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Park J, Kim JS, Song JH, Nam K, Kim SE, Jeong ES, Kim JH, Jeon SR. Discordance Rate and Risk Factor of Other Diagnostic Modalities for Small Bowel Tumors Detected by Device-Assisted Enteroscopy: A Korean Association for the Study of Intestinal Disease (KASID) Multicenter Study. Gut Liver 2024; 18:686-694. [PMID: 38726559 PMCID: PMC11249927 DOI: 10.5009/gnl240030] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/16/2024] [Revised: 03/05/2024] [Accepted: 03/11/2024] [Indexed: 07/16/2024] Open
Abstract
Background/Aims Despite advances in imaging and endoscopic technology, diagnostic modalities for small bowel tumors are simultaneously performed. We investigated the discrepancy rate between each modality and predictive factors of discrepancy in patients with definite small bowel tumors. Methods Data of patients with definite small bowel tumors who underwent both device-assisted enteroscopy (DAE) and computed tomography (CT) were retrieved from web-based enteroscopy registry database in Korea. Predictive risk factors associated with discrepancy were analyzed using logistic regression analysis. Results Among 998 patients, 210 (21.0%) were diagnosed with small bowel tumor using DAE, in 193 patients with definite small bowel tumor, DAE and CT were performed. Of these patients, 12 (6.2%) showed discrepancy between examinations. Among 49 patients who underwent DAE and video capsule endoscopy (VCE) examination, 13 (26.5%) showed discrepancy between examinations. No significant independent risk factors were associated with concordance between DAE and CT in multivariate logistic regression analysis among the patients. In a multivariate logistic regression analysis, red blood cell transfusion was negatively associated with concordance between DAE and VCE in patients with small bowel tumor (odds ratio, 0.163; 95% confidence interval, 0.026 to 1.004; p=0.050). Conclusions For small bowel tumors, the discrepancy rate between DAE and CT was 6.2%, and 26.5% between DAE and VCE. Despite developments in cross-sectional imaging (VCE and DAE modalities), discrepancies still exist. For small bowel bleeding that require significant transfusion while showing insignificant VCE findings, DAE should be considered as the next diagnostic approach, considering the possibility of missed small bowel tumor.
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Affiliation(s)
- Jihye Park
- Department of Internal Medicine, Severance Hospital, Yonsei University College of Medicine, Seoul, Korea
- Institute of Gastroenterology, Severance Hospital, Yonsei University College of Medicine, Seoul, Korea
| | - Jin Su Kim
- Department of Internal Medicine, Eunpyeong St. Mary’s Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Joo Hye Song
- Department of Internal Medicine, Konkuk University Medical Center, Konkuk University School of Medicine, Seoul, Korea
| | - Kwangwoo Nam
- Department of Gastroenterology, Dankook University Hospital, Dankook University College of Medicine, Cheonan, Korea
| | - Seong-Eun Kim
- Department of Internal Medicine, Ewha Womans University College of Medicine, Seoul, Korea
| | - Eui Sun Jeong
- Department of Internal Medicine, Ewha Womans University College of Medicine, Seoul, Korea
| | - Jae Hyun Kim
- Department of Internal Medicine, Kosin University College of Medicine, Busan, Korea
| | - Seong Ran Jeon
- Institute for Digestive Research, Digestive Disease Center, Soonchunhyang University College of Medicine, Seoul, Korea
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Vitello A, Maida M, Shahini E, Macaluso FS, Orlando A, Grova M, Ramai D, Serviddio G, Facciorusso A. Current Approaches for Monitoring of Patients with Inflammatory Bowel Diseases: A Narrative Review. J Clin Med 2024; 13:1008. [PMID: 38398321 PMCID: PMC10888591 DOI: 10.3390/jcm13041008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2024] [Revised: 02/05/2024] [Accepted: 02/07/2024] [Indexed: 02/25/2024] Open
Abstract
BACKGROUND Patients with inflammatory bowel diseases (IBD) require proactive monitoring both during the active phase to evaluate therapeutic response and during the remission phase to evaluate relapse or colorectal cancer surveillance. However, monitoring may vary between patients with ulcerative colitis (UC) and Crohn's disease (CD), with distinct tools and intervals. METHODS This narrative review aims to focus on modern approaches to IBD monitoring, considering international guidelines and expert consensus. RESULTS The most recent European diagnostic guidelines advocate a combination of clinical, laboratory, endoscopic, and radiological parameters to evaluate the disease course of patients with IBD. Unfortunately, the conventional symptom-based therapeutic approach does not improve long-term outcomes and there is no single ideal biomarker available. Endoscopy plays a key role in evaluating response to therapy as well as monitoring disease activity. Recently, bedside intestinal ultrasound (IUS) has gained increasing interest and diffusion as it appears to offer several advantages including the monitoring of therapeutic response. CONCLUSION In light of growing clinical advances, we present a schematic evidence-based monitoring algorithm that can be easily applied in clinical practice which combines all major monitoring modalities, including noninvasive tools such as IUS and video-capsule endoscopy.
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Affiliation(s)
- Alessandro Vitello
- Gastroenterology and Endoscopy Unit, S. Elia Hospital, 93100 Caltanissetta, Italy; (A.V.); (M.M.)
| | - Marcello Maida
- Gastroenterology and Endoscopy Unit, S. Elia Hospital, 93100 Caltanissetta, Italy; (A.V.); (M.M.)
- Department of Medicine and Surgery, School of Medicine and Surgery, University of Enna ‘Kore’, 94100 Enna, Italy
| | - Endrit Shahini
- Gastroenterology Unit, National Institute of Gastroenterology-IRCCS “Saverio de Bellis”, 70013 Castellana Grotte, Italy;
| | - Fabio Salvatore Macaluso
- Inflammatory Bowel Disease Unit, Department of Medicine, A.O.O.R. “Villa Sofia-Cervello” Hospital, 90146 Palermo, Italy; (F.S.M.); (A.O.); (M.G.)
| | - Ambrogio Orlando
- Inflammatory Bowel Disease Unit, Department of Medicine, A.O.O.R. “Villa Sofia-Cervello” Hospital, 90146 Palermo, Italy; (F.S.M.); (A.O.); (M.G.)
| | - Mauro Grova
- Inflammatory Bowel Disease Unit, Department of Medicine, A.O.O.R. “Villa Sofia-Cervello” Hospital, 90146 Palermo, Italy; (F.S.M.); (A.O.); (M.G.)
| | - Daryl Ramai
- Division of Gastroenterology and Hepatology, University of Utah Health, Salt Lake City, UT 84132, USA;
| | - Gaetano Serviddio
- Department of Medical and Surgical Sciences, University of Foggia, 71122 Foggia, Italy;
| | - Antonio Facciorusso
- Department of Medical and Surgical Sciences, University of Foggia, 71122 Foggia, Italy;
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Brodersen JB, Jensen MD, Leenhardt R, Kjeldsen J, Histace A, Knudsen T, Dray X. Artificial Intelligence-assisted Analysis of Pan-enteric Capsule Endoscopy in Patients with Suspected Crohn's Disease: A Study on Diagnostic Performance. J Crohns Colitis 2024; 18:75-81. [PMID: 37527554 DOI: 10.1093/ecco-jcc/jjad131] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/30/2023] [Indexed: 08/03/2023]
Abstract
BACKGROUND AND AIM Pan-enteric capsule endoscopy [PCE] is a highly sensitive but time-consuming tool for detecting pathology. Artificial intelligence [AI] algorithms might offer a possibility to assist in the review and reduce the analysis time of PCE. This study examines the agreement between PCE assessments aided by AI technology and standard evaluations, in patients suspected of Crohn's disease [CD]. METHOD PCEs from a prospective, blinded, multicentre study, including patients suspected of CD, were processed by the deep learning solution AXARO® [Augmented Endoscopy, Paris, France]. Based on the image output, two observers classified the patient's PCE as normal or suggestive of CD, ulcerative colitis, or cancer. The primary outcome was per-patient sensitivities and specificities for detecting CD and inflammatory bowel disease [IBD]. Complete reading of PCE served as the reference standard. RESULTS A total of 131 patients' PCEs were analysed, with a median recording time of 303 min. The AXARO® framework reduced output to a median of 470 images [2.1%] per patient, and the pooled median review time was 3.2 min per patient. For detecting CD, the observers had a sensitivity of 96% and 92% and a specificity of 93% and 90%, respectively. For the detection of IBD, both observers had a sensitivity of 97% and had a specificity of 91% and 90%, respectively. The negative predictive value was 95% for CD and 97% for IBD. CONCLUSIONS Using the AXARO® framework reduced the initial review time substantially while maintaining high diagnostic accuracy-suggesting its use as a rapid tool to rule out IBD in PCEs of patients suspected of Crohn's disease.
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Affiliation(s)
- Jacob Broder Brodersen
- Department of Internal Medicine, Section of Gastroenterology, Hospital of South West Jutland, Esbjerg, Denmark
- Department of Regional Health Research, University of Southern Denmark, Odense, Denmark
| | - Michael Dam Jensen
- Department of Regional Health Research, University of Southern Denmark, Odense, Denmark
- Department of Internal Medicine, Section of Gastroenterology, Lillebaelt Hospital, Vejle, Denmark
| | - Romain Leenhardt
- Équipes Traitement de l'Information et Systèmes, ETIS UMR 8051, CY Paris Cergy University, ENSEA, CNRS, Cergy, France
- Sorbonne University, Center for Digestive Endoscopy, Saint-Antoine Hospital, APHP, Paris, France
| | - Jens Kjeldsen
- Department of Medical Gastroenterology, Odense University Hospital, Odense, Denmark
- Department of Clinical Research, University of Southern Denmark, Odense, Denmark
- OPEN Odense Patient Data Explorative Network, Odense University Hospital, Odense, Denmark
| | - Aymeric Histace
- Équipes Traitement de l'Information et Systèmes, ETIS UMR 8051, CY Paris Cergy University, ENSEA, CNRS, Cergy, France
| | - Torben Knudsen
- Department of Internal Medicine, Section of Gastroenterology, Hospital of South West Jutland, Esbjerg, Denmark
- Department of Regional Health Research, University of Southern Denmark, Odense, Denmark
| | - Xavier Dray
- Équipes Traitement de l'Information et Systèmes, ETIS UMR 8051, CY Paris Cergy University, ENSEA, CNRS, Cergy, France
- Sorbonne University, Center for Digestive Endoscopy, Saint-Antoine Hospital, APHP, Paris, France
- Department of Clinical Research, University of Southern Denmark, Odense, Denmark
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