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Gastrointestinal bleeding is the most frequent major complication of antiplatelet therapy. In patients at low bleeding risk, however, clinically overt gastrointestinal bleeding is relatively uncommon.The authors sought to assess the effects of different antiplatelet regimens on gastrointestinal mucosal injury by means of a novel magnetically controlled capsule endoscopy system in patients at low bleeding risk.Patients (n = 505) undergoing percutaneous coronary intervention in whom capsule endoscopy demonstrated no ulcerations or bleeding (although erosions were permitted) after 6 months of dual antiplatelet therapy (DAPT) were randomly assigned to aspirin plus placebo (n = 168), clopidogrel plus placebo (n = 169), or aspirin plus clopidogrel (n = 168) for an additional 6 months. The primary endpoint was the incidence of gastrointestinal mucosal injury (erosions, ulceration, or bleeding) at 6-month or 12-month capsule endoscopy.Gastrointestinal mucosal injury through 12 months was less with single antiplatelet therapy (SAPT) than with DAPT (94.3% vs 99.2%; P = 0.02). Aspirin and clopidogrel monotherapy had similar effects. Among 68 patients without any gastrointestinal injury at randomization (including no erosions), SAPT compared with DAPT caused less gastrointestinal injury (68.1% vs 95.2%; P = 0.006), including fewer new ulcers (8.5% vs 38.1%; P = 0.009). Clinical gastrointestinal bleeding from 6 to 12 months was less with SAPT than with DAPT (0.6% vs 5.4%; P = 0.001).Despite being at low risk of bleeding, nearly all patients receiving antiplatelet therapy developed gastrointestinal injury, although overt bleeding was infrequent. DAPT for 6 months followed by SAPT with aspirin or clopidogrel from 6 to 12 months resulted in less gastrointestinal mucosal injury and clinical bleeding compared with DAPT through 12 months. (OPT-PEACE [Optimal Antiplatelet Therapy for Prevention of Gastrointestinal Injury Evaluated by Ankon Magnetically Controlled Capsule Endoscopy]; NCT03198741).

Wireless Capsule Endoscopy (WCE) has been widely accepted due to its painless method of imaging the entire gastrointestinal tract. In this paper, we propose deep Convolutional Neural Network(CNN) for automatic discrimination of ulcers on different ratios of augmented datasets ranging from 1000 to 10000 WCE images comprising of ulcer and non-ulcer images. A detailed investigation of network configuration for various nodes and depth were performed. The proposed network architecture of four convolutional layers with ( 3 * 3 ) convolutional filters demonstrated significant improvement in terms of performance. The WCE images were obtained from publicly available WCE datasets and real-time WCE video frames. The test results were subjected to hyper-parameter optimization for various tweaking parameters such as epochs, pooling schemes, learning rate, number of layers, optimizer, activation functions and drop out scheme. The experimental results were compared with ten different machine learning classifiers, demonstrating higher prediction performance.

Background Capsule endoscopy (SBCE) has developed a relevant role in patients with established Crohn's Disease (CD). However, evaluation of the impact in clinical management has been scarce. Aims To evaluate therapeutic impact of SBCE in an 11-year real-life cohort of known CD patients. Methods Retrospective single center study including all patients with established CD submitted to SBCE procedure from 01/01/2008 to 31/12/2019. Patency capsule was used in selected patients. Small bowel mucosal inflammation was quantified using Lewis score. Therapeutic impact was defined as a change in CD-related treatment recommended based on SBCE results. Patients were assigned to four groups regarding SBCE indication: staging, flare, post-op and remission. Results From the 432 SBCE performed 87.5% were conclusive. Active disease was present in 63.7 of patients; 41.6% mild inflammation and 21.9% moderate-to-severe activity. A change of management was guided by SBCE in 51.3% of procedures: 199 (46.1%) escalation and 23 (5.3%) de-escalation, with significant changes in all groups. Escalation increased with disease activity: 57.8% in mild and 89.5% in moderate-to-severe disease. De-escalation was conducted in 13.9% procedures with mucosal healing and 1.1% with mild disease. Conclusion SBCE is a useful tool for guiding therapeutic management in CD patients both for treatment escalation and de-escalation.

Lower gastrointestinal diagnostics have been facing significant capacity constraints, which the COVID-19 pandemic has exacerbated due to significant reductions in endoscopy procedures. Colon Capsule Endoscopy (CCE) provides a safe, viable solution to offset ongoing demand and could be a valuable tool for the recovery of endoscopy services post-COVID. NHS Scotland has already begun a country-wide rollout of CCE as a managed service, and NHS England have committed to a pilot scheme of 11,000 capsules via hospital-based delivery. Here, we outline a proven method of CCE delivery that ensures the CCE and results are delivered in an efficient, clinically robust manner with high patient acceptability levels through a managed service. Delivering CCE without a managed service is likely to be slower, more costly, and less effective, limiting the many benefits of CCE as an addition to the standard diagnostic pathway for bowel cancer.

Background and study aims Colon capsule endoscopy (CCE) is an alternative to conventional colonoscopy (CC) in specific clinical settings. High completion rates (CRs) and adequate cleanliness rates (ACRs) are fundamental quality parameters if CCE is to be widely implemented as a CC equivalent diagnostic modality. We conducted a systematic review and meta-analysis to investigate the efficacy of different bowel preparations regimens on CR and ACR in CCE. Patients and methods We performed a systematic literature search in PubMed, Embase, CINAHL, Web of Science, and the Cochrane Library. Data were independently extracted per the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA). The primary outcome measures (CR, ACR) were retrieved from the individual studies and pooled event rates were calculated. Results Thirty-four observational (OBS) studies (n = 3,789) and 12 randomized clinical trials (RCTs) (n = 1,214) comprising a total 5,003 patients were included. The overall CR was 0.798 (95 % CI, 0.764–0.828); the highest CRs were observed with sodium phosphate (NaP) + gastrografin booster (n = 2, CR = 0.931, 95 % CI, 0.820–0.976). The overall ACR was 0.768 (95 % CI, 0.735–0.797); the highest ACRs were observed with polyethylene glycol (PEG) + magnesium citrate (n = 4, ER = 0.953, 95 % CI, 0.896–0.979). Conclusions In the largest meta-analysis on CCE bowel preparation regimens, we found that both CRs and ACRs are suboptimal compared to the minimum recommended standards for CC. PEG laxative and NaP booster were the most commonly used but were not associated with higher CRs or ACRs. Well-designed studies on CCE should be performed to find the optimal preparation regimen.

Summary Background The use of magnetically controlled capsules for gastroscopy is in the early stages of clinical adoption. We aimed to evaluate the safety and efficacy of a fully automated magnetically controlled capsule endoscopy (FAMCE) system in clinical practice for gastroscopy and small bowel examination. Methods We did a prospective, comparative study to evaluate the safety and efficacy of FAMCE. Patients from two hospitals in Chongqing, China were consecutively enrolled. Eligible participants were aged 18–80 years with suspected gastric pathology and no previous surgery. Participants underwent FAMCE for screening of gastric lesions, then conventional transoral gastroscopy 2 h later, and stomach examination results were compared. The primary outcome was the rate of complete detection of gastric anatomy landmarks (cardia, fundus, body, angulus, antrum, and pylorus) by FAMCE. Secondary outcomes were the time required for gastric completion by FAMCE, the rate of detection of gastric lesions by FAMCE compared with conventional transoral gastroscopy, and the rate of complete small bowel examination. Adverse events were also evaluated. The study was registered in the Chinese Clinical Trial Registry, ChiCTR2000040507. Findings Between May 12 and Aug 17, 2020, 114 patients (mean age 44·0 years [IQR 34·0–55·0]; 63 [55%] female) were enrolled. The rate of complete detection of gastric anatomical structures by FAMCE was 100% (95% CI 99·3–100·0). The concordance between FAMCE and conventional transoral gastroscopy was 99·61% (99·45–99·78). The mean completion time of a gastroscopy with FAMCE was 19·17 min (SD 1·43; median 19·00, IQR 19·00–20·00), compared with 5·21 min (2·00; 5·18, 3·68–6·45) for conventional transoral gastroscopy. In 114 enrolled patients, 214 lesions were detected by FAMCE and conventional transoral gastroscopy. Of those, 193 were detected by both modalities. FAMCE missed five pathologies (four cases of gastritis and one polyp), whereas conventional transoral gastroscopy missed 16 pathologies (12 cases of gastritis, one polyp, one fundal xanthoma, and two antral erosions). FAMCE was able to provide a complete small bowel examination for all 114 patients and detected intestinal lesions in 50 (44%) patients. During the study, two (2%) patients experienced adverse events. No serious adverse events were recorded, and there was no evidence of capsule retention. Interpretation The performance of FAMCE is similar to conventional transoral gastroscopy in completion of gastric examination and lesion detection. Furthermore, it can provide a complete small bowel examination. Therefore, FAMCE could be effective method for examination of the gastrointestinal tract. Funding Chinese National Key Research and Development Program.

Wireless capsule endoscopy is a modern non-invasive Internet of Medical Imaging Things that has been increasingly used in gastrointestinal tract examination. With about one gigabyte image data generated for a patient in each examination, automatic lesion detection is highly desirable to improve the efficiency of the diagnosis process and mitigate human errors. Despite many approaches for lesion detection have been proposed, they mainly focus on large lesions and are not directly applicable to tiny lesions due to the limitations of feature representation. As bleeding lesions are a common symptom in most serious gastrointestinal diseases, detecting tiny bleeding lesions is extremely important for early diagnosis of those diseases, which is highly relevant to the survival, treatment, and expenses of patients. In this article, a method is proposed to extract and fuse multi-scale deep features for detecting and locating both large and tiny lesions. A feature extracting network is first used as our backbone network to extract the basic features from wireless capsule endoscopy images, and then at each layer multiple regions could be identified as potential lesions. As a result, the features maps of those potential lesions are obtained at each level and fused in a top-down manner to the fully connected layer for producing final detection results. Our proposed method has been evaluated on a clinical dataset that contains 20,000 wireless capsule endoscopy images with clinical annotation. Experimental results demonstrate that our method can achieve 98.9% prediction accuracy and 93.5% score, which has a significant performance improvement of up to 31.69% and 22.12% in terms of recall rate and score, respectively, when compared to the state-of-the-art approaches for both large and tiny bleeding lesions. Moreover, our model also has the highest AP and the best medical diagnosis performance compared to state-of-the-art multi-scale models.

BACKGROUND Colon capsule endoscopy (CCE), which became clinically applicable in 2006, is a simple and noninvasive procedure to evaluate colonic diseases; the accuracy of second-generation CCE, introduced in 2009, has dramatically improved. Currently, CCE is used as an alternative method for colorectal cancer screening, as well as for evaluating the mucosal lesions of inflammatory bowel disease, in cases where performing colonoscopy (CS) is difficult. However, the outcomes of CCE are uncertain. AIM To investigate the outcomes of Japanese patients with negative findings (no polyps or colorectal cancer) on initial CCE. METHODS This retrospective, single-center study was conducted at the Endoscopic Center at Aishinkai Nakae Hospital. This study included patients who underwent continuous CCE between November 2013 and August 2019, that exhibited no evidence of polyps or colorectal cancer at the initial CCE, and could be followed up using either the fecal immunochemical test (FIT), CS, or CCE. The observational period, follow-up method, presence or absence of polyps and colorectal cancer, pathological diagnosis, and number of colorectal cancer deaths were evaluated. RESULTS Thirty-one patients (mean age, 60.4 ± 15.6 years; range, 28–84 years; 14 men and 17 women) were enrolled in this study. The reasons for performing the first CCE were screening in 12, a positive FIT in six, lower abdominal pain in nine, diarrhea in two, and anemia in two patients. The mean total water volume at the time of examination was 3460 ± 602 mL (2250–4800 mL), and a total CS was performed in 28 patients (90%). The degree of cleanliness was excellent in 15 patients and good in 16, and no poor cases were observed. No adverse events, such as retention or capsule aspiration, were observed in any of the patients. The mean follow-up period was 3.1 ± 1.5 years (range, 0.3–5.5 years). Follow-up included FIT in nine, CS in 20, and CCE in four patients (including duplicate patients). The FIT was positive in two patients, while CS revealed five polyp lesions (three in the ascending colon, one in the transverse colon, and one in the descending colon), with sizes ranging between 2 mm and 8 mm. Histopathological findings revealed a hyperplastic polyp in one patient, and adenoma with low grade dysplasia in four patients; colorectal cancers were not recognized. In the follow-up example by CCE, polyps and colorectal cancer could not be recognized. During the follow-up period, there were no deaths due to colorectal cancer in any of the patients. CONCLUSION We determined the outcomes in patients with negative initial CCE findings.

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

Colon capsule endoscopy (CCE) is a minimally invasive alternative for patients unwilling to undergo conventional colonoscopy, or for whom the latter exam is contraindicated. This is particularly important in the setting of colorectal cancer screening. Nevertheless, these exams produce large numbers of images, and reading them is a monotonous and time-consuming task, with the risk of overlooking important lesions. The development of automated tools based on artificial intelligence (AI) technology may improve some of the drawbacks of this diagnostic instrument. A database of CCE images was used for development of a Convolutional Neural Network (CNN) model. This database included anonymized images of patients with protruding lesions in the colon or patients with normal colonic mucosa or with other pathologic findings. A total of 3,387,259 frames from 24 CCE exams were retrospectively reviewed. For CNN development, 3640 images (860 protruding lesions and 2780 with normal mucosa or other findings) were ultimately extracted. Training and validation datasets were constructed for the development and testing of the CNN. The CNN detected protruding lesions with a sensitivity, specificity, positive and negative predictive values of 90.7, 92.6, 79.2 and 96.9%, respectively. The area under the receiver operating characteristic curve for detection of protruding lesions was 0.97. The deep learning algorithm we developed is capable of accurately detecting protruding lesions. The application of AI technology to CCE may increase its diagnostic accuracy and acceptance for screening of colorectal neoplasia.

This review paper explores the potential use of the planar miniaturized antenna for wireless capsule endoscopy application: one of the promising fields in the current era. The paper highlights the design strategy, various optimization techniques with respect to system realization, material compatibility issues and finally the mandatory EM radiation effect analysis for the said application. It compares amongst various currently reported structures in context with different performance metrics. Inherent challenges of this emerging field of bio-medical engineering have also been detailed here along with futuristic approaches for enhancing the throughput.

Sprue-like enteropathy associated with olmesartan is characterized by villous atrophy in the duodenum. We report the case of an 81-year-old woman diagnosed with olmesartan-associated sprue-like enteropathy with no villous atrophy in the duodenum. The patient had been taking olmesartan for 10 years and complained of diarrhea and weight loss. Despite undergoing general treatment for 2 months, her symptoms showed no improvement. Gastrointestinal endoscopy and pathological findings showed no villous atrophy in the duodenum. However, villous atrophy was observed in the small intestine by capsule endoscopy. Pathological biopsy with double balloon endoscopy provided a definitive diagnosis. Diarrhea improved with the discontinuation of olmesartan and weight increased within a week of withdrawal. After the improvement of clinical symptoms, both endoscopic and pathological findings of villous atrophy in small intestine showed improvement.

In the article they are determined peculiarities, principles and possibilities of using capsule endoscopy as the method for intravital anatomical investigation of gastrointestinal tract on the basis of resalts capsule endoscopy by 170 patients without pathology of digestive canal and received experience. They are showed its connections with other methods of intravital visualization.

Objective CT enterography/enteroclysis (CTE) is listed in the clinical practice guidelines as a method for diagnosing small bowel bleeding, as is capsule endoscopy (CE), but there are no real-world data yet available on CTE in Japan. This study aimed to investigate the diagnostic ability of CTE and long-term prognosis after CTE in Japan. Patients We conducted a retrospective cohort study of patients suspected of having small bowel bleeding who underwent both CTE and CE within 30 days between April 2008 and March 2019. The number of patients free from rebleeding for up to 24 months was thus determined. Results Seventy-one patients were extracted from the database. The 43 patients (60.6%) with a definite and suspicious source of bleeding in the small bowel were detected by CTE. When the 31 patients with a definite source of bleeding in the small bowel were analyzed, the sensitivity of CTE was 19/31 (61.3%) and that of CE was 24/31 (77.4%), thus indicating no significant difference (p=0.332). However, the sensitivity when CTE and CE were used in combination was 30/31 (96.8%), which was significantly higher than that of CE alone (p=0.0412). No rebleeding was observed in the CTE and CE negative group (p=0.0965). Conclusion The combined use of CTE and CE increased the detection rate of small bowel bleeding. Therefore, in patients with suspected tumor/polyp lesions, not only CE, but also CTE should be performed. This study provides the first real-world data on the diagnostic accuracy of CTE for small bowel bleeding in Japan.

Background and aims Capsule endoscopy (CE) interpretation requires the review of many thousands of images, with lesions often limited to just a few frames. In this study we aim to determine whether lesion detection declines according to the number of capsule videos read. Methods 32 participants, 16 of which were novices (NR) and 16 experienced (ER) capsule readers took part in this prospective evaluation study. Participants read six capsule cases with a variety of lesions, in a randomly assigned order during a single sitting. Psychomotor Vigilance Tests and Fatigue Scores were recorded prior to commencing and then after every two capsules read. Changes in lesion detection and measures of fatigue were assessed across the duration of the study. Results Mean agreement with the predefined lesions was 48.3% (SD:16.1), and 21.3% (SD:15.1) for the experienced and novice readers respectively. Lesion detection declined amongst experienced reader after the first study (p = 0.01), but remained stable after subsequent capsules read, while NR accuracy was unaffected by capsule numbers read. Objective measures of fatigue did not correlate with reading accuracy. Conclusion This study demonstrates that reader accuracy declines after reading just one capsule study. Subjective and objective measures of fatigue were not sufficient to predict the onset of the effects of fatigue.

The current study evaluated the application of small-bowel capsule endoscopy (SBCE) in SARS-CoV-2-infected patients with suspected small bowel bleeding. We analyzed the clinical characteristics, SBCE procedures, examination results, and treatment for cases of suspected small bowel bleeding in two patients with critical COVID-19. SBCE showed active spotting bleeding in the jejunum and ileum with no identifiable lesions in case 1, while multiple small bowel ulcers were detected in case 2. Two patients had relevant changes in their management plans and received specific treatment based on SBCE findings. In summary, SBCE proved to be a non-invasive diagnostic tool for critical COVID-19 patients with suspected small bowel bleeding.

BACKGROUND Preparation for colon capsule endoscopy (CCE) requires a large liquid laxative volume for capsule excretion, which compromises the procedure's tolerability. AIM To assess the safety and utility of castor oil-boosted bowel preparation. METHODS This prospective cohort study including 20 patients (age range, 16-80 years; six men and 14 women) suspected of having colorectal disease was conducted at Kindai University Hospital from September 2017 to August 2019. All patients underwent CCE because of the following inclusion criteria: previous incomplete colonoscopy in other facility (n = 20), history of abdominal surgery (n = 7), or organ abnormalities such as multiple diverticulum (n = 4) and adhesion after surgery (n = 6). The exclusion criteria were as follows: Dysphagia, history of allergic reactions to the drugs used in this study (magnesium citrate, polyethylene glycol, metoclopramide, and castor oil), possibility of pregnancy, possibility of bowel obstruction or stenosis based on symptoms, or scheduled magnetic resonance imaging within 2 wk after CCE. The primary outcome was the capsule excretion rate within the battery life, as evaluated by the total large bowel observation rate, large bowel transit time, and bowel creasing level using a five-grade scale in different colorectal segments. The secondary outcomes were complications, colorectal lesion detection rates, and patients’ tolerability. RESULTS The castor oil-based regimen was implemented in 17 patients. Three patients cancelled CCE because they could tolerate castor oil, but not liquid laxatives. The capsule excretion rate within the battery life was 88% (15/17). The mean large bowel transit time was 236 min. Approximately 70% of patients had satisfactory colon cleansing levels. CCE detected colon polyps (14/17, 82%) and colonic diverticulum (4/12, 33%). The sensitivity, specificity, and diagnostic accuracy rates for detecting colorectal polyps (size ≥ 6 mm) were 76.9%, 75.0%, and 76.4%, respectively. The sensitivity, specificity, and diagnostic accuracy rates for detection of diverticulum were 100% each. Twelve patients (71%) rated CCE as more than “good”, confirming the new regimen’s tolerability. No serious adverse events occurred during this study. CONCLUSION The castor oil-based regimen could reduce bowel preparation dose and improve CCE tolerability.

Magnetic resonance imaging (MRI)-powered magnetic robotics aims to convert clinical MR scanners into a remote robotic manipulation platform to provide an alternative approach for interventional MRI procedures. The presence of the main magnetic field $(\mathbf {B_0})$ inside of MRI systems imposes magnetic constraints. Because of this static and strong magnetic field, many magnetic actuation techniques to orient or rotate magnetic objects are not feasible under MRI. Therefore, the robot design and actuation methods should consider these constraints for the intended medical applications. A free-to-rotate robot design could be utilized under MRI for providing rotational motion with magnetic pulling. However, the coupled translation with rotation induces difficulty in control of these robots, especially for camera pointing towards capsule endoscopy. In this study, we present a wireless magnetic robot that exploits a surface contact to create a rotation around a contact point with minimal translation. The proposed robot is integrated with a camera and an on-board battery for endoscopy purposes. The robot's tuned density also allows three-dimensional (3D) navigation to visually scan the workspace. We also demonstrate the open- and closed-loop actuation and control performance to explore the range of pitch angles accomplishable and closed-loop feedback control accuracy by using visual feedback. The closed-loop control experiments have shown 0.19 $^\circ$ of steady-state error with 1.9 seconds rise time and 20% overshoot. Thanks to the surface contact during orientation control, the worst-case undesired translation is found to be 6.7 mm. Such robot provides the first steps towards active capsule endoscopy actuated by MRI devices for combining physiological images from an MRI device and the auxiliary visual camera images via the capsule robot to diagnose certain diseases in the gastrointestinal (GI) tract.

In recent years, panintestinal capsule endoscopy (PCE) with double-headed capsules has been used to perform complete, single-sitting exploration of both small bowel and colon in different clinical conditions. Double-headed capsules for colonic examination (CCE) have been exploited first in this setting, followed by newer generations of capsules (i.e. PillCam Crohn, PCC) specifically engineered for this purpose. The aim of this study was to evaluate the feasibility of PCE in the form of a systematic review. We performed a comprehensive literature search to identify papers in which CE was specifically used for a PCE of the gastrointestinal tract. Data on CE, bowel preparation regimen, rate of cleanliness and completeness, and data on transit times were analyzed. The primary outcome was to assess the feasibility of a whole-gut exploration with CE. Sixteen (n = 16) studies including 915 CE procedures with CCE1 (n = 134), CCE2 (n = 357) and PCC (n = 424) were included. 13/16 studies were performed in the setting of Crohn's disease. Cleanliness and completeness rates were acceptable in all studies, ranging from 63.9% and 68.6% to 100%, respectively. In conclusion, PCE is a feasible technique, although further structured studies are needed to explore its full potential.

INTRODUCTION Capsule endoscopy has proven its utility in diagnosing villous atrophy and lymphoma in patients with celiac disease. Recently, a novel capsule endoscopy system was introduced which enables the examination of the small and large bowel. So far, it has not been evaluated in patients with celiac disease. OBJECTIVE The primary objective of this study was to evaluate the novel panintestinal capsule endoscopy system in patients with celiac disease. METHODS Eleven patients with histologically proven celiac disease (Marsh 0-IV), who underwent a panintestinal capsule endoscopy between March 2018 and April 2019 at our institution, were included in this retrospective single-center study. All patients performed standard bowel preparation prior to the examination. Diagnostic yield, safety and therapeutic impact were analyzed. In addition, the correlation between capsule endoscopy findings and the histology of the duodenal mucosa was assessed. RESULTS Panintestinal capsule endoscopy was feasible and produced an acceptable visualization quality in all cases. Concordance of capsule endoscopy findings with the Marsh classification showed a good correlation (r = 0.8). No lymphomas were detected. Evaluation of the colon revealed diminutive polyps (median size 4 mm) in 18% of patients. CONCLUSIONS The novel panintestinal capsule endoscopy system shows a fair correlation with the Marsh classification in patients with celiac disease. It is also capable of identifying colon polyps. Therefore, the novel panintestinal capsule endoscopy system can be considered for patients with celiac disease and an indication for capsule endoscopy.

In the setting of chronic liver disease, capsule endoscopy is safe and well tolerated, making it an appealing diagnostic procedure. It is used mainly for the surveillance of esophageal varices, investigation of anemia, and exploration of the small bowel for complications of portal hypertension. Capsule endoscopy is recognized as a viable alternative in patients unable or unwilling to undergo upper gastrointestinal endoscopy for investigations of esophageal varices. In evaluating the small bowel of patients with liver disease and unexplained anemia, capsule endoscopy increases recognition of mucosal abnormalities, although their clinical significance is often unclear.

The Capsule Endoscopy Group of the Chinese Society of Digestive Endoscopy has issued recommendations for capsule endoscopy (CE) practice during the COVID-19 pandemic to standardize workflow, preventive strategies, and management of a CE unit and in so doing, ensure the safety of both medical staff and patients.

Background/Aims The diagnosis of small bowel Crohn’s disease with negative ileocolonoscopic findings has been challenging. Fecal calprotectin (FC) has been used to detect colonic inflammation, but its efficacy for detecting small bowel inflammation is less established. We performed an updated meta-analysis to evaluate the diagnostic accuracy of FC to detect active small bowel inflammation observed during capsule endoscopy. Methods We conducted a systematic literature search for studies that evaluated the correlation between small bowel inflammation and FC in patients with suspected/established Crohn’s disease. We calculated the pooled sensitivity, specificity, and diagnostic odds ratios (DORs) and constructed hierarchical summary receiver operating characteristic curves for FC cutoffs of 50, 100, and 200 µg/g. Results Fourteen studies were eligible for the final analysis. The DORs of all FC cutoffs were significant. The highest DOR was observed at 100 µg/g (sensitivity, 0.73; specificity, 0.73; and DOR, 7.89) and was suggested as the optimal diagnostic cutoff. If we analyzed only studies that included patients with suspected Crohn’s disease, the DOR was 8.96. If we analyzed only studies that included patients with a Lewis score ≥135 as a diagnostic criterion for active disease, the DOR was 10.90. Conclusions FC has significant diagnostic accuracy for detecting small bowel inflammation, and an FC cutoff of 100 µg/g can be used as a tool to screen for small bowel Crohn’s disease. (Gut Liver 2021;15-741)

Background Wireless capsule endoscopy (WCE) is considered to be a powerful instrument for the diagnosis of intestine diseases. Convolution neural network (CNN) is a type of artificial intelligence that has the potential to assist the detection of WCE images. We aimed to perform a systematic review of the current research progress to the CNN application in WCE. Methods A search in PubMed, SinoMed, and Web of Science was conducted to collect all original publications about CNN implementation in WCE. Assessment of the risk of bias was performed by Quality Assessment of Diagnostic Accuracy Studies-2 risk list. Pooled sensitivity and specificity were calculated by an exact binominal rendition of the bivariate mixed-effects regression model. I2 was used for the evaluation of heterogeneity. Results 16 articles with 23 independent studies were included. CNN application to WCE was divided into detection on erosion/ulcer, gastrointestinal bleeding (GI bleeding), and polyps/cancer. The pooled sensitivity of CNN for erosion/ulcer is 0.96 [95% CI 0.91, 0.98], for GI bleeding is 0.97 (95% CI 0.93–0.99), and for polyps/cancer is 0.97 (95% CI 0.82–0.99). The corresponding specificity of CNN for erosion/ulcer is 0.97 (95% CI 0.93–0.99), for GI bleeding is 1.00 (95% CI 0.99–1.00), and for polyps/cancer is 0.98 (95% CI 0.92–0.99). Conclusion Based on our meta-analysis, CNN-dependent diagnosis of erosion/ulcer, GI bleeding, and polyps/cancer approached a high-level performance because of its high sensitivity and specificity. Therefore, future perspective, CNN has the potential to become an important assistant for the diagnosis of WCE.

Gastrointestinal (GI) bleeding is a common problem and may lead to fatal consequences. The detection of bleeding is currently determined through conventional examination of wireless capsule endoscopy (WCE) images. Image-based bleeding detection is performed using only color pixels; therefore, image and color distortion affect the accuracy of RGB-based methods adversely. On the other hand, imaging modalities like multispectral features contain several unique characteristics of the target material, and therefore are less error-prone. In this regard, an on-chip bleeding detection sensor based on blood’s optical properties is developed in this article. For creating this sensor, an array of 12 optical sensors, six in visible and six in near-infrared range, is tested with blood samples (BS) in various concentrations and non-blood samples (NBS), such as food pigments and natural foods (digestible and nondigestible). Various feature selection and machine learning approaches have been used to select the optimal bandwidth for the best detection accuracy. A capsule prototype is designed that uses 450 nm, 610 nm, and 810 nm of wavelengths. The prototype is tested in two in vitro experiments using two porcine intestines to validate the proof of concept. The results indicate that the designed system can distinguish occult and acute bleeding from a distance of 1 cm with angles of 45 and 90 degrees. An F1-score of 99% is achieved using the bagged decision tree algorithm. The proposed solution for detecting GI bleeding will eliminate the need to use a camera module and large data transmission, and thereby consumes 1.48 times less power than conventional WCE systems.

The diagnostic yield (DY) of small-bowel capsule endoscopy (SBCE) varies considerably according to its indication. Some strategies have been used to increase DY with varying results. The intention of this study was to identify whether evaluation of the SBCE recordings by a second reviewer can increase DY and change patient management.One hundred SBCEs with different indications, already read by an endoscopist were read by a second blinded endoscopist. When the results of the 2 readings were different, the images were discussed by the endoscopists; if no consensus was reached, they took the opinion of a third endoscopist into account. All the participating endoscopists had experience in reading SBCEs (i.e.,50 per year). The SBCE findings were divided into positive (vascular lesions, ulcers, and tumors), equivocal (erosions or red spots), and negative. The interobserver agreement and the increase in DY were assessed as well as the percentage of false-negatives (FNs) in the first evaluation.The indications for SBCE were small-bowel bleeding (SBB) in 48 cases, Crohn's disease (CD) in 30, and other causes (iron-deficiency anemia, small-bowel tumors, and diarrhea) in 22. There was substantial interobserver agreement between evaluations (κ = 0.79). The findings in the first evaluation were positive in 60%, equivocal in 20% and, negative in 20%. In the second evaluation, 66% were positive, 18% were equivocal, and 16% were negative. The increase in DY with the second reading was 6% (A second evaluation of the SBCE recordings identified significant pathology that the first evaluation had missed, resulting in a nonsignificant 6% increase in DY and a change in the management of 4% of the patients.O rendimento diagnóstico (DY) da enteroscopia por cápsula (SBCE) varia consideravelmente de acordo com as suas indicações. Foram estudadas algumas estratégias para melhorar o DY, com resultados variados. O objetivo deste estudo é avaliar se uma segunda leitura de registos de enteroscopia por cápsula por um segundo endoscopista pode melhorar o DY e alterar o manejo dos doentes.100 SBCE realizadas por indicações variadas, previamente avaliadas por um endoscopista, foram reavaliadas por um segundo endoscopista cego para a primeira leitura. Na presença de resultados discordantes nas 2 leituras, as imagens foram discutidas pelos 2 endoscopistas, e por um terceiro na ausência de consenso entre os 2 primeiros. Todos os endoscopistas são experientes na leitura de SBCE (50 SBCE/ano). Os achados foram categorizados em positivos (lesões vasculares, úlceras e tumores), equívocos (erosões e pontos vermelhos) e negativos. Foi avaliada a concordância inter-observador e o aumento do DY, bem como a percentagem de falsos negativos da primeira avaliação.As indicações para SBCE foram hemorragia do intestino delgado (SBB) em 48 casos, doença de Crohn (CD) em 30 e outras causas (anemia por défice de ferro, pesquisa de tumores do intestino delgado e diarreia) em 22. A concordância inter-observador foi substancial (k = 0.79). Os achados da primeira avaliação foram positivos em 60%, equívocos em 20% e negativos em 20%, enquanto na segunda avaliação foram positivos em 66%, equívocos em 18% e negativos em 16%. O aumento de DY foi de 6% com a segunda leitura (A segunda avaliação dos registos de SBCE identificou patologia significativa previamente não identificada, resultando num aumento não significativo de 6% do DY e numa alteração no manejo de 4% dos doentes.

Objective Although colorectal polyps (CPs) can be observed with colon capsule endoscopy (CCE), it is difficult to determine the type of polyp using CCE. The objective of this study was to differentiate adenomatous polyps (APs) from hyperplastic polyps (HPs) with CCE. Methods In this single-center retrospective study, an analysis was conducted on the same CPs with both CCE and colonoscopy (CS) and histopathologically diagnosed as AP or HP. The color difference (ΔE) between the polyp surface and the surrounding mucosa was calculated using the CIE1976 L*a*b* color space method on white light (WL), flexible spectral imaging color enhancement (FICE), and blue mode (BM) CP images. We investigated the ability of the ratio of the color differences (ΔE') to differentiate between APs and HPs. Results The size of all 51 polyps (34 APs, 17 HPs) was 7.5±4.6 mm with CCE and 7.3±4.2 mm with CS, and this difference was not significant (p=0.28). The FICEΔE' of APs was 3.3±1.8, which was significantly higher than the FICEΔE' of HPs (1.3±0.6; p

Abdomen Bleeding, Ulcer, Tumour, Crohn's disease, Celiac disease and other diseases in the gastrointestinal tract (GI) are difficult to diagnose, due to the inescapable inherent difficulty in accessing a volute setting in the human body. Wireless Capsule Endoscopy (WCE) offers a patient-cordial, non-invasive and painless investigation in the GI tract. Automatic detection of anomalies in WCE images using Deep Learning Models improves the detection accuracy but it requires a huge number of labeled data for model training. But these deep models suffer from explain-ability and fail to include expert knowledge in the model decision-making process. By keeping these aspects in mind, this survey aims to identify the opportunities for using Semi-Supervised deep learning models over supervised deep learning methods in Wireless Capsule Endoscopy (WCE) anomaly detection and classification. This paper presents a comprehensive survey on various deep learning solutions for anomaly detection and localization techniques utilized in WCE images in the aspect of performance, complexity, and the quality of the dataset. The survey outlined the proposed Attention and Domain Assisted Generative Adversarial Network (ADA-GAN) based Semi-Supervised Model for WCE anomaly image classification along with initial results. The result derives the shortcomings of the current literature methods and paves the potential research opportunities in the Semi-Supervised models in Wireless capsule endoscopy image analysis.

Capsule endoscopy offers increased patient comfort and improved visibility of the entire gastrointestinal (GI) tract. Besides imaging, numerous literary studies on capsule endoscopy have demonstrated drug delivery, navigation strategies, tactile sensing for tumor diagnosis, and biopsy. Yet, the size limitation hampers the availability of multiple features within a single capsule. In an effort to increase the space and functionality, we propose the use of multiple capsules. All capsules together form a capsule-train, whose wagons are connected with magnetic push/pull forces. Magnets located on each capsule form the virtual magnetic spring. The presence of a preset gap allows for joint tasks on the targeted tissue. The gap in-between capsules also ensures ease of motion throughout the GI, while negating the risk of clinching of tissue parts in between the capsules. Designed capsule train with two capsules successfully traveled through straight phantom without breaking connection for typical bowel speed. Also, same experiment is repeated with higher (2 × to 16 × of expected) speeds to inspect possible abrupt conditions, where capsules traveled together without any disconnection while maintaining constant distance in-between. Experiment results successfully imitate the developed magnet spring model (10–30% mismatch) even with ignored friction forces and camera pixilation errors. As future work, we will be working on adapting the capsule train for curved trajectories and perform demonstrations on ex-vivo animal bowel models. With further development, magnetically connected multi-capsule train can be adapted to clinic for improved functionality and multitasking through the GI tract.

Video capsule endoscopy (VCE) is a crucial adjunct to conventional endoscopy in small intestinal bleeding, with a high positive and negative predictive value. Timing is critical in VCE, with earlier deployment associated with improved diagnostic yield. VCE is also useful as a first-line diagnostic modality in the evaluation of acute gastrointestinal bleeding, with accumulating evidence demonstrating expedited VCE can increase diagnostic yield, reduce unneeded admissions, and overall improve patient care. In resource-limited settings, first-line VCE also can reduce unneeded procedures and protect staff from dangerous exposures.

Objective patients presenting with melena and nondiagnostic esophagogastroduodenoscopy are usually investigated with colonoscopy and if negative, with small bowel capsule endoscopy. In this pilot study, we tested feasibility and performance of panenteric capsule endoscopy (PCE) in patients presenting with melena and negative esophagogastroduodenoscopy. Methods Between January and December 2018, consecutive patients presenting with melena, clinically significant bleeding and negative esophagogastroduodenoscopy were invited to undergo PCE by swallowing PillCam Colon 2 (Medtronic Inc., Dublin, Ireland). PCE results, further diagnostic or therapeutic examinations, rebleeding rates at 30 days and 12 months were recorded. Results Out of 128 patients with melena, 23 had negative esophagogastroduodenoscopy. Of them, 12 (8 female, mean age 76 years) underwent PCE, which allowed complete small bowel and colonic evaluation in 12 (100%) and 11 (91.7%) patients, respectively. The small bowel and colon cleansing were adequate in 100 and 83.3%, respectively. No PCE-related complications were observed. The PCE diagnostic yield was 83.3%: significant findings were located in the small bowel, colon or both in 5 (41.7%), 4 (33.3%) and 1 (8.3%) patients, respectively. Device-assisted enteroscopy was performed in 6 (50%) patients. Thirty days and 1 year rebleeding rates were 0 and 18.1%, respectively. Conclusions In this proof-of-concept study, PCE was feasible and safe in patients with melena and negative esophagogastroduodenoscopy, identifying the bleeding site in 83% of patients. PCE lead to small bowel therapeutic interventions in 50% of patients, thus avoiding unnecessary standard colonoscopy. Further large prospective randomized studies investigating this strategy are warranted.

Small-bowel capsule endoscopy (SBCE) has become an increasingly utilized imaging modality for patients suspected of having small intestinal diseases. However, data regarding the role of SBCE in patients with Billroth II gastrojejunostomy are limited. The objective is to evaluate the safety and efficacy of SBCE in Billroth II gastrojejunostomy patients. We retrospectively studied patients with Billroth II gastrojejunostomy who underwent MiroCam capsule endoscopy between August 2013 and October 2019. Baseline patient characteristics; gastroscopic and SBCE findings; capsule transit time; and the occurrence of adverse events were collected and compared between groups with and without anastomotic lesions. In total, 30 patients were analyzed in the study. The median age was 59 years, and 26 patients (86.7%) were men. The majority of SBCE positive findings including ulcers (10.0%), angioectasias (6.7%) and polyps (6.7%). In patients with (n = 10) and without (n = 20) anastomotic lesions, the anastomotic lesion was significantly associated with a delayed gastric transit time (GTT) (P = 0.026), but the two groups showed no significant difference in completion (P > 0.05). All patients underwent successful SBCE examinations without adverse events, except device transit into the afferent loop, where it remained for nearly 2 h, occurred in one case with anastomotic ulcers. This retrospective study demonstrates that SBCE is a safe and effective diagnostic tool in patients with Billroth II gastrojejunostomy with a favorable gastroscopic evaluation within 7 days prior. The frequently real-time monitoring is suggested due to the risk of retention in the afferent loop, and a delayed food intake is required when a prolonged stay in the afferent loop occurred.

Introduction: Video capsule endoscopy and balloon-assisted enteroscopy are complementary diagnostic methods in the study of small bowel bleeding, and different factors can affect their diagnostic yield. Aims: To define the level of agreement between video capsule endoscopy and enteroscopy in small bowel bleeding, according to the type of lesion, in a cohort of patients at a tertiary care referral center. Materials and methods: A retrospective study was conducted that included 428 capsule endoscopies performed within the time frame of 2011 and 2019 at our healthcare institution. Seventy-four video capsule endoscopies, followed by enteroscopy, in 71 patients suspected of presenting with small bowel bleeding, were analyzed. Results: Mean patient age was 63.9 ± 13.5 years and 42 patients were women. The two diagnostic procedures were performed. Overall diagnostic yield of positive findings between video capsule endoscopy and enteroscopy was 86.5% vs. 58.1%, respectively (p = 0.0527). Agreement between video capsule endoscopy and enteroscopy for positive pathologic findings was weak (Ik = 0.17, 95% CI: -0.0097-0.3543), but according to lesion type, it was good for inflammatory lesions (Ik = 0.71, 95% CI: 0.5182-0.9119) and moderate for angiectasias (Ik = 0.45, 95% CI: 0.2469-0.6538) and tumors (Ik = 0.40, 95% CI: 0.1217-0.6794). The results between the two methods differed in 38 patients (51.3%). There was complete intestinal capsule retention in one patient (1.4%) and active bleeding in 13 (17.6%). Conclusions: The present study showed that the two techniques had a similar overall detection rate for small bowel lesions, but the type of lesion was the main factor that could modify diagnostic agreement. Resumen: Introducción y objetivos: La videocápsula endoscópica (VCE) y la enteroscopia asistida por balón son métodos diagnósticos complementarios en el estudio de la hemorragia de intestino delgado, donde diversos factores pueden afectar su rendimiento diagnóstico. Objetivos: Definir el grado de concordancia entre la VCE y la enteroscopia en la hemorragia de intestino delgado según el tipo de lesión, en una cohorte de pacientes de un centro referencia de alta complejidad. Materiales y Métodos: estudio retrospectivo; 428 VCE se realizaron entre el año 2011 a 2019 en la institución. Se analizaron total de 74 VCE con posterior realización de enteroscopia en 71 pacientes con sospecha de hemorragia de intestino delgado. Resultados: Edad media: 63,9 ± 13,5 años, 42 mujeres; realizamos ambos procedimientos diagnósticos. El rendimiento diagnóstico global de hallazgos positivos entre VCE y enteroscopia fue (86.5% vs. 58.1%, respectivamente p = 0.0527), la concordancia entre VCE y enteroscopia para hallazgos positivos patológicos fue débil Ik = 0,17 (IC 95% -0.0097-0.3543); sin embargo, según el tipo de lesión fue buena para lesiones inflamatorias Ik = 0,71 (IC 95% 0.5182-0.9119), moderada para angiectasias Ik = 0,45 (IC 95% 0.2469-0.6538) y tumores Ik = 0,40 (IC 95% 0.1217-0.6794). Los resultados entre ambos estudios difirieron en 38 pacientes (51.3%). Retención completa intestinal de la VCE en 1 paciente (1.4%). Hemorragia activa se evidencio en 13 pacientes (17.6%). Conclusiones: El presente estudio evidencia que la tasa de detección global de lesiones del intestino delgado de ambas técnicas es similar; sin embargo, el principal factor que puede modificar la concordancia diagnóstica es el tipo de lesión.

Advanced computer vision technologies can be used to improve the performance of capsule endoscopy. Specifically, new technologies can be used to enhance the image quality of capsule endoscopes, which has previously been limited by mechanical constraints. The trajectory of a capsule endoscope, which can be estimated by reconstructing the captured images, helps to predict the location of lesions. Computer vision technology is utilized in a more practical way in a recently developed capsule endoscope comprising a stereo camera. Using this device, images can be interpreted in three dimensions, enabling more accurate measurements of size. The use of deep learning for image recognition is associated with an improved lesion detection rate and reduced reading time in clinicians. This evolving technology requires close cooperation between medical and IT professionals for optimized clinical use. (Korean J Med 2021;96:190-194)

The demand for small bowel (SB) capsule endoscopy (CE) is increasing in the UK. However, there remains a wide variation in the number of CE procedures performed in different centres. Across the UK there is a lack of a clear training pathway or certification process. A standardised national Joint Advisory Group (JAG) on Gastrointestinal Endoscopy approved a 1-year training and accreditation programme accessible to all professional groups that may wish to train in SB CE. Structured training is delivered using JAG-accredited CE courses and an electronic learning module. Prior to setting a knowledge-based assessment, a minimum of 50 SB CE cases are recommended to be read in tandem with a trainer at a local centre, with proficiency documented using Direct Observation of Procedural Skill (DOPS) assessments.

A wireless capsule endoscopy is a noninvasive medical device designed for human gastrointestinal tract diagnosis. The localization function of the capsule provides a real‐time monitoring on the capsule movement, which can detect the retention at an early stage. The static magnetic localization system requires little power consumption, and it is easy to transform the system structure into a wearable system for capsule endoscopy. This chapter discusses the challenges and possible solutions of the magnetic localization. The DC signal measured in the static magnetic localization suffers from the static noise interference in the environment. One of the methods to avoid DC interference is to modulate the information to a certain frequency, where the alternating magnetic field is adopted. The chapter also discusses the aspects of challenges and corresponding solutions, including the model of the target magnet, the adaptive noise cancellation, the calculation of the position retrieval algorithm, and the impact of the placement of sensors.

A 13-year-old boy was admitted to our hospital because of bloody stools. Although a Meckel's diverticulum (MD) was suspected, capsule endoscopy (CE) revealed no remarkable findings. Seven months later, he was admitted again because of rebleeding. CE was performed again and revealed an elevated lesion and fresh blood in the ileum. A single balloon endoscopic examination revealed a diverticulum with an elevated lesion in it. Histologic findings showed ectopic gastric mucosa, thus we diagnosed this patient as having MD. Although CE is useful for the examination of obscure gastrointestinal bleeding, a single CE is not enough to diagnose MD bleeding. The timing in performing CE and the evaluation of other modalities would be valuable for patients suspected of having MD.

Background Capsule endoscopy (CE) and double-balloon enteroscopy (DBE) have provided great help in the diagnosis and treatment of small bowel diseases (SBD). The aim of this study was to explore the positive rate and diagnostic value of CE and DBE for patients who were suspected of having SBD, and to make a comparison between the two methods. Methods A retrospective study was conducted to analyze the cases at Renmin Hospital of Wuhan University. We divided the patients into CE and DBE group, and recorded the basic characteristics of the patients, checking the results of CE and DBE, positive rate, sensitivity and specificity for statistical analysis. Results A total of 244 patients were included in our research, including 122 in the CE group and 122 in the DBE group. The positive rate of CE for intestinal diseases was 84.4%, higher than that of DBE (78.7%), but DBE (75.2% and 92.3%) had higher sensitivity and specificity than CE (70.5% and 88.2%), though the differences were not statistically significant. The three most common positive findings in patients were inflammation, erosion, or ulcers (28.7%), vascular malformations (14.3%), and eminence lesions (9.0%). CE had a higher rate detection of inflammation, erosion, or ulcers than DBE (36.1% vs 21.3%), but they both had high positive rates for vascular malformations (13.9% and 14.8%). In addition, both methods had higher positive rates in patients with gastrointestinal bleeding compared to other symptoms. Conclusion CE and DBE are both important methods for intestinal examination. Patients can choose appropriate tests according to their condition.

Capsule endoscopy is being widely used to identify the origin of an obscure gastrointestinal bleeding. Capsule retention is one of its complications. Herein, we present 2 cases of a retained capsule one in a gastric diverticula that was managed endoscopically, and one in jejunal diverticula managed by small bowel resection.

Background/aims Small bowel malignancies often present a diagnostic challenge due to their relative rarity and nonspecific clinical symptoms. However, technical developments in endoscopic instruments, including video capsule endoscopy (VCE) and enteroscopy, have allowed for the visualization of the entire small bowel. This study aimed to investigate the clinicopathological features of small bowel malignant tumors diagnosed by VCE and double-balloon enteroscopy (DBE) in a single tertiary center. Methods We retrospectively analyzed VCE and DBE findings from Korea University Guro Hospital from January 2010 through September 2018. Results A total of 510 VCE and 126 DBE examinations were performed in 478 patients. Small bowel malignancies were diagnosed in 28 patients (15 males; mean age, 61.0 years; range, 42 to 81 years). Among them, 8 had lymphoma, 8 had primary adenocarcinoma, 7 had gastrointestinal stromal tumor (GIST) and 5 had metastatic cancer. Abdominal pain and obstructive symptoms were the most common findings in metastatic cancers (4/5, 80%). On the other hand, obscure gastrointestinal bleeding was the most common symptom of GIST (6/7, 85.7%) and adenocarcinoma (3/8, 37.5%). Conclusions Approximately 6% of the patients who underwent either VCE or DBE were diagnosed with small bowel malignancy. These findings demonstrated the different clinical characteristics among small bowel malignancies and merit further study.

In Crohn’s disease, postoperative endoscopic activity of small bowel lesions outside the scope of ileocolonoscopy has been insufficiently studied. We aimed to assess this postoperative activity using capsule endoscopy (CE) and analyze the association between treatment optimization based on CE findings and the long-term course. In patients who underwent intestinal resection, we performed CE and assessed the endoscopic activity using the Lewis score within 3 months postoperatively (1st CE) and during follow-up. Postoperative treatments were adjusted according to clinical symptoms or CE findings (severity of 1st CE or worsening of follow-up CEs). Hospitalization, repeat surgery, or endoscopic dilation defined the primary outcome. Among the CE group (N = 48), 85.7% (1st CE) and 79.2% (2nd CE) exhibited endoscopic activities indicating residual or recurrent lesions. Postoperative treatments were adjusted according to clinical symptoms in the non-CE group (N = 57) and clinical symptoms or CE findings in the CE group. Compared to the non-CE group, the CE group had significantly fewer primary outcomes. Patients with treatment adjustments based on CE findings had even lower primary outcome rate. Multivariate analysis identified the CE group as an independent protective factor (hazard ratio = 0.45, 95% confidence interval = 0.20–0.96). Treatment adjustments based on CE findings showed a stronger protective effect (0.30, 0.10–0.75). Postoperative repeated CE enabled us to assess residual and recurrent lesions accurately before clinical symptoms appeared. The regular assessment of endoscopic activity and subsequent treatment optimization have the potential for improving postoperative course.

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.

Recent facts and figures published in various studies in the US show that approximately 27,510 new cases of gastric infections are diagnosed. Furthermore, it has also been reported that the mortality rate is quite high in diagnosed cases. The early detection of these infections can save precious human lives. As the manual process of these infections is time-consuming and expensive, therefore automated Computer-Aided Diagnosis (CAD) systems are required which helps the endoscopy specialists in their clinics. Generally, an automated method of gastric infection detections using Wireless Capsule Endoscopy (WCE) is comprised of the following steps such as contrast preprocessing, feature extraction, segmentation of infected regions, and classification into their relevant categories. These steps consist of various challenges that reduce the detection and recognition accuracy as well as increase the computation time. In this review, authors have focused on the importance of WCE in medical imaging, the role of endoscopy for bleeding-related infections, and the scope of endoscopy. Further, the general steps and highlighting the importance of each step have been presented. A detailed discussion and future directions have been provided at the end.

Neural network-based solutions are under development to alleviate physicians from the tedious task of small-bowel capsule endoscopy reviewing. Computer-assisted detection is a critical step, aiming to reduce reading times while maintaining accuracy. Weakly supervised solutions have shown promising results; however, video-level evaluations are scarce, and no prospective studies have been conducted yet. Automated characterization (in terms of diagnosis and pertinence) by supervised machine learning solutions is the next step. It relies on large, thoroughly labeled databases, for which preliminary "ground truth" definitions by experts are of tremendous importance. Other developments are under ways, to assist physicians in localizing anatomical landmarks and findings in the small bowel, in measuring lesions, and in rating bowel cleanliness. It is still questioned whether artificial intelligence will enter the market with proprietary, built-in or plug-in software, or with a universal cloud-based service, and how it will be accepted by physicians and patients.

Background: Oral administration of medications and current oral modified-release systems are the most preferred drug delivery routes, but they provide efficacy up to 12-24 hours per administration and are not useful when the patient has short transit time. The once-daily administered formulations are the endpoint of many types of drug development, and some innovations in capsule endoscopy (CE) can solve this problem. Objective: This review aims to reveal recent advances in drug delivery systems (DDS) for CE as an essential field of research for more precise drug targeting at the gastrointestinal (GI) tract. Methods: We performed a narrative overview of the MEDLINE database from 1991-2020 using the keywords of DDS and CE with synthesizing the findings, hand searches, and authoritative articles. Results: There are microelectromechanical systems and non-mechanical patent technologies for DDS for CE, and the implementation of wireless-capsule medical devices into the human body will provide new diagnostic and therapeutic options. Integrating biomedical CE with DDS and the cloud technology will bring remote real-time feedbackbased automated treatment or responsive medication. Conclusion: Swallowable drug delivery systems for capsule endoscopy brings an entirely new approach for diagnostic and therapeutic methods in digestive diseases.