of patients with a relevant lesion (56.1% vs. 39.0%; P = 0.023), resulting in higher Lewis score (222,8 vs. 185.7; P = 0.031), and improved clinical management (48.8% vs. 31.7%, P = 0.023). CONCLUSIONS The panoramic 344°-view increases small-bowel CE accuracy, thereby improving the clinical management of CD patients with mild small-bowel active disease. This system should be regarded as a new standard for both small-bowel diagnosis and monitoring in inflammatory bowel diseases.
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Affiliation(s)
- 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.
| | - Fernando Rizzello
- IBD Unit, Department of Medical and Surgical Sciences (DIMEC), Policlinico S.Orsola-Malpighi, University of Bologna, Bologna, Italy
| | - Flaminia Cavallaro
- Gastroenterology and Digestive Endoscopy Unit, IRCCS Policlinico San Donato, San Donato Milanese, Milan, Italy
| | - Gianluca Bonitta
- Gastroenterology and Digestive Endoscopy Unit, IRCCS Policlinico San Donato, San Donato Milanese, Milan, Italy
| | - Dania Gelli
- IBD Unit, Department of Medical and Surgical Sciences (DIMEC), Policlinico S.Orsola-Malpighi, University of Bologna, Bologna, Italy
| | - Luca Pastorelli
- Gastroenterology and Digestive Endoscopy Unit, IRCCS Policlinico San Donato, San Donato Milanese, Milan, Italy
- Department of Biomedical Sciences for Health, University of Milan, Milan, Italy
| | - Marco Salice
- IBD Unit, Department of Medical and Surgical Sciences (DIMEC), Policlinico S.Orsola-Malpighi, University of Bologna, Bologna, 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
| | - Paolo Gionchetti
- IBD Unit, Department of Medical and Surgical Sciences (DIMEC), Policlinico S.Orsola-Malpighi, University of Bologna, Bologna, Italy
| | - Carlo Calabrese
- IBD Unit, Department of Medical and Surgical Sciences (DIMEC), Policlinico S.Orsola-Malpighi, University of Bologna, Bologna, Italy
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25
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Eliakim R, Yablecovitch D, Lahat A, Ungar B, Shachar E, Carter D, Selinger L, Neuman S, Ben-Horin S, Kopylov U. A novel PillCam Crohn's capsule score (Eliakim score) for quantification of mucosal inflammation in Crohn's disease. United European Gastroenterol J 2020; 8:544-551. [PMID: 32213037 DOI: 10.1177/2050640620913368] [Citation(s) in RCA: 34] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
Abstract
INTRODUCTION Capsule endoscopy is an important modality for monitoring of Crohn's disease. Recently, a novel panenteric capsule, PillCam Crohn's (Medtronic, USA), was approved for use. No quantitative index of inflammation for this method is currently available. This sub-study of a prospective randomized controlled Comprehensive individUalized pRoactive ThErapy of Crohn's Disease trial (CURE-CD) which aimed to compare the correlation and reliability of the novel PillCam Crohn's score with the existing small bowel capsule Lewis inflammatory score. METHODS The study cohort included Crohn's disease patients in remission who were evaluated with PillCam Crohn's. Each result was independently reviewed by two experienced readers. Inflammation was scored in all studies using Lewis inflammatory score and PillCam Crohn's score (comprised of a sum of scores for most common and most severe lesions multiplied by percentage of segmental involvement + stricture score). RESULTS Fifty-four PillCam Crohn's studies from 41 patients were included. The median Lewis inflammatory score was 225 for both readers. The median PillCam Crohn's score was six (0-14) and four (3-15) for readers 1 and 2, respectively. There was a high inter-rater reliability coefficient between the two readers for Lewis inflammatory and PillCam Crohn's score (0.9, p < 0.0001 for both). The correlation between PillCam Crohn's score and fecal calprotectin was stronger than for Lewis inflammatory score (r = 0.32 and 0.54 respectively, p = 0.001 for both). CONCLUSIONS The novel panenteric capsule score correlates well with the Lewis inflammatory score, has excellent reliability, and may be potentially more accurate in estimation of the panenteric inflammatory burden.
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Affiliation(s)
- Rami Eliakim
- Department of Gastroenterology, Sheba Medical Center, Ramat Gan, Israel.,Sackler Medical School, Tel-Aviv University, Tel-Aviv, Israel
| | - Doron Yablecovitch
- Department of Gastroenterology, Sheba Medical Center, Ramat Gan, Israel.,Sackler Medical School, Tel-Aviv University, Tel-Aviv, Israel
| | - Adi Lahat
- Department of Gastroenterology, Sheba Medical Center, Ramat Gan, Israel.,Sackler Medical School, Tel-Aviv University, Tel-Aviv, Israel
| | - Bella Ungar
- Department of Gastroenterology, Sheba Medical Center, Ramat Gan, Israel.,Sackler Medical School, Tel-Aviv University, Tel-Aviv, Israel
| | - Eyal Shachar
- Department of Gastroenterology, Sheba Medical Center, Ramat Gan, Israel.,Sackler Medical School, Tel-Aviv University, Tel-Aviv, Israel
| | - Dan Carter
- Department of Gastroenterology, Sheba Medical Center, Ramat Gan, Israel.,Sackler Medical School, Tel-Aviv University, Tel-Aviv, Israel
| | - Limor Selinger
- Department of Gastroenterology, Sheba Medical Center, Ramat Gan, Israel.,Sackler Medical School, Tel-Aviv University, Tel-Aviv, Israel
| | - Sandra Neuman
- Department of Gastroenterology, Sheba Medical Center, Ramat Gan, Israel.,Sackler Medical School, Tel-Aviv University, Tel-Aviv, Israel
| | - Shomron Ben-Horin
- Department of Gastroenterology, Sheba Medical Center, Ramat Gan, Israel.,Sackler Medical School, Tel-Aviv University, Tel-Aviv, Israel
| | - Uri Kopylov
- Department of Gastroenterology, Sheba Medical Center, Ramat Gan, Israel.,Sackler Medical School, Tel-Aviv University, Tel-Aviv, Israel
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26
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Pasha SF, Pennazio M, Rondonotti E, Wolf D, Buras MR, Albert JG, Cohen SA, Cotter J, D'Haens G, Eliakim R, Rubin DT, Leighton JA. Capsule Retention in Crohn's Disease: A Meta-analysis. Inflamm Bowel Dis 2020; 26:33-42. [PMID: 31050736 DOI: 10.1093/ibd/izz083] [Citation(s) in RCA: 56] [Impact Index Per Article: 14.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/29/2019] [Indexed: 12/14/2022]
Abstract
BACKGROUND The main factor that limits wider utilization of capsule endoscopy (CE) in Crohn's disease (CD) is the potential risk of retention. The aim of this systematic review was to evaluate capsule retention rates in adult and pediatric CD and determine if retention risk is reduced in established CD (ECD) with patency capsule (PC) or magnetic resonance/computed tomography (MR/CT) enterography. METHODS Studies of CD patients undergoing CE that reported retention were identified. Pooled estimates for retention rates and relative risk in ECD to suspected CD (SCD) were calculated. All hypothesis tests were 2-sided; statistical significance was set at a P value of <0.05. RESULTS In the overall CD cohort, retention rates were 3.32% (95% confidence interval [CI], 2.62%-4.2%): 4.63% (95% CI, 3.42%-6.25%) and 2.35% (95% CI, 1.31%-4.19%) in ECD and SCD, respectively. Retention rates were 3.49% (95% CI, 2.73%-4.46%) and 1.64% (95% CI, 0.68%-3.89%) in adult and pediatric CD, respectively. Retention risk in adult ECD was 3.4 times higher than SCD, but there was no difference in retention risk in pediatric ECD compared with SCD. Retention rates in ECD were decreased after patency capsule (2.88%; 95% CI, 1.74%-4.74%) and MR/CT enterography (2.32%; 95% CI, 0.87%-6.03%). CONCLUSIONS In comparison with older literature, this meta-analysis demonstrates lower CE retention rates in SCD and ECD. Retention rates in pediatric CD were lower than in adult CD. Retention rates in adult ECD were higher than SCD, but there were no differences between pediatric ECD and SCD. Retention rates in ECD were lower after negative PC or MR/CT enterography.
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Affiliation(s)
| | - Marco Pennazio
- Division of Gastroenterology U, San Giovanni AS University-Teaching Hospital, Torino, Italy
| | | | - Douglas Wolf
- Atlanta Gastroenterology Associates, Atlanta, Georgia, USA
| | - Matthew R Buras
- Division of Health Sciences Research, Mayo Clinic Arizona, Scottsdale, Arizona, USA
| | - Jörg G Albert
- Abteilung für Gastroenterologie, Hepatologie und Endokrinologie, Robert-Bosch-Krankenhaus, Stuttgart, Germany
| | - Stanley A Cohen
- Children's Center for Digestive Health Care, Children's Healthcare of Atlanta, Atlanta, Georgia, USA
| | - Jose Cotter
- Gastroenterology Department, Hospital Senhora da Oliveira, Guimarães, Life and Health Sciences Research Institute (ICVS), School of Medicine, University of Minho, Braga, Portugal
| | - Geert D'Haens
- Amsterdam University Medical Center, Amsterdam, the Netherlands
| | | | - David T Rubin
- The University of Chicago Medicine, Chicago, Illinois, USA
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27
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Arieira C, Magalhães R, Dias de Castro F, Boal Carvalho P, Rosa B, Moreira MJ, Cotter J. CECDAIic - a new useful tool in pan-intestinal evaluation of Crohn's disease patients in the era of mucosal healing. Scand J Gastroenterol 2019; 54:1326-1330. [PMID: 31646914 DOI: 10.1080/00365521.2019.1681499] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
Background: Pan-intestinal capsule endoscopy (Pan-CE) has been used to assess both the small and large bowel inflammation in Crohn's disease (CD) patients in a single examination. The capsule endoscopy Crohn's disease activity index (CECDAI) was initially developed to measure mucosal disease activity in the small bowel, although in 2018, it was extended to the colon for standardization of inflammatory activity (CECDAIic). The aim of this study was to apply the CECDAIic in a cohort of CD patients that underwent Pan-CE to evaluate the inter-observer agreement and the correlation between this score and inflammatory parameters.Methods: The videos were read and scored using the CECDAIic by three independent experienced operators, blinded to the results of the standard workup. Statistical analysis was performed with SPSS®, using Kendall's coefficient to evaluate the inter-observer agreement. Spearman correlation (rs) was used to access the correlation between the score and inflammatory biomarkers.Results: Included 22 patients, 59.1% males with mean age of 30.7 ± 11.1 years. The median CECDAIic score was 9.17 (0-37). The overall CECDAIic score Kendall coefficient was 0.94, demonstrating a statistically significant (p < .001) and excellent agreement between the three observers. In addition, we found a very good correlation between CECDAIic and calprotectin (rs = 0.82; p = .012) and a moderate correlation with C-reactive protein (CRP, rs = 0.50; p = .019).Conclusions: CECDAIic is a new score with excellent inter-observer agreement and strong correlation with calprotectin levels.
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Affiliation(s)
- Cátia Arieira
- Gastroenterology Department, Hospital da Senhora da Oliveira, Guimarães, Portugal.,Life and Health Sciences Research Institute, School of Medicine, University of Minho, Braga/Guimarães, Portugal.,ICVS/3B's-PT Government Associate Laboratory, Braga/Guimarães, Portugal
| | - Rui Magalhães
- Gastroenterology Department, Hospital da Senhora da Oliveira, Guimarães, Portugal.,Life and Health Sciences Research Institute, School of Medicine, University of Minho, Braga/Guimarães, Portugal.,ICVS/3B's-PT Government Associate Laboratory, Braga/Guimarães, Portugal
| | - Francisca Dias de Castro
- Gastroenterology Department, Hospital da Senhora da Oliveira, Guimarães, Portugal.,Life and Health Sciences Research Institute, School of Medicine, University of Minho, Braga/Guimarães, Portugal.,ICVS/3B's-PT Government Associate Laboratory, Braga/Guimarães, Portugal
| | - Pedro Boal Carvalho
- Gastroenterology Department, Hospital da Senhora da Oliveira, Guimarães, Portugal.,Life and Health Sciences Research Institute, School of Medicine, University of Minho, Braga/Guimarães, Portugal.,ICVS/3B's-PT Government Associate Laboratory, Braga/Guimarães, Portugal
| | - Bruno Rosa
- Gastroenterology Department, Hospital da Senhora da Oliveira, Guimarães, Portugal.,Life and Health Sciences Research Institute, School of Medicine, University of Minho, Braga/Guimarães, Portugal.,ICVS/3B's-PT Government Associate Laboratory, Braga/Guimarães, Portugal
| | - Maria João Moreira
- Gastroenterology Department, Hospital da Senhora da Oliveira, Guimarães, Portugal.,Life and Health Sciences Research Institute, School of Medicine, University of Minho, Braga/Guimarães, Portugal.,ICVS/3B's-PT Government Associate Laboratory, Braga/Guimarães, Portugal
| | - José Cotter
- Gastroenterology Department, Hospital da Senhora da Oliveira, Guimarães, Portugal.,Life and Health Sciences Research Institute, School of Medicine, University of Minho, Braga/Guimarães, Portugal.,ICVS/3B's-PT Government Associate Laboratory, Braga/Guimarães, Portugal
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28
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Tontini GE, Manfredi G, Orlando S, Neumann H, Vecchi M, Buscarini E, Elli L. Endoscopic ultrasonography and small-bowel endoscopy: Present and future. Dig Endosc 2019; 31:627-643. [PMID: 31090965 DOI: 10.1111/den.13429] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/08/2019] [Accepted: 05/13/2019] [Indexed: 12/12/2022]
Abstract
Over the last decade, impressive technological advances have occurred in ultrasonography and small-bowel endoscopy. Nowadays, endoscopic ultrasonography is an essential diagnostic tool and a therapeutic weapon for pancreatobiliary disorders. Capsule endoscopy and device-assisted enteroscopy have quickly become the reference standard for the diagnosis of small-bowel luminal diseases, thereby leading to radical changes in diagnostic and therapeutic pathways. We herein provide an up-to-date overview of the latest advances in endoscopic ultrasonography and small-bowel endoscopy, focusing on the emerging paradigms and technological innovations that might improve clinical practice in the near future.
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Affiliation(s)
- Gian Eugenio Tontini
- Gastroenterology and Endoscopy Unit, Foundation IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy.,Department of Pathophysiology and Transplantation, University of Milan, Milan, Italy
| | | | - Stefania Orlando
- Gastroenterology and Endoscopy Unit, Foundation IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy.,Digestive Endoscopy and Gastroenterology Unit, ASST of Cremona, Cremona, Italy
| | - Helmut Neumann
- Department of Medicine I, University Medical Center Mainz, Mainz, Germany
| | - Maurizio Vecchi
- Gastroenterology and Endoscopy Unit, Foundation IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy.,Department of Pathophysiology and Transplantation, University of Milan, Milan, Italy
| | | | - Luca Elli
- Gastroenterology and Endoscopy Unit, Foundation IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
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29
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Adler SN, González Lama Y, Matallana Royo V, Suárez Ferrer C, Schwartz A, Bar-Gil Shitrit A. Comparison of small-bowel colon capsule endoscopy system to conventional colonoscopy for the evaluation of ulcerative colitis activity. Endosc Int Open 2019; 7:E1253-E1261. [PMID: 31579707 PMCID: PMC6773590 DOI: 10.1055/a-0982-2786] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/30/2018] [Accepted: 03/19/2019] [Indexed: 02/07/2023] Open
Abstract
Background and aims Diagnosis and monitoring of ulcerative colitis (UC) includes conventional colonoscopy. This procedure is invasive and does not exclude small-bowel Crohn's disease (CD). Current therapeutic goals include mucosal healing which may lead to an increased number of endoscopic procedures in many patients. The small-bowel colon capsule endoscopy (SBC-CE) system visualizes the small bowel and colon. The aim of this study was to evaluate the performance and adverse events of SBC-CE in patients with UC. Methods This was a prospective, feasibility study involving two study sites. Patients with active UC underwent SBC-CE and colonoscopy. Kappa statistics were performed to assess the agreement between SBC-CE and colonoscopy. Adverse events (AEs) data were collected throughout and following the procedure. Results In total, 30 consecutive patients were recruited, and 23 of those were included in the final analysis. For the primary end point, evaluation of the extent of UC disease in the colon, the percent agreement between SBC-CE and colonoscopy was moderate (56.5 %); kappa coefficient 0.42. The percent agreement between SBC-CE and colonoscopy for UC disease activity, based on Mayo endoscopic sub-score, was 95.7 %; kappa coefficient 0.86. Disease activity in the more proximal small bowel was detected in two patients with SBC-CE. No SBC-CE device-related AEs were reported. Conclusions When comparing SBC-CE to conventional colonoscopy, there was a moderate agreement for the extent of UC disease and a very good overall agreement between the two modalities for UC disease activity.
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Affiliation(s)
- Samuel N. Adler
- Digestive Disease Institute, Shaare Zedek Medical Center, Jerusalem, Israel,Corresponding author Samuel N. Adler, MD Digestive Disease InstituteShaare Zedek Medical CenterJerusalemIsrael+972-2-5636065
| | - Yago González Lama
- Gastroenterology and Hepatology Department, Puerta de Hierro University Hospital, Majadahonda, Madrid, Spain
| | - Virginia Matallana Royo
- Gastroenterology and Hepatology Department, Puerta de Hierro University Hospital, Majadahonda, Madrid, Spain
| | - Cristina Suárez Ferrer
- Gastroenterology and Hepatology Department, Puerta de Hierro University Hospital, Majadahonda, Madrid, Spain
| | - Avraham Schwartz
- Digestive Disease Institute, Shaare Zedek Medical Center, Jerusalem, Israel
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30
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Hosoe N, Takabayashi K, Ogata H, Kanai T. Capsule endoscopy for small-intestinal disorders: Current status. Dig Endosc 2019; 31:498-507. [PMID: 30656743 DOI: 10.1111/den.13346] [Citation(s) in RCA: 46] [Impact Index Per Article: 9.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/10/2018] [Accepted: 01/09/2019] [Indexed: 12/13/2022]
Abstract
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.
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Affiliation(s)
- Naoki Hosoe
- Center for Diagnostic and Therapeutic Endoscopy, School of Medicine, Keio University, Tokyo, Japan
| | - Kaoru Takabayashi
- Center for Diagnostic and Therapeutic Endoscopy, School of Medicine, Keio University, Tokyo, Japan
| | - Haruhiko Ogata
- Center for Diagnostic and Therapeutic Endoscopy, School of Medicine, Keio University, Tokyo, Japan
| | - Takanori Kanai
- Division of Gastroenterology and Hepatology, Department of Internal Medicine, School of Medicine, Keio University, Tokyo, Japan
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31
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Sturm A, Maaser C, Calabrese E, Annese V, Fiorino G, Kucharzik T, Vavricka SR, Verstockt B, van Rheenen P, Tolan D, Taylor SA, Rimola J, Rieder F, Limdi JK, Laghi A, Krustiņš E, Kotze PG, Kopylov U, Katsanos K, Halligan S, Gordon H, González Lama Y, Ellul P, Eliakim R, Castiglione F, Burisch J, Borralho Nunes P, Bettenworth D, Baumgart DC, Stoker J. ECCO-ESGAR Guideline for Diagnostic Assessment in IBD Part 2: IBD scores and general principles and technical aspects. J Crohns Colitis 2019; 13:273-284. [PMID: 30137278 DOI: 10.1093/ecco-jcc/jjy114] [Citation(s) in RCA: 236] [Impact Index Per Article: 47.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Affiliation(s)
- Andreas Sturm
- Department of Gastroenterology, DRK Kliniken Berlin I Westend, Berlin, Germany
| | - Christian Maaser
- Outpatients Department of Gastroenterology, Hospital Lüneburg, Lüneburg, Germany
| | - Emma Calabrese
- Department of Systems Medicine, University of Rome, Tor Vergata, Italy
| | - Vito Annese
- Department of Gastroenterology, Valiant Clinic & American Hospital, Dubai, UAE
| | - Gionata Fiorino
- Department of Gastroenterology, Humanitas Clinical and Research Institute, Milan, Italy
| | - Torsten Kucharzik
- Department of Internal Medicine and Gastroenterology, Hospital Lüneburg, Lüneburg, Germany
| | | | - Bram Verstockt
- Department of Gastroenterology and Hepatology, University Hospitals Leuven and CHROMETA - Translational Research in Gastrointestinal Disorders, KU Leuven, Belgium
| | - Patrick van Rheenen
- Department of Paediatric Gastroenterology, Hepatology and Nutrition, University Medical Center Groningen, Groningen, The Netherlands
| | - Damian Tolan
- Clinical Radiology, St James's University Hospital, Leeds, UK
| | - Stuart A Taylor
- Centre for Medical Imaging, University College London, London, UK
| | - Jordi Rimola
- Department of Radiology, Hospital Clínic Barcelona, Barcelona, Spain
| | - Florian Rieder
- Department of Gastroenterology, Hepatology & Nutrition, Digestive Diseases and Surgery Institute, Cleveland Clinic, Cleveland, OH, USA
| | - Jimmy K Limdi
- Department of Gastroenterology, Pennine Acute Hospitals NHS Trust, Manchester; Manchester Academic Health Sciences Centre, University of Manchester, Manchester, UK
| | - Andrea Laghi
- Department of Clinical and Surgical Translational Medicine, Sapienza - University of Rome, Rome, Italy
| | - Eduards Krustiņš
- Department of Gastroenterology, Hepatology and Nutrition, Pauls Stradins Clinical University Hospital, Riga, Latvia
| | - Paulo G Kotze
- Colorectal Surgery Unit, Catholic University of Paraná PUCPR, Curitiba, Brazil
| | - Uri Kopylov
- Department of Gastroenterology, Sheba Medical Center, Sackler School of Medicine, Tel Aviv, Israel
| | - Konstantinos Katsanos
- Department of Gastroenterology and Hepatology, University and Medical School of Ioannina, Ioannina, Greece
| | - Steve Halligan
- Centre for Medical Imaging, University College London, London, UK
| | - Hannah Gordon
- Section of Gastroenterology & Hepatology, Royal London Hospital, London, UK
| | - Yago González Lama
- Department of Gastroenterology, University Hospital Puerta De Hierro, Majadahonda Madrid, Spain
| | - Pierre Ellul
- Department of Medicine, Mater Dei Hospital, Msida, Malta
| | - Rami Eliakim
- Department of Gastroenterology, Sheba Medical Center, Sackler School of Medicine, Tel Aviv, Israel
| | - Fabiana Castiglione
- Department of Clinical Medicine and Surgery, "Federico II" University of Naples, Naples, Italy
| | - Johan Burisch
- Department of Gastroenterology, North Zealand University Hospital; Center for Clinical Research and Prevention, Bispebjerg and Frederiksberg Hospital, Frederiksberg, Denmark
| | - Paula Borralho Nunes
- Department of Anatomic Pathology, Hospital Cuf Descobertas; Faculdade de Medicina da Universidade de Lisboa, Lisbon, Portugal
| | - Dominik Bettenworth
- Department of Medicine B, Gastroenterology and Hepatology, University Hospital Münster, Münster, Germany
| | - Daniel C Baumgart
- Division of Gastroenterology, University of Alberta, Edmonton, AB, Canada
| | - Jaap Stoker
- Department of Radiology and Nuclear Medicine, Academic Medical Center AMC, University of Amsterdam, Amsterdam, The Netherlands
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32
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Deepak P, Fowler KJ, Fletcher JG, Bruining DH. Novel Imaging Approaches in Inflammatory Bowel Diseases. Inflamm Bowel Dis 2019; 25:248-260. [PMID: 30010908 DOI: 10.1093/ibd/izy239] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/21/2018] [Indexed: 12/12/2022]
Abstract
Inflammatory bowel diseases are chronic autoimmune conditions of the gastrointestinal tract, mainly grouped into ulcerative colitis or Crohn's disease. Traditionally, symptoms have been used to guide IBD management, but this approach is fatally flawed, as symptoms don't correlate with disease activity and often fail to predict disease complications, especially with Crohn's disease. Hence, there is increasing recognition of the need for treatment algorithms based on objective measures of bowel inflammation. In this review, we will focus on advancements in the endoscopic and radiological imaging armamentarium that allow detailed assessments from intestinal mucosa to mesentery.
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Affiliation(s)
- Parakkal Deepak
- Division of Gastroenterology, John T. Milliken Department of Medicine, Washington University in St. Louis School of Medicine, St. Louis, Missouri
| | - Kathryn J Fowler
- Department of Radiology, Washington University in St. Louis School of Medicine, St. Louis, Missouri
| | - Joel G Fletcher
- Division of Abdominal Imaging, Mayo Clinic College of Medicine, Rochester, Minnesota
| | - David H Bruining
- Division of Gastroenterology and Hepatology, Mayo Clinic College of Medicine, Rochester, Minnesota
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33
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Eliakim R, Spada C, Lapidus A, Eyal I, Pecere S, Fernández-Urién I, Lahat A, Costamagna G, Schwartz A, Ron Y, Yanai H, Adler S. Evaluation of a new pan-enteric video capsule endoscopy system in patients with suspected or established inflammatory bowel disease - feasibility study. Endosc Int Open 2018; 6:E1235-E1246. [PMID: 30302381 PMCID: PMC6175676 DOI: 10.1055/a-0677-170] [Citation(s) in RCA: 35] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/05/2018] [Accepted: 05/30/2018] [Indexed: 01/09/2023] Open
Abstract
Background and study aims Inflammatory bowel disease (IBD) affects the small bowel and colon. Endoscopic evaluation of these organs is essential. The new pan-enteric Crohn's capsule (PCC) system is customized for complete coverage of IBD lesions in the entire bowel, allowing assessment and follow-up of disease severity and extent. The aim of this study was to evaluate the functionality of the PCC system in patients with suspected or established IBD. Patients and methods This was a prospective five-center feasibility study assessing the performance of PCC. Subjects ingested PCC after patency assurance with standard bowel preparation plus boosts. The primary endpoint was successful procedure, that is, video creation and report generation in accordance with methodology. Secondary endpoints were subjective coverage of the entire bowel, duration of reading time, video quality and occurrence of adverse events. Results Forty-one patients were included in the study with a mean age of 40.8 years ± 15.5, 46 % of whom were males. Seventy-one percent of patients had established Crohn's disease (CD) and 53 % had active disease. Cleansing was graded good/excellent in 95 %. All 41 videos met the primary endpoint. There was no retention, 83 % reached the toilet while still recording. Thirty-one percent of patients with CD had proximal disease. Bowel coverage was graded 6.7 ± 0.6 and 6.1 ± 1.3 (1 - 7, unconfident - confident), image quality 6.1 ± 0.8 (1 - 7, poor - excellent), and reading time 3.7 ± 1.4 (1 - 7, very short to very long). Conclusions The PCC system is a minimally invasive system allowing extensive evaluation of the entire bowel in patients with IBD.
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Affiliation(s)
- Rami Eliakim
- Sheba Medical Center, Gastroenterology, Ramat Gan, Israel
| | - Cristiano Spada
- Catholic University – Digestive Endoscopy Unit, Rome, Italy,Fondazione Poliambulanza Istituto Ospedaliero – Digestive Endoscopy, Brescia, Italy
| | | | | | - Silvia Pecere
- Policlinico Universitario Agostino Gemelli – Digestive Endoscopy Unit, Rome, Italy
| | | | - Adi Lahat
- Sheba Medical Center, Gastroenterology, Ramat Gan, Israel
| | - Guido Costamagna
- Catholic University – Digestive Endoscopy Unit, Rome, Italy,Fondazione Poliambulanza Istituto Ospedaliero – Digestive Endoscopy, Brescia, Italy
| | - Avraham Schwartz
- Shaare Zedek Medical Center – Gastroenterology, Jerusalem, Israel
| | - Yulia Ron
- Tel Aviv Sourasky Medical Ceneter – Gastroenterology, Tel Aviv, Irael
| | - Henit Yanai
- Tel Aviv Sourasky Medical Ceneter – Gastroenterology, Tel Aviv, Irael
| | - Samuel Adler
- Shaare Zedek Medical Center – Gastroenterology, Jerusalem, Israel
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34
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Oliva S, Thomson M, de Ridder L, Martín-de-Carpi J, Van Biervliet S, Braegger C, Dias JA, Kolacek S, Miele E, Buderus S, Bronsky J, Winter H, Navas-López VM, Assa A, Chong SKF, Afzal NA, Smets F, Shaoul R, Hussey S, Turner D, Cucchiara S. Endoscopy in Pediatric Inflammatory Bowel Disease: A Position Paper on Behalf of the Porto IBD Group of the European Society for Pediatric Gastroenterology, Hepatology and Nutrition. J Pediatr Gastroenterol Nutr 2018; 67:414-430. [PMID: 30130311 DOI: 10.1097/mpg.0000000000002092] [Citation(s) in RCA: 58] [Impact Index Per Article: 9.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
Endoscopy is a central tool for the evaluation and management of inflammatory bowel disease (IBD). In the last few decades, gastrointestinal (GI) endoscopy has undergone significant technological developments including availability of pediatric-size equipment, enabling comprehensive investigation of the GI tract in children. Simultaneously, professional organization of GI experts have developed guidelines and training programs in pediatric GI endoscopy. This prompted the Porto Group on Pediatric IBD of the European Society for Pediatric Gastroenterology, Hepatology and Nutrition to develop updated guidelines on the role of GI endoscopy in pediatric IBD, specifically taking into considerations of recent advances in the diagnosis, disease stratification, and novel therapeutic targets in these patients.
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Affiliation(s)
- Salvatore Oliva
- Pediatric Gastroenterology and Liver Unit, Sapienza-University of Rome, Italy
| | - Mike Thomson
- Centre for Paediatric Gastroenterology, Sheffield Children's Hospital, Sheffield, United Kingdom
| | - Lissy de Ridder
- Pediatric Gastroenterology, Erasmus Medical Center/Sophia Children's Hospital, Rotterdam, The Netherlands
| | - Javier Martín-de-Carpi
- Department of Pediatric Gastroenterology, Hepatology, and Nutrition, Hospital Sant Joan de Déu, Barcelona, Spain
| | | | - Christian Braegger
- Division of Gastroenterology and Nutrition, University Children's Hospital, Zurich, Switzerland
| | - Jorge Amil Dias
- Pediatric Gastroenterology Unit, Hospital Sao João, Porto, Portugal
| | - Sanja Kolacek
- Children's Hospital Zagreb, Faculty of Medicine, Zagreb, Croatia
| | - Erasmo Miele
- Department of Translational Medical Science, Section of Pediatrics, "Federico II," University of Naples, Italy
| | | | - Jiri Bronsky
- Department of Paediatrics, University Hospital Motol, Prague, Czech Republic
| | - Harland Winter
- Department of Pediatrics, Massachusetts General Hospital, Boston, MA
| | | | - Amit Assa
- Institute of Gastroenterology, Nutrition and Liver Diseases, Schneider Children's Medical Center, affiliated to the Sackler faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Sonny K F Chong
- Queen Mary's Hospital for Children, Epsom & St Helier University Hospitals NHS Trust, Carshalton, Surrey
| | - Nadeem Ahmad Afzal
- Department of Paediatric Gastroenterology, University Hospital Southampton, Southampton, UK
| | - Francoise Smets
- Pediatric Gastroenterology and Hepatology Unit, IREC, Cliniques Universitaires Saint-Luc, Université Catholique de Louvain, Brussels, Belgium
| | | | - Séamus Hussey
- National Children's Research Centre and Royal College of Surgeons of Ireland, Dublin, Ireland
| | - Dan Turner
- Institute of Paediatric Gastroenterology, Hebrew University of Jerusalem, Jerusalem, Israel
| | - Salvatore Cucchiara
- Pediatric Gastroenterology and Liver Unit, Sapienza-University of Rome, Italy
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35
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Arieira C, Dias de Castro F, Rosa B, Moreira MJ, Firmino-Machado J, Cotter J. Can we rely on inflammatory biomarkers for the diagnosis and monitoring Crohn's disease activity? REVISTA ESPANOLA DE ENFERMEDADES DIGESTIVAS 2018; 109:828-833. [PMID: 28950707 DOI: 10.17235/reed.2017.5126/2017] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
BACKGROUND Small bowel capsule endoscopy (SBCE) is a very important tool in the diagnosis and monitoring of Crohn's disease (CD). The Lewis score (LS) and Capsule Endoscopy Crohn's Disease Activity Index (CECDAI) are used to quantify and standardize inflammatory activity observed in the SBCE. AIM To evaluate the correlation between the LS and CECDAI scores and inflammation biomarkers (C-reactive protein [CRP] and erythrocyte sedimentation rate [ESR]). A secondary goal was to define thresholds for CECDAI based on thresholds already established for LS. METHODS This was a retrospective study of 110 patients with suspect or known CD, with involvement of small bowel. Linear regression was used to calculate thresholds of CECDAI corresponding to the thresholds already established for LS. A Pearson correlation (r) was used to calculate the correlation between the LS and CECDAI scores and biomarker levels. Only patients with exclusive involvement of the small bowel were selected (n = 78). RESULTS A moderate correlation was found between the endoscopic scores (r = 0.59, p < 0.001). CECDAI scores of 5.57 and 7.53 corresponded to scores of 135 and 790 in LS, respectively. There was a statistically significant correlation between CRP and the LS (r = 0.28, p = 0.014) and CECDAI (r = 0.29, p = 0.009). There was also a significant correlation between ESR and CECDAI (r = 0.29, p = 0.019), but not with LS. CONCLUSION There is a moderate correlation between the two scores. This study allowed the calculation of thresholds for CECDAI based on those defined for LS. We found a weak correlation between SBCE endoscopic activity and inflammatory biomarkers.
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Affiliation(s)
- Cátia Arieira
- Gastrenterologia, Hospital da Senhora da Oliveira- Guimarães, Portugal
| | | | - Bruno Rosa
- Gastrenterologia, Hospital da Senhora da Oliveira -Guimarães, Portugal
| | | | | | - José Cotter
- Gastrenterologia, Hospital da Senhora da Oliveira -Guimarães, Portugal
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36
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Ling C, Gavin M, Hanson J, McCarthy DM. Progressive Epigastric Pain with Abnormal Liver Tests in a Patient with Crohn's Disease: Don't DILI Dally. Dig Dis Sci 2018; 63:1751-1755. [PMID: 29934698 DOI: 10.1007/s10620-018-5135-z] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Affiliation(s)
- Christina Ling
- Division of Gastroenterology and Hepatology, Department of Medicine, University of New Mexico School of Medicine, 1 University of New Mexico, MSC10-5550, Albuquerque, NM, 87131, USA. .,Division of Gastroenterology and Hepatology, Department of Medicine, Raymond G. Murphy VA Medical Center, 1501 San Pedro SE, Albuquerque, NM, 87108, USA.
| | - Michael Gavin
- Division of Gastroenterology and Hepatology, Department of Medicine, University of New Mexico School of Medicine, 1 University of New Mexico, MSC10-5550, Albuquerque, NM, 87131, USA.,Division of Gastroenterology and Hepatology, Department of Medicine, Raymond G. Murphy VA Medical Center, 1501 San Pedro SE, Albuquerque, NM, 87108, USA
| | - Joshua Hanson
- Department of Pathology, University of New Mexico School of Medicine, Albuquerque, NM, USA
| | - Denis M McCarthy
- Division of Gastroenterology and Hepatology, Department of Medicine, University of New Mexico School of Medicine, 1 University of New Mexico, MSC10-5550, Albuquerque, NM, 87131, USA.,Division of Gastroenterology and Hepatology, Department of Medicine, Raymond G. Murphy VA Medical Center, 1501 San Pedro SE, Albuquerque, NM, 87108, USA
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37
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Abstract
Colon capsule endoscopy (CCE) is designed for direct visualization of the colonic mucosa through passive propulsion. The role of CCE in the detection of colonic polyps has been extensively evaluated. As mucosal healing has emerged as a pivotal target for treatment of inflammatory bowel disease (IBD), there is increasing data to suggest that CCE can also be used in the monitoring of mucosal inflammation in patients with active IBD, particularly in ulcerative colitis (UC) and Crohn's disease (CD). Despite advantages such as its non-invasive nature, patient's comfort, safety, and access to anatomical regions not easily reached by conventional endoscopy, CE has limitations including the lack of ability to obtain biopsies or therapeutic capabilities and no control over movement. In this review, the role and diagnostic value of CCE on diagnosis and monitoring of UC and CD patients, its safety and limitations are discussed.
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Affiliation(s)
- Jiao Li
- Department of Medicine, University of Hong Kong, Hong Kong, China.,Department of Gastroenterology, Third People's Hospital of Chengdu, Chengdu, Sichuan Province, China
| | - Wai K Leung
- Department of Medicine, University of Hong Kong, Hong Kong, China
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38
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Abstract
PURPOSE OF REVIEW This is a review of colon capsule endoscopy (CCE) with a focus on its recent developments, technological improvements, and current and potential future indications. RECENT FINDINGS Based on the current literature, CCE II demonstrates comparable polyp detection rates as optical colonoscopy and CT colonography, and improved cost-effectiveness. The main limitation to patient acceptance is the requirement of a rigorous bowel preparation. Preliminary studies show good correlation between CCE and optical colonoscopy for assessment of colonic disease activity in inflammatory bowel disease (IBD). CCE II is currently FDA, approved as an adjunctive test in patients with prior incomplete colonoscopy, and in the evaluation of patients with suspected lower gastrointestinal bleeding. The test is approved in Europe as one of the options for average-risk colorectal cancer screening, and high-risk screening in patients with contraindications or unwilling to undergo colonoscopy. CCE has a potential role in the evaluation and monitoring of colonic disease activity in IBD. Future technological advances should focus on minimizing bowel preparation, improvement in reading times, and development of therapeutic capabilities. • With technological improvements, the second-generation colon capsule has a significantly higher sensitivity than the first-generation capsule for detection of colon polyps. • Colon capsule endoscopy has been approved in Europe as an option for average-risk colorectal cancer screening, and high-risk screening in patients with contraindications or unwilling to undergo colonoscopy. • Colon capsule endoscopy has received FDA approval as an option for colorectal cancer screening in patients with prior incomplete colonoscopy, and in evaluation of patients with suspected lower gastrointestinal bleeding. • Colon capsule endoscopy may have a role in evaluation and monitoring of inflammatory bowel disease. • Colon capsule endoscopy currently requires a bowel preparation that is more rigorous than colonoscopy.
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Affiliation(s)
- Shabana F Pasha
- Division of Gastroenterology and Hepatology, Mayo Clinic Arizona, Scottsdale, AZ, USA.
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39
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Kopylov U, Koulaouzidis A, Klang E, Carter D, Ben-Horin S, Eliakim R. Monitoring of small bowel Crohn's disease. Expert Rev Gastroenterol Hepatol 2017; 11:1047-1058. [PMID: 28737951 DOI: 10.1080/17474124.2017.1359541] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
In recent years, the therapeutic paradigm in Crohn's disease has shifted from a mere symptom-oriented approach, to aiming to healing of the underlying inflammation and prevention of long-term structural complications. Such 'treat-to-target' approach may allow for a more stable disease course with less hospitalizations, lower requirement for surgery and improved quality of life. In Crohn's disease, the small bowel is affected in the majority of patients; frequently, Crohn's involves only the small bowel, which remains inaccessible to conventional ileocolonoscopic techniques. Thus, non-invasive monitoring techniques are crucial for accurate disease assessment. Areas covered: This review addresses the indications and clinical implications of non-invasive small bowel monitoring modalities (magnetic resonance enterography, intestinal ultrasound, capsule endoscopy) in the assessment and management of Crohn's disease. Expert commentary: This review addresses the limitations of the current knowledge and future areas of research, including the possible utilization of transmural healing as an imaging target and the need to establish clear quantitative target values to guide treatment by imaging findings in Crohn's disease.
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Affiliation(s)
- Uri Kopylov
- a Department of Gastroenterology, Sheba Medical Center, Tel Hashomer and Sackler Medical School , Tel Aviv University , Tel-Aviv , Israel
| | - Anastasios Koulaouzidis
- b Centre for Liver & Digestive Disorders , The Royal Infirmary of Edinburgh , Edinburgh , UK
| | - Eyal Klang
- c Department of Diagnostic Imaging, Sheba Medical Center, Tel Hashomer and Sackler Medical School , Tel Aviv University , Tel-Aviv , Israel
| | - Dan Carter
- a Department of Gastroenterology, Sheba Medical Center, Tel Hashomer and Sackler Medical School , Tel Aviv University , Tel-Aviv , Israel
| | - Shomron Ben-Horin
- a Department of Gastroenterology, Sheba Medical Center, Tel Hashomer and Sackler Medical School , Tel Aviv University , Tel-Aviv , Israel
| | - Rami Eliakim
- a Department of Gastroenterology, Sheba Medical Center, Tel Hashomer and Sackler Medical School , Tel Aviv University , Tel-Aviv , Israel
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40
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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.
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Affiliation(s)
- Tanja Nowak
- Master Program MHMM (Health and Medical Management), Friedrich-Alexander-University Erlangen-Nuremberg, Germany.,Consultant Medical Affairs, Hamburg, Germany
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41
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Eliakim R. The impact of panenteric capsule endoscopy on the management of Crohn's disease. Therap Adv Gastroenterol 2017; 10:737-744. [PMID: 28932274 PMCID: PMC5598809 DOI: 10.1177/1756283x17720860] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/17/2017] [Accepted: 06/22/2017] [Indexed: 02/04/2023] Open
Abstract
Crohn's disease (CD) is a chronic inflammatory disease, in most patients involving the small and large bowel. In recent years, with the use of small bowel video capsule endoscopy (SBCE), it has become clear that in 50% or more of adults with established CD there is not only distal but also proximal small bowel involvement that suggests poor prognosis. A great deal of effort has been put into early diagnosis and stratification of patients into low versus high risk, thus directing treatment from step-up, or accelerated step-up, to top-down therapies. SBCE has been used for assessment of small bowel pathologies for over 15 years, mainly for occult gastrointestinal bleeding and suspected CD. In recent years, a colonic capsule, with cameras on both sides and a wider angle of view, has been developed and is used by some to survey both small and large bowel. Recently the same capsule, with adjustments, has been released in Europe, concentrating (with specialized software) on inflammatory bowel disease. In this review I summarize the new data regarding the use of SBCE as well as the small bowel colon (SBC) versions of capsule endoscopy in established CD and the ways these could alter the management of such patients.
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Hausmann J, Schmelz R, Walldorf J, Filmann N, Zeuzem S, Albert JG. Pan-intestinal capsule endoscopy in patients with postoperative Crohn's disease: a pilot study. Scand J Gastroenterol 2017; 52:840-845. [PMID: 28431493 DOI: 10.1080/00365521.2017.1310289] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
BACKGROUND Patients are at increased risk of disease recurrence after surgical treatment of Crohn's disease. Endoscopic detection of postoperative, ileo-colonic inflammation is well established, but the potential of pan-intestinal endoscopy is yet unknown. METHODS This prospective multicenter pilot study assessed the value of pan-intestinal capsule endoscopy using a colon capsule endoscope for the detection of inflammatory recurrence of Crohn´s disease. Patients who had been operatively treated for Crohn´s disease were included. Colon capsule endoscopy was performed 4-8 weeks (d1) and 4-8 months (d2) postoperatively together with ileo-colonoscopy at d2 using a modified Ruttgeerts index for evaluating disease activity. RESULTS Twenty-two patients were included into this study. At d1, significant disease activity (Ruttgeerts index ≥2) was detected in 3/16 (19%) of the patients. At d2, half of the patients (6/12) showed active disease, whereas ileo-colonoscopy revealed significant inflammation in 5/15 (33%). All patients rated as having active disease by ileo-colonoscopy had been revealed by PICE as well. These findings influenced the medical treatment in every case. CONCLUSION Pan-intestinal capsule endoscopy seems to be feasible in the postoperative surveillance of Crohn's disease. Disease activity is reliably detected. Especially, the findings in the small bowl might be a significant advantage in comparison to ileo-colonoscopy, as they can have significant impact on clinical management. Further studies with a larger number of patients are needed to confirm these findings and might lead to a replacement of the flexible ileo-colonoscopy with pan-intestinal capsule endoscopy in this indication in the future.
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Affiliation(s)
- Johannes Hausmann
- a Department of Internal Medicine 1 , J.W. Goethe University Hospital Frankfurt , Frankfurt , Germany
| | - Renate Schmelz
- b Department of Internal Medicine 1 , University Hospital Carl Gustav Carus , Dresden , Germany
| | - Jens Walldorf
- c Department of Internal Medicine 1 , University Hospital Halle (Saale) , Halle , Germany
| | - Natalie Filmann
- d Institute of Biostatistics and Math Modeling, J.W. Goethe University Hospital Frankfurt , Frankfurt , Germany
| | - Stefan Zeuzem
- a Department of Internal Medicine 1 , J.W. Goethe University Hospital Frankfurt , Frankfurt , Germany
| | - Jörg G Albert
- a Department of Internal Medicine 1 , J.W. Goethe University Hospital Frankfurt , Frankfurt , Germany
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43
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Small-bowel mucosal healing assessment by capsule endoscopy as a predictor of long-term clinical remission in patients with Crohn's disease: a systematic review and meta-analysis. Eur J Gastroenterol Hepatol 2017; 29:844-848. [PMID: 28410352 DOI: 10.1097/meg.0000000000000881] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
Capsule endoscopy (CE) may be used for the evaluation and follow-up of patients with Crohn's disease. CE scores correspond to the degree of mucosal inflammation, a major therapeutic target. The aim of this meta-analysis and systematic review was to determine whether mucosal healing assessment by CE may serve as a predictor of clinical remission in patients with Crohn's disease. To identify observational or controlled English-language full-text studies assessing mucosal healing by CE in patients with Crohn's disease up to 30 September 2016, we searched PubMed, Embase, Central, Medline, and Scopus using the key words 'mucosal healing' and 'capsule endoscopy'. A meta-analysis was carried out using 'Comprehensive meta-analysis' software. Pooled odds ratios and 95% confidence intervals were calculated. Five observational studies including 142 patients from five countries fulfilled the inclusion criteria. No publication bias was found by funnel plot. The mucosal healing CE score was found to be significantly associated with improved outcome after a follow-up of 12 weeks to 24 months, with an odds ratio of 11.06 (95% confidence interval: 3.74-32.73, P<0.001). The degree of heterogeneity among the studies was small (Q=2.014, d.f.[Q]=3, P=0.569 and I=0). Endoscopy scores may play a role in the long-term prognostic evaluation of patients with Crohn's disease. Our results may be accepted as proof of concept, but larger studies are needed to corroborate these findings.
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44
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Goran L, Negreanu L, Negreanu AM. Role of new endoscopic techniques in inflammatory bowel disease management: Has the change come? World J Gastroenterol 2017; 23:4324-4329. [PMID: 28706415 PMCID: PMC5487496 DOI: 10.3748/wjg.v23.i24.4324] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/28/2017] [Revised: 03/19/2017] [Accepted: 05/09/2017] [Indexed: 02/06/2023] Open
Abstract
Despite significant therapeutic progress in recent years, inflammatory bowel disease (IBD), which includes Crohn’s disease and ulcerative colitis, remains a challenge regarding its pathogenesis and long-term complications. New concepts have emerged in the management of this disease, such as the “treat-to-target” concept, in which mucosal healing plays a key role in the evolution of IBD, the risk of recurrence and the need for surgery. Endoscopy is essential for the assessment of mucosal inflammation and plays a pivotal role in the analysis of mucosal healing in patients with IBD. Endoscopy is also essential in the detection of dysplasia and in the identification of the risk of colon cancer. The current surveillance strategy for dysplasia in IBD patients indicates white-light endoscopy with non-targeted biopsies. The new chromoendoscopy techniques provide substantial benefits for both clinicians and patients. Narrow-band imaging (NBI) has similar rates of dysplastic lesion detection as white-light endoscopy, and it seems that NBI identifies more adenoma-like lesions. Because it is used instinctively by many endoscopists, the combination of these two techniques might improve the rate of dysplasia detection. Flexible spectral imaging color enhancement can help differentiate dysplastic and non-dysplastic lesions and can also predict the risk of recurrence, which allows us to modulate the treatment to gain better control of the disease. The combination of non-invasive serum and stool biomarkers with endoscopy will improve the monitoring and limit the evolution of IBD because it enables the use of a personalized approach to each patient based on that patient’s history and risk factors.
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45
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Affiliation(s)
- Bruno Rosa
- Gastroenterology Department, Hospital da Senhora da Oliveira, Guimarães, Portugal
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46
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Abstract
Colon capsule endoscopy is a wireless and minimally invasive technique for visualization of the whole colon. With recent improvements of technical features in second-generation systems, a more important role for colon capsule endoscopy is rapidly emerging. Although several limitations and drawbacks are yet to be resolved, its usefulness as a tool for colorectal cancer screening and monitoring disease activity in inflammatory bowel diseases has become more apparent with increased use. Further investigations, including multicenter trials, are required to evaluate the substantial role of the colon capsule in managing colorectal diseases.
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47
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Shen B. Is it a prime time for small-bowel colon video capsule endoscopy to cover both sides of the ileocecal valve in Crohn's disease? Gastrointest Endosc 2017; 85:206-209. [PMID: 27986111 DOI: 10.1016/j.gie.2016.09.005] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/06/2016] [Accepted: 09/07/2016] [Indexed: 12/11/2022]
Affiliation(s)
- Bo Shen
- The Interventional IBD Unit, Digestive Disease and Surgery Institute, The Cleveland Clinic Foundation, Cleveland, Ohio, USA
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48
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Yung DE, Rondonotti E, Koulaouzidis A. Review: capsule colonoscopy-a concise clinical overview of current status. ANNALS OF TRANSLATIONAL MEDICINE 2016; 4:398. [PMID: 27867950 DOI: 10.21037/atm.2016.10.71] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
The colon capsule endoscopy (CCE) was first introduced in 2007. Currently, the main clinical indications for CCE are completion of incomplete colonoscopy, polyp detection and investigation of inflammatory bowel disease (IBD). Although conventional colonoscopy is the gold standard in bowel cancer screening, incomplete colonoscopy remains a problem as lesions are missed. CCE compares favourably to computer tomography colonography (CTC) in adenoma detection and has therefore been proposed as a method for completing colonoscopy. However the data on CCE remains sparse and current evidence does not show its superiority over CTC or conventional colonoscopy in bowel cancer screening. CCE also seems to show good correlation with conventional colonoscopy when used to evaluate IBD, but there are not many published studies at present. Other significant limitations include the need for aggressive bowel preparation and the labour-intensiveness of CCE reading. Therefore, much further software and hardware development is required to enable CCE to fulfill its potential as a minimally-invasive and reliable method of colonoscopy.
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Affiliation(s)
- Diana E Yung
- Endoscopy Unit, the Royal Infirmary of Edinburgh, Edinburgh, UK
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49
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Carter D, Eliakim R. PillCam colon capsule endoscopy (PCCE) in colonic diseases. ANNALS OF TRANSLATIONAL MEDICINE 2016; 4:307. [PMID: 27668227 DOI: 10.21037/atm.2016.08.28] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
Diseases affecting the colon are common worldwide and can cause a major health problem. Colorectal cancer (CRC) as well as Inflammatory bowel diseases represent a major cause of morbidity and mortality in western countries. PillCam colon capsule endoscopy (PCCE) is a novel and promising technology that can be useful for the screening and monitoring of colonic diseases. In the recent years many articles examined the use of various versions of PCCE-the 1st and 2nd generation versus various other endoscopic or radiologic modalities both for detection of colonic polyps or cancer and in both ulcerative colitis (UC) and Crohn's disease. The aim of the current review is to provide up to date information regarding the use and usefulness of this method in these disease.
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Affiliation(s)
- Dan Carter
- Department of Gastroenterology, Chaim Sheba Medical Center, Ramat Gan, Israel and Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Rami Eliakim
- Department of Gastroenterology, Chaim Sheba Medical Center, Ramat Gan, Israel and Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
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50
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Adler SN, Farkash S, Sompolinsky Y, Gafanovich I, Goldin E, Bar-Gil Shitrit A. A novel purgative protocol for capsule endoscopy of the small bowel produces better quality of visibility than 2 l of PEG: Timing is of the essence. United European Gastroenterol J 2016; 5:485-490. [PMID: 28588878 DOI: 10.1177/2050640616665291] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/05/2016] [Accepted: 07/31/2016] [Indexed: 12/18/2022] Open
Abstract
INTRODUCTION The ideal way of preparing patients for small-bowel capsule endoscopy has been controversial. Previous studies have shown that ingestion of 2 l of polyethylenglycol (PEG) 12 hours prior to capsule ingestion leads to improved visibility in comparison to no preparation at all. We speculated that using a post-ingestion (PI), booster-based cleansing protocol might provide an alternative to the PEG cleansing protocol. METHODS This randomized, blinded, prospective study enrolled 45 individuals. Patients were allocated to either of two groups. The PEG group ingested 2 l PEG 12 hours prior to the exam (n = 22) and the PI group ingested one sachet of Picolax® dissolved in 250 ml of water one hour after swallowing the capsule with 500 ml of water (n = 18). Primary endpoints were overall small bowel and distal third of small bowel cleansing levels. Secondary endpoints were average gastric and small-bowel transit time. RESULTS Forty-five patients participated in this study. Five individuals were excluded because of incomplete study. Percentage of patients with adequate visibility in the distal third of the small bowel in the PEG group was 9% vs 72% in the PI group (p < 0.0001). Average gastric time and total transit time were shorter in the PI group vs the PEG group (p = 0.0065). CONCLUSION Timing of ingestion of the Picolax® purgative 60 minutes after swallowing the capsule endoscopy delivers better visibility in the distal third of the small bowel than the accepted cleansing protocol of ingesting 2 l PEG 12 hours prior to the capsule endoscopy procedure.
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Affiliation(s)
- Samuel N Adler
- Digestive Diseases Institute, Shaare Zedek Medical Center, Jerusalem, Israel
| | | | | | - Inna Gafanovich
- Digestive Diseases Institute, Shaare Zedek Medical Center, Jerusalem, Israel
| | - Eran Goldin
- Digestive Diseases Institute, Shaare Zedek Medical Center, Jerusalem, Israel
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