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The diagnostic work-up in iron deficiency anaemia (IDA) patients can be challenging when bleedings or malabsorption are not clinically manifest. Lesions on the small bowel mucosa may cause IDA. We evaluated the prevalence of lesions on the small bowel mucosa detected at Videocapsule Endoscopy (VCE) in IDA patients following negative upper and lower endoscopies. Clinical and endoscopic data collected in 5 centres were retrieved. Lesions with a high bleeding potential (P2) were computed, and predictive factors investigated at multivariate analysis. By considering data of 230 patients, the endoscopic examination detected a total of 96 (41.7%; 95% CI: 35.4–48.1) P2 lesions on the small bowel mucosa, including 4 (1.7%) cancers. The use of non-steroidal anti-inflammatory drugs was found to be the only associated factor at both univariate (OR: 5.7, 95% CI: 2.4–13.4; P <0.001) and multivariate (OR: 2.8; 95% CI: 1.7–3.9, P <0.01) analyses. Present study showed that evaluation of small bowel mucosa with VCE allows to disclose a potential cause of IDA in near half patients. The cooperation between haematologists and gastroenterologists in the diagnostic work-up may be useful. [ABSTRACT FROM AUTHOR]

Background: Videocapsule endoscopy (VCE) and double-balloon enteroscopy (DBE) are part of the diagnostic and therapeutic work-up of indications other than suspected small bowel bleeding (OSBB). The literature is currently lacking studies describing these procedures in this particular setting. Objectives: We assessed the clinical impact of VCE and DBE in a large monocentric cohort of OSBB patients, as compared to a control group of suspected small bowel bleeding (SSBB) patients who underwent enteroscopy over the same period. Design: Monocentric, retrospective, cohort study. Methods: We collected the data of consecutive patients with OSBB undergoing VCE and/or DBE from March 2001 to July 2020. The demographic and clinical parameters of the patients, technical characteristics, and adverse events for each procedure were collected. The impact of VCE and DBE was defined in terms of diagnostic yield (DY). The patients were subdivided according to the main indication into four groups: celiac disease, Crohn's disease (CD), neoplasia, and persistent gastrointestinal symptoms. Results: A total of 611 VCEs and 387 DBEs were performed for OSBB. The main indications were complicated celiac disease and CD. The DYs of VCE and DBE overall were 53 and 61.7%, respectively, with some variance among the four groups. We report no statistical differences in the DY of VCE and DBE in SSBB vs OSBB (57.7% vs 53%, p = 0.0859 and 68.8% vs 61.7%, p = 0.0582, respectively). OSBB patients were significantly younger than those with SSBB. However, similarly to SSBB (k = 0.059), poor agreement between the enteroscopic techniques was found in the OSBB population (k = 0.109). The safety of both procedures in OSBB was comparable to that in SSBB patients. Conclusion: VCE and DBE are effective and safe in suspected OSBB, where their role is similar to that in SSBB, their main indication. [ABSTRACT FROM AUTHOR]

Background : Videocapsule endoscopy (VCE) is considered the gold standard for overt and obscure gastrointestinal bleeding (OGIB), after negative upper and lower endoscopy. Nonetheless, VCE's diagnostic yield is suboptimal, and it represents a costly, time-consuming, and often not easily available technique. In order to evaluate bleeding risk in patients with atrial fibrillation, several scoring systems have been proposed, but their utilization outside the original clinical setting has rarely been explored. The aim of the study is to evaluate potential role of bleeding risk scoring systems in predicting the occurrence of positive findings at VCE examination, and therefore in increasing VCE diagnostic yield. Methods: Data from consecutive patients undergoing VCE between April 2015 and June 2020 were retrospectively retrieved, and clinical and demographic characteristics were collected. HAS-BLED, ATRIA, and ORBIT scores were calculated, and patients were considered at low or high risk of bleeding accordingly. Discriminative ability of the scores for positive VCE findings has been evaluated by area under receiver operator characteristic curve (AUC) calculation. Diagnostic yield of scores in high- and low-risk patients was calculated. Results: A total of 413 patients underwent VCE examination, among which 368 (89%) for OGIB. Positive findings were observed in 246 patients (67%), with angiodysplasias being the most frequent lesion (92%). The three scores displayed similar consistent discriminative ability for positive VCE findings (mean AUC = 0.69), and identified high-risk group of patients in which VCE has a higher diagnostic yield. Conclusions: In the present retrospective study, bleeding scores accurately discriminated patients with higher probability of positive findings at VCE examination. Bleeding scores utilization may help in the management of patients with OGIB, with a potential consistent resource optimization and cost-saving. [ABSTRACT FROM AUTHOR]

Background: Videocapsule endoscopy (VCE) and double-balloon enteroscopy (DBE) are part of the diagnostic and therapeutic work-up of indications other than suspected small bowel bleeding (OSBB). The literature is currently lacking studies describing these procedures in this particular setting. Objectives: We assessed the clinical impact of VCE and DBE in a large monocentric cohort of OSBB patients, as compared to a control group of suspected small bowel bleeding (SSBB) patients who underwent enteroscopy over the same period. Design: Monocentric, retrospective, cohort study. Methods: We collected the data of consecutive patients with OSBB undergoing VCE and/or DBE from March 2001 to July 2020. The demographic and clinical parameters of the patients, technical characteristics, and adverse events for each procedure were collected. The impact of VCE and DBE was defined in terms of diagnostic yield (DY). The patients were subdivided according to the main indication into four groups: celiac disease, Crohn’s disease (CD), neoplasia, and persistent gastrointestinal symptoms. Results: A total of 611 VCEs and 387 DBEs were performed for OSBB. The main indications were complicated celiac disease and CD. The DYs of VCE and DBE overall were 53 and 61.7%, respectively, with some variance among the four groups. We report no statistical differences in the DY of VCE and DBE in SSBB vs OSBB (57.7% vs 53%, 푝 = 0.0859 and 68.8% vs 61.7%, 푝 = 0.0582, respectively). OSBB patients were significantly younger than those with SSBB. However, similarly to SSBB (푘 = 0.059), poor agreement between the enteroscopic techniques was found in the OSBB population (푘 = 0.109). The safety of both procedures in OSBB was comparable to that in SSBB patients. Conclusion: VCE and DBE are effective and safe in suspected OSBB, where their role is similar to that in SSBB, their main indication. [ABSTRACT FROM AUTHOR]

Gastrointestinal involvement occurs in approximately 4% of cases of systemic amyloidosis and may be associated with heterogeneous and nonspecific clinical manifestations and endoscopic findings, which poses important diagnostic challenges. A 76-year-old female with previous medical history of breast cancer, hypertension, dyslipidemia, asthma, and depression presented to emergency department with a 1-month history of diarrhea, abdominal pain, anorexia, asthenia, and weight loss. Physical examination revealed dehydration and abdominal tenderness. Stool microbiologic studies, Clostridium difficile toxin, fecal leukocyte count, stool fat, and celiac serology were all negative. Remarkably, an axillary lymphadenopathy was also noted and its investigation revealed multiple myeloma, which raised suspicion for gastrointestinal amyloidosis. However, upper digestive endoscopy and colonoscopy did not reveal abnormalities and both gastric and colon biopsies were negative for amyloid, as was abdominal fat biopsy. As the patient also presented hypoproteinemia and hypoalbuminemia suggestive of protein-losing enteropathy, videocapsule endoscopy was performed where petechiae, villous atrophy, and fissures were seen along jejunal mucosa. These findings were confirmed with double-balloon enteroscopy and jejunal biopsies revealed extensive deposition of an amorphous hyaline material in lamina propria and muscularis mucosae that exhibited apple-green birefringence under polarized light after Congo red staining, consistent with localized small bowel amyloidosis secondary to multiple myeloma. Chemotherapy was started, but she would die after 3 weeks. This case illustrates the role of balloon-assisted enteroscopy in diagnosis of localized small bowel amyloidosis with jejunal involvement. [ABSTRACT FROM AUTHOR]

Simple Summary: Small bowel adenocarcinoma is a rare tumor. Diagnosis is often obtained at an advanced stage and prognosis remains poor. The aim of this review is to report the recent epidemiological and risk factor data related to small bowel adenocarcinoma. New diagnostic tools are also described in this review. Adenocarcinomas of the small intestine are rare tumors but their incidence is increasing. There is a slight male predominance. The median age at diagnosis is the 6th decade. The most frequent primary location is the duodenum. There is no clearly identified environmental risk factor, but adenocarcinomas of the small intestine are associated in almost 20% of cases with predisposing diseases (Crohn's disease, Lynch syndrome, familial adenomatous polyposis, Peutz–Jeghers syndrome and celiac disease). [ABSTRACT FROM AUTHOR]

Small bowel bleeding occurs in 10% of patients with gastrointestinal bleeding. In these patients, the origin of the bleeding is not found after performing upper and lower digestive endoscopy. Persistent small bowel bleeding is characterized by continuous presence of melena and/or hematochezia and is severe when is accompanied by hemodynamic instability. The diagnostic studies for this pathology are: videocapsule endoscopy, balloon-assisted enteroscopy, CT angiography, mesenteric angiography, scintigraphy with red blood cells and intraoperative enteroscopy. [ABSTRACT FROM AUTHOR]

Inflammatory bowel diseases are diagnosed based on a combination of endoscopical, radiological and pathological criteria. Endoscopy plays a central role in the diagnosis and management of patients with inflammatory bowel disease, because of its ability to directly view the lining mucosa and due to the possibility of taking biopsies for the histological confirmation of the diagnosis. Lesions localized in the esophagus, stomach or duodenum are accessible for diagnostic upper gastrointestinal endoscopy, and the colonic lesions can be diagnosed by lower gastrointestinal endoscopy; more difficult to assess endoscopically is the small bowel, lesions in this location being usually evaluated initially by videocapsule endoscopy, and recently directly through enteroscopy, which is still a less accessible endoscopic method, being also laborious and requiring patient sedation and an experienced endoscopist. In present, the first types of enteroscopy: pushenteroscopy and intraoperative enteroscopy, were replaced by innovative endoscopic procedures: balloonenteroscopy and spiral enteroscopy, which are less invasive and more efficient in complete visualization of the entire small bowel. With the evolution of technology, videocapsule examination and enteroscopy will become widely available, guidelines for their use in the diagnosis of gastrointestinal lesions being already prepared both in Europe and in the USA. [ABSTRACT FROM AUTHOR]

Celiac disease (CD) is a common and chronic disorder requiring a long-life gluten-free diet. There is evidence that asymptomatic or subclinical presentation of CD has increased in the last decades, so that several cases are diagnosed during adulthood or even in the elderly. Celiac disease patients are at an increased risk of developing malignancies, particularly when the disease is diagnosed in the elderly. We describe a case of a challenging diagnosis of small bowel adenocarcinoma which developed in a patient with CD discovered only in the elderly. We also performed a systematic review of the literature. A tailored follow-up in a sub-group of CD patients at an increased risk of developing intestinal adenocarcinoma could be implemented. [ABSTRACT FROM AUTHOR]

Clinical indications of capsule endoscopy (CE) have been quickly broadening with the evolving technology. Small bowel CE, deep enteroscopy, CT-enterography, and small bowel MRI have considerably improved over the last decade, and in addition, colon capsule use and indications are becoming more widespread. A trained operator; valid indication; exclusion of contraindications; and patient information, consent and preparation are required prior to CE examination, as for any endoscopy procedure. CE is minimally invasive and is routinely performed in adult or pediatric outpatients. Contraindications (mainly bowel obstructions) and complications (capsule retention) are rare in CE. After normal gastroscopy and ileocolonoscopy, obscure gastrointestinal bleeding and suspected Crohn's disease are validated indications of small bowel CE, whereas inflammatory bowel disease evaluation and monitoring, surveillance of Peutz-Jeghers syndrome, and suspicion of celiac disease complications are emerging indications. Colon capsules are now validated in case of incomplete coonoscopy, and may be reimbursed soon. Therefore, colon capsules can compete with virtual colonoscopy and even with videocolonoscopy. When gastrointestinal endoscopy is contraindicated or denied, esophageal capsules are an option for the evaluation of gastroesophageal reflux disease as well as the diagnosis and surveillance of portal hypertension. High resolution image sensors, low power consumption, and computer-aided diagnoses should bring significant advances in the field of CE in the next coming years. [ABSTRACT FROM AUTHOR]

Angiosarcoma rarely involves the gastrointestinal tract. Herein, we describe the case of a 68-year-old man with haemoptysis and melena who was eventually diagnosed with multifocal angiosarcoma of the stomach, small bowel, lungs, and thyroid. The peculiarity was that the histological feature of the polypoid lesions removed at endoscopy was initially misinterpreted as benign hyperplastic polyps, whilst their neoplastic nature was clinically suspected only when the videocapsule endoscopy revealed the presence of multiple variable-sized nodules with apical erosion or active bleeding in the small bowel. Based on the very low incidence, diagnosis of angiosarcoma involving the gastrointestinal tract may be misinterpreted by both the endoscopist and pathologist. [ABSTRACT FROM AUTHOR]

Inflammatory bowel diseases are diagnosed based on a combination of endoscopical, radiological and pathological criteria. Endoscopy plays a central role in the diagnosis and management of patients with inflammatory bowel disease, because of its ability to directly view the lining mucosa and due to the possibility of taking biopsies for the histological confirmation of the diagnosis. Lesions localized in the esophagus, stomach or duodenum are accessible for diagnostic upper gastrointestinal endoscopy, and the colonic lesions can be diagnosed by lower gastrointestinal endoscopy; more difficult to assess endoscopically is the small bowel, lesions in this location being usually evaluated initially by videocapsule endoscopy, and recently directly through enteroscopy, which is still a less accessible endoscopic method, being also laborious and requiring patient sedation and an experienced endoscopist. In present, the first types of enteroscopy: pushenteroscopy and intraoperative enteroscopy, were replaced by innovative endoscopic procedures: balloonenteroscopy and spiral enteroscopy, which are less invasive and more efficient in complete visualization of the entire small bowel. With the evolution of technology, videocapsule examination and enteroscopy will become widely available, guidelines for their use in the diagnosis of gastrointestinal lesions being already prepared both in Europe and in the USA. [ABSTRACT FROM AUTHOR]

Celiac disease is a clinically heterogeneous disease characterized by an inadequate immunological response when patients with specific genetic phenotypes are exposed to gluten. This article presents a case of a young woman diagnosed in Gastroenterology Department of ' St. Andrew Apostle' Emergency Hospital of Constanta with celiac disease after multiple admissions into the hospital for unspecific symptoms such as pallor, fatigue, pirosis, weight loss and 1-2 soft stools/day. The history with period irregularities and infertility without a known cause, a recent unexplained bone fracture, the muscle weakness, neuropsychiatric symptoms characterized by sleep disturbances and irritability correlated with the biological features characterized by moderate feriprive anemia, Ca and Mg decreased level, thyroid autoimmune impairment and gastrointestinal symptoms raised the suspicion of an autoimmune disorder with multiple targets. The videcapsule endoscopy (VCE) revealed the specific pattern of the celiac disease: villous atrophy of jejunum, scalloping, absent folds and cobblestone mucosal pattern. Results were correlated with immunology tests results. The patient was transferred on a gluten free diet and the clinical and VCE controlsrevealed the healing of the jejunum mucosa. The VCE can be the tool for positive diagnosis of an unusual and heterogeneous celiac disease in patients with various symptoms without an apparent cause. [ABSTRACT FROM AUTHOR]

Background & Aims: Behçet's disease presents some similar clinical features with seronegative spondyloarthritides (SpA), raising the question whether a subgroup of patients with Behçet's disease belong in fact to the latter. As the already known inflammatory involvement at the level of the small bowel in SpA patients could not be extrapolated for patients with Behçet's disease associated SpA (BehSpA), the present study aims to investigate and compare it in these diseases. Methods: 54 consecutive patients with a form of SpA, and 7 patients with BehSpA were enrolled and submitted to videocapsule endoscopy (VCE) examination. After reviewing the VCE findings, calculation of the score of small bowel mucosal inflammatory change (Lewis) was performed for each patient. The comparison was made with a control group, sex and age-matched to the patients in the study groups. Results: The Lewis score differed in the groups considered for analysis (mean of 439, 179 and 81 in the SpA, BehSpA and the control group, respectively, with p = 0.04 for the comparison SpA vs. BehSpA and 0.05 for the comparison BehSpA vs. controls). C reactive protein (CRP) level was markedly reduced in the BehSpA group vs. the other SpA group (2.08 and 14.02 mg/L, respectively; p = 0.053). Conclusion: The significant difference in intestinal inflammatory involvement in BehSpA versus the other SpAs, as well as the significantly lower serum levels of CRP, as revealed by the present study, clearly draw a line between the two disease entities. [ABSTRACT FROM AUTHOR]

Background: Prior work has shown that videocapsule endoscopy image features are a useful tool for quantitatively distinguishing the intestinal mucosal surface of untreated celiac patients from that of controls. The use of dynamic estimates of wall motility may further help to improve classification. Methods: Videocapsule endoscopy clips (200 frames each, 2 frames/s, 576 × 576 pixels/frame) were acquired at five small intestinal locations in 11 untreated celiac patients (celiacs) and ten controls. Color images were converted to grayscale and analyzed frame-by-frame. Variations in the position and width of the center of the small intestinal lumen were quantitatively estimated. The darkest grayscale pixels were used as an estimate of the lumen center. Over 200 frames, the standard deviation of the lumen center xy position and the mean and standard deviation in lumen center width were used as dynamic estimates of wall motility. These parameters were plotted in three-dimensional space, and the best discriminant function was used to classify celiacs versus controls at each of the following five locations: (1) duodenal bulb, (2) distal duodenum, (3) jejunum, (4) ileum, and (5) distal ileum. Results: The overall sensitivity for the classification of celiacs versus controls at all five locations was 98.2 %, while the specificity was 96.0 %. From location 1 to 5, there was a tendency for the lumen center width to diminish in terms of frame-to-frame variability by 7.6 % in celiacs ( r = 0.4) and 9.7 % in controls ( r = 0.7). Conclusions: In addition to examining the mucosal surface, videocapsule endoscopy can assess small bowel intestinal motility and aid in distinguishing celiac patients from controls. [ABSTRACT FROM AUTHOR]

Gastric antral vascular ectasia (GAVE) syndrome represents a rare cause of gastrointestinal bleeding. More extensive small-bowel involvement must be excluded in those patients with GAVE syndrome in whom aggressive endoscopic treatment of antral lesions results in lack of control of digestive bleeding, and for this subset of patients videocapsule endoscopy examination should be considered. However, since the dim angioectatic lesions, even if located in the gastric antrum, might be difficult to accurately outline with standard endoscopy, virtual chromoendoscopy techniques have been employed to aid in their detection, and the presented case illustrates how Fujinon intelligent color-enhancement (FICE) technology implemented in videocapsule endoscopy clearly emphasizes the vascular morphology and delineation of antral angioectasias, allowing better targeted endoscopic treatment and improving patient outcome. [ABSTRACT FROM AUTHOR]

Introduction: The diagnosis and management of gastrointestinal bleeding have always been a challenge to clinicians. In most patients, the source of bleeding is easily identified during conventional upper and/or lower gastrointestinal endoscopies. A significant progress in the evaluation of patients with obscure gastrointestinal bleeding was brought by the advent of capsule endoscopy. Since colonoscopy is not always technically feasible, colon VCE might be useful where the conventional procedure poses substantial nsks to patients or it is refused by them. Case-report: We present the case of a 58-year-old patient, with severe anemia caused by bleeding from a gastrointestinal source. The patient was diabetic, hypertensive and with impaired heart function, aggravated by anemia. We used the Pillcam Colon 2 capsule to investigate the colon and we found 2 tumors in the cecum and transverse colon. Conclusion: Pillcam Colon 2 capsule turned out to be an additional patient-friendly method to complement colonoscopy for colon visualization and colorectal cancer screening. [ABSTRACT FROM AUTHOR]

• A novel block wise feature recalibrate module merged into CNN-based networks for CD recognition. • Squeeze and excitation block with channel recalibration is firstly applied to adaptively recalibrate the feature of CD image. • The combination of ResNet50 with the SVM classifier can be useful to measure discriminative and subtle villous atrophy in CD. Videocapsule endoscopy (VCE) is a relatively new technique for evaluating the presence of villous atrophy in celiac disease patients. The diagnostic analysis of video frames is currently time-consuming and tedious. Recently, computer-aided diagnosis (CAD) systems have become an attractive research area for diagnosing celiac disease. However, the images captured from VCE are susceptible to alterations in light illumination, rotation direction, and intestinal secretions. Moreover, textural features of the mucosal villi obtained by VCE are difficult to characterize and extract. This work aims to find a novel deep learning feature learning module to assist in the diagnosis of celiac disease. In this manuscript, we propose a novel deep learning recalibration module which shows significant gain in diagnosing celiac disease. In this recalibration module, the block-wise recalibration component is newly employed to capture the most salient feature in the local channel feature map. This learning module was embedded into ResNet50, Inception-v3 to diagnose celiac disease using a 10-time 10-fold cross-validation based upon analysis of VCE images. In addition, we employed model weights to extract feature points from training and test samples before the last fully connected layer, and then input to a support vector machine (SVM), k-nearest neighbor (KNN), and linear discriminant analysis (LDA) for differentiating celiac disease images from heathy controls. Overall, the accuracy, sensitivity and specificity of the 10-time 10-fold cross-validation were 95.94%, 97.20% and 95.63%, respectively. A novel deep learning recalibration module, with global response and local salient factors is proposed, and it has a high potential for utilizing deep learning networks to diagnose celiac disease using VCE images. Image, graphical abstract [ABSTRACT FROM AUTHOR]