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Ghoshal UC, Mishra P, Mathur A, Reddy SP, Fatima B, Misra A. Capsule endoscopy for obscure gastrointestinal bleed in the tropics: A single-center experience on 350 patients. Indian J Gastroenterol 2024:10.1007/s12664-024-01526-0. [PMID: 38517665 DOI: 10.1007/s12664-024-01526-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/24/2023] [Accepted: 01/03/2024] [Indexed: 03/24/2024]
Abstract
BACKGROUND Obscure gastrointestinal bleed (OGIB), now called small bowel bleed (SBB), comprises 5% to 10% of all gastrointestinal (GI) bleed episodes and capsule endoscopy (CE) is a tool for its evaluation. Studies on CE in a large sample of SBB patients from the tropics are limited. METHODS We did a retrospective analysis of a prospectively maintained database of patients with SBB undergoing CE using PillCam or MiroCam CE. RESULTS Of 350 patients (age 52.4 ± 17.4 years; 248 [70.9%] male) undergoing CE, 243 (69.4%) and 107 (30.6%) had overt and occult SBB, respectively. CE detected lesions in 244 (69.7%) patients (single lesion in 172 [49.1%]; multiple in 72 [20.6%]). The single lesions included vascular malformations (52, 14.9%), ulcer/erosion (47, 13.4%), tumor (24, 6.9%), hookworm (19, 5.4%), stricture (15, 4.3%), hemobilia (1, 0.3%) and blood without identifiable lesion (9, 2.6%). Of 72 with multiple lesions, ulcer with stricture was the commonest finding (n = 43, 12.3%). No abnormality was detected in 106 (30.3%) patients. The frequency of lesion detection was comparable among patients with overt and occult SBB (173/243, 71.2% vs. 71/107, 66.3%, respectively; p = 0.4). Younger patients (0 to 39 years) more often had multiple lesions on CE than the older (≥ 40 years) ones (26/76, 34.2% vs. 46/228, 20.2%, respectively; p = 0.001). CONCLUSION CE has a high diagnostic yield in SBB in the tropics, regardless of the type of bleed or of CE brand and the duration of recording. Multiple lesions associated with SBB are commoner among younger (< 40 years) patients.
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Affiliation(s)
- Uday C Ghoshal
- Department of Gastroenterology, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Raebareli Road, Lucknow, 226 014, India.
- Institute of Gastrosciences and Liver Transplantation, Apollo Multispeciality Hospitals, Kolkata, 700 054, India.
| | - Piyush Mishra
- Department of Gastroenterology, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Raebareli Road, Lucknow, 226 014, India
| | - Akash Mathur
- Department of Gastroenterology, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Raebareli Road, Lucknow, 226 014, India
| | - Sai Prathap Reddy
- Department of Gastroenterology, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Raebareli Road, Lucknow, 226 014, India
| | - Bushra Fatima
- Department of Gastroenterology, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Raebareli Road, Lucknow, 226 014, India
| | - Asha Misra
- Department of Gastroenterology, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Raebareli Road, Lucknow, 226 014, India
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Rosa B, Cúrdia Gonçalves T, Moreira MJ, Dias de Castro F, Sousa-Pinto B, Dinis-Ribeiro M, Cotter J. Pan-intestinal capsule endoscopy as first-line procedure in patients with suspected mid or lower gastrointestinal bleeding. Endoscopy 2024. [PMID: 38365215 DOI: 10.1055/a-2270-4601] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/18/2024]
Abstract
BACKGROUND Pan-intestinal capsule endoscopy (PCE) evaluates the small bowel and colon noninvasively. This study evaluated diagnostic accuracy and safety of PCE vs. colonoscopy as first-line examination in suspected mid-lower gastrointestinal bleeding (MLGIB). METHODS In this prospective, single-center, single-blinded cohort study, consecutive patients with suspected MLGIB underwent PCE followed by same-day colonoscopy. Diagnostic accuracy for potentially hemorrhagic lesions (PHLs; combined diagnosis by PCE + colonoscopy) and incidence of adverse events were assessed. RESULTS 100 patients were included (median age 70 [range 18-92] years; 65% female). PHLs were diagnosed in 46 patients, including small-bowel and/or colon angioectasias in 32. PCE correctly identified 54 individuals without PHLs, and 95.7% (44/46) of those with PHLs vs. 50.0% (23/46) for colonoscopy (P<0.01). PHLs were detected by PCE alone in 65.2% (30/46), both examinations in 28.3% (13/46), and colonoscopy alone in 6.5% (3/46). PHLs were diagnosed at the ileocolonic region in 28% of patients, with PCE diagnosing 25/28 cases (89.3%) and colonoscopy diagnosing 23/28 (82.1%; P=0.13). Interventional procedures were performed at colonoscopy in 13/81 patients with iron-deficiency anemia (16.0%) vs. 6/19 patients with overt bleeding (31.6%; P<0.01). No significant adverse events occurred with PCE vs. 2% with colonoscopy. CONCLUSIONS In patients with MLGIB, PCE avoided further invasive procedures in >50% of patients. PCE was safe and more effective than colonoscopy in identifying PHL both in the small bowel and colon. These results support the potential use of PCE as first-line examination in patients with suspected MLGIB.
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Affiliation(s)
- Bruno Rosa
- Department of Gastroenterology, Hospital da Senhora da Oliveira, Guimarães, Portugal
- Life and Health Sciences Research Institute, School of Medicine, University of Minho, Braga, Portugal
- ICVS/3B's, PT Government Associate Laboratory, Braga, Portugal
| | - Tiago Cúrdia Gonçalves
- Department of Gastroenterology, Hospital da Senhora da Oliveira, Guimarães, Portugal
- Life and Health Sciences Research Institute, School of Medicine, University of Minho, Braga, Portugal
- ICVS/3B's, PT Government Associate Laboratory, Braga, Portugal
| | - Maria J Moreira
- Department of Gastroenterology, Hospital da Senhora da Oliveira, Guimarães, Portugal
- Life and Health Sciences Research Institute, School of Medicine, University of Minho, Braga, Portugal
- ICVS/3B's, PT Government Associate Laboratory, Braga, Portugal
| | - Francisca Dias de Castro
- Department of Gastroenterology, Hospital da Senhora da Oliveira, Guimarães, Portugal
- Life and Health Sciences Research Institute, School of Medicine, University of Minho, Braga, Portugal
- ICVS/3B's, PT Government Associate Laboratory, Braga, Portugal
| | - Bernardo Sousa-Pinto
- MEDCIDS, Department of Community Medicine, Information and Health Decision Sciences, Faculty of Medicine, University of Porto, Porto, Portugal
- CINTESIS, Center for Health Technology and Services Research, University of Porto, Porto, Portugal
| | - Mário Dinis-Ribeiro
- MEDCIDS, Department of Community Medicine, Information and Health Decision Sciences, Faculty of Medicine, University of Porto, Porto, Portugal
- RISE@CI-IPO (Health Research Network), Portuguese Oncology Institute of Porto (IPO Porto) / Porto Comprehensive Cancer Center (Porto.CCC), Porto, Portugal
| | - José Cotter
- Department of Gastroenterology, Hospital da Senhora da Oliveira, Guimarães, Portugal
- Life and Health Sciences Research Institute, School of Medicine, University of Minho, Braga, Portugal
- ICVS/3B's, PT Government Associate Laboratory, Braga, Portugal
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Compare D, Sgamato C, Rocco A, Coccoli P, Donnarumma D, Marchitto SA, Cinque S, Palmieri P, Nardone G. The professional background of a referring physician predicts the diagnostic yield of small bowel capsule endoscopy in suspected small bowel bleeding. Endosc Int Open 2024; 12:E282-E290. [PMID: 38455125 PMCID: PMC10919998 DOI: 10.1055/a-2251-3285] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/22/2023] [Accepted: 12/22/2023] [Indexed: 03/09/2024] Open
Abstract
Background and study aims The diagnostic yield of small-bowel capsule endoscopy (SBCE) in suspected small bowel bleeding (SSBB) is highly variable. Different reimbursement systems and equipment costs also limit SBCE use in clinical practice. Thus, minimizing non-diagnostic procedures is advisable. This study aimed to assess the SBCE diagnostic yield and identify factors predicting diagnostic findings in a cohort of patients with SSBB. Patients and methods In this retrospective cohort study, we analyzed the medical records of patients who consecutively underwent SBCE for SSBB over 9 years. By logistic regression, we identified covariates predicting diagnostic findings at SBCE. Finally, we performed a post-hoc cost analysis based on previous gastroenterologist or endoscopist consultations versus direct SBCE ordering by other specialists. Results The final analysis included 584 patients. Most SBCEs were ordered by a gastroenterologist or endoscopist (74%). The number of SBCEs without any finding was significantly lower in the gastroenterologist/endoscopist group P <0.001). The SBCE diagnostic yield ordered by a gastroenterologist or endoscopist was significantly higher than that by other specialists (63% vs 52%, odds ratio [OR] 1.57; 95% confidence interval [CI] 1.07-2.26, P =0.019). At multivariate analysis, older age (OR 1.7, 95%CI 1.2-2.4, P =0.005), anemia (OR 4.9, 95%CI 1.9-12, P =0.001), small bowel transit time (OR 1, 95%CI 1-1.02, P =0.039), and referring physician (OR 1.8, 95%CI 1.1-2.7, P =0.003) independently predicted diagnostic findings. Implementing prior gastroenterologist or endoscopist referral vs direct SBCE ordering would reduce medical expenditures by 16%. Conclusions The professional background of referring physicians significantly improves the diagnostic yield of SBCE and contributes to controlling public health costs.
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Affiliation(s)
- Debora Compare
- Gastroenterology Unit, Clinical Medicine and Surgery, University of Naples Federico II, Napoli, Italy
| | - Costantino Sgamato
- Gastroenterology Unit, Clinical Medicine and Surgery, University of Naples Federico II, Napoli, Italy
| | - Alba Rocco
- Gastroenterology Unit, Clinical Medicine and Surgery, University of Naples Federico II, Napoli, Italy
| | - Pietro Coccoli
- Gastroenterology Unit, Clinical Medicine and Surgery, University of Naples Federico II, Napoli, Italy
| | - Durante Donnarumma
- Gastroenterology Unit, Clinical Medicine and Surgery, University of Naples Federico II, Napoli, Italy
| | - Stefano Andrea Marchitto
- Gastroenterology Unit, Clinical Medicine and Surgery, University of Naples Federico II, Napoli, Italy
| | - Sofia Cinque
- Gastroenterology Unit, Clinical Medicine and Surgery, University of Naples Federico II, Napoli, Italy
| | - Pietro Palmieri
- Gastroenterology Unit, Clinical Medicine and Surgery, University of Naples Federico II, Napoli, Italy
| | - Gerardo Nardone
- Gastroenterology Unit, Clinical Medicine and Surgery, University of Naples Federico II, Napoli, Italy
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Mascarenhas M, Mendes F, Ribeiro T, Afonso J, Cardoso P, Martins M, Cardoso H, Andrade P, Ferreira J, Mascarenhas Saraiva M, Macedo G. Deep Learning and Minimally Invasive Endoscopy: Automatic Classification of Pleomorphic Gastric Lesions in Capsule Endoscopy. Clin Transl Gastroenterol 2023; 14:e00609. [PMID: 37404050 PMCID: PMC10584281 DOI: 10.14309/ctg.0000000000000609] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/13/2023] [Accepted: 06/02/2023] [Indexed: 07/06/2023] Open
Abstract
INTRODUCTION Capsule endoscopy (CE) is a minimally invasive examination for evaluating the gastrointestinal tract. However, its diagnostic yield for detecting gastric lesions is suboptimal. Convolutional neural networks (CNNs) are artificial intelligence models with great performance for image analysis. Nonetheless, their role in gastric evaluation by wireless CE (WCE) has not been explored. METHODS Our group developed a CNN-based algorithm for the automatic classification of pleomorphic gastric lesions, including vascular lesions (angiectasia, varices, and red spots), protruding lesions, ulcers, and erosions. A total of 12,918 gastric images from 3 different CE devices (PillCam Crohn's; PillCam SB3; OMOM HD CE system) were used from the construction of the CNN: 1,407 from protruding lesions; 994 from ulcers and erosions; 822 from vascular lesions; and 2,851 from hematic residues and the remaining images from normal mucosa. The images were divided into a training (split for three-fold cross-validation) and validation data set. The model's output was compared with a consensus classification by 2 WCE-experienced gastroenterologists. The network's performance was evaluated by its sensitivity, specificity, accuracy, positive predictive value and negative predictive value, and area under the precision-recall curve. RESULTS The trained CNN had a 97.4% sensitivity; 95.9% specificity; and positive predictive value and negative predictive value of 95.0% and 97.8%, respectively, for gastric lesions, with 96.6% overall accuracy. The CNN had an image processing time of 115 images per second. DISCUSSION Our group developed, for the first time, a CNN capable of automatically detecting pleomorphic gastric lesions in both small bowel and colon CE devices.
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Affiliation(s)
- Miguel Mascarenhas
- Precision Medicine Unit, Department of Gastroenterology, São João University Hospital, Alameda Professor Hernâni Monteiro, Porto, Portugal
- WGO Gastroenterology and Hepatology Training Center, Porto, Portugal
- Faculty of Medicine of the University of Porto, Alameda Professor Hernâni Monteiro, Porto, Portugal
| | - Francisco Mendes
- Precision Medicine Unit, Department of Gastroenterology, São João University Hospital, Alameda Professor Hernâni Monteiro, Porto, Portugal
- WGO Gastroenterology and Hepatology Training Center, Porto, Portugal
| | - Tiago Ribeiro
- Precision Medicine Unit, Department of Gastroenterology, São João University Hospital, Alameda Professor Hernâni Monteiro, Porto, Portugal
- WGO Gastroenterology and Hepatology Training Center, Porto, Portugal
| | - João Afonso
- Precision Medicine Unit, Department of Gastroenterology, São João University Hospital, Alameda Professor Hernâni Monteiro, Porto, Portugal
- WGO Gastroenterology and Hepatology Training Center, Porto, Portugal
| | - Pedro Cardoso
- Precision Medicine Unit, Department of Gastroenterology, São João University Hospital, Alameda Professor Hernâni Monteiro, Porto, Portugal
- WGO Gastroenterology and Hepatology Training Center, Porto, Portugal
| | - Miguel Martins
- Precision Medicine Unit, Department of Gastroenterology, São João University Hospital, Alameda Professor Hernâni Monteiro, Porto, Portugal
- WGO Gastroenterology and Hepatology Training Center, Porto, Portugal
| | - Hélder Cardoso
- Precision Medicine Unit, Department of Gastroenterology, São João University Hospital, Alameda Professor Hernâni Monteiro, Porto, Portugal
- WGO Gastroenterology and Hepatology Training Center, Porto, Portugal
- Faculty of Medicine of the University of Porto, Alameda Professor Hernâni Monteiro, Porto, Portugal
| | - Patrícia Andrade
- Precision Medicine Unit, Department of Gastroenterology, São João University Hospital, Alameda Professor Hernâni Monteiro, Porto, Portugal
- WGO Gastroenterology and Hepatology Training Center, Porto, Portugal
- Faculty of Medicine of the University of Porto, Alameda Professor Hernâni Monteiro, Porto, Portugal
| | - João Ferreira
- Department of Mechanical Engineering, Faculty of Engineering of the University of Porto, Porto, Portugal
- Digestive Artificial Intelligence Development, Porto, Portugal
| | | | - Guilherme Macedo
- Precision Medicine Unit, Department of Gastroenterology, São João University Hospital, Alameda Professor Hernâni Monteiro, Porto, Portugal
- WGO Gastroenterology and Hepatology Training Center, Porto, Portugal
- Faculty of Medicine of the University of Porto, Alameda Professor Hernâni Monteiro, Porto, Portugal
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Hamdeh S, Fathallah J, Zhang H, Charoen A, Altamimi BA, Odufalu FD, Dave D, Sayed AE, Glick LR, Grisolano S, Hachem C, Hammami MB, Mahmoud KH, Levy AN, Rao VL, Shim HG, Semrad C, Olyaee M, Micic D. Predictive Model for Positive Video Capsule Endoscopy in Iron Deficiency Anemia. Dig Dis Sci 2023; 68:3083-3091. [PMID: 36917313 DOI: 10.1007/s10620-023-07918-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/05/2023] [Accepted: 03/06/2023] [Indexed: 03/16/2023]
Abstract
BACKGROUND AND AIMS Bleeding from the gastrointestinal tract can contribute to the development of iron deficiency anemia (IDA) among individuals without another obvious source of bleeding. In order to identify patients most likely to benefit from examination of the small bowel, our aim was to create a risk score for positive video capsule endoscopy (VCE) in IDA utilizing a multicenter collection of studies. METHODS We performed a retrospective multicenter study utilizing VCE studies performed for an indication of IDA between 1/1/2005 and 7/31/2018. VCE findings were graded based on the P0-P2 grading system. The primary outcome of interest was a positive (P2) VCE. Data were analyzed with Student's t test for continuous variables and the Fisher's exact test for categorical variables. Logistic regression was used to identify independent associations with positive VCE. RESULTS In total, 765 VCE procedures were included with 355 (46.5%) male subjects and a median age of 63.2 (SD 15.3) years. One hundred ninety studies (24.8%) were positive (P2) for small bowel bleeding. Four variables associated with positive VCE which were incorporated into a point scoring system: (+) 1 for age ≥ 66 years, active smoking and cardiac arrythmia and (-) 1 for preceding hemoglobin level ≥ 8.5. The risk probabilities for positive VCE-assigned scores - 1, 0, 1, and 2 + were 12.3% (95% CI 7.3-17.3%), 20% (14.9-25.1%), 34.8% (28.6-41%), and 39% (30-47.8%). CONCLUSION In order to improve the diagnostic yield of capsule examinations, risk factors should be applied to clinical decision-making. We created a risk score for positive VCE in IDA, including the risk factors of age, smoking, history of cardiac arrythmia, and preceding hemoglobin level.
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Affiliation(s)
- Shadi Hamdeh
- Department of Internal Medicine, Division of Gastroenterology, Hepatology and Motility, University of Kansas Medical Center, Kansas City, KS, USA
| | - Jihan Fathallah
- Department of Internal Medicine, University of Kansas Medical Center, Kansas City, KS, USA
| | - Hui Zhang
- The Center for Health and the Social Sciences, University of Chicago, Chicago, IL, USA
| | - Amber Charoen
- Department of Medicine, Division of Gastroenterology, Hepatology and Nutrition, John Hopkins University School of Medicine, Baltimore, MD, USA
| | - Barakat Aburajab Altamimi
- Department of Internal Medicine, Division of Gastroenterology and Hepatology, University of Iowa Hospital and Clinics, Iowa City, IA, USA
| | - Florence-Damilola Odufalu
- Department of Internal Medicine, Division of Gastroenterology and Hepatology, Saint Louis University School of Medicine, Saint Louis, MO, USA
| | - Devashree Dave
- Department of Internal Medicine, University of Iowa Hospital and Clinics, Iowa City, IA, USA
| | - Amer El Sayed
- Department of Internal Medicine, Division of Gastroenterology and Hepatology, University of Iowa Hospital and Clinics, Iowa City, IA, USA
| | - Laura R Glick
- Department of Internal Medicine, Section of Gastroenterology, Hepatology and Nutrition, University of Chicago Medicine, 5841 South Maryland Avenue, MC4076, Chicago, IL, 60637, USA
| | - Scott Grisolano
- Department of Internal Medicine, Division of Gastroenterology, Hepatology and Motility, University of Kansas Medical Center, Kansas City, KS, USA
| | - Christine Hachem
- Department of Internal Medicine, Division of Gastroenterology and Hepatology, Saint Louis University School of Medicine, Saint Louis, MO, USA
| | - Muhammad Bader Hammami
- Department of Internal Medicine, Division of Gastroenterology and Hepatology, Saint Louis University School of Medicine, Saint Louis, MO, USA
| | - Khaldoun Haj Mahmoud
- Department of Internal Medicine, University of Kansas Medical Center, Kansas City, KS, USA
| | - Alexander N Levy
- Division of Gastroenterology and Hepatology, Tufts Medical Center, Boston, MA, USA
| | - Vijaya L Rao
- Department of Internal Medicine, Section of Gastroenterology, Hepatology and Nutrition, University of Chicago Medicine, 5841 South Maryland Avenue, MC4076, Chicago, IL, 60637, USA
| | - Hong Gi Shim
- Division of Gastroenterology and Hepatology, Tufts Medical Center, Boston, MA, USA
| | - Carol Semrad
- Department of Internal Medicine, Section of Gastroenterology, Hepatology and Nutrition, University of Chicago Medicine, 5841 South Maryland Avenue, MC4076, Chicago, IL, 60637, USA
| | - Mojtaba Olyaee
- Department of Internal Medicine, Division of Gastroenterology, Hepatology and Motility, University of Kansas Medical Center, Kansas City, KS, USA
| | - Dejan Micic
- Department of Internal Medicine, Section of Gastroenterology, Hepatology and Nutrition, University of Chicago Medicine, 5841 South Maryland Avenue, MC4076, Chicago, IL, 60637, USA.
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Singla N, Inavolu P, Jagtap N, Singh AP, Kalapala R, Memon SF, Katukuri GR, Pal P, Nabi Z, Ramchandani M, Lakhtakia S, Banerjee R, Reddy PM, Tandan M, Reddy N. Small Bowel Capsule Endoscopy: Experience from a single large tertiary care centre. Endosc Int Open 2023; 11:E623-E628. [PMID: 37614640 PMCID: PMC10442921 DOI: 10.1055/a-2096-2453] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/10/2022] [Accepted: 12/20/2022] [Indexed: 08/25/2023] Open
Abstract
Background and study aims Capsule endoscopy (CE) has transformed examination of the small bowel (SB), once considered a dark continent. The present study aimed to describe the indications, diagnostic yield, practical issues and complications of CE in one of the largest tertiary center in India. Patients and methods This retrospective analysis from a prospectively maintained database, conducted from January 2013 to June 2021 included 1155 CEs performed during this period. Patient medical records were reviewed for indications, results, and complications of CE. Results A total of 1154 patients (809 males and 345 females), mean age 53 years (range 6-87 years), one capsule got stuck in the esophagus, were included in the study. Active SB bleeding had no effect on SB transit time (324.7±161 minutes, n = 137 patients with active bleed vs 310.6±166.9 minutes, n = 1017 patients without active bleed; P = 0.35). The indication and diagnostic yield (DY) of CE were potential overt SB bleed (68.6% & 43.9%), potential occult SB bleed (8.2% and 40%), chronic diarrhea (7.9% and 28.4%), abdominal pain (6.5% and 21.3%), anemia (5.9% and 57.9%), and suspected/known case of Crohn's disease (2.3% & 56.5%) respectively. The DY for patients with age ≥60 years was similar to those with age < 60 years (61.9% vs. 51.8% respectively; P = 0.4). 21 patients (1.8%) had capsule retention of which six (0.5%) had to be referred for surgery. Conclusions CE is a safe and effective investigation with ever increasing range of indications. Potential SB bleed remains the most common indication for CE with high detection rate.
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Affiliation(s)
- Neeraj Singla
- Gastroenterology, Asian Institute of Gastroenterology, Hyderabad, India
| | - Pradev Inavolu
- Gastroenterology, Asian Institute of Gastroenterology, Hyderabad, India
| | - Nitin Jagtap
- Gastroenterology, Asian Institute of Gastroenterology, Hyderabad, India
| | | | - Rakesh Kalapala
- Gastroenterology, Asian Institute of Gastroenterology, Hyderabad, India
| | | | | | - Partha Pal
- Gastroenterology, Asian Institute of Gastroenterology, Hyderabad, India
| | - Zaheer Nabi
- Gastroenterology, Asian Institute of Gastroenterology, Hyderabad, India
| | - Mohan Ramchandani
- Gastroenterology, Asian Institute of Gastroenterology, Hyderabad, India
| | - Sundeep Lakhtakia
- Gastroenterology, Asian Institute of Gastroenterology, Hyderabad, India
| | - Rupa Banerjee
- Gastroenterology, Asian Institute of Gastroenterology, Hyderabad, India
| | | | - Manu Tandan
- Gastroenterology, Asian Institute of Gastroenterology, Hyderabad, India
| | - Nageshwar Reddy
- Gastroenterology, Asian Institute of Gastroenterology, Hyderabad, India
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Defarges A, Stiller J, Solomon JA. Gastrointestinal angiodysplasias diagnosed using video capsule endoscopy in 15 dogs. J Vet Intern Med 2023; 37:428-436. [PMID: 36866722 DOI: 10.1111/jvim.16677] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2021] [Accepted: 02/16/2023] [Indexed: 03/04/2023] Open
Abstract
BACKGROUND Angiodysplasia (AGD) is rarely diagnosed in dogs with gastrointestinal bleeding (GIB) and is reported in case reports in dogs. OBJECTIVE Describe signalment, clinical and diagnostic features of dogs with gastrointestinal (GI) AGD diagnosed by video capsule endoscopy (VCE). ANIMALS Dogs with overt or suspected GIB which underwent VCE. METHODS Dogs for which a VCE was submitted for overt or suspected GIB from 2016 to 2021 were selected retrospectively. Medical records and full-length VCE recordings where AGDs were initially detected, were reviewed by 2 trained internists. AGD was considered definitive if 2 readers detected it. Signalment, clinical signs, blood work, medications, concurrent diseases, findings of previous conventional endoscopy, and surgical exploration (if applicable) of dogs with AGD were recorded. RESULTS Definitive AGD was diagnosed in 15 of 291 (5%) dogs (12 males, 3 females). Twelve (80%) had overt GIB, 11 (73%) had hematochezia, and 6 (40%) had microcytic and hypochromic anemia. AGD was missed by conventional endoscopy in 9/9 dogs and exploratory surgery in 3/3 dogs. Thirteen capsules were administered by mouth (1 incomplete study), and 2 via endoscopy directly into the duodenum. AGD was visualized in the stomach of 3 dogs, in the small intestine of 4, and in the colon of 13 dogs. CONCLUSION AND CLINICAL IMPORTANCE Although rare, AGD should be considered in dogs with suspected GIB after a negative conventional endoscopy or surgical exporation. Video capsuel endoscopy appears to be a sensitive test to identify AGD within the GI tract.
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Affiliation(s)
- Alice Defarges
- University of Guelph, Ontario Veterinary College, Guelph, Ontario, Canada
| | - Jenny Stiller
- Universität Leipzig Veterinärmedizinische Fakultät Klinik, Leipzig, Germany
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8
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Sorge A, Elli L, Rondonotti E, Pennazio M, Spada C, Cadoni S, Cannizzaro R, Calabrese C, de Franchis R, Girelli CM, Marmo R, Riccioni ME, Marmo C, Oliva S, Scarpulla G, Soncini M, Vecchi M, Tontini GE. Enteroscopy in diagnosis and treatment of small bowel bleeding: A Delphi expert consensus. Dig Liver Dis 2023; 55:29-39. [PMID: 36100515 DOI: 10.1016/j.dld.2022.08.021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/29/2022] [Accepted: 08/14/2022] [Indexed: 12/31/2022]
Abstract
BACKGROUND Enteroscopy plays an important role in the management of small bowel bleeding. However, current guidelines are not specifically designed for small bowel bleeding and recommendations from different international societies do not always align. Consequently, there is heterogeneity in the definitions of clinical entities, clinical practice policies, and adherence to guidelines among clinicians. This represents an obstacle to providing the best patient care and to obtain homogeneous data for clinical research. AIMS The aims of the study were to establish a consensus on the definitions of bleeding entities and on the role of enteroscopy in the management of small bowel bleeding using a Delphi process. METHODS A core group of eight experts in enteroscopy identified five main topics of small bowel bleeding management and drafted statements on each topic. An expert panel of nine gastroenterologists participated in three rounds of the Delphi process, together with the core group. RESULTS A total of 33 statements were approved after three rounds of Delphi voting. CONCLUSION This Delphi consensus proposes clear definitions and a unifying strategy to standardize the management of small bowel bleeding. Furthermore, it provides a useful guide in daily practice for both clinical and technical issues of enteroscopy.
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Affiliation(s)
- Andrea Sorge
- Gastroenterology and Endoscopy Unit, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy; Department of Pathophysiology and Transplantation, University of Milan, Milan, Italy.
| | - Luca Elli
- Gastroenterology and Endoscopy Unit, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
| | | | - Marco Pennazio
- University Division of Gastroenterology, City of Health and Science University Hospital, Turin, Italy
| | - Cristiano Spada
- Digestive Endoscopy Unit, Catholic University of Rome, Rome, Italy; Digestive Endoscopy Unit, Fondazione Poliambulanza, Brescia, Italy
| | - Sergio Cadoni
- Digestive Endoscopy Unit, Centro Traumatologico Ortopedico, Iglesias, Italy
| | - Renato Cannizzaro
- Experimental Oncological Gastroenterology Unit, Centro di Riferimento Oncologico di Aviano (CRO), Istituto Nazionale Tumori IRCCS, Aviano, Italy
| | - Carlo Calabrese
- University of Bologna Alma Mater - School of Medicine, Department of Medical and Surgical Sciences - Regional Referral Center for IBD, Bologna, Italy
| | | | | | | | - Maria Elena Riccioni
- Digestive Endoscopy Unit, IRCCS Fondazione Policlinico Universitario A. Gemelli, Rome, Italy
| | - Clelia Marmo
- Digestive Endoscopy Unit, IRCCS Fondazione Policlinico Universitario A. Gemelli, Rome, Italy
| | - Salvatore Oliva
- Gastroenterology and Paeditric Hepatology Unit, Università La Sapienza, Rome, Italy
| | | | - Marco Soncini
- Department of Internal Medicine, "A. Manzoni" Hospital, ASST Lecco, Italy
| | - Maurizio Vecchi
- Gastroenterology and Endoscopy Unit, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy; Department of Pathophysiology and Transplantation, University of Milan, Milan, Italy
| | - Gian Eugenio Tontini
- Gastroenterology and Endoscopy Unit, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy; Department of Pathophysiology and Transplantation, University of Milan, Milan, Italy
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9
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Leighton JA, Brock AS, Semrad CE, Hass DJ, Guda NM, Barkin JA, Eisen GM. Quality indicators for capsule endoscopy and deep enteroscopy. Gastrointest Endosc 2022; 96:693-711. [PMID: 36175176 DOI: 10.1016/j.gie.2022.08.039] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/31/2022] [Accepted: 08/31/2022] [Indexed: 12/11/2022]
Abstract
BACKGROUND AND AIMS Capsule endoscopy (CE) and deep enteroscopy (DE) can be useful for diagnosing and treating suspected small-bowel disease. Guidelines and detailed recommendations exist for the use of CE/DE, but comprehensive quality indicators are lacking. The goal of this task force was to develop quality indicators for appropriate use of CE/DE by using a modified RAND/UCLA Appropriateness Method. METHODS An expert panel of 7 gastroenterologists with diverse practice experience was assembled to identify quality indicators. A literature review was conducted to develop a list of proposed quality indicators applicable to preprocedure, intraprocedure, and postprocedure periods. The panelists reviewed the literature; identified and modified proposed quality indicators; rated them on the basis of scientific evidence, validity, and necessity; and determined proposed performance targets. Agreement and consensus with the proposed indicators were verified using the RAND/UCLA Appropriateness Method. RESULTS The voting procedure to prioritize metrics emphasized selecting measures to improve quality and overall patient care. Panelists rated indicators on the perceived appropriateness and necessity for clinical practice. After voting and discussion, 2 quality indicators ranked as inappropriate or uncertain were excluded. Each quality indicator was categorized by measure type, performance target, and summary of evidence. The task force identified 13 quality indicators for CE and DE. CONCLUSIONS Comprehensive quality indicators have not existed for CE or DE. The task force identified quality indicators that can be incorporated into clinical practice. The panel also addressed existing knowledge gaps and posed research questions to better inform future research and quality guidelines for these procedures.
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Leighton JA, Brock AS, Semrad CE, Hass DJ, Guda NM, Barkin JA, Eisen GM. Quality Indicators for Capsule Endoscopy and Deep Enteroscopy. Am J Gastroenterol 2022; 117:1780-96. [PMID: 36155365 DOI: 10.14309/ajg.0000000000001903] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/06/2022] [Indexed: 12/11/2022]
Abstract
INTRODUCTION Capsule endoscopy (CE) and deep enteroscopy (DE) can be useful for diagnosing and treating suspected small-bowel disease. Guidelines and detailed recommendations exist for the use of CE/DE, but comprehensive quality indicators are lacking. The goal of this task force was to develop quality indicators for appropriate use of CE/DE by using a modified RAND/UCLA Appropriateness Method. METHODS An expert panel of 7 gastroenterologists with diverse practice experience was assembled to identify quality indicators. A literature review was conducted to develop a list of proposed quality indicators applicable to preprocedure, intraprocedure, and postprocedure periods. The panelists reviewed the literature; identified and modified proposed quality indicators; rated them on the basis of scientific evidence, validity, and necessity; and determined proposed performance targets. Agreement and consensus with the proposed indicators were verified using the RAND/UCLA Appropriateness Method. RESULTS The voting procedure to prioritize metrics emphasized selecting measures to improve quality and overall patient care. Panelists rated indicators on the perceived appropriateness and necessity for clinical practice. After voting and discussion, 2 quality indicators ranked as inappropriate or uncertain were excluded. Each quality indicator was categorized by measure type, performance target, and summary of evidence. The task force identified 13 quality indicators for CE and DE. DISCUSSION Comprehensive quality indicators have not existed for CE or DE. The task force identified quality indicators that can be incorporated into clinical practice. The panel also addressed existing knowledge gaps and posed research questions to better inform future research and quality guidelines for these procedures.
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Elli L, Marinoni B, Sidhu R, Bojarski C, Branchi F, Tontini GE, Chetcuti Zammit S, Khater S, Eliakim R, Rondonotti E, Saurin JC, Bruno M, Buchkremer J, Cadoni S, Cavallaro F, Dray X, Ellul P, Urien IF, Keuchel M, Kopylov U, Koulaouzidis A, Leenhardt R, Baltes P, Beaumont H, Marmo C, McNamara D, Mussetto A, Nemeth A, Cuadrado Robles EP, Perrod G, Rahmi G, Riccioni ME, Robertson A, Spada C, Toth E, Triantafyllou K, Wurm Johansson G, Rimondi A. Nomenclature and Definition of Atrophic Lesions in Small Bowel Capsule Endoscopy: A Delphi Consensus Statement of the International CApsule endoscopy REsearch (I-CARE) Group. Diagnostics (Basel) 2022; 12:diagnostics12071704. [PMID: 35885608 PMCID: PMC9325291 DOI: 10.3390/diagnostics12071704] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2022] [Revised: 06/25/2022] [Accepted: 07/07/2022] [Indexed: 11/16/2022] Open
Abstract
(1) Background: Villous atrophy is an indication for small bowel capsule endoscopy (SBCE). However, SBCE findings are not described uniformly and atrophic features are sometimes not recognized; (2) Methods: The Delphi technique was employed to reach agreement among a panel of SBCE experts. The nomenclature and definitions of SBCE lesions suggesting the presence of atrophy were decided in a core group of 10 experts. Four images of each lesion were chosen from a large SBCE database and agreement on the correspondence between the picture and the definition was evaluated using the Delphi method in a broadened group of 36 experts. All images corresponded to histologically proven mucosal atrophy; (3) Results: Four types of atrophic lesions were identified: mosaicism, scalloping, folds reduction, and granular mucosa. The core group succeeded in reaching agreement on the nomenclature and the descriptions of these items. Consensus in matching the agreed definitions for the proposed set of images was met for mosaicism (88.9% in the first round), scalloping (97.2% in the first round), and folds reduction (94.4% in the first round), but granular mucosa failed to achieve consensus (75.0% in the third round); (4) Conclusions: Consensus among SBCE experts on atrophic lesions was met for the first time. Mosaicism, scalloping, and folds reduction are the most reliable signs, while the description of granular mucosa remains uncertain.
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Affiliation(s)
- Luca Elli
- Department of Pathophysiology and Transplantation, Università degli Studi di Milano, 20122 Milan, Italy;
- Gastroenterology and Endoscopy Unit, Fondazione IRCCS Ca’ Granda Ospedale Maggiore Policlinico, 20122 Milan, Italy; (B.M.); (F.C.); (A.R.)
- Correspondence: ; Tel.: +39-02-55-03-33-64
| | - Beatrice Marinoni
- Gastroenterology and Endoscopy Unit, Fondazione IRCCS Ca’ Granda Ospedale Maggiore Policlinico, 20122 Milan, Italy; (B.M.); (F.C.); (A.R.)
- Postgraduate Specialization in Gastrointestinal Diseases, Università degli Studi di Milano, 20122 Milan, Italy
| | - Reena Sidhu
- Department of Infection, Immunity and Cardiovascular Diseases, Royal Hallamshire Hospital, University of Sheffield, Sheffield S10 2TN, UK;
| | - Christian Bojarski
- Charité-Universitätsmedizin Berlin, Campus Benjamin Franklin, 10117 Berlin, Germany; (C.B.); (F.B.); (J.B.)
| | - Federica Branchi
- Charité-Universitätsmedizin Berlin, Campus Benjamin Franklin, 10117 Berlin, Germany; (C.B.); (F.B.); (J.B.)
| | - Gian Eugenio Tontini
- Department of Pathophysiology and Transplantation, Università degli Studi di Milano, 20122 Milan, Italy;
- Gastroenterology and Endoscopy Unit, Fondazione IRCCS Ca’ Granda Ospedale Maggiore Policlinico, 20122 Milan, Italy; (B.M.); (F.C.); (A.R.)
| | - Stefania Chetcuti Zammit
- Department of Medicine, Division of Gastroenterology, Mater Dei Hospital, MSD 2090 Msida, Malta; (S.C.Z.); (P.E.)
| | - Sherine Khater
- Department of Gastroenterology, Georges-Pompidou European Hospital, 75015 Paris, France; (S.K.); (E.P.C.R.); (G.P.); (G.R.)
| | - Rami Eliakim
- Gastroenterology Department, Sheba Medical Center, Tel Aviv University, Tel Aviv 52621, Israel; (R.E.); (U.K.)
| | | | - Jean Cristhophe Saurin
- Gastroenterology Department, Hospices Civils de Lyon-Centre Hospitalier Universitaire, 69002 Lyon, France;
| | - Mauro Bruno
- University Division of Gastroenterology, City of Health and Science University Hospital, 10126 Turin, Italy;
| | - Juliane Buchkremer
- Charité-Universitätsmedizin Berlin, Campus Benjamin Franklin, 10117 Berlin, Germany; (C.B.); (F.B.); (J.B.)
| | - Sergio Cadoni
- Digestive Endoscopy Unit, CTO Hospital, 09016 Iglesias, Italy;
| | - Flaminia Cavallaro
- Gastroenterology and Endoscopy Unit, Fondazione IRCCS Ca’ Granda Ospedale Maggiore Policlinico, 20122 Milan, Italy; (B.M.); (F.C.); (A.R.)
| | - Xavier Dray
- Centre for Digestive Endoscopy, Sorbonne University, Saint Antoine Hospital, APHP, 75012 Paris, France; (X.D.); (R.L.)
| | - Pierre Ellul
- Department of Medicine, Division of Gastroenterology, Mater Dei Hospital, MSD 2090 Msida, Malta; (S.C.Z.); (P.E.)
| | | | - Martin Keuchel
- Clinic for Internal Medicine, Agaplesion Bethesda Krankenhaus Bergedorf, Academic Teaching Hospital of the University of Hamburg, 21029 Hamburg, Germany; (M.K.); (P.B.)
| | - Uri Kopylov
- Gastroenterology Department, Sheba Medical Center, Tel Aviv University, Tel Aviv 52621, Israel; (R.E.); (U.K.)
| | - Anastasios Koulaouzidis
- Department of Medicine, Odense University Hospital (OUH)-Svendborg Sygehus, 5700 Svendborg, Denmark;
- Department of Clinical Research, University of Southern Denmark (SDU), 5230 Odense, Denmark
- Surgical Research Unit, OUH, 5000 Odense, Denmark
| | - Romain Leenhardt
- Centre for Digestive Endoscopy, Sorbonne University, Saint Antoine Hospital, APHP, 75012 Paris, France; (X.D.); (R.L.)
| | - Peter Baltes
- Clinic for Internal Medicine, Agaplesion Bethesda Krankenhaus Bergedorf, Academic Teaching Hospital of the University of Hamburg, 21029 Hamburg, Germany; (M.K.); (P.B.)
| | - Hanneke Beaumont
- Department of Gastroenterology and Hepatology, Amsterdam University Medical Center, Location VU, 1118 Amsterdam, The Netherlands;
| | - Clelia Marmo
- Fondazione Policlinico Universitario Agostino Gemelli, IRCCS, Università Cattolica del Sacro Cuore, 00168 Roma, Italy; (C.M.); (M.E.R.); (C.S.)
| | - Deirdre McNamara
- Trinity College Dublin, Tallaght University Hospital, D24 NR0A Dublin, Ireland;
| | - Alessandro Mussetto
- Gastroenterology Unit, Santa Maria delle Croci Hospital, 48121 Ravenna, Italy;
| | - Artur Nemeth
- Skåne University Hospital Malmö, Lund University, 221 00 Lund, Sweden; (A.N.); (E.T.); (G.W.J.)
| | - Enrique Perez Cuadrado Robles
- Department of Gastroenterology, Georges-Pompidou European Hospital, 75015 Paris, France; (S.K.); (E.P.C.R.); (G.P.); (G.R.)
- Small Bowel Unit, Morales Meseguer Hospital, 30008 Murcia, Spain
| | - Guillame Perrod
- Department of Gastroenterology, Georges-Pompidou European Hospital, 75015 Paris, France; (S.K.); (E.P.C.R.); (G.P.); (G.R.)
| | - Gabriel Rahmi
- Department of Gastroenterology, Georges-Pompidou European Hospital, 75015 Paris, France; (S.K.); (E.P.C.R.); (G.P.); (G.R.)
| | - Maria Elena Riccioni
- Fondazione Policlinico Universitario Agostino Gemelli, IRCCS, Università Cattolica del Sacro Cuore, 00168 Roma, Italy; (C.M.); (M.E.R.); (C.S.)
| | - Alexander Robertson
- Department of Gastroenterology, Western General Hospital, Edinburgh EH4 2XU, UK;
| | - Cristiano Spada
- Fondazione Policlinico Universitario Agostino Gemelli, IRCCS, Università Cattolica del Sacro Cuore, 00168 Roma, Italy; (C.M.); (M.E.R.); (C.S.)
- Digestive Endoscopy and Gastroenterology Unit, Poliambulanza Foundation, 25124 Brescia, Italy
| | - Ervin Toth
- Skåne University Hospital Malmö, Lund University, 221 00 Lund, Sweden; (A.N.); (E.T.); (G.W.J.)
| | - Konstantinos Triantafyllou
- Hepatogastroenterology Unit, 2nd Department of Propaedeutic Internal Medicine, Medical School, Attikon University General Hospital, National and Kapodistrian University, 157 72 Athens, Greece;
| | - Gabriele Wurm Johansson
- Skåne University Hospital Malmö, Lund University, 221 00 Lund, Sweden; (A.N.); (E.T.); (G.W.J.)
| | - Alessandro Rimondi
- Gastroenterology and Endoscopy Unit, Fondazione IRCCS Ca’ Granda Ospedale Maggiore Policlinico, 20122 Milan, Italy; (B.M.); (F.C.); (A.R.)
- Postgraduate Specialization in Gastrointestinal Diseases, Università degli Studi di Milano, 20122 Milan, Italy
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Xie X, Xiao YF, Zhao XY, Li JJ, Yang QQ, Peng X, Nie XB, Zhou JY, Zhao YB, Yang H, Liu X, Liu E, Chen YY, Zhou YY, Fan CQ, Bai JY, Lin H, Koulaouzidis A, Yang SM. Development and Validation of an Artificial Intelligence Model for Small Bowel Capsule Endoscopy Video Review. JAMA Netw Open 2022; 5:e2221992. [PMID: 35834249 PMCID: PMC9284338 DOI: 10.1001/jamanetworkopen.2022.21992] [Citation(s) in RCA: 16] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/17/2022] Open
Abstract
IMPORTANCE Reading small bowel capsule endoscopy (SBCE) videos is a tedious task for clinicians, and a new method should be applied to solve the situation. OBJECTIVES To develop and evaluate the performance of a convolutional neural network algorithm for SBCE video review in real-life clinical care. DESIGN, SETTING, AND PARTICIPANTS In this multicenter, retrospective diagnostic study, a deep learning neural network (SmartScan) was trained and validated for the SBCE video review. A total of 2927 SBCE examinations from 29 medical centers were used to train SmartScan to detect 17 types of CE structured terminology (CEST) findings from January 1, 2019, to June 30, 2020. SmartScan was later validated with conventional reading (CR) and SmartScan-assisted reading (SSAR) in 2898 SBCE examinations collected from 22 medical centers. Data analysis was performed from January 25 to December 31, 2021. EXPOSURE An artificial intelligence-based tool for interpreting clinical images of SBCE. MAIN OUTCOMES AND MEASURES The detection rate and efficiency of CEST findings detected by SSAR and CR were compared. RESULTS A total of 5825 SBCE examinations were retrospectively collected; 2898 examinations (1765 male participants [60.9%]; mean [SD] age, 49.8 [15.5] years) were included in the validation phase. From a total of 6084 CEST-classified SB findings, SSAR detected 5834 findings (95.9%; 95% CI, 95.4%-96.4%), significantly higher than CR, which detected 4630 findings (76.1%; 95% CI, 75.0%-77.2%). SmartScan-assisted reading achieved a higher per-patient detection rate (79.3% [2298 of 2898]) for CEST findings compared with CR (70.7% [2048 of 2298]; 95% CI, 69.0%-72.3%). With SSAR, the mean (SD) number of images (per SBCE video) requiring review was reduced to 779.2 (337.2) compared with 27 910.8 (12 882.9) with CR, for a mean (SD) reduction rate of 96.1% (4.3%). The mean (SD) reading time with SSAR was shortened to 5.4 (1.5) minutes compared with CR (51.4 [11.6] minutes), for a mean (SD) reduction rate of 89.3% (3.1%). CONCLUSIONS AND RELEVANCE This study suggests that a convolutional neural network-based algorithm is associated with an increased detection rate of SBCE findings and reduced SBCE video reading time.
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Affiliation(s)
- Xia Xie
- Department of Gastroenterology, The Second Affiliated Hospital, the Third Military Medical University, Chongqing, China
| | - Yu-Feng Xiao
- Department of Gastroenterology, The Second Affiliated Hospital, the Third Military Medical University, Chongqing, China
| | - Xiao-Yan Zhao
- Department of Gastroenterology, The Second Affiliated Hospital, the Third Military Medical University, Chongqing, China
| | - Jian-Jun Li
- Department of Gastroenterology, The Second Affiliated Hospital, the Third Military Medical University, Chongqing, China
| | - Qiang-Qiang Yang
- Department of Gastroenterology, The Second Affiliated Hospital, the Third Military Medical University, Chongqing, China
| | - Xue Peng
- Department of Gastroenterology, The Second Affiliated Hospital, the Third Military Medical University, Chongqing, China
| | - Xu-Biao Nie
- Department of Gastroenterology, The Second Affiliated Hospital, the Third Military Medical University, Chongqing, China
| | - Jian-Yun Zhou
- Department of Gastroenterology, The Second Affiliated Hospital, the Third Military Medical University, Chongqing, China
| | - Yong-Bing Zhao
- Department of Gastroenterology, The Second Affiliated Hospital, the Third Military Medical University, Chongqing, China
| | - Huan Yang
- Department of Gastroenterology, The Second Affiliated Hospital, the Third Military Medical University, Chongqing, China
| | - Xi Liu
- Department of Gastroenterology, The Second Affiliated Hospital, the Third Military Medical University, Chongqing, China
| | - En Liu
- Department of Gastroenterology, The Second Affiliated Hospital, the Third Military Medical University, Chongqing, China
| | - Yu-Yang Chen
- Department of Gastroenterology, The Second Affiliated Hospital, the Third Military Medical University, Chongqing, China
| | - Yuan-Yuan Zhou
- Department of Gastroenterology, The Second Affiliated Hospital, the Third Military Medical University, Chongqing, China
| | - Chao-Qiang Fan
- Department of Gastroenterology, The Second Affiliated Hospital, the Third Military Medical University, Chongqing, China
| | - Jian-Ying Bai
- Department of Gastroenterology, The Second Affiliated Hospital, the Third Military Medical University, Chongqing, China
| | - Hui Lin
- Department of Gastroenterology, The Second Affiliated Hospital, the Third Military Medical University, Chongqing, China
- Department of Epidemiology, the Third Military Medical University, Chongqing, China
| | | | - Shi-Ming Yang
- Department of Gastroenterology, The Second Affiliated Hospital, the Third Military Medical University, Chongqing, China
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Sey M. Artificial Intelligence and the Promise of Expediting and Standardizing the Reviewing and Reporting of Capsule Endoscopy Videos. JAMA Netw Open 2022; 5:e2222006. [PMID: 35834257 DOI: 10.1001/jamanetworkopen.2022.22006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Affiliation(s)
- Michael Sey
- Schulich School of Medicine, Western University, London, Ontario, Canada
- Gastroenterology and Therapeutic Endoscopy, London Health Sciences Centre, London, Ontario, Canada
- Lawson Health Research Institute, London Health Sciences Centre, London, Ontario, Canada
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Houdeville C, Leenhardt R, Souchaud M, Velut G, Carbonell N, Nion-Larmurier I, Nuzzo A, Histace A, Marteau P, Dray X. Evaluation by a Machine Learning System of Two Preparations for Small Bowel Capsule Endoscopy: The BUBS (Burst Unpleasant Bubbles with Simethicone) Study. J Clin Med 2022; 11:2822. [PMID: 35628947 PMCID: PMC9146856 DOI: 10.3390/jcm11102822] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2022] [Revised: 05/04/2022] [Accepted: 05/12/2022] [Indexed: 11/27/2022] Open
Abstract
Background: Bubbles often mask the mucosa during capsule endoscopy (CE). Clinical scores assessing the cleanliness and the amount of bubbles in the small bowel (SB) are poorly reproducible unlike machine learning (ML) solutions. We aimed to measure the amount of bubbles with ML algorithms in SB CE recordings, and compare two polyethylene glycol (PEG)-based preparations, with and without simethicone, in patients with obscure gastro-intestinal bleeding (OGIB). Patients & Methods: All consecutive outpatients with OGIB from a tertiary care center received a PEG-based preparation, without or with simethicone, in two different periods. The primary outcome was a difference in the proportions (%) of frames with abundant bubbles (>10%) along the full-length video sequences between the two periods. SB CE recordings were analyzed by a validated computed algorithm based on a grey-level of co-occurrence matrix (GLCM), to assess the abundance of bubbles in each frame. Results: In total, 105 third generation SB CE recordings were analyzed (48 without simethicone and 57 with simethicone-added preparations). A significant association was shown between the use of a simethicone-added preparation and a lower abundance of bubbles along the SB (p = 0.04). A significantly lower proportion of “abundant in bubbles” frames was observed in the fourth quartile (30.5% vs. 20.6%, p = 0.02). There was no significant impact of the use of simethicone in terms of diagnostic yield, SB transit time and completion rate. Conclusion: An accurate and reproducible computed algorithm demonstrated significant decrease in the abundance of bubbles along SB CE recordings, with a marked effect in the last quartile, in patients for whom simethicone had been added in PEG-based preparations, compared to those without simethicone.
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Affiliation(s)
- Charles Houdeville
- Sorbonne University, Center for Digestive Endoscopy, Saint-Antoine Hospital, APHP, 75012 Paris, France; (C.H.); (R.L.); (G.V.)
- Équipes Traitement de l’Information et Systèmes, ETIS UMR 8051, CY Paris Cergy University, ENSEA, CNRS, 95000 Cergy, France; (M.S.); (A.H.)
| | - Romain Leenhardt
- Sorbonne University, Center for Digestive Endoscopy, Saint-Antoine Hospital, APHP, 75012 Paris, France; (C.H.); (R.L.); (G.V.)
- Équipes Traitement de l’Information et Systèmes, ETIS UMR 8051, CY Paris Cergy University, ENSEA, CNRS, 95000 Cergy, France; (M.S.); (A.H.)
| | - Marc Souchaud
- Équipes Traitement de l’Information et Systèmes, ETIS UMR 8051, CY Paris Cergy University, ENSEA, CNRS, 95000 Cergy, France; (M.S.); (A.H.)
| | - Guillaume Velut
- Sorbonne University, Center for Digestive Endoscopy, Saint-Antoine Hospital, APHP, 75012 Paris, France; (C.H.); (R.L.); (G.V.)
| | - Nicolas Carbonell
- Sorbonne University, Hepatology Department, Saint Antoine Hospital, APHP, Reference Center for Inflammatory Biliary Diseases and Autoimmune Hepatitis, 75012 Paris, France;
| | - Isabelle Nion-Larmurier
- Sorbonne University, Hepatology, Gastroenterology and Saint Antoine IBD NeTwork, Saint-Antoine Hospital, APHP, 75012 Paris, France;
| | - Alexandre Nuzzo
- Department of Gastroenterology, IBD and Intestinal Failure, Intestinal Stroke Center, Structure d’Urgences Vasculaires Intestinales (SURVI), Beaujon Hospital, APHP, 92110 Clichy, France;
| | - Aymeric Histace
- Équipes Traitement de l’Information et Systèmes, ETIS UMR 8051, CY Paris Cergy University, ENSEA, CNRS, 95000 Cergy, France; (M.S.); (A.H.)
| | - Philippe Marteau
- Sorbonne University, Department of Hepato-Gastroenterology, Tenon Hospital, APHP, 75020 Paris, France;
| | - Xavier Dray
- Sorbonne University, Center for Digestive Endoscopy, Saint-Antoine Hospital, APHP, 75012 Paris, France; (C.H.); (R.L.); (G.V.)
- Équipes Traitement de l’Information et Systèmes, ETIS UMR 8051, CY Paris Cergy University, ENSEA, CNRS, 95000 Cergy, France; (M.S.); (A.H.)
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de Sousa Magalhães R, Chálim Rebelo C, Sousa-Pinto B, Pereira J, Boal Carvalho P, Rosa B, Moreira MJ, Duarte MA, Cotter J. CC-CLEAR (Colon Capsule Cleansing Assessment and Report): the novel scale to evaluate the clinical impact of bowel preparation in capsule colonoscopy - a multicentric validation study. Scand J Gastroenterol 2022; 57:625-632. [PMID: 35068293 DOI: 10.1080/00365521.2022.2026463] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
BACKGROUND Colon Capsule Cleansing Assessment and Report (CC-CLEAR) is a novel quantitative bowel preparation scale for colon capsule. AIM The aim of this study is to validate the association between CC-CLEAR's classification and major CC outcomes: lesion detection rate, surveillance recommendations and post-CC endoscopic treatment. METHODS Multicentric cohort of consecutive CCs. An expert's panel decided post-CC recommendations. Data included CC-CLEAR and Leighton-REX scales. Major CC outcomes were associated with the different cleansing grades. RESULTS From 168 CC's included, findings were reported in 123 (73.2%), 67 (54.4%) of those being colorectal polyps. CC-CLEAR influenced CC's lesion detection (OR 1.25 95% IC [1.07-1.46], p-value .004) and polyp detection rate (OR 1.22 95% IC [1.04-1.43], p-value.014). Thirty-two (19%) post-CC colonoscopies were recommended, including 22 (68.75%) with at least one polypectomy. CC-CLEAR was associated with post-CC colonoscopy treatment (OR 1.40 95% IC [1.07-1.84], p-value .015). Regarding surveillance, CC-CLEAR influenced the decision for immediate CC repetition (OR 0.21 95% IC [0.12-0.36], p-value < .001) and the recommendation for CC in 3-5 years' time (OR 1.47 95% IC [1.50-1.86], p-value < .002). The Leighton-Rex scale was not correlated with major CC outcomes. CONCLUSION CC-CLEAR impacts major CC outcomes: lesion detection, surveillance recommendations and post-CC endoscopic treatment.
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Affiliation(s)
- Rui de Sousa Magalhães
- Department of Gastroenterology, Hospital Senhora da Oliveira, Guimarães, Portugal.,Life and Health Sciences Research Institute (ICVS), School of Medicine, University of Minho, Braga, Portugal.,ICVS/3B's, PT Government Associate Laboratory, Guimarães/Braga, Portugal
| | - Carolina Chálim Rebelo
- Department of Gastroenterology, Hospital do Divino Espírito Santo de Ponta Delgada, EPER, Ponta Delgada, Portugal
| | - Bernardo Sousa-Pinto
- MEDCIDS - Department of Community Medicine, Information and Health Decision Sciences, Faculty of Medicine, University of Porto, Porto, Portugal.,CINTESIS - Centre for Health Technology and Services Research, University of Porto, Porto, Portugal
| | - José Pereira
- Department of Gastroenterology, Hospital do Divino Espírito Santo de Ponta Delgada, EPER, Ponta Delgada, Portugal
| | - Pedro Boal Carvalho
- Department of Gastroenterology, Hospital Senhora da Oliveira, Guimarães, Portugal.,Life and Health Sciences Research Institute (ICVS), School of Medicine, University of Minho, Braga, Portugal.,ICVS/3B's, PT Government Associate Laboratory, Guimarães/Braga, Portugal
| | - Bruno Rosa
- Department of Gastroenterology, Hospital Senhora da Oliveira, Guimarães, Portugal.,Life and Health Sciences Research Institute (ICVS), School of Medicine, University of Minho, Braga, Portugal.,ICVS/3B's, PT Government Associate Laboratory, Guimarães/Braga, Portugal
| | - Maria J Moreira
- Department of Gastroenterology, Hospital Senhora da Oliveira, Guimarães, Portugal.,Life and Health Sciences Research Institute (ICVS), School of Medicine, University of Minho, Braga, Portugal.,ICVS/3B's, PT Government Associate Laboratory, Guimarães/Braga, Portugal
| | - Maria A Duarte
- Department of Gastroenterology, Hospital do Divino Espírito Santo de Ponta Delgada, EPER, Ponta Delgada, Portugal
| | - José Cotter
- Department of Gastroenterology, Hospital Senhora da Oliveira, Guimarães, Portugal.,Life and Health Sciences Research Institute (ICVS), School of Medicine, University of Minho, Braga, Portugal.,ICVS/3B's, PT Government Associate Laboratory, Guimarães/Braga, Portugal
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Chetcuti Zammit S, Sidhu R. Artificial intelligence within the small bowel: are we lagging behind? Curr Opin Gastroenterol 2022; 38:307-317. [PMID: 35645023 DOI: 10.1097/mog.0000000000000827] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/10/2022]
Abstract
PURPOSE OF REVIEW The use of artificial intelligence in small bowel capsule endoscopy is expanding. This review focusses on the use of artificial intelligence for small bowel pathology compared with human data and developments to date. RECENT FINDINGS The diagnosis and management of small bowel disease has been revolutionized with the advent of capsule endoscopy. Reading of capsule endoscopy videos however is time consuming with an average reading time of 40 min. Furthermore, the fatigued human eye may miss subtle lesions including indiscreet mucosal bulges. In recent years, artificial intelligence has made significant progress in the field of medicine including gastroenterology. Machine learning has enabled feature extraction and in combination with deep neural networks, image classification has now materialized for routine endoscopy for the clinician. SUMMARY Artificial intelligence is in built within the Navicam-Ankon capsule endoscopy reading system. This development will no doubt expand to other capsule endoscopy platforms and capsule endoscopies that are used to visualize other parts of the gastrointestinal tract as a standard. This wireless and patient friendly technique combined with rapid reading platforms with the help of artificial intelligence will become an attractive and viable choice to alter how patients are investigated in the future.
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Affiliation(s)
| | - Reena Sidhu
- Academic Department of Gastroenterology, Royal Hallamshire Hospital
- Academic Unit of Gastroenterology, Department of Infection, Immunity and Cardiovascular Disease, University of Sheffield, Sheffield, United Kingdom
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17
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de Sousa Magalhães R, Sousa-Pinto B, Boal Carvalho P, Rosa B, Moreira MJ, Cotter J. RHEMITT score: Predicting the risk of mid gastrointestinal rebleeding after small bowel capsule endoscopy: A prospective validation. J Gastroenterol Hepatol 2022; 37:310-318. [PMID: 34555864 DOI: 10.1111/jgh.15695] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/25/2021] [Revised: 09/02/2021] [Accepted: 09/21/2021] [Indexed: 12/15/2022]
Abstract
BACKGROUND AND AIM The RHEMITT score (Renal disease; Heart failure; Endoscopic findings; Major bleeding; Incomplete SBCE; Tobacco; Treatment by enteroscopy) was the first score to accurately predict the individual risk of small bowel rebleeding after capsule endoscopy (SBCE). The aim of the study is on the prospective validation of the RHEMITT score. METHODS Cohort of consecutive patients with mid-gastrointestinal bleeding (MGIB) submitted to SBCE and followed prospectively, during at least 12 months, since 2017 until 2020. Rebleeding was defined as an overt bleeding event (melena or hematochezia) or a hemoglobin decrease of at least 2 g/dL. The RHEMITT score was calculated for each patient and the rebleeding rates compared. The performance of the score was tested by calculating the area under curve of the receiver operator characteristic curve. A rebleeding-free survival was assessed, corresponding to the period between the date of SBCE and the date of the first post-SBCE rebleeding event. RESULTS We included 162 patients, 102 (62.9%) were female, with a mean age of 64 years old. The sensitivities and specificities of the score grades for predicting rebleeding were as following: for low-risk patients, 0% (0-10%) and 28.8% (21.1-36.5%); for intermediate-risk patients, 23.3% (8.2-38.4%) and 72% (64.3-79.7%); for high-risk patients, 76.7% (61.6-91.8%) and 99.2% (97.7-100%), corresponding to an area under curve of the receiver operator characteristic of 0.988 (P < 0.001). Kaplan-Meyer plots were statistically different according to the attributed risk (log-rank P value <0.001; Breslow-Wilcoxon P value <0.001). CONCLUSION The RHEMITT score performed with excellent discriminative power in predicting rebleeding risk, and we herewith propose a surveillance of MGIB patients guided by the RHEMITT score.
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Affiliation(s)
- Rui de Sousa Magalhães
- Gastroenterology Department, Hospital Senhora da Oliveira-Guimarães, Guimarães, Portugal.,Life and Health Sciences Research Institute (ICVS), School of Medicine, University of Minho, Braga, Portugal.,ICVS/3B's, PT Government Associate Laboratory, Guimarães, Portugal
| | - Bernardo Sousa-Pinto
- MEDCIDS-Department of Community Medicine, Information and Health Decision Sciences, Faculty of Medicine, University of Porto, Porto, Portugal.,CINTESIS-Center for Health Technology and Services Research, University of Porto, Porto, Portugal
| | - Pedro Boal Carvalho
- Gastroenterology Department, Hospital Senhora da Oliveira-Guimarães, Guimarães, Portugal.,Life and Health Sciences Research Institute (ICVS), School of Medicine, University of Minho, Braga, Portugal.,ICVS/3B's, PT Government Associate Laboratory, Guimarães, Portugal
| | - Bruno Rosa
- Gastroenterology Department, Hospital Senhora da Oliveira-Guimarães, Guimarães, Portugal.,Life and Health Sciences Research Institute (ICVS), School of Medicine, University of Minho, Braga, Portugal.,ICVS/3B's, PT Government Associate Laboratory, Guimarães, Portugal
| | - Maria João Moreira
- Gastroenterology Department, Hospital Senhora da Oliveira-Guimarães, Guimarães, Portugal.,Life and Health Sciences Research Institute (ICVS), School of Medicine, University of Minho, Braga, Portugal.,ICVS/3B's, PT Government Associate Laboratory, Guimarães, Portugal
| | - José Cotter
- Gastroenterology Department, Hospital Senhora da Oliveira-Guimarães, Guimarães, Portugal.,Life and Health Sciences Research Institute (ICVS), School of Medicine, University of Minho, Braga, Portugal.,ICVS/3B's, PT Government Associate Laboratory, Guimarães, Portugal
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18
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Rahmi G, Cholet F, Gaudric M, Filippi J, Duburque C, Bramli S, Quentin V, Alavi Z, Nowak E, Saurin JC, Cellier C, Quénéhervé L; PREPINTEST working group. Effect of Different Modalities of Purgative Preparation on the Diagnostic Yield of Small Bowel Capsule for the Exploration of Suspected Small Bowel Bleeding: A Multicenter Randomized Controlled Trial. Am J Gastroenterol 2022; 117:327-35. [PMID: 35041627 DOI: 10.14309/ajg.0000000000001597] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/28/2021] [Accepted: 11/12/2021] [Indexed: 02/06/2023]
Abstract
INTRODUCTION The aim of our study was to compare clear liquid diet with 2 different polyethylene glycol (PEG)-based bowel preparation methods regarding diagnostic yield of small bowel capsule endoscopy (SBCE) in patients with suspected small bowel bleeding (SBB). METHODS In this prospective multicenter randomized controlled trial, consecutive patients undergoing SBCE for suspected SBB between September 2010 and February 2016 were considered. Patients were randomly assigned to standard regimen, that is, clear fluids only (prep 1), standard regimen plus 500 mL PEG after SBCE ingestion (prep 2), or standard regimen plus 2 L PEG plus 500 mL PEG after SBCE ingestion (prep 3). The primary outcome was the detection of at least one clinically significant lesion in the small bowel. The quality of small bowel cleansing was assessed. A questionnaire on the clinical tolerance was filled by the patients. RESULTS We analyzed 834 patients. No significant difference was observed for detection of P1 or P2 small bowel lesions between prep1 group (40.5%), prep 2 group (40.2%), and prep 3 group (38.5%). Small bowel cleansing was improved in prep 2 and 3 groups compared with that in prep 1 group. Compliance to the preparation and tolerance was better in prep 2 group than in prep 3 group. DISCUSSION Small bowel purgative before SBCE allowed better quality of cleansing. However, it did not improve diagnostic yield of SBCE for suspected SBB.
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Ribeiro T, Saraiva MM, Ferreira JPS, Cardoso H, Afonso J, Andrade P, Parente M, Jorge RN, Macedo G. Artificial intelligence and capsule endoscopy: automatic detection of vascular lesions using a convolutional neural network. Ann Gastroenterol 2021; 34:820-828. [PMID: 34815648 PMCID: PMC8596215 DOI: 10.20524/aog.2021.0653] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/30/2021] [Accepted: 04/07/2021] [Indexed: 12/09/2022] Open
Abstract
Background Capsule endoscopy (CE) is the first line for evaluation of patients with obscure gastrointestinal bleeding. A wide range of small intestinal vascular lesions with different hemorrhagic potential are frequently found in these patients. Nevertheless, reading CE exams is time-consuming and prone to errors. Convolutional neural networks (CNN) are artificial intelligence tools with high performance levels in image analysis. This study aimed to develop a CNN-based model for identification and differentiation of vascular lesions with distinct hemorrhagic potential in CE images. Methods The development of the CNN was based on a database of CE images. This database included images of normal small intestinal mucosa, red spots, and angiectasia/varices. The hemorrhagic risk was assessed by Saurin's classification. For CNN development, 11,588 images (9525 normal mucosa, 1026 red spots, and 1037 angiectasia/varices) were ultimately extracted. Two image datasets were created for CNN training and testing. Results The network was 91.8% sensitive and 95.9% specific for detection of vascular lesions, providing accurate predictions in 94.4% of cases. In particular, the CNN had a sensitivity and specificity of 97.1% and 95.3%, respectively, for detection of red spots. Detection of angiectasia/varices occurred with a sensitivity of 94.1% and a specificity of 95.1%. The CNN had a frame reading rate of 145 frames/sec. Conclusions The developed algorithm is the first CNN-based model to accurately detect and distinguish enteric vascular lesions with different hemorrhagic risk. CNN-assisted CE reading may improve the diagnosis of these lesions and overall CE efficiency.
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Affiliation(s)
- Tiago Ribeiro
- Department of Gastroenterology, São João University Hospital, Alameda Professor Hernâni Monteiro (Tiago Ribeiro, Miguel Mascarenhas Saraiva, Hélder Cardoso, João Afonso, Patrícia Andrade, Guilherme Macedo).,WGO Gastroenterology and Hepatology Training Center (Tiago Ribeiro, Miguel Mascarenhas Saraiva, Hélder Cardoso, João Afonso, Patrícia Andrade, Guilherme Macedo)
| | - Miguel Mascarenhas Saraiva
- Department of Gastroenterology, São João University Hospital, Alameda Professor Hernâni Monteiro (Tiago Ribeiro, Miguel Mascarenhas Saraiva, Hélder Cardoso, João Afonso, Patrícia Andrade, Guilherme Macedo).,WGO Gastroenterology and Hepatology Training Center (Tiago Ribeiro, Miguel Mascarenhas Saraiva, Hélder Cardoso, João Afonso, Patrícia Andrade, Guilherme Macedo).,Faculty of Medicine of the University of Porto, Alameda Professor Hernâni Monteiro (Miguel Mascarenhas Saraiva, Hélder Cardoso, Patrícia Andrade, Guilherme Macedo)
| | - João P S Ferreira
- Faculty of Engineering of the University of Porto (João P.S. Ferreira, Marco Parente, Renato Natal Jorge).,INEGI - Institute of Science and Innovation in Mechanical and Industrial Engineering (João P.S. Ferreira, Marco Parente, Renato Natal Jorge), Porto, Portugal
| | - Hélder Cardoso
- Department of Gastroenterology, São João University Hospital, Alameda Professor Hernâni Monteiro (Tiago Ribeiro, Miguel Mascarenhas Saraiva, Hélder Cardoso, João Afonso, Patrícia Andrade, Guilherme Macedo).,WGO Gastroenterology and Hepatology Training Center (Tiago Ribeiro, Miguel Mascarenhas Saraiva, Hélder Cardoso, João Afonso, Patrícia Andrade, Guilherme Macedo).,Faculty of Medicine of the University of Porto, Alameda Professor Hernâni Monteiro (Miguel Mascarenhas Saraiva, Hélder Cardoso, Patrícia Andrade, Guilherme Macedo)
| | - João Afonso
- Department of Gastroenterology, São João University Hospital, Alameda Professor Hernâni Monteiro (Tiago Ribeiro, Miguel Mascarenhas Saraiva, Hélder Cardoso, João Afonso, Patrícia Andrade, Guilherme Macedo).,WGO Gastroenterology and Hepatology Training Center (Tiago Ribeiro, Miguel Mascarenhas Saraiva, Hélder Cardoso, João Afonso, Patrícia Andrade, Guilherme Macedo)
| | - Patrícia Andrade
- Department of Gastroenterology, São João University Hospital, Alameda Professor Hernâni Monteiro (Tiago Ribeiro, Miguel Mascarenhas Saraiva, Hélder Cardoso, João Afonso, Patrícia Andrade, Guilherme Macedo).,WGO Gastroenterology and Hepatology Training Center (Tiago Ribeiro, Miguel Mascarenhas Saraiva, Hélder Cardoso, João Afonso, Patrícia Andrade, Guilherme Macedo).,Faculty of Medicine of the University of Porto, Alameda Professor Hernâni Monteiro (Miguel Mascarenhas Saraiva, Hélder Cardoso, Patrícia Andrade, Guilherme Macedo)
| | - Marco Parente
- Faculty of Engineering of the University of Porto (João P.S. Ferreira, Marco Parente, Renato Natal Jorge).,INEGI - Institute of Science and Innovation in Mechanical and Industrial Engineering (João P.S. Ferreira, Marco Parente, Renato Natal Jorge), Porto, Portugal
| | - Renato Natal Jorge
- Faculty of Engineering of the University of Porto (João P.S. Ferreira, Marco Parente, Renato Natal Jorge).,INEGI - Institute of Science and Innovation in Mechanical and Industrial Engineering (João P.S. Ferreira, Marco Parente, Renato Natal Jorge), Porto, Portugal
| | - Guilherme Macedo
- Department of Gastroenterology, São João University Hospital, Alameda Professor Hernâni Monteiro (Tiago Ribeiro, Miguel Mascarenhas Saraiva, Hélder Cardoso, João Afonso, Patrícia Andrade, Guilherme Macedo).,WGO Gastroenterology and Hepatology Training Center (Tiago Ribeiro, Miguel Mascarenhas Saraiva, Hélder Cardoso, João Afonso, Patrícia Andrade, Guilherme Macedo).,Faculty of Medicine of the University of Porto, Alameda Professor Hernâni Monteiro (Miguel Mascarenhas Saraiva, Hélder Cardoso, Patrícia Andrade, Guilherme Macedo)
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20
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Leenhardt R, Koulaouzidis A, McNamara D, Keuchel M, Sidhu R, McAlindon ME, Saurin JC, Eliakim R, Fernandez-Urien Sainz I, Plevris JN, Rahmi G, Rondonotti E, Rosa B, Spada C, Toth E, Houdeville C, Li C, Robaszkiewicz M, Marteau P, Dray X. A guide for assessing the clinical relevance of findings in small bowel capsule endoscopy: analysis of 8064 answers of international experts to an illustrated script questionnaire. Clin Res Hepatol Gastroenterol 2021; 45:101637. [PMID: 33662785 DOI: 10.1016/j.clinre.2021.101637] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/26/2020] [Revised: 06/10/2020] [Accepted: 09/10/2020] [Indexed: 02/04/2023]
Abstract
BACKGROUND AND AIM Although recommended, the P-score used for assessing the pertinence / relevance of findings seen in small bowel (SB) capsule endoscopy (CE) is based on a low level of knowledge. The aim of this study was to evaluate the clinical relevance of the most frequent SBCE findings through an illustrated script questionnaire. MATERIALS AND METHODS Sixteen types of SBCE findings were illustrated four times each in three different settings (occult and overt obscure gastrointestinal bleeding and suspected Crohn's disease), and with a variable number (n = 1/n = 2-5/n ≥ 6), thus providing a questionnaire with 192 scenarios and 576 illustrated questions. Fifteen international experts were asked to rate the finding's relevance for each question as very unlikely (-2) / unlikely (-1) / doubtful (0) / likely (+1) / very likely (+2). The median score (≤-0.75, between -0.75 and 0.75, or ≥0.75) obtained for each scenario determined a low (P0), intermediate (P1) or high (P2) relevance, respectively. RESULTS 8064 answers were analyzed. Participation and completion rates were 93% and 100%, respectively. In overt or occult OGIB, resultant P2 findings were 'typical angiectasia', 'deep ulceration', 'stenosis', and'blood', whatever their numbers, and 'superficial ulcerations' when multiple. While in suspected CD, consensus P2 lesions were 'deep ulceration' and 'stenosis' whatever their numbers, and 'aphthoid erosions' and 'superficial ulcerations' when multiple. CONCLUSION This study establishes a guide for the evaluation of relevance of SBCE findings. It represents a step forward for SB-CE interpretation and is intended to be used as a tool for teaching and academic research.
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Affiliation(s)
- R Leenhardt
- Sorbonne Université, Endoscopy Unit, Hôpital Saint-Antoine, APHP, Paris, France
| | - A Koulaouzidis
- The Royal Infirmary of Edinburgh, Centre For Liver & Digestive Disorders, Edinburgh, United Kingdom
| | - D McNamara
- TAGG Research Centre, Department of Clinical Medicine Tallaght Hospital, Trinity College Dublin, Ireland
| | - M Keuchel
- Bethesda Krankenhaus Bergedorf, Klinik für Innere Medizin, Hamburg, Germany
| | - R Sidhu
- Dept. of Gastroenterology, Royal Hallamshire Hospital, Sheffield, United Kingdom
| | - M E McAlindon
- Dept. of Gastroenterology, Royal Hallamshire Hospital, Sheffield, United Kingdom
| | - J C Saurin
- Gastroenterology and Endoscopy Unit, Edouard Herriot Hospital, Lyon, France
| | - R Eliakim
- Dept. of Gastroenterology, Sheba Medical Center, Ramat Gan, and Sackler School of Medicine, Tel-Aviv University, Tel-Aviv, Israel
| | | | - J N Plevris
- The Royal Infirmary of Edinburgh, Centre For Liver & Digestive Disorders, Edinburgh, United Kingdom
| | - G Rahmi
- Université de Paris, Department of Gastroenterology and Digestive Endoscopy, Georges-Pompidou European Hospital, Paris, France
| | - E Rondonotti
- Gastroenterology Unit, Valduce Hospital, Como, Italy
| | - B Rosa
- Universidade do Minho, Hospital Senhora da Oliveira, Departamento de Gastroenterologia, Guimarães, Portugal
| | - C Spada
- Digestive Endoscopy Unit and Gastroenterology, Fondazione Poliambulanza, Brescia, Italy; Digestive Endoscopy Unit, Universita Cattolica del Sacro Cuore, Roma, Italy
| | - E Toth
- Department of Gastroenterology, Skåne University Hospital, Lund University, Malmö, Sweden
| | - C Houdeville
- Sorbonne Université, Endoscopy Unit, Hôpital Saint-Antoine, APHP, Paris, France
| | - C Li
- Sorbonne Université, Endoscopy Unit, Hôpital Saint-Antoine, APHP, Paris, France; Drexel University, College of Arts & Sciences, Philadelphia, USA
| | - M Robaszkiewicz
- La Cavale Blanche University Hospital, Endoscopy Unit, Brest, France
| | - P Marteau
- Sorbonne Université, Endoscopy Unit, Hôpital Saint-Antoine, APHP, Paris, France
| | - X Dray
- Sorbonne Université, Endoscopy Unit, Hôpital Saint-Antoine, APHP, Paris, France.
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21
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Mascarenhas Saraiva MJ, Afonso J, Ribeiro T, Ferreira J, Cardoso H, Andrade AP, Parente M, Natal R, Mascarenhas Saraiva M, Macedo G. Deep learning and capsule endoscopy: automatic identification and differentiation of small bowel lesions with distinct haemorrhagic potential using a convolutional neural network. BMJ Open Gastroenterol 2021; 8:bmjgast-2021-000753. [PMID: 34580155 PMCID: PMC8477239 DOI: 10.1136/bmjgast-2021-000753] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/28/2021] [Accepted: 09/15/2021] [Indexed: 12/11/2022] Open
Abstract
OBJECTIVE Capsule endoscopy (CE) is pivotal for evaluation of small bowel disease. Obscure gastrointestinal bleeding most often originates from the small bowel. CE frequently identifies a wide range of lesions with different bleeding potentials in these patients. However, reading CE examinations is a time-consuming task. Convolutional neural networks (CNNs) are highly efficient artificial intelligence tools for image analysis. This study aims to develop a CNN-based model for identification and differentiation of multiple small bowel lesions with distinct haemorrhagic potential using CE images. DESIGN We developed, trained, and validated a denary CNN based on CE images. Each frame was labelled according to the type of lesion (lymphangiectasia, xanthomas, ulcers, erosions, vascular lesions, protruding lesions, and blood). The haemorrhagic potential was assessed by Saurin's classification. The entire dataset was divided into training and validation sets. The performance of the CNN was measured by the area under the receiving operating characteristic curve, sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV). RESULTS A total of 53 555 CE images were included. The model had an overall accuracy of 99%, a sensitivity of 88%, a specificity of 99%, a PPV of 87%, and an NPV of 99% for detection of multiple small bowel abnormalities and respective classification of bleeding potential. CONCLUSION We developed and tested a CNN-based model for automatic detection of multiple types of small bowel lesions and classification of the respective bleeding potential. This system may improve the diagnostic yield of CE for these lesions and overall CE efficiency.
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Affiliation(s)
- Miguel José Mascarenhas Saraiva
- Department of Gastroenterology, Hospital São João, Porto, Portugal .,Gastroenterology and Hepatology, WGO Gastroenterology and Hepatology Training Centre, Porto, Portugal.,University of Porto Faculty of Medicine, Porto, Porto, Portugal
| | - João Afonso
- Department of Gastroenterology, Hospital São João, Porto, Portugal.,Gastroenterology and Hepatology, WGO Gastroenterology and Hepatology Training Centre, Porto, Portugal
| | - Tiago Ribeiro
- Department of Gastroenterology, Hospital São João, Porto, Portugal.,Gastroenterology and Hepatology, WGO Gastroenterology and Hepatology Training Centre, Porto, Portugal
| | - João Ferreira
- Department of Mechanical Engineering, Faculty of Engineering of the University of Porto, Porto, Portugal.,INEGI - Institute of Science and Innovation in Mechanical and Industrial Engineering, Porto, Portugal
| | - Helder Cardoso
- Department of Gastroenterology, Hospital São João, Porto, Portugal.,Gastroenterology and Hepatology, WGO Gastroenterology and Hepatology Training Centre, Porto, Portugal.,University of Porto Faculty of Medicine, Porto, Porto, Portugal
| | - Ana Patricia Andrade
- Department of Gastroenterology, Hospital São João, Porto, Portugal.,Gastroenterology and Hepatology, WGO Gastroenterology and Hepatology Training Centre, Porto, Portugal.,University of Porto Faculty of Medicine, Porto, Porto, Portugal
| | - Marco Parente
- Department of Mechanical Engineering, Faculty of Engineering of the University of Porto, Porto, Portugal.,INEGI - Institute of Science and Innovation in Mechanical and Industrial Engineering, Porto, Portugal
| | - Renato Natal
- Department of Mechanical Engineering, Faculty of Engineering of the University of Porto, Porto, Portugal.,INEGI - Institute of Science and Innovation in Mechanical and Industrial Engineering, Porto, Portugal
| | | | - Guilherme Macedo
- Department of Gastroenterology, Hospital São João, Porto, Portugal.,Gastroenterology and Hepatology, WGO Gastroenterology and Hepatology Training Centre, Porto, Portugal.,University of Porto Faculty of Medicine, Porto, Porto, Portugal
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22
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Rosa B, Margalit-Yehuda R, Gatt K, Sciberras M, Girelli C, Saurin JC, Cortegoso Valdivia P, Cotter J, Eliakim R, Caprioli F, Baatrup G, Keuchel M, Ellul P, Toth E, Koulaouzidis A. Scoring systems in clinical small-bowel capsule endoscopy: all you need to know! Endosc Int Open 2021; 9:E802-E823. [PMID: 34079861 PMCID: PMC8159625 DOI: 10.1055/a-1372-4051] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/01/2020] [Accepted: 11/26/2020] [Indexed: 02/08/2023] Open
Abstract
AbstractCapsule endoscopy (CE) emerged out of the pressing clinical need to image the small bowel (SB) in cases of midgut bleeding and provide an overall comfortable and reliable gastrointestinal (GI) diagnosis 1. Since its wider adoption in clinical practice, significant progress has been made in several areas including software development, hardware features and clinical indications, while innovative applications of CE never cease to appear 2
3. Currently, several manufacturers provide endoscopic capsules with more or less similar technological features 4. Although there is engaging and continuous academic and industry-fueled R&D, promising furtherment of CE technology 4
5, the current status of clinical CE remains that of by and large an imaging modality. Clinical relevance of CE images is cornerstone in the decision-making process for medical management. In one of the larger to date SB CE studies, 4,206 abnormal images were detected in 3,280 patients 6. Thus, CE leads to the identification of a large amount of potential pathology, some of which are pertinent (or relevant) while some (probably the majority) are not.Soon artificial intelligence (AI) is likely to carry out several roles currently performed by humans; in fact, we are witnessing only the first stages of a transition in the clinical adoption of AI-based solutions in several aspects of gastroenterology including CE 7. Until then though, human-based decision-making profoundly impacts patient care and – although not suggested in the updated European Society of Gastrointestinal Endoscopy (ESGE) European curriculum 8
9 – it should be an integral part of CE training. Frequently, interpretation of CE images by experts or at least experienced readers differs. In a tandem CE reading study, expert review of discordant cases revealed a 50 % (13/25 discordant results) error rate by experienced readers, corresponding (in 5/13 cases) to ‘over-classification’ of an irrelevant abnormality 10. Another comparative study showed an ‘over-classification’ of such irrelevant abnormalities in ~10 % of CE readings 11. One thing which has been for a while on the table – in relation to optimizing and/or standardizing CE reporting and subsequent decision-making – is the need for reproducible scoring systems and for a reliable common language among clinicians responsible for further patient’s management.Over the years, several of these scoring systems were developed while others appear in the wake of software and hardware improvements aiming to replace and/or complement their predecessors. This review presents a comprehensive account of the currently available classification/scoring systems in clinical CE spanning from predicting the bleeding potential of identified SB lesions (with emphasis on vascular lesions), and the individual rebleeding risk; scoring systems for the prediction of SB lesions in patients with obscure gastrointestinal bleeding (OGlB), having the potential to improve patient selection and rationalize the use of enteroscopy, with better allocation of resources, optimized diagnostic workflow and tailored treatment. This review also includes scores for reporting the inflammatory burden, the cleansing level that underscores confidence in CE reporting and the mass or bulge question in CE. Essentially, the aim is to become a main text for reference when scoring is required and facilitate the inclusion of -through readiness of access- one of the other in the final report.
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Affiliation(s)
- Bruno Rosa
- Gastroenterology Department, Hospital da Senhora da Oliveira, Guimarães, Portugal,Life and Health Sciences Research Institute (ICVS), School of Medicine, University of Minho-Braga. Portugal,ICVS/3B’s, PT Government Associate Laboratory – Braga/Guimarães, Portugal.
| | - Reuma Margalit-Yehuda
- Department of Gastroenterology, Sheba Medical Center, Sackler School of Medicine, Tel-Aviv, Israel
| | - Kelly Gatt
- Division of Gastroenterology, Mater Dei Hospital, Msida, Malta
| | | | - Carlo Girelli
- Department of Internal Medicine, Gastroenterology & Digestive Endoscopy, Hospital of Busto Arsizio, Italy
| | - Jean-Christophe Saurin
- Hospices Civils de Lyon, Hôpital Edouard Herriot, Service d'Hépato-Gastro-Entérologie et d'Endoscopie Digestive, Lyon, France
| | - Pablo Cortegoso Valdivia
- Gastroenterology & Endoscopy Unit, University Hospital of Parma, University of Parma, Parma, Italy
| | - Jose Cotter
- Gastroenterology Department, Hospital da Senhora da Oliveira, Guimarães, Portugal,Life and Health Sciences Research Institute (ICVS), School of Medicine, University of Minho-Braga. Portugal,ICVS/3B’s, PT Government Associate Laboratory – Braga/Guimarães, Portugal.
| | - Rami Eliakim
- Department of Gastroenterology, Sheba Medical Center, Sackler School of Medicine, Tel-Aviv, Israel
| | - Flavio Caprioli
- Unit of Gastroenterology and Endoscopy, Fondazione IRCCS Cà Granda, Ospedale Policlinico di Milano, Milan, Italy
| | - Gunnar Baatrup
- Department of Clinical Research, University of Southern Denmark, Odense, Denmark
| | - Martin Keuchel
- Clinic for Internal Medicine, Bethesda Krankenhaus Bergedorf, Hamburg, Germany
| | - Pierre Ellul
- Division of Gastroenterology, Mater Dei Hospital, Msida, Malta
| | - Ervin Toth
- Skåne University Hospital, Lund University, Malmö, Sweden
| | - Anastasios Koulaouzidis
- Endoscopy Unit, The Royal Infirmary of Edinburgh, Scotland, UK,Department of Social Medicine & Public Health, Pomeranian Medical University, Szczecin, Poland
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Aoki T, Yamada A, Koike K. The exceptional performance of deep learning for capsule endoscopy: Will such quality be maintained in clinical scenarios? Gastrointest Endosc 2021; 93:365-366. [PMID: 33478661 DOI: 10.1016/j.gie.2020.08.014] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/05/2020] [Accepted: 08/15/2020] [Indexed: 02/07/2023]
Affiliation(s)
- Tomonori Aoki
- Department of Gastroenterology, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
| | - Atsuo Yamada
- Department of Gastroenterology, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
| | - Kazuhiko Koike
- Department of Gastroenterology, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
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Juliao-Baños F, Galiano MT, Camargo J, Mosquera-Klinger G, Carvajal J, Jaramillo C, Sabbagh L, Cure H, García F, Velasco B, Manrique C, Parra V, Flórez C, Bareño J. Clinical utility of the small bowel capsule endoscopy in the study of small bowel diseases in Colombia: Results of a national registry. Gastroenterol Hepatol 2020; 44:346-354. [PMID: 33199128 DOI: 10.1016/j.gastrohep.2020.09.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/22/2020] [Revised: 09/06/2020] [Accepted: 09/25/2020] [Indexed: 11/24/2022]
Abstract
INTRODUCTION The small bowel capsule endoscopy (SBCE) has revolutionised the study of small bowel diseases. The objective of this study is to determine the indications, findings and diagnostic yield of SBCE in a national registry. PATIENTS AND METHODS An observational, analytical cross-sectional study was carried out, analysing the SBCE records at seven centres in the country, where different variables were collected. RESULTS 1,883 SBCEs were evaluated. The average age was 55.4 years (5.6-94.2). The most frequent indications were suspicion of small bowel bleeding (SBB) (64.4%), study of Crohn's disease (15.2%) and chronic diarrhoea (11.2%). 54.3% were prepared with laxatives. The most frequent lesions found were erosions/ulcers (31.6%), angioectasias (25.7%) and parasitosis (2.7%). The diagnostic yield (P1+P2, Saurin classification) of SBCE in SBB was 60.6%, being higher in overt SBB (66.0%) compared to occult SBB (56.0%) (P=.003). The studies with better preparation showed higher detection of lesions (93.8% vs. 89.4%) (OR=1.8, CI: 95%: 1.2-2.6; P=.004). The SBCE complication rate was 3.1%, with complete SB visualisation at 96.6% and SB retention rate of 0.7%. 81.5% of SBCEs were performed on an outpatient basis, and presented a greater complete SB visualisation than hospital ones (97.1% vs. 94.3%) (OR=2.1, CI: 95%, 1.2-3.5; P=.008). CONCLUSIONS The indications, findings and diagnostic performance of SBCEs in Colombia are similar to those reported in the literature, with a high percentage of complete studies and a low rate of complications.
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Affiliation(s)
| | | | - Joselyn Camargo
- Fellow de Gastroenterología, Universidad CES, Medellín, Colombia
| | | | | | - Claudia Jaramillo
- Clínica Reina Sofía, Fundación Universitaria Sanitas, Bogotá, Colombia
| | - Luis Sabbagh
- Clínica Reina Sofía, Fundación Universitaria Sanitas, Bogotá, Colombia
| | - Héctor Cure
- Clínica General del Norte, Barranquilla, Colombia
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Xu Y, Tan Y, Wang Y, Gao J, Wu D, Xu X. A Gratifying Step forward for the Application of Artificial Intelligence in the Field of Endoscopy: A Narrative Review. Surg Laparosc Endosc Percutan Tech 2020; 31:254-63. [PMID: 33122593 DOI: 10.1097/SLE.0000000000000881] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2020] [Accepted: 09/22/2020] [Indexed: 12/24/2022]
Abstract
Endoscopy is the optimal choice of diagnosis of gastrointestinal (GI) diseases. Following the advancements made in medical technology, different kinds of novel endoscopy-methods have emerged. Although the significant progress in the penetration of endoscopic tools that have markedly improved the diagnostic rate of GI diseases, there are still some limitations, including instability of human diagnostic performance caused by intensive labor burden and high missed diagnosis rate of subtle lesions. Recently, artificial intelligence (AI) has been applied gradually to assist endoscopists in addressing these issues.
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Yung DE, Plevris JN, Leenhardt R, Dray X, Koulaouzidis A. Poor Quality of Small Bowel Capsule Endoscopy Images Has a Significant Negative Effect in the Diagnosis of Small Bowel Malignancy. Clin Exp Gastroenterol 2020; 13:475-484. [PMID: 33116745 PMCID: PMC7586059 DOI: 10.2147/ceg.s260906] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/19/2020] [Accepted: 09/14/2020] [Indexed: 12/22/2022] Open
Abstract
Background and Aims Capsule endoscopy (CE) is a visual modality; hence, diagnosis relies on image quality. We studied the contribution of image parameters to visualization quality and their effect on diagnostic certainty of small bowel (SB) lesions. Methods Five clear CE images of common SB pathology – two vascular lesions, two inflammatory, one polyp – were processed for three image parameters to simulate poor SB conditions: opacity (color-matched to luminal content; 10–90%, 10% increments); blurriness (radius 1–10 pixels; one pixel increments); and contrast (−50-50%; 10% increments). Nine expert readers evaluated whether images were adequate for diagnosis. Points where perception of image quality changed significantly were determined for each parameter. Three further sets of SBCE images (vascular, inflammatory, and neoplastic lesions; nine images/set) were processed for four points/parameters. Twenty experienced/expert CE readers reviewed these images. Results The negative effects of opacity in diagnostic certainty were mostly evident in images of neoplasia; images of vascular and inflammatory lesions were less affected. Similar results were observed with increasing blur radius, simulating movement, and poor focus. The proportions of readers finding vascular and inflammatory images adequate for diagnosis did not drop significantly at wider blur radii, while images of neoplasia were quickly deemed inadequate. Low contrast had a greater negative effect than high, most consistently in neoplastic lesions. Conclusion Poor visualization quality in all parameters affected mostly neoplastic lesions. Software to increase contrast and sharpen images can improve visualization quality; smart frame rate adaptation could improve the number of high-quality frames obtained. Thoroughness in SB cleansing is most important when there is a suspicion of neoplasia.
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Affiliation(s)
- Diana E Yung
- Centre for Liver and Digestive Disorders, The Royal Infirmary of Edinburgh, Edinburgh, UK
| | - John N Plevris
- Centre for Liver and Digestive Disorders, The Royal Infirmary of Edinburgh, Edinburgh, UK
| | - Romain Leenhardt
- Sorbonne University, Endoscopy Unit, APHP Saint-Antoine Hospital, Paris, France
| | - Xavier Dray
- Sorbonne University, Endoscopy Unit, APHP Saint-Antoine Hospital, Paris, France
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Zimmer V. Cap-assisted detection and characterization of a spurting deep duodenal vascular lesion. Clin Res Hepatol Gastroenterol 2020; 44:387-388. [PMID: 31987783 DOI: 10.1016/j.clinre.2019.11.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/08/2019] [Revised: 10/28/2019] [Accepted: 11/07/2019] [Indexed: 02/04/2023]
Affiliation(s)
- Vincent Zimmer
- Department of Medicine, Marienhausklinik St. Josef Kohlhof, Klinikweg 1-5, 66539 Neunkirchen, Germany; Department of Medicine II, Saarland University Medical Center, Saarland University, Homburg, Germany.
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Branchi F, Ferretti F, Orlando S, Tontini GE, Penagini R, Vecchi M, Elli L. Small-bowel capsule endoscopy in patients with celiac disease, axial versus lateral/panoramic view: Results from a prospective randomized trial. Dig Endosc 2020; 32:778-784. [PMID: 31680344 DOI: 10.1111/den.13575] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/14/2019] [Accepted: 10/31/2019] [Indexed: 02/08/2023]
Abstract
BACKGROUND AND AIM Capsule enteroscopy (CE) is recommended in the management of complicated celiac disease (CD). However, published data are derived from axial-view capsule systems. No data are available on the use of lateral/panoramic view capsules. This study aimed at evaluating the diagnostic yield and efficacy of the lateral/panoramic versus the axial view capsule system in CD. METHODS Consecutive CD patients were enrolled in a prospective monocentric study. Each patient ingested an axial (PillCam SB3) and a lateral/panoramic (CapsoCam Plus) view capsule with a 3-h interval in a randomized order. Two experts blindly evaluated the CE carried out. A third expert reviewed the videos in cases of discordance. RESULTS Twenty-five CD patients were enrolled (four males, age at CE 51.2 ± 16.6 years, age at CD diagnosis 41.7 ± 20.6, years on a gluten-free diet [GFD] 9.6 ± 9.4). Indications at CE were refractory CD in nine cases, non-responsiveness to GFD in 10 and GFD non-compliance in six. A positive finding was evidenced in 15 (60%) and 13 (52%) cases by CapsoCam and PillCam respectively (not significant). Atrophy was detected by both capsules. Considering the percentage of the small-bowel mucosa presenting atrophy signs, mean values were 22% ± 35 and 20% ± 29 for lateral/panoramic and axial systems, respectively (not significant). Compared to duodenal histology, PillCam correctly identified 80% of patients with SB atrophy, whereas CapsoCam identified 73% of cases. CONCLUSIONS Lateral/panoramic view CE is effective in the detection of small-bowel atrophy in CD and presents good sensitivity and specificity when compared to histology.
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Affiliation(s)
- Federica Branchi
- Division of Gastroenterology and Endoscopy, Center for Prevention and Diagnosis of Celiac Disease, Foundation IRCCS Ca' Granda Major Polyclinic Hospital, Milan, Italy.,Department of Pathophysiology and Transplantation, University of Milan, Milan, Italy
| | - Francesca Ferretti
- Division of Gastroenterology and Endoscopy, Center for Prevention and Diagnosis of Celiac Disease, Foundation IRCCS Ca' Granda Major Polyclinic Hospital, Milan, Italy.,Department of Pathophysiology and Transplantation, University of Milan, Milan, Italy
| | - Stefania Orlando
- Division of Gastroenterology and Endoscopy, Center for Prevention and Diagnosis of Celiac Disease, Foundation IRCCS Ca' Granda Major Polyclinic Hospital, Milan, Italy
| | - Gian Eugenio Tontini
- Division of Gastroenterology and Endoscopy, Center for Prevention and Diagnosis of Celiac Disease, Foundation IRCCS Ca' Granda Major Polyclinic Hospital, Milan, Italy.,Department of Pathophysiology and Transplantation, University of Milan, Milan, Italy
| | - Roberto Penagini
- Division of Gastroenterology and Endoscopy, Center for Prevention and Diagnosis of Celiac Disease, Foundation IRCCS Ca' Granda Major Polyclinic Hospital, Milan, Italy.,Department of Pathophysiology and Transplantation, University of Milan, Milan, Italy
| | - Maurizio Vecchi
- Division of Gastroenterology and Endoscopy, Center for Prevention and Diagnosis of Celiac Disease, Foundation IRCCS Ca' Granda Major Polyclinic Hospital, Milan, Italy.,Department of Pathophysiology and Transplantation, University of Milan, Milan, Italy
| | - Luca Elli
- Division of Gastroenterology and Endoscopy, Center for Prevention and Diagnosis of Celiac Disease, Foundation IRCCS Ca' Granda Major Polyclinic Hospital, Milan, Italy.,Department of Pathophysiology and Transplantation, University of Milan, Milan, Italy
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Tontini GE, Rizzello F, Cavallaro F, Bonitta G, Gelli D, Pastorelli L, Salice M, Vecchi M, Gionchetti P, Calabrese C. Usefulness of panoramic 344°-viewing in Crohn's disease capsule endoscopy: a proof of concept pilot study with the novel PillCam™ Crohn's system. BMC Gastroenterol 2020; 20:97. [PMID: 32264831 PMCID: PMC7140388 DOI: 10.1186/s12876-020-01231-0] [Citation(s) in RCA: 19] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/03/2019] [Accepted: 03/24/2020] [Indexed: 02/07/2023] Open
Abstract
BACKGROUND A new capsule endoscopy (CE) system featuring two advanced optics for 344°-viewing and a prolonged operative time has been recently developed for Crohn's disease (CD) patients. Hence, we evaluated, for the first time, the performance of this novel CE and the add-on value of the 344°-viewing in a multi-center real-life setting. METHODS Consecutive patients with suspected or established CD received the PillCam™ Crohn's System as supplementary diagnostic work-up focused on the small-bowel between June 2017 and June 2018. Technical and clinical data, including the panenteric CE diagnostic yield, the Lewis score and the impact of small-bowel findings on clinical management during a 6-months follow-up (new diagnosis, staging or treatment upgrade) were collected, thereby evaluating the added value of the 344° panoramic-view (lesions detected by camera A and B) over the standard 172°-view (lesions detected by one camera only). RESULTS Among 41 patients (aged 43 ± 20 years), 73% underwent CE for suspected CD and 27% for established CD. The rate of complete enteroscopy was 90%. No technical failure or retention occurred. Compared to the standard 172° view, the panoramic 344°-view revealed a greater number of patients with a relevant lesion (56.1% vs. 39.0%; P = 0.023), resulting in higher Lewis score (222,8 vs. 185.7; P = 0.031), and improved clinical management (48.8% vs. 31.7%, P = 0.023). CONCLUSIONS The panoramic 344°-view increases small-bowel CE accuracy, thereby improving the clinical management of CD patients with mild small-bowel active disease. This system should be regarded as a new standard for both small-bowel diagnosis and monitoring in inflammatory bowel diseases.
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Affiliation(s)
- Gian Eugenio Tontini
- Gastroenterology and Endoscopy Unit, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy.
- Department of Pathophysiology and Transplantation, University of Milan, Milan, Italy.
| | - Fernando Rizzello
- IBD Unit, Department of Medical and Surgical Sciences (DIMEC), Policlinico S.Orsola-Malpighi, University of Bologna, Bologna, Italy
| | - Flaminia Cavallaro
- Gastroenterology and Digestive Endoscopy Unit, IRCCS Policlinico San Donato, San Donato Milanese, Milan, Italy
| | - Gianluca Bonitta
- Gastroenterology and Digestive Endoscopy Unit, IRCCS Policlinico San Donato, San Donato Milanese, Milan, Italy
| | - Dania Gelli
- IBD Unit, Department of Medical and Surgical Sciences (DIMEC), Policlinico S.Orsola-Malpighi, University of Bologna, Bologna, Italy
| | - Luca Pastorelli
- Gastroenterology and Digestive Endoscopy Unit, IRCCS Policlinico San Donato, San Donato Milanese, Milan, Italy
- Department of Biomedical Sciences for Health, University of Milan, Milan, Italy
| | - Marco Salice
- IBD Unit, Department of Medical and Surgical Sciences (DIMEC), Policlinico S.Orsola-Malpighi, University of Bologna, Bologna, Italy
| | - Maurizio Vecchi
- Gastroenterology and Endoscopy Unit, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
- Department of Pathophysiology and Transplantation, University of Milan, Milan, Italy
| | - Paolo Gionchetti
- IBD Unit, Department of Medical and Surgical Sciences (DIMEC), Policlinico S.Orsola-Malpighi, University of Bologna, Bologna, Italy
| | - Carlo Calabrese
- IBD Unit, Department of Medical and Surgical Sciences (DIMEC), Policlinico S.Orsola-Malpighi, University of Bologna, Bologna, Italy
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Affiliation(s)
- Anastasios Koulaouzidis
- Endoscopy Unit, Centre for Liver & Digestive Disorders, The Royal Infirmary of Edinburgh, Scotland
| | - Ervin Toth
- Department of Gastroenterology, Skåne University Hospital, Malmö, Lund University, Sweden
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Leenhardt R, Li C, Le Mouel JP, Rahmi G, Saurin JC, Cholet F, Boureille A, Amiot X, Delvaux M, Duburque C, Leandri C, Gérard R, Lecleire S, Mesli F, Nion-Larmurier I, Romain O, Sacher-Huvelin S, Simon-Shane C, Vanbiervliet G, Marteau P, Histace A, Dray X. CAD-CAP: a 25,000-image database serving the development of artificial intelligence for capsule endoscopy. Endosc Int Open 2020; 8:E415-E420. [PMID: 32118115 PMCID: PMC7035135 DOI: 10.1055/a-1035-9088] [Citation(s) in RCA: 27] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/05/2019] [Accepted: 09/16/2019] [Indexed: 02/06/2023] Open
Abstract
Background and study aims Capsule endoscopy (CE) is the preferred method for small bowel (SB) exploration. With a mean number of 50,000 SB frames per video, SBCE reading is time-consuming and tedious (30 to 60 minutes per video). We describe a large, multicenter database named CAD-CAP (Computer-Assisted Diagnosis for CAPsule Endoscopy, CAD-CAP). This database aims to serve the development of CAD tools for CE reading. Materials and methods Twelve French endoscopy centers were involved. All available third-generation SB-CE videos (Pillcam, Medtronic) were retrospectively selected from these centers and deidentified. Any pathological frame was extracted and included in the database. Manual segmentation of findings within these frames was performed by two pre-med students trained and supervised by an expert reader. All frames were then classified by type and clinical relevance by a panel of three expert readers. An automated extraction process was also developed to create a dataset of normal, proofread, control images from normal, complete, SB-CE videos. Results Four-thousand-one-hundred-and-seventy-four SB-CE were included. Of them, 1,480 videos (35 %) containing at least one pathological finding were selected. Findings from 5,184 frames (with their short video sequences) were extracted and delimited: 718 frames with fresh blood, 3,097 frames with vascular lesions, and 1,369 frames with inflammatory and ulcerative lesions. Twenty-thousand normal frames were extracted from 206 SB-CE normal videos. CAD-CAP has already been used for development of automated tools for angiectasia detection and also for two international challenges on medical computerized analysis.
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Affiliation(s)
| | - Cynthia Li
- Drexel University, College of Arts & Sciences, Philadelphia, Pennsylvania, United States
| | - Jean-Philippe Le Mouel
- Gastroenterology, Amiens University Hospital, Université de Picardie Jules Verne, Amiens, France
| | - Gabriel Rahmi
- Georges Pompidou European Hospital, APHP, Department of Gastroenterology and Endoscopy, Paris, France
| | - Jean Christophe Saurin
- Department of Endoscopy and Gastroenterology, Pavillon L, Hôpital Edouard Herriot, Lyon, France
| | - Franck Cholet
- Digestive Endoscopy Unit, University Hospital, Brest, France
| | - Arnaud Boureille
- Department of Hepato-Gastroenterology, Institut des Maladies de l'Appareil Digestif, Nantes, France
| | - Xavier Amiot
- Tenon Hospital, Gastroenterology Department, Paris, France
| | - Michel Delvaux
- CHU Strasbourg, Gastroenterology Department, Strasbourg, France
| | | | - Chloé Leandri
- Cochin Hospital Gastroenterology Department, Paris, France
| | - Romain Gérard
- CHRU Lille, Gastroenterology Department, Lille, France
| | | | - Farida Mesli
- CHU Henri Mondor, Gastroenterology Department, Creteil, France
| | | | - Olivier Romain
- ETIS, Université de Cergy-Pontoise, ENSEA, CNRS, Cergy-Pontoise Cedex, France
| | - Sylvie Sacher-Huvelin
- Department of Hepato-Gastroenterology, Institut des Maladies de l'Appareil Digestif, Nantes, France
| | - Camille Simon-Shane
- ETIS, Université de Cergy-Pontoise, ENSEA, CNRS, Cergy-Pontoise Cedex, France
| | | | | | - Aymeric Histace
- ETIS, Université de Cergy-Pontoise, ENSEA, CNRS, Cergy-Pontoise Cedex, France
| | - Xavier Dray
- Sorbonne University, Endoscopy Unit,ETIS, Université de Cergy-Pontoise, ENSEA, CNRS, Cergy-Pontoise Cedex, France,Corresponding author Pr Xavier Dray Hopital Saint-Antoine – Endoscopy Unit184 Rue du Faubourg Saint-AntoineParis 75012France
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Leenhardt R, Buisson A, Bourreille A, Marteau P, Koulaouzidis A, Li C, Keuchel M, Rondonotti E, Toth E, Plevris JN, Eliakim R, Rosa B, Triantafyllou K, Elli L, Wurm Johansson G, Panter S, Ellul P, Pérez-Cuadrado Robles E, McNamara D, Beaumont H, Spada C, Cavallaro F, Cholet F, Fernandez-Urien Sainz I, Kopylov U, McAlindon ME, Németh A, Tontini GE, Yung DE, Niv Y, Rahmi G, Saurin JC, Dray X. Nomenclature and semantic descriptions of ulcerative and inflammatory lesions seen in Crohn's disease in small bowel capsule endoscopy: An international Delphi consensus statement. United European Gastroenterol J 2020; 8:99-107. [PMID: 32213061 PMCID: PMC7005999 DOI: 10.1177/2050640619895864] [Citation(s) in RCA: 28] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/31/2019] [Accepted: 11/24/2019] [Indexed: 12/21/2022] Open
Abstract
BACKGROUND In the medical literature, the nomenclature and descriptions (ND) of small bowel (SB) ulcerative and inflammatory (U-I) lesions in capsule endoscopy (CE) are scarce and inconsistent. Inter-observer variability in interpreting these findings remains a major limitation in the assessment of the severity of mucosal lesions, which can impact negatively on clinical care, training and research on SB-CE. OBJECTIVE Focusing on SB-CE in Crohn's disease (CD), our aim is to establish a consensus on the ND of U-I lesions. METHODS An international panel of experienced SB-CE readers was formed during the 2016 United European Gastroenterology Week meeting. A core group of five CE and inflammatory bowel disease (IBD) experts established an Internet-based, three-round Delphi consensus but did not participate in the voting process. The core group built illustrated questionnaires, including SB-CE still frames of U-I lesions from patients with documented CD. Twenty-seven other experts were asked to rate and comment on the different proposals for the ND of the most frequent SB U-I lesions. For each round, we used a 6-point rating scale (varying from 'strongly disagree' to 'strongly agree'). The consensus was reached when at least 80 % of the voting members scored the statement within the 'agree' or 'strongly agree' categories. RESULTS A 100% participation rate was obtained for all the rounds. Consensual ND were reached for the following seven U-I lesions: aphthoid erosion, deep ulceration, superficial ulceration, stenosis, edema, hyperemia and denudation. CONCLUSION Considering the most frequent SB U-I lesions seen in CE in CD, a consensual ND was reached by the international group of experts. These descriptions and names are useful not only for daily practice and medical education, but also for medical research.
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Affiliation(s)
- Romain Leenhardt
- Sorbonne Université, Endoscopy Unit, Hôpital Saint-Antoine, AP-HP, Paris, France
| | - Anthony Buisson
- Dept. of Gastroenterology, CHU Estaing Clermont-Ferrand, Clermont-ferrand, France
| | - Arnaud Bourreille
- Institut des Maladies de l’Appareil Digestif (IMAD), Dept of Gastroenterology, CHU Nantes, University of Nantes, Nantes, France
| | - Philippe Marteau
- Sorbonne Université, Endoscopy Unit, Hôpital Saint-Antoine, AP-HP, Paris, France
| | - Anastasios Koulaouzidis
- Centre For Liver & Digestive Disorders, The Royal Infirmary of Edinburgh, Edinburgh, United Kingdom
| | - Cynthia Li
- Sorbonne Université, Endoscopy Unit, Hôpital Saint-Antoine, AP-HP, Paris, France
- College of Arts & Sciences, Drexel University, Philadelphia, USA
| | - Martin Keuchel
- Klinik für Innere Medizin, Bethesda Krankenhaus Bergedorf, Hamburg, Germany
| | | | - Ervin Toth
- Department of Gastroenterology, Skåne University Hospital, Lund University, Malmö, Sweden
| | - John N Plevris
- Centre For Liver & Digestive Disorders, The Royal Infirmary of Edinburgh, Edinburgh, United Kingdom
| | - Rami Eliakim
- Dept. of Gastroenterology, Sheba Medical Center, Ramat Gan, and Sackler School of Medicine, Tel-Aviv University, Tel-Aviv, Israel
| | - Bruno Rosa
- Departamento de Gastroenterologia, Universidade do Minho, Hospital Senhora da Oliveira, Guimarães, Portugal
| | - Konstantinos Triantafyllou
- Hepatogastroenterology Unit, Second Department of Internal Medicine - Propaedeutic Research Institute and Diabetes Center, National and Kapodistrian University of Athens, Medical School, Attikon University General Hospital, Athens, Greece
| | - Luca Elli
- Center for Prevention and Diagnosis of Celiac Disease, Fondazione IRCCS Ca Granda, Milano, Italy
| | | | - Simon Panter
- Gastroenterology, South Tyneside Hospital, South Shields, United Kingdom
| | - Pierre Ellul
- Department of Medicine, Mater Dei Hospital, Msida, Malta
| | - Enrique Pérez-Cuadrado Robles
- Department of Gastroenterology, Cliniques Universitaires Saint-Luc, Bruxelles, Belgium
- Department of Gastroenterology and Digestive Endoscopy, Georges-Pompidou European hospital, Paris, France
| | - Deirdre McNamara
- Trinity Academic Gastroenterology Group, Departement of Clinical Medicine, Tallaght Hospital, Trinity College Dublin, Ireland
| | - Hanneke Beaumont
- Department of Gastroenterology, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
| | - Cristiano Spada
- Digestive Endoscopy Unit and Gastroenterology, Fondazione Poliambulanza, Brescia, Italia; Digestive Endoscopy Unit, Università Cattolica del Sacro Cuore, Roma, Italia
| | - Flaminia Cavallaro
- Gastroenterology and Endoscopy Unit, IRCCS Policlinico San Donato, San Donato Milanese, Milan, Italy
| | - Franck Cholet
- Endoscopy unit, CHU La Cavale Blanche, Brest, France
| | | | - Uri Kopylov
- Dept. of Gastroenterology, Sheba Medical Center, Ramat Gan, and Sackler School of Medicine, Tel-Aviv University, Tel-Aviv, Israel
| | - Mark E McAlindon
- Dept. of Gastroenterology, Royal Hallamshire Hospital, Sheffield, United Kingdom
| | - Artur Németh
- Department of Gastroenterology, Skåne University Hospital, Lund University, Malmö, Sweden
| | - Gian Eugenio Tontini
- Department of Pathophysiology and Transplantation, University of Milan - Gastroenterology and Endoscopy Unit, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Diana E Yung
- Centre For Liver & Digestive Disorders, The Royal Infirmary of Edinburgh, Edinburgh, United Kingdom
| | - Yaron Niv
- Rabin Medical Center, Dept. of Gastroenterology, Petach Tikva, Israel, and Sackler School of Medicine, Tel-Aviv University, Tel-Aviv, Israel
| | - Gabriel Rahmi
- Department of Gastroenterology and Digestive Endoscopy, Georges-Pompidou European hospital, Paris, France
| | | | - Xavier Dray
- Sorbonne Université, Endoscopy Unit, Hôpital Saint-Antoine, AP-HP, Paris, France
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Tontini GE, Manfredi G, Orlando S, Neumann H, Vecchi M, Buscarini E, Elli L. Endoscopic ultrasonography and small-bowel endoscopy: Present and future. Dig Endosc 2019; 31:627-643. [PMID: 31090965 DOI: 10.1111/den.13429] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/08/2019] [Accepted: 05/13/2019] [Indexed: 12/12/2022]
Abstract
Over the last decade, impressive technological advances have occurred in ultrasonography and small-bowel endoscopy. Nowadays, endoscopic ultrasonography is an essential diagnostic tool and a therapeutic weapon for pancreatobiliary disorders. Capsule endoscopy and device-assisted enteroscopy have quickly become the reference standard for the diagnosis of small-bowel luminal diseases, thereby leading to radical changes in diagnostic and therapeutic pathways. We herein provide an up-to-date overview of the latest advances in endoscopic ultrasonography and small-bowel endoscopy, focusing on the emerging paradigms and technological innovations that might improve clinical practice in the near future.
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Affiliation(s)
- Gian Eugenio Tontini
- Gastroenterology and Endoscopy Unit, Foundation IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy.,Department of Pathophysiology and Transplantation, University of Milan, Milan, Italy
| | | | - Stefania Orlando
- Gastroenterology and Endoscopy Unit, Foundation IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy.,Digestive Endoscopy and Gastroenterology Unit, ASST of Cremona, Cremona, Italy
| | - Helmut Neumann
- Department of Medicine I, University Medical Center Mainz, Mainz, Germany
| | - Maurizio Vecchi
- Gastroenterology and Endoscopy Unit, Foundation IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy.,Department of Pathophysiology and Transplantation, University of Milan, Milan, Italy
| | | | - Luca Elli
- Gastroenterology and Endoscopy Unit, Foundation IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
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Affiliation(s)
- Dejan Micic
- Section of Gastroenterology, Hepatology and Nutrition, Department of Internal Medicine, University of Chicago Medicine, 5841 South Maryland Avenue, MC4076, Chicago, IL, 60637, USA.
| | - Neil Sengupta
- Section of Gastroenterology, Hepatology and Nutrition, Department of Internal Medicine, University of Chicago Medicine, 5841 South Maryland Avenue, MC4076, Chicago, IL, 60637, USA
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