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
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
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
BACKGROUND Wireless capsule endoscopy(WCE)has become an important noninvasive and portable tool for diagnosing digestive tract diseases and has been propelled by advancements in medical imaging technology.However,the ...BACKGROUND Wireless capsule endoscopy(WCE)has become an important noninvasive and portable tool for diagnosing digestive tract diseases and has been propelled by advancements in medical imaging technology.However,the complexity of the digestive tract structure,and the diversity of lesion types,results in different sites and types of lesions distinctly appearing in the images,posing a challenge for the accurate identification of digestive tract diseases.AIM To propose a deep learning-based lesion detection model to automatically identify and accurately label digestive tract lesions,thereby improving the diagnostic efficiency of doctors,and creating significant clinical application value.METHODS In this paper,we propose a neural network model,WCE_Detection,for the accurate detection and classification of 23 classes of digestive tract lesion images.First,since multicategory lesion images exhibit various shapes and scales,a multidetection head strategy is adopted in the object detection network to increase the model's robustness for multiscale lesion detection.Moreover,a bidirectional feature pyramid network(BiFPN)is introduced,which effectively fuses shallow semantic features by adding skip connections,significantly reducing the detection error rate.On the basis of the above,we utilize the Swin Transformer with its unique self-attention mechanism and hierarchical structure in conjunction with the BiFPN feature fusion technique to enhance the feature representation of multicategory lesion images.RESULTS The model constructed in this study achieved an mAP50 of 91.5%for detecting 23 lesions.More than eleven single-category lesions achieved an mAP50 of over 99.4%,and more than twenty lesions had an mAP50 value of over 80%.These results indicate that the model outperforms other state-of-the-art models in the end-to-end integrated detection of human digestive tract lesion images.CONCLUSION The deep learning-based object detection network detects multiple digestive tract lesions in WCE images with high accuracy,improving the diagnostic efficiency of doctors,and demonstrating significant clinical application value.展开更多
BACKGROUND Traditional esophagogastroduodenoscopy(EGD),an invasive examination method,can cause discomfort and pain in patients.In contrast,magnetically controlled capsule endoscopy(MCE),a noninvasive method,is being ...BACKGROUND Traditional esophagogastroduodenoscopy(EGD),an invasive examination method,can cause discomfort and pain in patients.In contrast,magnetically controlled capsule endoscopy(MCE),a noninvasive method,is being applied for the detection of stomach and small intestinal diseases,but its application in treating esophageal diseases is not widespread.AIM To evaluate the safety and efficacy of detachable string MCE(ds-MCE)for the diagnosis of esophageal diseases.METHODS Fifty patients who had been diagnosed with esophageal diseases were pros-pectively recruited for this clinical study and underwent ds-MCE and conven-tional EGD.The primary endpoints included the sensitivity,specificity,positive predictive value,negative predictive value,and diagnostic accuracy of ds-MCE for patients with esophageal diseases.The secondary endpoints consisted of visualizing the esophageal and dentate lines,as well as the subjects'tolerance of the procedure.RESULTS Using EGD as the gold standard,the sensitivity,specificity,positive predictive value,negative predictive value,and diagnostic accuracy of ds-MCE for esophageal disease detection were 85.71%,86.21%,81.82%,89.29%,and 86%,respectively.ds-MCE was more comfortable and convenient than EGD was,with 80%of patients feeling that ds-MCE examination was very comfortable or comfortable and 50%of patients believing that detachable string v examination was very convenient.CONCLUSION This study revealed that ds-MCE has the same diagnostic effects as traditional EGD for esophageal diseases and is more comfortable and convenient than EGD,providing a novel noninvasive method for treating esophageal diseases.展开更多
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 miniaturi...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.展开更多
Climate change due to sustained carbon dioxide(CO_(2))emissions poses a serious threat to human existence,such as extreme weather events that must be addressed in all sectors of society.Gastrointestinal endoscopy is a...Climate change due to sustained carbon dioxide(CO_(2))emissions poses a serious threat to human existence,such as extreme weather events that must be addressed in all sectors of society.Gastrointestinal endoscopy is a healthcare sector that produces high levels of CO_(2) emissions.Colonoscopy(CS)is the gold standard for colorectal cancer(CRC)screening that reduces the number of CRC-related deaths.However,vast amounts of cleaning solutions used to disinfect the colonoscope are disposed of,and multiple nonrenewable wastes are generated in performing CS,which significantly impact the environment.Currently,colon capsule endoscopy(CCE)retains good accuracy and has excellent potential to reduce CO_(2) emission through a simple procedure.However,to date,colon capsules are single-use and lack a clear collection pathway.In addition,there is a lack of specific data regarding the environmental impact of CCE.Further research is needed to prove that CCE is a more environmentally friendly tool than CS.展开更多
BACKGROUND Capsule endoscopy(CE)is a pivotal diagnostic tool for gastrointestinal(GI)disorders,yet capsule retention poses a significant risk,especially in patients with known risk factors.The patency capsule(PC)helps...BACKGROUND Capsule endoscopy(CE)is a pivotal diagnostic tool for gastrointestinal(GI)disorders,yet capsule retention poses a significant risk,especially in patients with known risk factors.The patency capsule(PC)helps assess the functional patency of the GI tract to mitigate this risk.However,the standard 28-hour protocol for confirming patency often results in high false-positive rates,unnecessarily excluding many patients from undergoing diagnostic CE.AIM To investigate the use of a 72-hour extended patency protocol to improve functional patency rates in patients at risk of capsule retention.METHODS We performed a prospective,open-label study evaluating an extended 72-hour protocol for confirming functional patency with the PC.Conducted over six months,135 patients with risk factors for capsule retention were enrolled.The primary endpoint was the capsule retention rate in patients with confirmed functional patency.Secondary endpoints included the rates of confirmed patency via self-reporting or radiology,small bowel transit times,and adverse events.RESULTS Functional patency was confirmed in 48.9%(n=66)of patients within 28 hours,with an additional 17.4%(n=12)confirmed within 72 hours,increasing the overall patency rate to 57.8%.There was no significant difference in small bowel transit time between patients confirmed for patency at 28 hours vs those confirmed at 72 hours.Importantly,no capsule retention was observed in patients who were confirmed for patency under the extended protocol.Notably,50%(n=39)of patients who proceeded to CE had clinically significant findings.CONCLUSION Extending the patency assessment protocol to 72 hours significantly improves the rate of confirmed functional patency without increasing the risk of capsule retention.This protocol is safe,effective,and cost-neutral,allowing more patients to benefit from CE.Further studies are recommended to refine the protocol and enhance its clinical utility.展开更多
BACKGROUND Colon capsule endoscopy(CCE)is a modern,non-invasive method for large bowel visualization,offering a less invasive alternative to traditional colonoscopy(TC).While TC remains the gold standard for comprehen...BACKGROUND Colon capsule endoscopy(CCE)is a modern,non-invasive method for large bowel visualization,offering a less invasive alternative to traditional colonoscopy(TC).While TC remains the gold standard for comprehensive large bowel assessment,including the detection and treatment of various conditions,the effectiveness of CCE in detecting polyps is less established.AIM To systematically review and compare the polyp detection rates(PDR)of CCE and TC.METHODS A systematic literature search was conducted using four scientific databases:CINAHL,MEDLINE via EBSCO,Cochrane Library,and MEDLINE/PubMed.A standardized search command was utilized to ensure consistency.Full papers were retrieved if they compared PDR between CCE and TC and involved patients over 18 years old.A meta-analysis was then conducted using the meta package in R software.RESULTS Initially,339 articles were identified,with 128 duplicates and 15 non-English articles excluded,leaving 196 for screening.After further exclusions,9 articles were included in the review.The meta-analysis revealed minimal differences in PDR between CCE and TC.The pooled PDR for TC was 0.61(95%CI:0.48–0.72),and for CCE,it was 0.61(95%CI:0.48–0.73).The overall comparison of the pooled PDR of both methods was 0.96(95%CI:0.90–1.02),indicating that CCE is noninferior to TC.CONCLUSION CCE has emerged as a modern and safe diagnostic alternative to TC for polyp detection,demonstrating noninferiority when compared to the conventional method.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
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
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
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.
基金Supported by The Science and Technology Development Center of The Ministry of Education,No.2022BC004。
文摘BACKGROUND Wireless capsule endoscopy(WCE)has become an important noninvasive and portable tool for diagnosing digestive tract diseases and has been propelled by advancements in medical imaging technology.However,the complexity of the digestive tract structure,and the diversity of lesion types,results in different sites and types of lesions distinctly appearing in the images,posing a challenge for the accurate identification of digestive tract diseases.AIM To propose a deep learning-based lesion detection model to automatically identify and accurately label digestive tract lesions,thereby improving the diagnostic efficiency of doctors,and creating significant clinical application value.METHODS In this paper,we propose a neural network model,WCE_Detection,for the accurate detection and classification of 23 classes of digestive tract lesion images.First,since multicategory lesion images exhibit various shapes and scales,a multidetection head strategy is adopted in the object detection network to increase the model's robustness for multiscale lesion detection.Moreover,a bidirectional feature pyramid network(BiFPN)is introduced,which effectively fuses shallow semantic features by adding skip connections,significantly reducing the detection error rate.On the basis of the above,we utilize the Swin Transformer with its unique self-attention mechanism and hierarchical structure in conjunction with the BiFPN feature fusion technique to enhance the feature representation of multicategory lesion images.RESULTS The model constructed in this study achieved an mAP50 of 91.5%for detecting 23 lesions.More than eleven single-category lesions achieved an mAP50 of over 99.4%,and more than twenty lesions had an mAP50 value of over 80%.These results indicate that the model outperforms other state-of-the-art models in the end-to-end integrated detection of human digestive tract lesion images.CONCLUSION The deep learning-based object detection network detects multiple digestive tract lesions in WCE images with high accuracy,improving the diagnostic efficiency of doctors,and demonstrating significant clinical application value.
基金the Science and Technology Commission of Shanghai,No.18DZ1930309.
文摘BACKGROUND Traditional esophagogastroduodenoscopy(EGD),an invasive examination method,can cause discomfort and pain in patients.In contrast,magnetically controlled capsule endoscopy(MCE),a noninvasive method,is being applied for the detection of stomach and small intestinal diseases,but its application in treating esophageal diseases is not widespread.AIM To evaluate the safety and efficacy of detachable string MCE(ds-MCE)for the diagnosis of esophageal diseases.METHODS Fifty patients who had been diagnosed with esophageal diseases were pros-pectively recruited for this clinical study and underwent ds-MCE and conven-tional EGD.The primary endpoints included the sensitivity,specificity,positive predictive value,negative predictive value,and diagnostic accuracy of ds-MCE for patients with esophageal diseases.The secondary endpoints consisted of visualizing the esophageal and dentate lines,as well as the subjects'tolerance of the procedure.RESULTS Using EGD as the gold standard,the sensitivity,specificity,positive predictive value,negative predictive value,and diagnostic accuracy of ds-MCE for esophageal disease detection were 85.71%,86.21%,81.82%,89.29%,and 86%,respectively.ds-MCE was more comfortable and convenient than EGD was,with 80%of patients feeling that ds-MCE examination was very comfortable or comfortable and 50%of patients believing that detachable string v examination was very convenient.CONCLUSION This study revealed that ds-MCE has the same diagnostic effects as traditional EGD for esophageal diseases and is more comfortable and convenient than EGD,providing a novel noninvasive method for treating esophageal diseases.
文摘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.
文摘Climate change due to sustained carbon dioxide(CO_(2))emissions poses a serious threat to human existence,such as extreme weather events that must be addressed in all sectors of society.Gastrointestinal endoscopy is a healthcare sector that produces high levels of CO_(2) emissions.Colonoscopy(CS)is the gold standard for colorectal cancer(CRC)screening that reduces the number of CRC-related deaths.However,vast amounts of cleaning solutions used to disinfect the colonoscope are disposed of,and multiple nonrenewable wastes are generated in performing CS,which significantly impact the environment.Currently,colon capsule endoscopy(CCE)retains good accuracy and has excellent potential to reduce CO_(2) emission through a simple procedure.However,to date,colon capsules are single-use and lack a clear collection pathway.In addition,there is a lack of specific data regarding the environmental impact of CCE.Further research is needed to prove that CCE is a more environmentally friendly tool than CS.
文摘BACKGROUND Capsule endoscopy(CE)is a pivotal diagnostic tool for gastrointestinal(GI)disorders,yet capsule retention poses a significant risk,especially in patients with known risk factors.The patency capsule(PC)helps assess the functional patency of the GI tract to mitigate this risk.However,the standard 28-hour protocol for confirming patency often results in high false-positive rates,unnecessarily excluding many patients from undergoing diagnostic CE.AIM To investigate the use of a 72-hour extended patency protocol to improve functional patency rates in patients at risk of capsule retention.METHODS We performed a prospective,open-label study evaluating an extended 72-hour protocol for confirming functional patency with the PC.Conducted over six months,135 patients with risk factors for capsule retention were enrolled.The primary endpoint was the capsule retention rate in patients with confirmed functional patency.Secondary endpoints included the rates of confirmed patency via self-reporting or radiology,small bowel transit times,and adverse events.RESULTS Functional patency was confirmed in 48.9%(n=66)of patients within 28 hours,with an additional 17.4%(n=12)confirmed within 72 hours,increasing the overall patency rate to 57.8%.There was no significant difference in small bowel transit time between patients confirmed for patency at 28 hours vs those confirmed at 72 hours.Importantly,no capsule retention was observed in patients who were confirmed for patency under the extended protocol.Notably,50%(n=39)of patients who proceeded to CE had clinically significant findings.CONCLUSION Extending the patency assessment protocol to 72 hours significantly improves the rate of confirmed functional patency without increasing the risk of capsule retention.This protocol is safe,effective,and cost-neutral,allowing more patients to benefit from CE.Further studies are recommended to refine the protocol and enhance its clinical utility.
文摘BACKGROUND Colon capsule endoscopy(CCE)is a modern,non-invasive method for large bowel visualization,offering a less invasive alternative to traditional colonoscopy(TC).While TC remains the gold standard for comprehensive large bowel assessment,including the detection and treatment of various conditions,the effectiveness of CCE in detecting polyps is less established.AIM To systematically review and compare the polyp detection rates(PDR)of CCE and TC.METHODS A systematic literature search was conducted using four scientific databases:CINAHL,MEDLINE via EBSCO,Cochrane Library,and MEDLINE/PubMed.A standardized search command was utilized to ensure consistency.Full papers were retrieved if they compared PDR between CCE and TC and involved patients over 18 years old.A meta-analysis was then conducted using the meta package in R software.RESULTS Initially,339 articles were identified,with 128 duplicates and 15 non-English articles excluded,leaving 196 for screening.After further exclusions,9 articles were included in the review.The meta-analysis revealed minimal differences in PDR between CCE and TC.The pooled PDR for TC was 0.61(95%CI:0.48–0.72),and for CCE,it was 0.61(95%CI:0.48–0.73).The overall comparison of the pooled PDR of both methods was 0.96(95%CI:0.90–1.02),indicating that CCE is noninferior to TC.CONCLUSION CCE has emerged as a modern and safe diagnostic alternative to TC for polyp detection,demonstrating noninferiority when compared to the conventional method.
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.
