In this letter,we comment on a recent article published in the World Journal of Gastroenterology by Xiao et al,where the authors aimed to use a deep learning model to automatically detect gastrointestinal lesions duri...In this letter,we comment on a recent article published in the World Journal of Gastroenterology by Xiao et al,where the authors aimed to use a deep learning model to automatically detect gastrointestinal lesions during capsule endoscopy(CE).CE was first presented in 2000 and was approved by the Food and Drug Administration in 2001.The indications of CE overlap with those of regular diagnostic endoscopy.However,in clinical practice,CE is usually used to detect lesions in areas inaccessible to standard endoscopies or in cases of bleeding that might be missed during conventional endoscopy.Since the emergence of CE,many physiological and technical challenges have been faced and addressed.In this letter,we summarize the current challenges and briefly mention the proposed methods to overcome these challenges to answer a central question:Do we still need CE?展开更多
BACKGROUND Surveillance colonoscopies are predominantly normal,identifying patients for potential polypectomy is advantageous.AIM To assess colon capsule endoscopy(CCE)and/or faecal immunochemical test(FIT)as filters ...BACKGROUND Surveillance colonoscopies are predominantly normal,identifying patients for potential polypectomy is advantageous.AIM To assess colon capsule endoscopy(CCE)and/or faecal immunochemical test(FIT)as filters in surveillance.METHODS Patients aged≥18 due for polyp surveillance were invited for CCE and FIT.Identifying polyps or colorectal cancer resulted in a positive CCE.Significant lesions(≥3 polyps or≥6 mm polyps),incomplete studies and positive FITs(≥225 ng/mL)were referred for endoscopy.CCE and endoscopy results,FIT accuracy and patient preference were assessed.RESULTS From a total of 126 CCEs[mean age 64(31-80),67(53.2%)males),70.6%(89/126)were excreted,86.5%(109/126)had adequate image quality.CCE positivity was 70.6%(89/126),42.9%(54/126)having significant polyps with 63.5%(80/126)referred for endoscopy(19 sigmoidoscopies,61 colonoscopies).CCE reduced endoscopy need by 36.5%(46/126)and 51.6%(65/126)were spared a colonoscopy.CCE positive predictive value was 88.2%(45/51).Significant extracolonic findings were reported in 3.2%(4/126).Patients with positive CCEs were older>65[odds ratio(OR)=2.5,95%confidence interval(CI):1.1517-5.5787,P=0.0159],with personal history of polyps(OR=2.3,95%CI:0.9734-5.4066,P=0.045),with high/intermediate polyp surveillance risk(OR=5.4,95%CI:1.1979-24.3824,P=0.0156).Overall,5/114(4.4%)FITs were positive(range:0-1394 ng/mL,mean:54 ng/mL).Sensitivity(9.6%)and negative predictive values(20.3%)were inadequate.Receiver operating curve analysis gave a sensitivity and specificity of 26.9%and 91.7%,for FIT of 43 ng/mL.Patients preferred CCE 63.3%(76/120),with less impact on daily activities(21.7%vs 93.2%)and time off work(average days 0.9 vs 1.2,P=0.0201).CONCLUSION CCE appears effective in low-risk polyp surveillance.FIT does not appear to be of benefit in surveillance.展开更多
BACKGROUND Video capsule endoscopy(VCE)is a noninvasive technique used to examine small bowel abnormalities in both adults and children.However,manual review of VCE images is time-consuming and labor-intensive,making ...BACKGROUND Video capsule endoscopy(VCE)is a noninvasive technique used to examine small bowel abnormalities in both adults and children.However,manual review of VCE images is time-consuming and labor-intensive,making it crucial to develop deep learning methods to assist in image analysis.AIM To employ deep learning models for the automatic classification of small bowel lesions using pediatric VCE images.METHODS We retrospectively analyzed VCE images from 162 pediatric patients who underwent VCE between January 2021 and December 2023 at the Children's Hospital of Nanjing Medical University.A total of 2298 high-resolution images were extracted,including normal mucosa and lesions(erosions/erythema,ulcers,and polyps).The images were split into training and test datasets in a 4:1 ratio.Four deep learning models:DenseNet121,Visual geometry group-16,ResNet50,and vision transformer were trained using 5-fold cross-validation,with hyperparameters adjusted for optimal classification performance.The models were evaluated based on accuracy,precision,recall,F1-score,and area under the receiver operating curve(AU-ROC).Lesion visualization was performed using gradient-weighted class activation mapping.RESULTS Abdominal pain was the most common indication for VCE,accounting for 62%of cases,followed by diarrhea,vomiting,and gastrointestinal bleeding.Abnormal lesions were detected in 93 children,with 38 diagnosed with inflammatory bowel disease.Among the deep learning models,DenseNet121 and ResNet50 demonstrated excellent classification performance,achieving accuracies of 90.6%[95%confidence interval(CI):89.2-92.0]and 90.5%(95%CI:89.9-91.2),respectively.The AU-ROC values for these models were 93.7%(95%CI:92.9-94.5)for DenseNet121 and 93.4%(95%CI:93.1-93.8)for ResNet50.CONCLUSION Our deep learning-based diagnostic tool developed in this study effectively classified lesions in pediatric VCE images,contributing to more accurate diagnoses and increased diagnostic efficiency.展开更多
BACKGROUND Small-bowel capsule endoscopy(SBCE)is widely used to evaluate obscure gastrointestinal bleeding;however,its interpretation is time-consuming and reader-dependent.Although artificial intelligence(AI)has emer...BACKGROUND Small-bowel capsule endoscopy(SBCE)is widely used to evaluate obscure gastrointestinal bleeding;however,its interpretation is time-consuming and reader-dependent.Although artificial intelligence(AI)has emerged to address these limitations,few models simultaneously perform small-bowel(SB)loca lization and abnormality detection.AIMTo develop an AI model that automatically distinguishes the SB from the stomach and colon and diagnoses SBabnormalities.METHODSWe developed an AI model using 87005 CE images (11925, 33781, and 41299 from the stomach, SB, and colon,respectively) for SB localization and 28405 SBCE images (1337 erosions/ulcers, 126 angiodysplasia, 494 bleeding,and 26448 normal) for abnormality detection. The diagnostic performances of AI-assisted reading and conventionalreading were compared using 32 SBCE videos in patients with suspicious SB bleeding.RESULTSRegarding organ localization, the AI model achieved an area under the receiver operating characteristic curve(AUC) and accuracy exceeding 0.99 and 97%, respectively. For SB abnormality detection, the performance was asfollows: Erosion/ulcer: 99.4% accuracy (AUC, 0.98);angiodysplasia: 99.8% accuracy (AUC, 0.99);bleeding: 99.9%accuracy (AUC, 0.99);normal: 99.3% accuracy (AUC, 0.98). In external validation, AI-assisted reading (8.7 minutes)was significantly faster than conventional reading (53.9 minutes;P < 0.001). The SB localization accuracies (88.6% vs72.7%, P = 0.07) and SB abnormality detection rates (77.3% vs 77.3%, P = 1.00) of the conventional reading and AIassistedreading were comparable.CONCLUSIONOur AI model decreased SBCE reading time and achieved performance comparable to that of experiencedendoscopists, suggesting that AI integration into SBCE reading enables efficient and reliable SB abnormalitydetection.展开更多
BACKGROUND The clinical effectiveness of magnetically controlled capsule endoscopy(MCE)is well established.However,problems,such as abdominal distension,insufficient gastric filling,and prolonged gastric retention tim...BACKGROUND The clinical effectiveness of magnetically controlled capsule endoscopy(MCE)is well established.However,problems,such as abdominal distension,insufficient gastric filling,and prolonged gastric retention time,persist with MCE gastric preparations.AIM To compare gastric filling using a carbonated soft drink with that using pure water during MCE.METHODS We performed an open-label randomised controlled trial at the Endoscopy Centre of Changhai Hospital in Shanghai.Patients aged 18-80 years,with or without gastrointestinal symptoms,scheduled for MCE were consecutively recruited.Those who provided informed consent were randomly assigned to the carbonated soft drink group(C group)or water group(W group)in a 1:1 ratio.For patients in the W group,1000 mL of water was ingested to distend the stomach,whereas for patients in the C group,550 mL of carbonated soft drink was provided,and patients were required to drink quickly while minimising burping.The primary endpoint was the number of patients with a gastric filling score of≥4 within 5 minutes after the capsule entered the stomach.RESULTS From December 3,2020 to May 17,2021,252 patients(141 men),aged 18-77 years,were assigned to the C(n=126)and W(n=126)groups.For the primary outcome,123 patients in the C group achieved a gastric filling score of≥4(97.62%vs 80.16%,P<0.0001).More patients in the C group had the highest gastric filling scores within the first 5 min(78.57%vs 29.37%,P<0.0001)and 10 minutes(54.76%vs 13.49%,P<0.0001)after the capsule entered the stomach.More patients in the W group required extra liquid for gastric refilling(1.59%vs 16.67%,P<0.0001).Transpyloric passage of the capsule under magnetic control was successfully performed in 43 patients in the C group(P<0.0001),accompanied by a shorter gastric transit time(53.27±53.83 minutes vs 71.12±52.19 minutes,P=0.001).CONCLUSION Carbonated soft drinks demonstrated superior and more sustained gastric filling compared with those of water alone,with the potential to promote gastric emptying.展开更多
The role of small bowel capsule endoscopy (CE) in suspected small bowel bleedingis well established and current European and other international guidelinesposition it as the first line test after negative bidirectiona...The role of small bowel capsule endoscopy (CE) in suspected small bowel bleedingis well established and current European and other international guidelinesposition it as the first line test after negative bidirectional endoscopies. Insuspected mid-lower gastrointestinal bleeding (MLGIB) the diagnostic yield ofcolonoscopy is poor and may cause a delay in detecting small bowel disease. Acrucial aspect of small bowel capsule endoscope performance is the timing of theprocedure, the interval between the bleeding episode and capsule ingestion isinversely related to the diagnostic yield as confirmed by a recent meta-analysis.Currently the ongoing advances achieved by video CE in particular to evaluateboth small bowel and colon in a single test using double headed capsules, raisesquestions regarding the position of pan intestinal capsule in the current algorithmto investigate patients presenting with suspected MLGIB ahead of colonoscopy.Early evidence suggests pan intestinal capsule could fit well as a diagnostic“filter” test in this cohort of patients, thereby reserving invasive conventionalcolonoscopy or device assisted enteroscopy as therapeutics options only. The recentdevelopment of magnetically controlled CE and a blood sensing capsule pushthe boundaries of CE even further in patients presenting with suspected gastrointestinalbleeding. This review will discuss the current available evidence andfuture directions of CE in suspected MLGIB.展开更多
Background:To evaluate the feasibility and safety of a novel cable-transmitted magnetically controlled capsule endoscopy(CTMCE)system for upper gastrointestinal examination.Methods:Twenty-six participants(19 healthy v...Background:To evaluate the feasibility and safety of a novel cable-transmitted magnetically controlled capsule endoscopy(CTMCE)system for upper gastrointestinal examination.Methods:Twenty-six participants(19 healthy volunteers and seven patients with gastrointestinal symptoms)willing to undergo upper gastrointestinal endoscopy were recruited.Each participant underwent CT-MCE followed by conventional gastroscopy within 24 h.Maneuverability and visibility of the CT-MCE capsule in the upper gastrointestinal tract,adverse events,and discomfort during the procedure were evaluated.The sensitivity and specificity of CT-MCE for diagnosing upper gastrointestinal lesions were evaluated using conventional gastroscopy findings as the standard.Results:Maneuverability was graded as“good”for all segments of the esophagus.The percentage of participants in which maneuverability was good according to gastric region was as follows:cardia(100.00%),pylorus(96.15%),angulus(92.31%),antrum(88.46%),fundus(84.62%),and body(73.08%).In the duodenal bulb and descending duodenum,it was good in only 20.83% and 16.67% of participants,respectively.Visibility was graded as“excellent”or“good”in the esophagus,Z line,and duodenal bulb in all participants;excellent/good visibility was achieved in the stomach and descending duodenum in 96.15% and 79.17% of participants,respectively.Forty-one lesions were detected overall.The sensitivity and specificity of CT-MCE in diagnosing upper gastrointestinal lesions were 85.00% and 98.15%,respectively.The CT-MCE capsule was successfully removed through the mouth in all participants.No serious adverse events or capsule retention occurred.Conclusions:CT-MCE showed good feasibility and safety for upper gastrointestinal examination.The system was effective in examining the esophagus and stomach with no risk of capsule retention.展开更多
There is still a dearth of systematic study on picture stitching techniques for the natural tubular structures of intestines,and traditional stitching techniques have a poor application to endoscopic images with deep ...There is still a dearth of systematic study on picture stitching techniques for the natural tubular structures of intestines,and traditional stitching techniques have a poor application to endoscopic images with deep scenes.In order to recreate the intestinal wall in two dimensions,a method is developed.The normalized Laplacian algorithm is used to enhance the image and transform it into polar coordinates according to the characteristics that intestinal images are not obvious and usually arranged in a circle,in order to extract the new image segments of the current image relative to the previous image.The improved weighted fusion algorithm is then used to sequentially splice the segment images.The experimental results demonstrate that the suggested approach can improve image clarity and minimize noise while maintaining the information content of intestinal images.In addition,the method's seamless transition between the final portions of a panoramic image also demonstrates that the stitching trace has been removed.展开更多
Small-bowel capsule endoscopy(SBCE)is the first-line diagnostic tool for obscure gastrointestinal bleeding but is limited by labor-intensive review,reader dependency,and interobserver variability.In this issue,Kwon et...Small-bowel capsule endoscopy(SBCE)is the first-line diagnostic tool for obscure gastrointestinal bleeding but is limited by labor-intensive review,reader dependency,and interobserver variability.In this issue,Kwon et al present a convolutional neural network-based system capable of both gastrointestinal segment localization and multi-lesion detection,erosions/ulcers,angiodysplasia,and bleeding,using full-length SBCE videos.The model achieved>97%localization accuracy and approximately 99%lesion detection accuracy in internal testing,and in external validation reduced reading time from nearly one hour to nine minutes without compromising detection performance.Methodological strengths include a two-step detection-classification pipeline,temporal smoothing,and ensemble learning,closely simulating human reading workflow.Compared with previous artificial intelligence(AI)-SBCE studies,this integrated“localization+detection”approach represents a step toward clinically deployable AI assistance.However,generalizability remains limited by single-platform training,a focus on three lesion types,and modest external validation size.Wider lesion coverage,multiplatform validation,and real-time integration will be essential for broader adoption.This study underscores the potential of AI to improve efficiency and consistency in SBCE interpretation and marks meaningful progress toward its routine clinical use.展开更多
BACKGROUND Small-bowel disorders,including obscure gastrointestinal bleeding(OGIB),Crohn's disease,and tumors,require accurate diagnostic approaches for effective treatment.Video capsule endoscopy(VCE)and simple b...BACKGROUND Small-bowel disorders,including obscure gastrointestinal bleeding(OGIB),Crohn's disease,and tumors,require accurate diagnostic approaches for effective treatment.Video capsule endoscopy(VCE)and simple balloon enteroscopy(SBE)are widely used;however,each modality has limitations,particularly regarding therapeutic intervention and diagnostic yield.AIM To evaluate diagnostic yields of various modalities for small bowel bleeding,analyze factors affecting heterogeneity,and improve understanding of clinical outcomes associated with different diagnostic approaches.METHODS A comprehensive search of four databases(PubMed,Embase,Cochrane Library,and Scopus)revealed over 600 citations related to the use of capsule endoscopy and balloon enteroscopy for diagnosing small intestine disorders with wall thickening.Based on predetermined eligibility criteria,seven moderateto-high-quality retrospective studies were analyzed to evaluate the diagnostic performance of VCE and SBE in patients with small bowel disorders.Quality Assessment of Diagnostic Accuracy Studies was applied to evaluate the risk of bias and overall methodological quality.RESULTS Analysis of seven moderate-to-high-quality retrospective studies revealed comparable overall detection rates for small bowel lesions between VCE and SBE.VCE demonstrated superior performance in detecting vascular lesions.Conversely,SBE exhibited a higher efficacy in detecting ulcerative lesions.The overall diagnostic yield varied across studies,with VCE showing a range of 32%–83%for small bowel bleeding,whereas SBE demonstrated a higher overall detection rate of 69.7%compared to 57.6%for VCE(P<0.05).Notably,SBE showed superior performance in diagnosing Crohn's disease,with a detection rate of 35%,compared to 11.3%for VCE(P<0.001).The diagnostic concordance between VCE and SBE was influenced by the lesion type.Strong agreement was observed for inflammatory lesions(κ=0.82,95%CI:0.75-0.89),whereas moderate agreement was noted for tumors(κ=0.61,95%CI:0.52-0.70)and angiectasias(κ=0.58,95%CI:0.49-0.67).SBE demonstrated significant advantages in therapeutic interventions,particularly in overt bleeding.Patient tolerability was generally higher for VCE,with a completion rate of 95%(95%CI:92%-98%),compared to 85%for SBE(95%CI:80%-90%).However,the capsule retention rate for VCE was 1.4%(95%CI:0.8%-2.0%),necessitating subsequent intervention.CONCLUSION VCE and SBE are complementary techniques for evaluating small intestinal disorders.Although VCE remains the initial test of choice for patients with stable OGIB,SBE should be considered in patients requiring therapeutic intervention.Thus,combining both modalities enhances diagnostic accuracy and patient management.展开更多
Capsule endoscopy is nowadays the diagnostic technique of choice in the study of small bowel pathologies,allowing the non-invasive study of the entire mucosa.This has led,together with new technical advances,to the cr...Capsule endoscopy is nowadays the diagnostic technique of choice in the study of small bowel pathologies,allowing the non-invasive study of the entire mucosa.This has led,together with new technical advances,to the creation of two new models(PillCam ESO and PillCam Colon)for the study of esophageal and colonic diseases.These two new capsules offer an interesting alternative to conventional endoscopy in the study of the upper and lower digestive tracts,because traditional endoscopy is often unpleasant and uncomfortable for the patient,can be painful,often requires moderate or deep sedation and is not without complications(hemorrhage,perforation,etc.).PillCam Colon is particularly important for its usefulness in the diagnosis of colonic polyps,and is a potentially useful tool in cases of incomplete colonoscopy or in colorectal cancer screening,even more when most patients are reluctant to undergo screening programs due to the said disadvantages of conventional colonoscopy.This article discusses the advantages of capsule endoscopy over conventional endoscopy,its current application possibilities and indications in routine clinical practice.In the various sections of the work,we assess the application of endoscopic capsule in different sections of the digestive tract(esophagus,stomach,and colon)and finally the potential role of panendoscopy with PillCam Colon.展开更多
Colon capsule endoscopy(CCE; Pill Cam Colon; Given Imaging; Yoqneam, Israel) is a minimally invasive wireless technique for the visualization of the colon. With the recent introduction of the second generation colon c...Colon capsule endoscopy(CCE; Pill Cam Colon; Given Imaging; Yoqneam, Israel) is a minimally invasive wireless technique for the visualization of the colon. With the recent introduction of the second generation colon capsule the diagnostic accuracy of CCE for polyp detection has significantly improved and preliminary data suggest it may be useful to monitor mucosal inflammation in patients with inflammatory bowel disease. Limitations include the inability to take biopsies and the procedural costs. However, given the potentially higher acceptance within an average risk colorectal cancer(CRC) screening population, its usefulness as a screening tool with regard to CRC prevention should be further evaluated.展开更多
Wireless capsule endoscopy(CE) is a technology developed for the endoscopic exploration of the small bowel. The first capsule model was approved by the Food and Drug Administration in 2001, and its first and essential...Wireless capsule endoscopy(CE) is a technology developed for the endoscopic exploration of the small bowel. The first capsule model was approved by the Food and Drug Administration in 2001, and its first and essential indication was occult gastrointestinal(GI) bleeding. Over subsequent years, this technology has been refined to provide superior resolution, increased battery life, and capabilities to view different parts of the GI tract. Indeed, cases for which CE proved useful have increased significantly over the last few years, with new indications for the small bowel and technical improvements that have expanded its use to other parts of the GI tract, including the esophagus and colon. The main challenges in the development of CE are new devices with the ability to provide therapy, air inflation for a better vision of the small bowel, biopsy sampling systems attached to the capsule and the possibility to guide and move the capsule with an external motion control. In this article we review the current and new indications of CE, and the evolving technological changes shaping this technology, which has a promising potential in the coming future of gastroenterology.展开更多
Wireless capsule endoscopy(WCE)enables physicians to examine the gastrointestinal tract by transmitting images wirelessly from a disposable capsule to a data recorder.Although WCE is the least invasive endoscopy techn...Wireless capsule endoscopy(WCE)enables physicians to examine the gastrointestinal tract by transmitting images wirelessly from a disposable capsule to a data recorder.Although WCE is the least invasive endoscopy technique for diagnosing gastrointestinal disorders,interpreting a WCE study requires significant time effort and training.Analysis of images by artificial intelligence,through advances such as machine or deep learning,has been increasingly applied to medical imaging.There has been substantial interest in using deep learning to detect various gastrointestinal disorders based on WCE images.This article discusses basic knowledge of deep learning,applications of deep learning in WCE,and the implementation of deep learning model in a clinical setting.We anticipate continued research investigating the use of deep learning in interpreting WCE studies to generate predictive algorithms and aid in the diagnosis of gastrointestinal disorders.展开更多
BACKGROUND Meckel’s diverticulum （MD） occurs predominantly in chil-dren and adolescents. It is rarely diagnosed in adults. Preoperative diagnosis is diffcult due to low sensitivity of the radiological imaging studi...BACKGROUND Meckel’s diverticulum （MD） occurs predominantly in chil-dren and adolescents. It is rarely diagnosed in adults. Preoperative diagnosis is diffcult due to low sensitivity of the radiological imaging studies. The role of video capsule endoscopy （VCE） in the diagnosis of MD is unknown, and the endoscopic patterns are not defned. We will describe four of our cases of MD evaluated with VCE and make a review of the literature focusing on the endoscopic characteristics.CASE SUMMARYWe present four cases of MD confirmed by surgery. They were all adult males with ages going from 18 to 50 years, referred to our service from 2004 to 2018, due to obscure gastrointestinal bleeding （OGIB）. TheyGarcía-Compeán D et al . Merckel’s diverticulum diagnosis by VCEhad a history of 1 mo to 10 years of overt and occult bleeding episodes. Laboratory blood test showed an iron-deficiency anemia from 4 to 9 g/dL of hemoglo-bin that required multiple hospitalizations and blood transfusions in all cases. Repeated upper digestive endoscopies and colonoscopies were negative. Small bowel was examined with VCE, which revealed double lumen images in all cases, one with polyps and three with circumferential ulcers in the diverticulum. However, based on VCE findings, preoperative diagnosis of MD was suggested only in two patients. Capsule was retain-ed in one patient, which was recovered with surgery. The anatomopathological report revealed ulcerated ectopic gastric mucosa in all cases.CONCLUSIONVCE is useful for the diagnosis of MD. However, endo-scopic characteristics must be recognized in order to establish preoperative diagnosis.展开更多
BACKGROUND Video-capsule endoscopy(VCE)is an efficient tool that has proven to be highly useful in approaching several gastrointestinal diseases.VCE was implemented in Colombia in 2003,however current characterization...BACKGROUND Video-capsule endoscopy(VCE)is an efficient tool that has proven to be highly useful in approaching several gastrointestinal diseases.VCE was implemented in Colombia in 2003,however current characterization of patients undergoing VCE in Colombia is limited,and mainly comes from two investigations conducted before the SARS-CoV-2 pandemic period.AIM To describe the characteristics of patients undergoing VCEs and establish the main indications,findings,technical limitations,and other outstanding features.METHODS A descriptive study was carried out using data from reports of VCE(PillCam SB3 system)use in a Gastroenterology Unit in Bogotá,Colombia between September 2019 and January 2023.Demographic and clinical variables such as indication for the VCE,gastric and small bowel transit times(GTT,SBTT),endoscopic preparation quality,and limitations were described[n(%),median(IQR)].RESULTS A total of 133 VCE reports were analyzed.Most were in men with a median age of 70 years.The majority had good preparation(96.2%),and there were technical limitations in 15.8%of cases.The main indications were unexplained anemia(91%)or occult bleeding(23.3%).The median GTT and SBTT were 14 and 30 minutes,respectively.The frequencies of bleeding stigma(3.79%)and active bleeding(9.09%)were low,and the most frequent abnormal findings were red spots(28.3%),erosions(17.6%),and vascular ectasias(12.5%).CONCLUSION VCE showed high-level safety.The main indication was unexplained anemia.Active bleeding was the most frequent finding.Combined with artificial intelligence,VCE can improve diagnostic precision and targeted therapeutic interventions.展开更多
Capsule endoscopy(CE)is a recently developed diagnostic method for diseases of the small bowel that is non-invasive,safe,and highly tolerable.Its role in patients with inflammatory bowel disease has been widely valida...Capsule endoscopy(CE)is a recently developed diagnostic method for diseases of the small bowel that is non-invasive,safe,and highly tolerable.Its role in patients with inflammatory bowel disease has been widely validated in suspected and established Crohn’s disease(CD)due to its ability to assess superficial lesions not detected by cross-sectional imaging and proximal lesions of the small bowel not evaluable by ileocolonoscopy.Because CE is a highly sensitive but less specific technique,differential diagnoses that can simulate CD must be considered,and its interpretation should be supported by other clinical and laboratory indicators.The use of validated scoring systems to characterize and estimate lesion severity(Lewis score,Capsule Endoscopy Crohn’s Disease Activity Index),as well as the standardization of the language used to define the lesions(Delphi Consensus),have reduced the interobserver variability in CE reading observed in clinical practice,allowing for the optimization of diagnoses and clinical management strategies.The appearance of the panenteric CE,the incorporation of artificial intelligence,magnetically-guided capsules,and tissue biopsies are elements that contribute to CE being a promising,unique diagnostic tool in digestive tract diseases.展开更多
Capsule endoscopy (CE) is a safe, non invasive diagnostic modality for the evaluation of small bowel lesions. Obscure gastrointestinal bleeding (OGIB) is one of the most important indications of capsule endoscopy. Cap...Capsule endoscopy (CE) is a safe, non invasive diagnostic modality for the evaluation of small bowel lesions. Obscure gastrointestinal bleeding (OGIB) is one of the most important indications of capsule endoscopy. Capsule endoscopy has a very high diagnostic yield especially if the bleeding is ongoing. This technique appears to be superior to other techniques for the detection of suspected lesions and the source of bleeding. Capsule endoscopy has been shown to change the outcome in patients with obscure gastrointestinal (GI) bleed.展开更多
Intestinal lymphangiectasia （IL） is a rare disease characterized by dilated lymphatic vessles in the intestinal wall and small bowel mesentery which induce loss of protein and lymphocytes into bowel lumen. Because i...Intestinal lymphangiectasia （IL） is a rare disease characterized by dilated lymphatic vessles in the intestinal wall and small bowel mesentery which induce loss of protein and lymphocytes into bowel lumen. Because it most often occurs in the intestine and cannot be detected by upper gastroendoscopy or colonoscopy, and the value of common image examinations such as X-ray and computerized tomography （CT） are limited, the diagnosis of IL is difficult, usually needing the help of surgery. Capsule endoscopy is useful in diagnosing intestinal diseases, such as IL. We here report a case of IL in a female patient who was admitted for the complaint of recurrent edema accompanied with diarrhea and abdominal pain over the last twenty years, and aggravated ten days ago. She was diagnosed by M2A capsule endoscopy as a primary IL and confirmed by surgical and pathological examination.展开更多
AIM： To evaluate the effect of various methods of small bowel preparation on the transit time and the quality of visualization of the entire small bowel mucosa. METHODS： Ninety-five patients underwent capsule endosc...AIM： To evaluate the effect of various methods of small bowel preparation on the transit time and the quality of visualization of the entire small bowel mucosa. METHODS： Ninety-five patients underwent capsule endoscopy （CE） by easily swallowing the capsule. They were divided into three study groups according to the preparation used： group A （n = 26） by polyethylene glycol （PEG） liter or with sodium phosphate （SP） 12 h prior to the CE study; group B （n = 29） by erythromycin 1 h prior to the CE study; and group C （n = 40） without any preparation. Visualization ranged from good to satisfactory to poor. RESULTS： The gastric emptying time in the group prepared with erythromycin was shorter but without statistical significance and the small bowel transit time was unaffected. In elderly subjects prepared by PEG or SP, the gastric emptying time was significantly longer （163.7 rain, P = 0.05）. The transit times of the three sub-groups were not affected by gender or pathology. The grade of cleaning of the entire study group was 3.27±1.1. The erythromycin group presented significantly the worst quality of images （P = 0.05） compared to the other sub-groups. Age, gender, and pathology had no effect on the quality of the cleaning of the small bowel in the sub-groups. One （1.05%） case had no natural excretion. CONCLUSION： Erythromycin markedly reduces gastric emptying time, but has a negative effect on the quality of the image in the small bowel. The preparation of elderly subjects with PEG or SP has a negative effect on the small bowel transit time.展开更多
文摘In this letter,we comment on a recent article published in the World Journal of Gastroenterology by Xiao et al,where the authors aimed to use a deep learning model to automatically detect gastrointestinal lesions during capsule endoscopy(CE).CE was first presented in 2000 and was approved by the Food and Drug Administration in 2001.The indications of CE overlap with those of regular diagnostic endoscopy.However,in clinical practice,CE is usually used to detect lesions in areas inaccessible to standard endoscopies or in cases of bleeding that might be missed during conventional endoscopy.Since the emergence of CE,many physiological and technical challenges have been faced and addressed.In this letter,we summarize the current challenges and briefly mention the proposed methods to overcome these challenges to answer a central question:Do we still need CE?
文摘BACKGROUND Surveillance colonoscopies are predominantly normal,identifying patients for potential polypectomy is advantageous.AIM To assess colon capsule endoscopy(CCE)and/or faecal immunochemical test(FIT)as filters in surveillance.METHODS Patients aged≥18 due for polyp surveillance were invited for CCE and FIT.Identifying polyps or colorectal cancer resulted in a positive CCE.Significant lesions(≥3 polyps or≥6 mm polyps),incomplete studies and positive FITs(≥225 ng/mL)were referred for endoscopy.CCE and endoscopy results,FIT accuracy and patient preference were assessed.RESULTS From a total of 126 CCEs[mean age 64(31-80),67(53.2%)males),70.6%(89/126)were excreted,86.5%(109/126)had adequate image quality.CCE positivity was 70.6%(89/126),42.9%(54/126)having significant polyps with 63.5%(80/126)referred for endoscopy(19 sigmoidoscopies,61 colonoscopies).CCE reduced endoscopy need by 36.5%(46/126)and 51.6%(65/126)were spared a colonoscopy.CCE positive predictive value was 88.2%(45/51).Significant extracolonic findings were reported in 3.2%(4/126).Patients with positive CCEs were older>65[odds ratio(OR)=2.5,95%confidence interval(CI):1.1517-5.5787,P=0.0159],with personal history of polyps(OR=2.3,95%CI:0.9734-5.4066,P=0.045),with high/intermediate polyp surveillance risk(OR=5.4,95%CI:1.1979-24.3824,P=0.0156).Overall,5/114(4.4%)FITs were positive(range:0-1394 ng/mL,mean:54 ng/mL).Sensitivity(9.6%)and negative predictive values(20.3%)were inadequate.Receiver operating curve analysis gave a sensitivity and specificity of 26.9%and 91.7%,for FIT of 43 ng/mL.Patients preferred CCE 63.3%(76/120),with less impact on daily activities(21.7%vs 93.2%)and time off work(average days 0.9 vs 1.2,P=0.0201).CONCLUSION CCE appears effective in low-risk polyp surveillance.FIT does not appear to be of benefit in surveillance.
文摘BACKGROUND Video capsule endoscopy(VCE)is a noninvasive technique used to examine small bowel abnormalities in both adults and children.However,manual review of VCE images is time-consuming and labor-intensive,making it crucial to develop deep learning methods to assist in image analysis.AIM To employ deep learning models for the automatic classification of small bowel lesions using pediatric VCE images.METHODS We retrospectively analyzed VCE images from 162 pediatric patients who underwent VCE between January 2021 and December 2023 at the Children's Hospital of Nanjing Medical University.A total of 2298 high-resolution images were extracted,including normal mucosa and lesions(erosions/erythema,ulcers,and polyps).The images were split into training and test datasets in a 4:1 ratio.Four deep learning models:DenseNet121,Visual geometry group-16,ResNet50,and vision transformer were trained using 5-fold cross-validation,with hyperparameters adjusted for optimal classification performance.The models were evaluated based on accuracy,precision,recall,F1-score,and area under the receiver operating curve(AU-ROC).Lesion visualization was performed using gradient-weighted class activation mapping.RESULTS Abdominal pain was the most common indication for VCE,accounting for 62%of cases,followed by diarrhea,vomiting,and gastrointestinal bleeding.Abnormal lesions were detected in 93 children,with 38 diagnosed with inflammatory bowel disease.Among the deep learning models,DenseNet121 and ResNet50 demonstrated excellent classification performance,achieving accuracies of 90.6%[95%confidence interval(CI):89.2-92.0]and 90.5%(95%CI:89.9-91.2),respectively.The AU-ROC values for these models were 93.7%(95%CI:92.9-94.5)for DenseNet121 and 93.4%(95%CI:93.1-93.8)for ResNet50.CONCLUSION Our deep learning-based diagnostic tool developed in this study effectively classified lesions in pediatric VCE images,contributing to more accurate diagnoses and increased diagnostic efficiency.
基金Supported by The Bio and Medical Technology Development Program of the National Research Foundation,No.NRF-2022R1C1C1010643.
文摘BACKGROUND Small-bowel capsule endoscopy(SBCE)is widely used to evaluate obscure gastrointestinal bleeding;however,its interpretation is time-consuming and reader-dependent.Although artificial intelligence(AI)has emerged to address these limitations,few models simultaneously perform small-bowel(SB)loca lization and abnormality detection.AIMTo develop an AI model that automatically distinguishes the SB from the stomach and colon and diagnoses SBabnormalities.METHODSWe developed an AI model using 87005 CE images (11925, 33781, and 41299 from the stomach, SB, and colon,respectively) for SB localization and 28405 SBCE images (1337 erosions/ulcers, 126 angiodysplasia, 494 bleeding,and 26448 normal) for abnormality detection. The diagnostic performances of AI-assisted reading and conventionalreading were compared using 32 SBCE videos in patients with suspicious SB bleeding.RESULTSRegarding organ localization, the AI model achieved an area under the receiver operating characteristic curve(AUC) and accuracy exceeding 0.99 and 97%, respectively. For SB abnormality detection, the performance was asfollows: Erosion/ulcer: 99.4% accuracy (AUC, 0.98);angiodysplasia: 99.8% accuracy (AUC, 0.99);bleeding: 99.9%accuracy (AUC, 0.99);normal: 99.3% accuracy (AUC, 0.98). In external validation, AI-assisted reading (8.7 minutes)was significantly faster than conventional reading (53.9 minutes;P < 0.001). The SB localization accuracies (88.6% vs72.7%, P = 0.07) and SB abnormality detection rates (77.3% vs 77.3%, P = 1.00) of the conventional reading and AIassistedreading were comparable.CONCLUSIONOur AI model decreased SBCE reading time and achieved performance comparable to that of experiencedendoscopists, suggesting that AI integration into SBCE reading enables efficient and reliable SB abnormalitydetection.
基金Supported by Shanghai Municipal Hospital Emerging Frontier Technology Joint Project,No.SHDC12019105Shanghai Science and Technology Development Funds,No.24YF2758200National Natural Science Foundation of China,No.82100699.
文摘BACKGROUND The clinical effectiveness of magnetically controlled capsule endoscopy(MCE)is well established.However,problems,such as abdominal distension,insufficient gastric filling,and prolonged gastric retention time,persist with MCE gastric preparations.AIM To compare gastric filling using a carbonated soft drink with that using pure water during MCE.METHODS We performed an open-label randomised controlled trial at the Endoscopy Centre of Changhai Hospital in Shanghai.Patients aged 18-80 years,with or without gastrointestinal symptoms,scheduled for MCE were consecutively recruited.Those who provided informed consent were randomly assigned to the carbonated soft drink group(C group)or water group(W group)in a 1:1 ratio.For patients in the W group,1000 mL of water was ingested to distend the stomach,whereas for patients in the C group,550 mL of carbonated soft drink was provided,and patients were required to drink quickly while minimising burping.The primary endpoint was the number of patients with a gastric filling score of≥4 within 5 minutes after the capsule entered the stomach.RESULTS From December 3,2020 to May 17,2021,252 patients(141 men),aged 18-77 years,were assigned to the C(n=126)and W(n=126)groups.For the primary outcome,123 patients in the C group achieved a gastric filling score of≥4(97.62%vs 80.16%,P<0.0001).More patients in the C group had the highest gastric filling scores within the first 5 min(78.57%vs 29.37%,P<0.0001)and 10 minutes(54.76%vs 13.49%,P<0.0001)after the capsule entered the stomach.More patients in the W group required extra liquid for gastric refilling(1.59%vs 16.67%,P<0.0001).Transpyloric passage of the capsule under magnetic control was successfully performed in 43 patients in the C group(P<0.0001),accompanied by a shorter gastric transit time(53.27±53.83 minutes vs 71.12±52.19 minutes,P=0.001).CONCLUSION Carbonated soft drinks demonstrated superior and more sustained gastric filling compared with those of water alone,with the potential to promote gastric emptying.
文摘The role of small bowel capsule endoscopy (CE) in suspected small bowel bleedingis well established and current European and other international guidelinesposition it as the first line test after negative bidirectional endoscopies. Insuspected mid-lower gastrointestinal bleeding (MLGIB) the diagnostic yield ofcolonoscopy is poor and may cause a delay in detecting small bowel disease. Acrucial aspect of small bowel capsule endoscope performance is the timing of theprocedure, the interval between the bleeding episode and capsule ingestion isinversely related to the diagnostic yield as confirmed by a recent meta-analysis.Currently the ongoing advances achieved by video CE in particular to evaluateboth small bowel and colon in a single test using double headed capsules, raisesquestions regarding the position of pan intestinal capsule in the current algorithmto investigate patients presenting with suspected MLGIB ahead of colonoscopy.Early evidence suggests pan intestinal capsule could fit well as a diagnostic“filter” test in this cohort of patients, thereby reserving invasive conventionalcolonoscopy or device assisted enteroscopy as therapeutics options only. The recentdevelopment of magnetically controlled CE and a blood sensing capsule pushthe boundaries of CE even further in patients presenting with suspected gastrointestinalbleeding. This review will discuss the current available evidence andfuture directions of CE in suspected MLGIB.
基金supported by the National Key Research and Development Program(2019YFC0120303)and was sponsored by the Beijing Nova Program(20240484678).
文摘Background:To evaluate the feasibility and safety of a novel cable-transmitted magnetically controlled capsule endoscopy(CTMCE)system for upper gastrointestinal examination.Methods:Twenty-six participants(19 healthy volunteers and seven patients with gastrointestinal symptoms)willing to undergo upper gastrointestinal endoscopy were recruited.Each participant underwent CT-MCE followed by conventional gastroscopy within 24 h.Maneuverability and visibility of the CT-MCE capsule in the upper gastrointestinal tract,adverse events,and discomfort during the procedure were evaluated.The sensitivity and specificity of CT-MCE for diagnosing upper gastrointestinal lesions were evaluated using conventional gastroscopy findings as the standard.Results:Maneuverability was graded as“good”for all segments of the esophagus.The percentage of participants in which maneuverability was good according to gastric region was as follows:cardia(100.00%),pylorus(96.15%),angulus(92.31%),antrum(88.46%),fundus(84.62%),and body(73.08%).In the duodenal bulb and descending duodenum,it was good in only 20.83% and 16.67% of participants,respectively.Visibility was graded as“excellent”or“good”in the esophagus,Z line,and duodenal bulb in all participants;excellent/good visibility was achieved in the stomach and descending duodenum in 96.15% and 79.17% of participants,respectively.Forty-one lesions were detected overall.The sensitivity and specificity of CT-MCE in diagnosing upper gastrointestinal lesions were 85.00% and 98.15%,respectively.The CT-MCE capsule was successfully removed through the mouth in all participants.No serious adverse events or capsule retention occurred.Conclusions:CT-MCE showed good feasibility and safety for upper gastrointestinal examination.The system was effective in examining the esophagus and stomach with no risk of capsule retention.
基金the Special Research Fund for the Natural Science Foundation of Chongqing(No.cstc2019jcyjmsxm1351)the Science and Technology Research Project of Chongqing Education Commission(No.KJQN2020006300)。
文摘There is still a dearth of systematic study on picture stitching techniques for the natural tubular structures of intestines,and traditional stitching techniques have a poor application to endoscopic images with deep scenes.In order to recreate the intestinal wall in two dimensions,a method is developed.The normalized Laplacian algorithm is used to enhance the image and transform it into polar coordinates according to the characteristics that intestinal images are not obvious and usually arranged in a circle,in order to extract the new image segments of the current image relative to the previous image.The improved weighted fusion algorithm is then used to sequentially splice the segment images.The experimental results demonstrate that the suggested approach can improve image clarity and minimize noise while maintaining the information content of intestinal images.In addition,the method's seamless transition between the final portions of a panoramic image also demonstrates that the stitching trace has been removed.
文摘Small-bowel capsule endoscopy(SBCE)is the first-line diagnostic tool for obscure gastrointestinal bleeding but is limited by labor-intensive review,reader dependency,and interobserver variability.In this issue,Kwon et al present a convolutional neural network-based system capable of both gastrointestinal segment localization and multi-lesion detection,erosions/ulcers,angiodysplasia,and bleeding,using full-length SBCE videos.The model achieved>97%localization accuracy and approximately 99%lesion detection accuracy in internal testing,and in external validation reduced reading time from nearly one hour to nine minutes without compromising detection performance.Methodological strengths include a two-step detection-classification pipeline,temporal smoothing,and ensemble learning,closely simulating human reading workflow.Compared with previous artificial intelligence(AI)-SBCE studies,this integrated“localization+detection”approach represents a step toward clinically deployable AI assistance.However,generalizability remains limited by single-platform training,a focus on three lesion types,and modest external validation size.Wider lesion coverage,multiplatform validation,and real-time integration will be essential for broader adoption.This study underscores the potential of AI to improve efficiency and consistency in SBCE interpretation and marks meaningful progress toward its routine clinical use.
文摘BACKGROUND Small-bowel disorders,including obscure gastrointestinal bleeding(OGIB),Crohn's disease,and tumors,require accurate diagnostic approaches for effective treatment.Video capsule endoscopy(VCE)and simple balloon enteroscopy(SBE)are widely used;however,each modality has limitations,particularly regarding therapeutic intervention and diagnostic yield.AIM To evaluate diagnostic yields of various modalities for small bowel bleeding,analyze factors affecting heterogeneity,and improve understanding of clinical outcomes associated with different diagnostic approaches.METHODS A comprehensive search of four databases(PubMed,Embase,Cochrane Library,and Scopus)revealed over 600 citations related to the use of capsule endoscopy and balloon enteroscopy for diagnosing small intestine disorders with wall thickening.Based on predetermined eligibility criteria,seven moderateto-high-quality retrospective studies were analyzed to evaluate the diagnostic performance of VCE and SBE in patients with small bowel disorders.Quality Assessment of Diagnostic Accuracy Studies was applied to evaluate the risk of bias and overall methodological quality.RESULTS Analysis of seven moderate-to-high-quality retrospective studies revealed comparable overall detection rates for small bowel lesions between VCE and SBE.VCE demonstrated superior performance in detecting vascular lesions.Conversely,SBE exhibited a higher efficacy in detecting ulcerative lesions.The overall diagnostic yield varied across studies,with VCE showing a range of 32%–83%for small bowel bleeding,whereas SBE demonstrated a higher overall detection rate of 69.7%compared to 57.6%for VCE(P<0.05).Notably,SBE showed superior performance in diagnosing Crohn's disease,with a detection rate of 35%,compared to 11.3%for VCE(P<0.001).The diagnostic concordance between VCE and SBE was influenced by the lesion type.Strong agreement was observed for inflammatory lesions(κ=0.82,95%CI:0.75-0.89),whereas moderate agreement was noted for tumors(κ=0.61,95%CI:0.52-0.70)and angiectasias(κ=0.58,95%CI:0.49-0.67).SBE demonstrated significant advantages in therapeutic interventions,particularly in overt bleeding.Patient tolerability was generally higher for VCE,with a completion rate of 95%(95%CI:92%-98%),compared to 85%for SBE(95%CI:80%-90%).However,the capsule retention rate for VCE was 1.4%(95%CI:0.8%-2.0%),necessitating subsequent intervention.CONCLUSION VCE and SBE are complementary techniques for evaluating small intestinal disorders.Although VCE remains the initial test of choice for patients with stable OGIB,SBE should be considered in patients requiring therapeutic intervention.Thus,combining both modalities enhances diagnostic accuracy and patient management.
文摘Capsule endoscopy is nowadays the diagnostic technique of choice in the study of small bowel pathologies,allowing the non-invasive study of the entire mucosa.This has led,together with new technical advances,to the creation of two new models(PillCam ESO and PillCam Colon)for the study of esophageal and colonic diseases.These two new capsules offer an interesting alternative to conventional endoscopy in the study of the upper and lower digestive tracts,because traditional endoscopy is often unpleasant and uncomfortable for the patient,can be painful,often requires moderate or deep sedation and is not without complications(hemorrhage,perforation,etc.).PillCam Colon is particularly important for its usefulness in the diagnosis of colonic polyps,and is a potentially useful tool in cases of incomplete colonoscopy or in colorectal cancer screening,even more when most patients are reluctant to undergo screening programs due to the said disadvantages of conventional colonoscopy.This article discusses the advantages of capsule endoscopy over conventional endoscopy,its current application possibilities and indications in routine clinical practice.In the various sections of the work,we assess the application of endoscopic capsule in different sections of the digestive tract(esophagus,stomach,and colon)and finally the potential role of panendoscopy with PillCam Colon.
文摘Colon capsule endoscopy(CCE; Pill Cam Colon; Given Imaging; Yoqneam, Israel) is a minimally invasive wireless technique for the visualization of the colon. With the recent introduction of the second generation colon capsule the diagnostic accuracy of CCE for polyp detection has significantly improved and preliminary data suggest it may be useful to monitor mucosal inflammation in patients with inflammatory bowel disease. Limitations include the inability to take biopsies and the procedural costs. However, given the potentially higher acceptance within an average risk colorectal cancer(CRC) screening population, its usefulness as a screening tool with regard to CRC prevention should be further evaluated.
文摘Wireless capsule endoscopy(CE) is a technology developed for the endoscopic exploration of the small bowel. The first capsule model was approved by the Food and Drug Administration in 2001, and its first and essential indication was occult gastrointestinal(GI) bleeding. Over subsequent years, this technology has been refined to provide superior resolution, increased battery life, and capabilities to view different parts of the GI tract. Indeed, cases for which CE proved useful have increased significantly over the last few years, with new indications for the small bowel and technical improvements that have expanded its use to other parts of the GI tract, including the esophagus and colon. The main challenges in the development of CE are new devices with the ability to provide therapy, air inflation for a better vision of the small bowel, biopsy sampling systems attached to the capsule and the possibility to guide and move the capsule with an external motion control. In this article we review the current and new indications of CE, and the evolving technological changes shaping this technology, which has a promising potential in the coming future of gastroenterology.
文摘Wireless capsule endoscopy(WCE)enables physicians to examine the gastrointestinal tract by transmitting images wirelessly from a disposable capsule to a data recorder.Although WCE is the least invasive endoscopy technique for diagnosing gastrointestinal disorders,interpreting a WCE study requires significant time effort and training.Analysis of images by artificial intelligence,through advances such as machine or deep learning,has been increasingly applied to medical imaging.There has been substantial interest in using deep learning to detect various gastrointestinal disorders based on WCE images.This article discusses basic knowledge of deep learning,applications of deep learning in WCE,and the implementation of deep learning model in a clinical setting.We anticipate continued research investigating the use of deep learning in interpreting WCE studies to generate predictive algorithms and aid in the diagnosis of gastrointestinal disorders.
文摘BACKGROUND Meckel’s diverticulum （MD） occurs predominantly in chil-dren and adolescents. It is rarely diagnosed in adults. Preoperative diagnosis is diffcult due to low sensitivity of the radiological imaging studies. The role of video capsule endoscopy （VCE） in the diagnosis of MD is unknown, and the endoscopic patterns are not defned. We will describe four of our cases of MD evaluated with VCE and make a review of the literature focusing on the endoscopic characteristics.CASE SUMMARYWe present four cases of MD confirmed by surgery. They were all adult males with ages going from 18 to 50 years, referred to our service from 2004 to 2018, due to obscure gastrointestinal bleeding （OGIB）. TheyGarcía-Compeán D et al . Merckel’s diverticulum diagnosis by VCEhad a history of 1 mo to 10 years of overt and occult bleeding episodes. Laboratory blood test showed an iron-deficiency anemia from 4 to 9 g/dL of hemoglo-bin that required multiple hospitalizations and blood transfusions in all cases. Repeated upper digestive endoscopies and colonoscopies were negative. Small bowel was examined with VCE, which revealed double lumen images in all cases, one with polyps and three with circumferential ulcers in the diverticulum. However, based on VCE findings, preoperative diagnosis of MD was suggested only in two patients. Capsule was retain-ed in one patient, which was recovered with surgery. The anatomopathological report revealed ulcerated ectopic gastric mucosa in all cases.CONCLUSIONVCE is useful for the diagnosis of MD. However, endo-scopic characteristics must be recognized in order to establish preoperative diagnosis.
文摘BACKGROUND Video-capsule endoscopy(VCE)is an efficient tool that has proven to be highly useful in approaching several gastrointestinal diseases.VCE was implemented in Colombia in 2003,however current characterization of patients undergoing VCE in Colombia is limited,and mainly comes from two investigations conducted before the SARS-CoV-2 pandemic period.AIM To describe the characteristics of patients undergoing VCEs and establish the main indications,findings,technical limitations,and other outstanding features.METHODS A descriptive study was carried out using data from reports of VCE(PillCam SB3 system)use in a Gastroenterology Unit in Bogotá,Colombia between September 2019 and January 2023.Demographic and clinical variables such as indication for the VCE,gastric and small bowel transit times(GTT,SBTT),endoscopic preparation quality,and limitations were described[n(%),median(IQR)].RESULTS A total of 133 VCE reports were analyzed.Most were in men with a median age of 70 years.The majority had good preparation(96.2%),and there were technical limitations in 15.8%of cases.The main indications were unexplained anemia(91%)or occult bleeding(23.3%).The median GTT and SBTT were 14 and 30 minutes,respectively.The frequencies of bleeding stigma(3.79%)and active bleeding(9.09%)were low,and the most frequent abnormal findings were red spots(28.3%),erosions(17.6%),and vascular ectasias(12.5%).CONCLUSION VCE showed high-level safety.The main indication was unexplained anemia.Active bleeding was the most frequent finding.Combined with artificial intelligence,VCE can improve diagnostic precision and targeted therapeutic interventions.
文摘Capsule endoscopy(CE)is a recently developed diagnostic method for diseases of the small bowel that is non-invasive,safe,and highly tolerable.Its role in patients with inflammatory bowel disease has been widely validated in suspected and established Crohn’s disease(CD)due to its ability to assess superficial lesions not detected by cross-sectional imaging and proximal lesions of the small bowel not evaluable by ileocolonoscopy.Because CE is a highly sensitive but less specific technique,differential diagnoses that can simulate CD must be considered,and its interpretation should be supported by other clinical and laboratory indicators.The use of validated scoring systems to characterize and estimate lesion severity(Lewis score,Capsule Endoscopy Crohn’s Disease Activity Index),as well as the standardization of the language used to define the lesions(Delphi Consensus),have reduced the interobserver variability in CE reading observed in clinical practice,allowing for the optimization of diagnoses and clinical management strategies.The appearance of the panenteric CE,the incorporation of artificial intelligence,magnetically-guided capsules,and tissue biopsies are elements that contribute to CE being a promising,unique diagnostic tool in digestive tract diseases.
文摘Capsule endoscopy (CE) is a safe, non invasive diagnostic modality for the evaluation of small bowel lesions. Obscure gastrointestinal bleeding (OGIB) is one of the most important indications of capsule endoscopy. Capsule endoscopy has a very high diagnostic yield especially if the bleeding is ongoing. This technique appears to be superior to other techniques for the detection of suspected lesions and the source of bleeding. Capsule endoscopy has been shown to change the outcome in patients with obscure gastrointestinal (GI) bleed.
文摘Intestinal lymphangiectasia （IL） is a rare disease characterized by dilated lymphatic vessles in the intestinal wall and small bowel mesentery which induce loss of protein and lymphocytes into bowel lumen. Because it most often occurs in the intestine and cannot be detected by upper gastroendoscopy or colonoscopy, and the value of common image examinations such as X-ray and computerized tomography （CT） are limited, the diagnosis of IL is difficult, usually needing the help of surgery. Capsule endoscopy is useful in diagnosing intestinal diseases, such as IL. We here report a case of IL in a female patient who was admitted for the complaint of recurrent edema accompanied with diarrhea and abdominal pain over the last twenty years, and aggravated ten days ago. She was diagnosed by M2A capsule endoscopy as a primary IL and confirmed by surgical and pathological examination.
文摘AIM： To evaluate the effect of various methods of small bowel preparation on the transit time and the quality of visualization of the entire small bowel mucosa. METHODS： Ninety-five patients underwent capsule endoscopy （CE） by easily swallowing the capsule. They were divided into three study groups according to the preparation used： group A （n = 26） by polyethylene glycol （PEG） liter or with sodium phosphate （SP） 12 h prior to the CE study; group B （n = 29） by erythromycin 1 h prior to the CE study; and group C （n = 40） without any preparation. Visualization ranged from good to satisfactory to poor. RESULTS： The gastric emptying time in the group prepared with erythromycin was shorter but without statistical significance and the small bowel transit time was unaffected. In elderly subjects prepared by PEG or SP, the gastric emptying time was significantly longer （163.7 rain, P = 0.05）. The transit times of the three sub-groups were not affected by gender or pathology. The grade of cleaning of the entire study group was 3.27±1.1. The erythromycin group presented significantly the worst quality of images （P = 0.05） compared to the other sub-groups. Age, gender, and pathology had no effect on the quality of the cleaning of the small bowel in the sub-groups. One （1.05%） case had no natural excretion. CONCLUSION： Erythromycin markedly reduces gastric emptying time, but has a negative effect on the quality of the image in the small bowel. The preparation of elderly subjects with PEG or SP has a negative effect on the small bowel transit time.
