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Introduction:  The environmental impact of endoscopy, including small-bowel capsule endoscopy (SBCE), is a topic of growing attention and concern. This study aimed to evaluate the greenhouse gas (GHG) emissions (kgCO 2 ) generated by an SBCE procedure., Methods:  Life cycle assessment methodology (ISO 14040) was used to evaluate three brands of SBCE device and included emissions generated by patient travel, bowel preparation, capsule examination, and video recording. A survey of 87 physicians and 120 patients was conducted to obtain data on travel, activities undertaken during the procedure, and awareness of environmental impacts., Results:  The capsule itself (4 g) accounted for < 6 % of the total product weight. Packaging (43-119 g) accounted for 9 %-97 % of total weight, and included deactivation magnets (5 g [4 %-6 %]) and paper instructions (11-50 g [up to 40 %]). A full SBCE procedure generated approximately 20 kgCO 2 , with 0.04 kgCO 2 (0.2 %) attributable to the capsule itself and 18 kgCO 2 (94.7 %) generated by patient travel. Capsule retrieval using a dedicated device would add 0.98 kgCO 2 to the carbon footprint. Capsule deconstruction revealed materials (e. g. neodymium) that are prohibited from environmental disposal; 76 % of patients were not aware of the illegal nature of capsule disposal via wastewater, and 63 % would have been willing to retrieve it. The carbon impact of data storage and capsule reading was negligible., Conclusion:  The carbon footprint of SBCE is mainly determined by patient travel. The capsule device itself has a relatively low carbon footprint. Given that disposal of capsule components via wastewater is illegal, retrieval of the capsule is necessary but would likely be associated with an increase in device-related emissions., Competing Interests: M. Pioche is a consultant for Olympus and a trainer for Olympus, Pentax, Norgine, Boston, and Cook. X. Dray is co-founder and a shareholder of Augmented Endoscopy; he provides consultancy for Norgine and Provepharma, and lectures and demonstrations for Alfasigma, Bouchara Recordati, Fujifilm, Medtronic, Norgine, and Sandoz. E. Rodriguez de Santiago has had educational and advisory roles for Olympus, educational roles at Apollo Endosurgery and Norgine, and has received conference fees from Norgine and Casen.J.A. Cunha Neves, H. Pohl, M.-Q. Lê, R.Grau, C. Yzet, M. Mochet, J. Jacques, T. Wallenhorst, J. Rivory, N. Siret, A.-L. Peillet, J.-B. Chevaux, F. Mion, U. Chaput, P. Jacob, D. Grinberg, J.-C. Saurin, R. Baddeley, and P.-J. Cottinet declare that they have no conflict of interest., (Thieme. All rights reserved.)

Competing Interests: The authors declare that they have no conflict of interest.

Competing Interests: The authors declare that they have no conflict of interest.

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., Competing Interests: B. Rosa has received consultancy fees from Medtronic, unrelated to the current work. T. Cúrdia Gonçalves, M.J. Moreira, F. Dias de Castro, B. Sousa-Pinto, M. Dinis-Ribeiro, and J. Cotter declare that they have no conflict of interest., (Thieme. All rights reserved.)

Competing Interests: The authors declare that they have no conflict of interest.

Competing Interests: The authors declare that they have no conflict of interest.

BACKGROUND : Further development of deep learning-based artificial intelligence (AI) technology to automatically diagnose multiple abnormalities in small-bowel capsule endoscopy (SBCE) videos is necessary. We aimed to develop an AI model, to compare its diagnostic performance with doctors of different experience levels, and to further evaluate its auxiliary role for doctors in diagnosing multiple abnormalities in SBCE videos. METHODS : The AI model was trained using 280 426 images from 2565 patients, and the diagnostic performance was validated in 240 videos. RESULTS : The sensitivity of the AI model for red spots, inflammation, blood content, vascular lesions, protruding lesions, parasites, diverticulum, and normal variants was 97.8 %, 96.1 %, 96.1 %, 94.7 %, 95.6 %, 100 %, 100 %, and 96.4 %, respectively. The specificity was 86.0 %, 75.3 %, 87.3 %, 77.8 %, 67.7 %, 97.5 %, 91.2 %, and 81.3 %, respectively. The accuracy was 95.0 %, 88.8 %, 89.2 %, 79.2 %, 80.8 %, 97.5 %, 91.3 %, and 93.3 %, respectively. For junior doctors, the assistance of the AI model increased the overall accuracy from 85.5 % to 97.9 % ( P  < 0.001, Bonferroni corrected), comparable to that of experts (96.6 %, P  > 0.0125, Bonferroni corrected). CONCLUSIONS : This well-trained AI diagnostic model automatically diagnosed multiple small-bowel abnormalities simultaneously based on video-level recognition, with potential as an excellent auxiliary system for less-experienced endoscopists., Competing Interests: The study was supported in part by Ankon company. Wuhan Union Hospital and Ankon company collaborated in this study. Hang Zhang, Hao Zhang, and Fanhua Ming are research staff of Ankon Technologies Inc. The remaining authors declare that they have no conflict of interest., (Thieme. All rights reserved.)

MR1: ESGE recommends small-bowel capsule endoscopy as the first-line examination, before consideration of other endoscopic and radiological diagnostic tests for suspected small-bowel bleeding, given the excellent safety profile of capsule endoscopy, its patient tolerability, and its potential to visualize the entire small-bowel mucosa.Strong recommendation, moderate quality evidence. MR2: ESGE recommends small-bowel capsule endoscopy in patients with overt suspected small-bowel bleeding as soon as possible after the bleeding episode, ideally within 48 hours, to maximize the diagnostic and subsequent therapeutic yield.Strong recommendation, high quality evidence. MR3: ESGE does not recommend routine second-look endoscopy prior to small-bowel capsule endoscopy in patients with suspected small-bowel bleeding or iron-deficiency anemia.Strong recommendation, low quality evidence. MR4: ESGE recommends conservative management in those patients with suspected small-bowel bleeding and high quality negative small-bowel capsule endoscopy.Strong recommendation, moderate quality evidence. MR5: ESGE recommends device-assisted enteroscopy to confirm and possibly treat lesions identified by small-bowel capsule endoscopy.Strong recommendation, high quality evidence. MR6: ESGE recommends the performance of small-bowel capsule endoscopy as a first-line examination in patients with iron-deficiency anemia when small bowel evaluation is indicated.Strong recommendation, high quality evidence. MR7: ESGE recommends small-bowel capsule endoscopy in patients with suspected Crohn's disease and negative ileocolonoscopy findings as the initial diagnostic modality for investigating the small bowel, in the absence of obstructive symptoms or known bowel stenosis.Strong recommendation, high quality evidence. MR8: ESGE recommends, in patients with unremarkable or nondiagnostic findings from dedicated small-bowel cross-sectional imaging, small-bowel capsule endoscopy as a subsequent investigation if deemed likely to influence patient management.Strong recommendation, low quality evidence. MR9: ESGE recommends, in patients with established Crohn's disease, the use of a patency capsule before small-bowel capsule endoscopy to decrease the capsule retention rate.Strong recommendation, moderate quality evidence. MR10: ESGE recommends device-assisted enteroscopy (DAE) as an alternative to surgery for foreign bodies retained in the small bowel requiring retrieval in patients without acute intestinal obstruction.Strong recommendation, moderate quality evidence. MR11: ESGE recommends DAE-endoscopic retrograde cholangiopancreatography (DAE-ERCP) as a first-line endoscopic approach to treat pancreaticobiliary diseases in patients with surgically altered anatomy (except for Billroth II patients).Strong recommendation, moderate quality evidence., Competing Interests: C. Carretero provides consultancy and receives speakers fees from Medtronic (ongoing). X. Dray is a founder of and shareholder in Augmented Endoscopy (May 2019 to present); he is a member of the International CApsule Endoscopy REsearch (iCARE) group (December 2021 to present); he holds four patents (shared with his institutions) related to artificial intelligence in endoscopy. E. J. Despott has received educational grants in support of conference organization, and honoraria, from Fujifilm, Pentax, and Olympus (2017–2021), and honoraria from Ambu (2021). L. Elli has held a lecture/consultancy role for Medtronic (2018-2020) and Capsocam (2016). L. Fuccio is a Co-Editor of Endoscopy journal. M. Keuchel has received speaker’s fees and travel support from and provided consultancy to Medtronic, and received speaker’s fees from Olympus (both from 2021 to present); his department has received study support from AnX Robotics (from 2021 to present). A. Koulaouzidis is a co-founder and shareholder of AJM MED-i-Caps (from 2017, ongoing) and iCERV (from 2022, ongoing), and has received consultancy fees from CHI and Jinshan Science & Technology and lecture honoraria from Medtronic (all from 2020, ongoing), travel assistance fees from Aquilant (2019), material support for clinical research from SynMed and Intromedic (2016–2020), and lecture honoraria and AB meeting fees from Dr Falk Pharma UK (2016–2020), and has participated in an advisory board for Ankon (2019); his department has received a grant from Medtronic (2016–2020); he is a founding and board member of iCARE; he or his department holds a patent related to this Guideline. D. McNamara received an iCloud Capsule Platform introductory fee waiver from Medtronic (2021–2022). T. Moreels received speaker’s fees from Olympus (2019–2022). H. Neumann is a consultant to Fujifilm, Medtronic, and Jinsha (from 2020, ongoing); his department receives study support from Fujifilm (from 2020, ongoing). M. Pennazio received speaker’s fees from Medtronic, Olympus, and Alfasigma (2015–2019). E. Perez-Cuadrado-Robles provided consultancy to Boston Scientific (2020–2021). E. Rondonotti has been an expert group member and speaker for Fujifilm (January 2021 to December 2021) and provided consultancy to Medtronic (2021); his department received a research grant from Fufifilm (January 2021 to December 2021). B. Rosa provided consultancy to Medtronic (2020–2021). C. Spada provided consultancy to Medtronic (2017–2022) and AnX Robotics (2020–2022). J. C. Saurin provided consultancy to Intromedic, Capsovision, Medtronic, and Povepharm (2021–2024), and teaching for Medtronic (2021–2024). I. Tacheci is Scientific Secretary to the Czech Society of Gastroenterology and responsible for dissemination of guidelines (2022). P. Cortegoso Valdivia, B. Gonzalez Suarez, L. Kunovsky, E. Perez-Cuadrado-Martinez, S. Piccirelli, D.S. Sanders, R. Sidhu, K. Triantafyllou, and E. Vlachou have no competing interests., (European Society of Gastrointestinal Endoscopy. All rights reserved.)

Competing Interests: The authors declare that they have no conflict of interest.

Competing Interests: The authors declare that they have no conflict of interest.

Competing Interests: The authors declare that they have no conflict of interest.

Background: Cleanliness scores in small-bowel capsule endoscopy (SBCE) have poor reproducibility. The aim of this study was to evaluate a neural network-based algorithm for automated assessment of small-bowel cleanliness during capsule endoscopy., Methods: 600 normal third-generation SBCE still frames were categorized as "adequate" or "inadequate" in terms of cleanliness by three expert readers, according to a 10-point scale, and served as a training database. Then, 156 third-generation SBCE recordings were categorized in a consensual manner as "adequate" or "inadequate" in terms of cleanliness; this testing database was split into two independent 78-video subsets for the tuning and evaluation of the algorithm, respectively., Results: Using a threshold of 79 % "adequate" still frames per video to achieve the best performance, the algorithm yielded a sensitivity of 90.3 %, specificity of 83.3 %, and accuracy of 89.7 %. The reproducibility was perfect. The mean calculation time per video was 3 (standard deviation 1) minutes., Conclusion: This neural network-based algorithm allowing automatic assessment of small-bowel cleanliness during capsule endoscopy was highly sensitive and paves the way for automated, standardized SBCE reports., Competing Interests: Xavier Dray, Romain Leenhardt, and Aymeric Histace are cofounders and shareholders of Augmented Endoscopy. Xavier Dray has acted as a consultant for Boston Scientific and Norgine, and has presented lectures for Fujifilm, Medtronic, and Pentax. Romain Leenhardt has presented lectures for Abbvie. All other authors declare that they have no conflicts of interest., (Thieme. All rights reserved.)

Background: We aimed to document international practices in small-bowel capsule endoscopy (SBCE), measuring adherence to European Society of Gastrointestinal Endoscopy (ESGE) technical and clinical recommendations., Methods: Participants reached through the ESGE contact list completed a 52-item web-based survey., Results: 217 responded from 47 countries (176 and 41, respectively, from countries with or without a national society affiliated to ESGE). Of respondents, 45 % had undergone formal SBCE training. Among SBCE procedures, 91 % were performed with an ESGE recommended indication, obscure gastrointestinal bleeding (OGIB), iron-deficiency anemia (IDA), and suspected/established Crohn's disease being the commonest and with higher rates of positive findings (49.4 %, 38.2 % and 53.5 %, respectively). A watchful waiting strategy after a negative SBCE for OGIB or IDA was preferred by 46.7 % and 70.3 %, respectively. SBCE was a second-line exam for evaluation of extent of new Crohn's disease for 62.2 % of respondents. Endoscopists adhered to varying extents to ESGE technical recommendations regarding bowel preparation ( > 60 %), use in those with pacemaker holders (62.5 %), patency capsule use (51.2 %), and use of a validated scale for bowel preparation assessment (13.3 %). Of the respondents, 67 % read and interpreted the exams themselves and 84 % classified exams findings as relevant or irrelevant. Two thirds anticipated future increase in SBCE demand. Inability to obtain tissue (78.3 %) and high cost (68.1 %) were regarded as the main limitations, and implementation of artificial intelligence as the top development priority (56.2 %)., Conclusions: To some extent, endoscopists follow ESGE guidelines on using SBCE in clinical practice. However, variations in practice have been identified, whose implications require further evaluation., Competing Interests: X. Dray is a co-founder of and shareholder in Augmented Endoscopy (from July 2019, ongoing); he has provided consultancy to Norgine (January to December 2020); he holds a patent for a device and method for classifying the quality of digestive capsule endoscopy image. R. Eliakim has provided consultancy to Medtronic (from 2016, ongoing). M. Keuchel has provided consultancy to and received speaker’s fees from Medtronic; he has received a speaker’s fee from Olympus; he is the co-editor of a book on capsule endoscopy. A. Koulaouzidis is a consultant for Jinshan (from March 2021, ongoing); he is a co-director of iCERV (from June 2020, ongoing); he is a co-founder of and a stakeholder in AJM Medicaps (from March 2021, ongoing). S. Panter has provided consultancy for and has received support for research projects from Medtronic. E. Rondonotti has received speaker honoraria from Fujifilm. B. Rosa has provided consultancy for and has received sponsorship from Medtronic (from 2020, ongoing). C. Spada has provided consultancy to Medtronic (from 2017 to 2021). E. Toth has provided consultancy to and received a lecture fee from Medtronic (2017 to 2021) and Norgine 2018 to 2021). H. Beaumont, P. Bhandari, P. Ellul, I. Fernandez-Urien, R. Jover, L.-D. Lazaridis, K. Triantafyllou, and G. Tziatzios, declare no competing interests., (European Society of Gastrointestinal Endoscopy. All rights reserved.)

Competing Interests: B. Rosa has received consultancy fees from Medtronic, unrelated to the current work. T. Cúrdia Gonçalves, M.J. Moreira, F. Dias de Castro, B. Sousa-Pinto, M. Dinis-Ribeiro, and J. Cotter declare that they have no conflict of interest.

Introduction: Primary colonoscopy and fecal immunochemical test (FIT) are the most commonly used colorectal cancer (CRC) screening modalities. Colon capsule endoscopy (CCE) might be an alternative. Data on the performance of CCE as a CRC screening tool in a screening population remain scarce. This is the first systematic review to provide an overview of the applicability of CCE as a CRC screening tool., Methods: A systematic search was conducted of literature published up to September 2020. Studies reporting on CRC screening by second-generation CCE in an average-risk screening population were included., Results: 582 studies were identified and 13 were included, comprising 2485 patients. Eight studies used CCE as a filter test after a positive FIT result and five studies used CCE for primary screening. The polyp detection rate of CCE was 24 % - 74 %. For polyps > 6 mm, sensitivity of CCE was 79 % - 96 % and specificity was 66 % - 97 %. For polyps ≥ 10 mm, sensitivity of CCE was 84 % - 97 %, which was superior to computed tomographic colonography (CTC). The CRC detection rate for completed CCEs was 93 % (25/27). Bowel preparation was adequate in 70 % - 92 % of examinations, and completion rates varied from 57 % to 92 %, depending on the booster used. No CCE-related complications were described., Conclusion: CCE appeared to be a safe and effective tool for the detection of CRC and polyps in a screening setting. Accuracy was comparable to colonoscopy and superior to CTC, making CCE a good alternative to colonoscopy in CRC screening programs, although completion rates require improvement., Competing Interests: E. Rondonotti received speaker honoraria from Fujifilm CO. C. has Hassan received loan of devices for research from Medtronic. M. Spaander received research support from Medtronic and Boston Scientific. C. Spada received scientific support and paid consultant from Medtronic. F. Vuik is a paid consultant from Medtronic., (Thieme. All rights reserved.)

Background: Colon capsule endoscopy (CCE) is a technology that might contribute to colorectal cancer (CRC) screening programs as a filter test between fecal immunochemical testing and standard colonoscopy. The aim was to systematically review the literature for studies investigating the diagnostic yield of second-generation CCE compared with standard colonoscopy., Methods: A systematic literature search was performed in PubMed, Embase, and Web of Science. Study characteristics including quality of bowel preparation and completeness of CCE transits were extracted. Per-patient sensitivity and specificity were extracted for polyps (any size, ≥ 10 mm, ≥ 6 mm) and lesion characteristics. Meta-analyses of diagnostic yield were performed., Results: The literature search revealed 1077 unique papers and 12 studies were included. Studies involved a total of 2199 patients, of whom 1898 were included in analyses. The rate of patients with adequate bowel preparation varied from 40 % to 100 %. The rates of complete CCE transit varied from 57 % to 100 %. Our meta-analyses demonstrated that mean (95 % confidence interval) sensitivity, specificity, and diagnostic odds ratio were: 0.85 (0.73-0.92), 0.85 (0.70-0.93), and 30.5 (16.2-57.2), respectively, for polyps of any size; 0.87 (0.82-0.90), 0.95 (0.92-0.97), and 136.0 (70.6-262.1), respectively, for polyps ≥ 10 mm; and 0.87 (0.83-0.90), 0.88 (0.75-0.95), and 51.1 (19.8-131.8), respectively, for polyps ≥ 6 mm. No serious adverse events were reported for CCE., Conclusion: CCE had high sensitivity and specificity for per-patient polyps compared with standard colonoscopy However, the relatively high rate of incomplete investigations limits the application of CCE in a CRC screening setting., Competing Interests: The authors declare that they have no conflicts of interest., (Thieme. All rights reserved.)

This article, published in the journal Endoscopy, discusses the impact of proximal small bowel lesions detected by capsule endoscopy in patients with Crohn's Disease (CD). The study included 70 patients with inflammatory bowel disease, including CD, ulcerative colitis (UC), and unclassified colitis. The results showed that capsule endoscopy was able to identify proximal disease in 42.9% of patients, with a high diagnostic field. These findings had a significant impact on treatment decisions, with 82.9% of patients requiring treatment modifications based on the findings of the capsule endoscopy. [Extracted from the article]

This article discusses the role of capsule endoscopy in cases of obscure gastrointestinal (GI) bleeding. The study aimed to identify patients who could benefit from proceeding directly to device-assisted enteroscopy (DAE) without undergoing capsule endoscopy. The researchers reviewed patients with suspected small bowel bleeding who underwent capsule endoscopy and analyzed various variables to identify suitable patients for DAE. The results showed that older patients were more likely to have proximal findings on capsule endoscopy, potentially due to a higher proportion of older patients with proximal angiodysplasia. The study suggests that patients aged 75 years and older could benefit from proceeding directly to DAE, but further research is needed to confirm these findings. [Extracted from the article]

This article, titled "Patency testing prior to Video Capsule Endoscopy: An Irish Experience," discusses the use of Patency Capsules (PC) in assessing gastrointestinal (GI) tract patency before Video Capsule Endoscopy (VCE). The study collected procedural data from five tertiary centers in Ireland to assess PC protocols and factors affecting outcomes. The results showed similar completion rates for PC across Ireland, regardless of age, gender, or PC/VCE indication. The study suggests the introduction of 3D imaging to improve location assessment and increase PC pass rates. [Extracted from the article]

This article, titled "Artificial Intelligence Assisted Capsule Endoscopy Versus Conventional Endoscopy for Detection of Small Bowel Lesions – Systematic Review and Meta-analysis," provides a systematic review and meta-analysis of studies comparing the diagnostic accuracy of AI-assisted capsule endoscopy (CE) to conventional CE in detecting small bowel lesions. The study found that AI-assisted CE had higher diagnostic accuracy, sensitivity, and positive predictive values compared to conventional CE. However, conventional CE had higher specificity, and the negative predictive value was higher in AI-assisted CE. The authors conclude that the use of AI-assisted CE can improve the detection and management of small bowel lesions. [Extracted from the article]

BACKGROUND : Previous computer-aided detection systems for diagnosing lesions in images from wireless capsule endoscopy (WCE) have been limited to a single type of small-bowel lesion. We developed a new artificial intelligence (AI) system able to diagnose multiple types of lesions, including erosions and ulcers, vascular lesions, and tumors. METHODS : We trained the deep neural network system RetinaNet on a data set of 167 patients, which consisted of images of 398 erosions and ulcers, 538 vascular lesions, 4590 tumors, and 34 437 normal tissues. We calculated the mean area under the receiver operating characteristic curve (AUC) for each lesion type using five-fold stratified cross-validation. RESULTS : The mean age of the patients was 63.6 years; 92 were men. The mean AUCs of the AI system were 0.996 (95 %CI 0.992 - 0.999) for erosions and ulcers, 0.950 (95 %CI 0.923 - 0.978) for vascular lesions, and 0.950 (95 %CI 0.913 - 0.988) for tumors. CONCLUSION : We developed and validated a new computer-aided diagnosis system for multiclass diagnosis of small-bowel lesions in WCE images., Competing Interests: The authors declare that they have no conflict of interest., (© Georg Thieme Verlag KG Stuttgart · New York.)

The European Society of Gastrointestinal Endoscopy (ESGE) has recognized the need to formalize training in small-bowel endoscopy across European centers. The following criteria and framework for training in small-bowel capsule endoscopy (SBCE) and device-assisted enteroscopy (DAE), which aim to provide uniform and high quality training to ensure that small-bowel endoscopists are competent to operate independently, are based on the current literature and experience of experts in the field. Three main areas are covered: skills required prior to commencing training in small-bowel endoscopy; structured training for trainees to become independent endoscopists; and ways of ensuring competence is achieved. 1 : Centers providing training in SBCE should perform a minimum of 75 - 100 SBCEs/year. 2 : Experience in bidirectional endoscopies is desirable for structured training in SBCE. 3 : SBCE courses should consist of at least 50 % hands-on training and cover information on technology, indications and contraindications for SBCE, pathologies that can be encountered on SBCE, and standard terminology that should be used during reporting of SBCE. An SBCE course should be completed prior to achieving competence in SBCE reporting. 4 : Competence in SBCE can be assessed by considering a minimum of 30 SBCEs. Direct Observation of Procedural Skills, short SBCE videos, and multiple-choice questions can be useful to assess improvement in the skills of trainees. 5 : Centers offering training in DAE should aim to carry out at least 75 DAEs/year, should have direct links with an SBCE service, and should allow regular discussion of cases at a radiology small-bowel MDT. Training centers with lower numbers are encouraged to offer training by "buddying-up" with other centers, or using mentoring systems. 6 : DAE trainees must be independent in bidirectional endoscopies and have experience in level 1 polypectomy prior to commencement of training. They should also be competent in reviewing SBCEs. 7 : Training in DAE should be structured with a minimum of 75 procedures, including 35 retrograde DAEs, with therapeutic procedures undertaken in at least 50 % of the DAEs performed. Training should cover the indications, contraindications, complications including prevention, and technicalities of the DAE procedure; formal evaluation should follow. DAE trainees must acquire skills to independently manage and advise on small-bowel pathology following DAE procedures. 8 : It is highly recommended that international societies develop online modules and courses on DAE, which are currently lacking across Europe., Competing Interests: M. Arvanitakis has received lecture fees from Olympus (2019 – 2020). P. Baltes has received speakerʼs fees from Medtronic (2014 to present). R. Bisschops has received research support, speaker’s and consultancy fees from Medtronic, Cook, Pentax, and Fujifilm (2009 – 2020), he has also received consultancy and speaker’s fees from Norgine, GI supply, Medivators, and Boston Scientific (2009 – 2020). C. Carretero has received speakerʼs and consultancy fees from Medtronic (ongoing). E. Dekker has received speaker’s fees from Olympus (2018), Roche (2016, 2018), and GI Supply (2019), has provided consultancy to Fujifilm (2017), Olympus (2019), Tillots (2018), GI Supply (2018 to present), and CPP-FAP (2019); she has received equipment on loan from Fujifilm (2017 to present); she received a research grant from Fujifilm. E.J. Despott has received speakerʼs honoraria from Fujifilm and Aquilant Endoscopy (2017 to present), and educational grants from Fujifilm, Aquilant Endoscopy, Pentax Medical, and Olympus Medical (2017 to present). M. Dinis-Ribeiro is co-editor in-chief of Endoscopy. X. Dray is a co-founder and shareholder of Augmented Endoscopy (2019 to present), and has given training for Fujifilm and Medtronic (2010 – 2019); he also holds a patent related to the guideline: European patent EP18305275. J.E. East is on the clinical advisory boards of Boston Scientific, Lumendi (2017 – 2019) and Satisfai Health (2020). G. Johnson has received speakerʼs fees from Boston Scientific (2012 to present) and has been a faculty member for annual training courses supported by Olympus, Pentax, and Boston Scientific (2012 to present). M. Keuchel has received speakerʼs fees from Medtronic and Olympus (2015 to present); he is co-editor of the book Video Capsule Endoscopy published by Springer. A. Murino has acted as a consultant for Boston Scientific and GI supply (2019), he has received academic grants from Fujifilm, Aquilant Endoscopy, Norgine, and Olympus (2017 – 2020). T. Ponchon has received research support from Olympus (2020). S. Chetcuti Zammit, P. Pimentel-Nunes, D. S. Sanders, and R. Sidhu declare that they have no conflict of interest., (© Georg Thieme Verlag KG Stuttgart · New York.)

Competing Interests: None

Competing Interests: E. Rondonotti has received speaker's honoraria from Fujifilm Co. and has a consultancy agreement with Medtronic Co.

This article, published in the journal Endoscopy, discusses the development and testing of a deep learning model for the automatic detection of vascular lesions during capsule endoscopy (CE). The study used a multicentric retrospective approach, analyzing data from 1188 CE exams and a total of 152312 frames. The results showed that the model had a mean sensitivity of 87.5% and a mean specificity of 99.5%, with a mean accuracy of 98.4%. The authors conclude that this AI deep learning model has high diagnostic performance and can be replicated in multiple technological settings. [Extracted from the article]

This article discusses the use of colon capsule endoscopy (CCE) as an alternative to CT colonography (CTC) for patients who have had an incomplete colonoscopy. The study found that CCE had comparable diagnostic yields to CTC, but lower completion rates. The researchers reviewed the clinical indications and patient history of 99 patients on the CTC waiting list and found that 41 were eligible for CCE. Of those, 21 patients underwent CCE, with 71% of them being successful and subsequently removed from the CTC waiting list. The study concludes that careful patient selection is important to improve completion rates and reduce unnecessary CTCs and colonoscopies. [Extracted from the article]

This article provides a descriptive analysis of patients who have undergone Small Bowel Capsule Endoscopy (SBCE). SBCE is recommended for patients with suspected small bowel bleeding, iron deficiency anemia, and suspected Crohn's disease. The study analyzed the demographic data, comorbidities, medication history, indications for the examination, main findings, and final diagnosis of 25 patients who underwent SBCE. The most common indication for the examination was suspected small bowel bleeding, and the most common finding was angiectasia. SBCE is useful for identifying the cause of bleeding in sites that cannot be assessed with conventional endoscopic modalities and for identifying unusual causes of gastrointestinal hemorrhage. [Extracted from the article]

The article discusses the use of the Glasgow-Blatchford Score (GBS) in predicting findings on video capsule endoscopy (VCE) in patients admitted with obscure overt gastrointestinal bleeding. The study conducted a retrospective analysis of patients admitted between January 2019 and June 2022, collecting demographic, clinical, biochemical, capsule findings, and outcome data. The results showed that GBS was useful in predicting findings on VCE, and it may be considered as a tool to identify patients who could benefit from early VCE. [Extracted from the article]

This article discusses the environmental impact of small-bowel capsule endoscopy (SBCE) and its contribution to greenhouse gas (GHG) emissions. The study evaluated three different SBCE devices using life cycle assessment methodology and found that the weight of the capsule itself was minimal compared to packaging and other components. A full SBCE procedure generated between 19 and 20 kgCO2e, with patient traveling accounting for the majority of emissions. The article emphasizes the importance of retrieving and properly disposing of the capsule due to the prohibited components it contains. [Extracted from the article]

This article, published in the journal Endoscopy, examines the cost implications of different imaging approaches for patients undergoing patency capsule investigation at a video capsule endoscopy service. The current approach involves patients retaining a patency capsule undergoing an initial abdominal X-ray, with further imaging if capsule retention is detected. The study explores alternative approaches, including stool observation counseling and pro-kinetic medication, immediate low-dose CT abdomen scans for all patients, and a sequential approach involving review by a radiologist. A retrospective analysis of patients undergoing patency capsule investigation between 2020-2022 was conducted, and a cost-evaluation of the different imaging approaches was performed. The study found that the alternative approaches were more cost-effective, although patient costs such as travel were not considered. [Extracted from the article]

This article, published in the journal Endoscopy, explores the spectrum of clinical symptoms and endoscopic presentations of non-steroidal anti-inflammatory drugs (NSAIDs)-induced small bowel injuries. The study, conducted at Sheffield Teaching Hospitals in the UK, retrospectively evaluated capsule endoscopy (CE) data from 2011 to July 2023 in patients with documented NSAID use and inflammatory small bowel injury. The findings indicate that NSAIDs enteropathy presents with a wide range of manifestations at CE, making it difficult to differentiate from Crohn's disease. Additionally, a significant percentage of patients still exhibit small bowel damage even after months of NSAID suspension, contrary to ESGE guidelines. [Extracted from the article]

This article, published in the journal Endoscopy, discusses the development of an automated scoring system for assessing inflammation in patients with Crohn's disease using capsule endoscopy (CE) images and artificial intelligence (AI). The study retrospectively reviewed CE videos of CD patients and calculated scores using validated methods. The researchers found a strong correlation between the AI-generated score and the validated scores, suggesting that it could be an objective and efficient method for evaluating inflammation in CD patients. The findings provide a promising basis for future refinement of a CE score that can accurately correlate with prognostic factors and aid in the management and treatment of CD patients. [Extracted from the article]

This article discusses the use of capsule endoscopy (CE) for screening and surveillance of varices in patients with chronic liver disease. The study evaluated the Pillcam UGI, a double-ended capsule camera, and found that it had a high success rate and completeness of examination. Varices were detected in 28% of patients, and CE changed management in 11.1% of cases. Overall, CE was deemed a non-invasive, safe, and effective method for detecting and managing oesophagogastric varices. [Extracted from the article]

This article, published in the journal Endoscopy, discusses the use of capsule endoscopy (CE) for small-bowel surveillance in patients with Lynch syndrome (LS), a hereditary disease that increases the risk of gastrointestinal and extra-GI malignancies. The study retrospectively analyzed data from LS patients who underwent CE over a 20-year period. The results showed that CE was effective in diagnosing small-bowel malignancies, but there were a significant number of false positives that required additional imaging confirmation. The authors suggest that further research is needed to establish standardized protocols for small-bowel cancer surveillance in LS patients. [Extracted from the article]

This article discusses a multicentric randomized trial that aimed to determine the optimal protocol for bowel preparation before small-bowel capsule endoscopy (SBCE). The study compared different purgative regimens and assessed small-bowel visualization quality (SBVQ), diagnostic yield (DY), patient-reported outcomes, and tolerability. The results showed that the group that received bowel preparation the night before SBCE had poorer outcomes, while intra-procedure purgative regimens improved visualization, DY, and angioectasia detection. The regimen that involved taking 1L of purgative after the capsule reached the duodenum (G4) was found to be the best-tolerated regimen. [Extracted from the article]