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Background and Objectives : Ulcerative colitis (UC) and Crohn's disease (CD) are idiopathic inflammatory bowel diseases (IBDs) without a unique, gold standard diagnostic test. UC and Crohn's colitis are impossible to distinguish in approximately 10% of cases. The term IBD type unclassified (IBD-U) is recommended for cases of chronic colitis showing overlapping endoscopic, radiological, and biopsy histological features between UC and CD, while indetermined colitis is reserved for colectomy specimens. Our aim was to assess the role of small-bowel capsule endoscopy (SBCE) in the diagnostic work-up of IBD-U. Materials and Methods : We retrospectively studied the cases of IBD-U explored by SBCE in a tertiary referral gastroenterology center. Patients were investigated using SBCE after contraindications were excluded. Diagnostic criteria for small bowel CD consisted in more than three ulcerations, irregular ulcers, or stenosis, and the Lewis score was used for the quantification of inflammation. The immediate impact of reclassification and outcome data was recorded over a follow-up period of more than one year. Results : Twenty-eight patients with IBD-U were examined using SBCE. Nine patients had small bowel lesions that met the diagnostic criteria for CD, resulting in a reclassification rate of 32.1%. In five of these cases, the treatment was subsequently changed. In the remaining nineteen examinations, no significant findings were observed. There were no complications associated with SBCE. Median follow-up time was 32.5 months (range 12-60). During follow-up, twelve patients were classified as having UC, and seven remained as having an unclassified type; one case of colectomy, for medically refractory UC, was recorded. Conclusions : SBCE is a useful safe tool in the work-up of IBD-U, allowing reclassification in about one third of cases, with subsequent treatment modifications. SBCE may provide a definite diagnosis, enhance the comprehension of the disease's progression, and optimize the short- and long-term management strategy.

Background and objectives: The most frequent indications for small bowel capsule endoscopy (SBCE) are obscure gastrointestinal bleeding (OGIB) and iron deficiency anemia (IDA). The aim of this study was to evaluate the diagnostic yield (DY) of SBCE in overt and occult OGIB, as well as its impact on the clinical outcome. Materials and Methods: This study retrospectively included all cases of OGIB investigated by SBCE in a tertiary care referral center, between 1st January 2016 and 31st December 2018. OGIB was defined by overt or occult gastrointestinal bleeding, with negative upper and lower endoscopy. Occult gastrointestinal bleeding was either proved by a fecal test or presumptively incriminated as a cause for IDA. DY was defined as the detection rate for what were thought to be clinically significant findings. DYs for overt and occult bleeding were assessed and compared. Gender, age, hemoglobin levels, NSAID consumption and the use of anticoagulants were recorded. Following SBCE results, individual therapeutic decisions were made, and follow-up data were recorded. Results: 224 SBCE examinations were performed for OGIB, of which 148 were for overt OGIB, and 76 for unexplained IDA. Positive findings were found in 139 patients, resulting in an overall DY for OGIB of 62%, higher in overt OGIB (75%) compared to IDA (37%). The most frequent findings were small bowel angioectasias (62.2% in overt OGIB and 78.5% in IDA). On multivariate logistic regression analysis, only hemoglobin level <10 g/dL and anticoagulants were the variables independently associated with positive findings. All patients received medical, endoscopic or surgical treatment and had good clinical outcome during follow-up. Conclusion: SBCE has a high diagnostic yield and a positive impact on management of patients with OGIB.

Introduction: Small bowel tumors (SBTs) are rare. The advent of small bowel capsule endoscopy (SBCE) revolutionized the diagnosis of small bowel pathology, the SBCE major breakthrough consequently doubled the diagnostic rate of SBTs. Being a visual technique, without ability to take biopsies, SBCE has limitations in the diagnostic work-up of SBTs., Aim: To assess if structured visual description of SBTs detected by SBCE correlates with the histological type., Patients, Materials and Methods: We included patients with SBTs, evaluated by SBCE and furthermore explored, for which a final histopathological diagnosis was made, either on biopsy tissue samples, or on surgical specimens, using routine techniques and immunohistochemistry. The SBCE findings and reports were reviewed in order to assess the main macroscopic features of the SBTs, which were further correlated with the histological type., Results: SBTs frequency at SBCE was 5.2%. All SBTs presented as protruding lesions. Features as size, color, type, shape, discoloration, presence of mucosa ulceration, bleeding stigmata or potential, contributed outlining a prototype. SBCE was accurate in terms of localization and suspected diagnosis., Conclusions: Even if SBCE is a purely visual technique, thorough examination and rigorous analysis of macroscopic features, as well as adoption of a structured terminology, may successfully predict the final diagnosis, empowering SBCE not only as a trust comrade in the diagnostic pathways of SBTs, but also as a valuable standalone technique mandating the final therapeutic decision.

Since its introduction into clinical practice 15 years ago, capsule endoscopy (CE) has become the first-line investigation procedure in some small bowel pathologies, and more recently, dedicated esophageal and colon CE have expanded the fields of application to include the upper and lower gastrointestinal disorders. During this time, CE has become increasingly popular among gastroenterologists, with more than 2 million capsule examinations performed worldwide, and nearly 3000 PubMed-listed studies on its different aspects published. This huge interest in CE may be explained by its non-invasive nature, patient comfort, safety, and access to anatomical regions unattainable via conventional endoscopy. However, CE has several limitations which impede its wider clinical applications, including the lack of therapeutic capabilities, inability to obtain biopsies and control its locomotion. Several research groups are currently working to overcome these limitations, while novel devices able to control capsule movement, obtain high quality images, insufflate the gut lumen, perform chromoendoscopy, biopsy of suspect lesions, or even deliver targeted drugs directly to specific sites are under development. Overlooking current limitations, especially as some of them have already been successfully surmounted, and based on the tremendous progress in technology, it is expected that, by the end of next 15 years, CE able to perform both diagnostic and therapeutic procedures will remain the major form of digestive endoscopy. This review summarizes the literature that prognosticates about the future developments of CE.

Since its introduction to clinical practice in 2001, small-bowel capsule endoscopy (SBCE) has become an important investigation procedure in many small bowel pathologies, including both suspected and known Crohn's disease (CD). SBCE has higher diagnostic yield than other radiologic and endoscopic modalities used in evaluation of patients with suspected CD. In addition, SBCE has proved useful, in a non-invasive and safe manner, as a monitoring method for evaluating the severity and extent of lesions, postoperative recurrence, and mucosal healing in patients with known CD. Monitoring of colonic inflammation in patients with ulcerative colitis (UC) using second-generation of colon capsule endoscopy (CCE-2) has also been reported. Besides its advantages, CE also has several limitations such as the inability to obtain biopsies and lack of therapeutic capabilities, hopefully to be overcome in the near future by advances in modern technologies.

Capsule endoscopy (CE) revolutionized the small bowel examination. We emphasize the role of CE in suspected Crohn's disease, studying 24 investigations performed in the Institute of Gastroenterology and Hepatology. The global diagnostic yield was 54%, the specific diagnostic yield for Crohn's disease was 37.5%, the specificity was 100% and the retention rate was 4.1%. For maximum accuracy and efficiency, unitary administration and diagnostic criteria are needed, and for minimising the risk of complications, specific prior investigations would be suitable.

Background and Aims: Small bowel tumors (SBTs) are rare, accounting for 1-3% of all gastrointestinal malignancies. Since the introduction of capsule endoscopy (CE), several studies have suggested that their frequency may be substantially higher. The present study is aimed at evaluating the prevalence, clinical presentation, laboratory parameters, endoscopic appearance, and diagnostic work-up of SBTs in patients undergoing CE in a single referral center., Patients and Methods: During 2003-2009, 102 patients underwent CE. For each patient with lesions suggesting SBT at CE, with subsequent diagnostic/ therapeutic work-up leading to histological confirmation, we registered: clinical presentation, hemoglobin level, small bowel follow-through, red blood cells scintigraphy, CT-enterography, enteroscopy, histological confirmation and management., Results: SBTs were detected in 5 patients (mean age 55.2+/-15.8 years) of 102 undergoing CE (4.9%). The main indication for CE was obscure gastrointestinal bleeding, occult or overt. All patients had undergone, before CE, at least one procedure evaluating the small bowel after negative upper endoscopy and colonoscopy. All patients had iron-deficiency anemia, three had abdominal pain, two had episodes of nausea /vomiting and one had diarrhoea and abdominal distension. The main SBT type was gastrointestinal stromal tumor. After CE, 3 patients underwent single-balloon enteroscopy; surgery was performed in all patients. Mean follow-up time was 19+/-17 (range 2-36) months; one patient died during follow-up. No retention of capsule occurred., Conclusions: CE could be used as first choice for diagnostic investigation in patients suspected to have SBTs.

Traditional methods have their limitations when it comes to unraveling the mysteries of the small bowel, an area historically seen as the "black box" of the gastrointestinal tract. This is where capsule endoscopy and enteroscopy have stepped in, offering a remarkable synergy that transcends the sum of their individual capabilities. From their introduction, small bowel capsule endoscopy and device-assisted enteroscopy have consistently evolved and improved, both on their own and interdependently. Each technique's history may be told as a success story, and their interaction has revolutionized the approach to the small bowel. Both have advantages that could be ideally combined into a perfect technique: safe, non-invasive, and capable of examining the entire small bowel, taking biopsies, and applying therapeutical interventions. Until the realization of this perfect tool becomes a reality, the key for an optimal approach lies in the right selection of exploration method. In this article, we embark on a journey through the intertwined development of capsule endoscopy and enteroscopy, exploring the origins, technological advancements, clinical applications, and evolving inquiries that have continually reshaped the landscape of small bowel imaging. [ABSTRACT FROM AUTHOR]

Introduction. Suspected small-bowel bleeding may be overt or occult. In the absence of clinically obvious hemorrhagic manifestations, the anemic syndrome secondary to chronic occult loss is often the alarm signal. We present the case of a patient with severe iron deficiency anemia, diagnosed by small-bowel capsule endoscopy (SBCE) with hemorrhagic ileal polyp, with further succesfull surgical solution. Clinical presentation. 74-year-old male patient with significant associated cardiovascular diseases - arterial hypertension, permanent atrial fibrillation, heart failure NYHA class III, undergoing oral anticoagulant therapy. The worsening of the cardiac symptoms lead to the detection of a severe iron deficiency anemia (Hb 6.4/dL), with no overt bleeding. Consequently, the exploration of the gastrointestinal tract was decided. After negative upper gastrointestinal endoscopy, colonoscopy, and abdominal CT examination, SBCE was performed. An irregular sessile protruding lesion, developped on less than a quarter of the circumference, with active bleeding, in the distal third of the small intestine, was seen. Consequently, the surgeon performed a cuneiform ileal resection, with anatomo-pathological result of ulcerated hyperplastic polyp. The immediate and long-term postoperative evolution was favorable, both clinically and biologically, with the amelioration and then remission of the anemia. Conclusions. Infrequent benign tumors, with extremely rare sporadic occurrence, ileal hyperplastic polyps may present with occult hemorrhage as complication, probably having as risk factor the associated anticoagulant treatment, with occult hemorrhage, responsible for severe secondary iron deficiency anemic syndrome. Applying the investigational algorithm for unexplained iron deficiency anemia allows the etiological diagnosis and the application of the curative therapeutic intervention. [ABSTRACT FROM AUTHOR]

Background. There is no unique diagnostic test for Crohn's disease, and the diagnosis of isolated small bowel Crohn's disease (SBCD) is even more challenging, due to non-patognomonic clinical picture and low availability of accurate exploration methods. Small bowel capsule endoscopy (SBCE) revolutionized the approach of middle gastrointestinal tract, becoming the first investigation tool when small bowel pathology is suspected. Objective of the study. The aim of our study was to assess the value of SBCE in diagnosing isolated SBCD. Materials and Methods. We retrospectively studied the patients undergoing SBCE for suspected isolated SBCD, in a six-year period, including in our analysis only the patients with a minimum one-year follow-up period. We calculated the diagnostic yield of SBCE, defined as number of capsule endoscopy exams whith positive findings, and we also assessed its yearly variation in time over the six-year period. Subsequently, analyzing follow-up data, positive and negative predictive values were assessed. Results. 78 patients were investigated by SBCE for suspected isolated SBCD. SBCE showed lesions compatible with the diagnosis of SBCD in 49 patients, corresponding to a specific diagnostic yield of 62.8%, while for the remaining 29 patients (37.2%), no CD lesions were found. Following additional investigations, three of the 49 patients initially thought as having isolated SBCD were reclassified as SB lymphoma, eosinophilic gastroenteritis and intestinal tuberculosis, respectively, corresponding to a positive predictive value of 93.8%. During followup, none of the 29 patients with negative SBCE was diagnosed with CD, corresponding to a negative predictive value of 100%. We found a progressively increase of the diagnostic yield over time (from 42.6% in the first year to 70.2% in the last year of the analyzed period), corresponding the most probably to the refinement of the indication. Conclusions. Despite a relatively low diagnostic yield, SBCE has a good positive predictive value for isolated SBCD. However, as CE is a purely visual technique with no capability of taking biopsies, final diagnosis needs confirmation by additional investigations. Nevertheless, SBCE has a 100% negative predictive value, being an excellent tool for rulling out isolated SBCD. Refinement of the indication could ensure a better diagostic yield. [ABSTRACT FROM AUTHOR]