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Abstract A 60‐year‐old man presented with a suspected small intestinal tumor on positron‐emission tomography‐computed tomography. Small bowel capsule endoscopy (SBCE) was planned for close examination of the small intestine. To avoid retention of the SBCE due to strictures, a patency capsule (PC) was first used to evaluate patency. However, PC discharge was not visually confirmed during the 24‐h period. No obvious PC was observed on plain abdominal radiography performed in the standing position. The patient underwent SBCE, assuming that the PC had been shed inconspicuously. SBCE revealed a neoplastic lesion with stenosis at a site thought to be the upper small intestine and remained stagnant at the same site for the duration of the battery. In addition, in the SBCE image, a PC shell was captured in the intestinal tract on the oral side of the stenosis. When the pre‐SBCE plain abdominal radiograph was enlarged to confirm the details, PC was observed in the lateral and decubitus views as a dissolved shell only. To the best of our knowledge, no previous report has described the complete dissolution of a PC leaving only its shell during a 30‐hour patency evaluation period. This case illustrates that, in the absence of visual confirmation of a PC discharge, PC may have remained in the body due to premature dissolution. Additional examinations or plain X‐ray imaging should be performed to confirm this, with no preconceived notions that the PC will not dissolve within 30 hours of administration.

Abstract Objectives Artificial intelligence (AI) may be practical for image classification of small bowel capsule endoscopy (CE). However, creating a functional AI model is challenging. We attempted to create a dataset and an object detection CE AI model to explore modeling problems to assist in reading small bowel CE. Methods We extracted 18,481 images from 523 small bowel CE procedures performed at Kyushu University Hospital from September 2014 to June 2021. We annotated 12,320 images with 23,033 disease lesions, combined them with 6161 normal images as the dataset, and examined the characteristics. Based on the dataset, we created an object detection AI model using YOLO v5 and we tested validation. Results We annotated the dataset with 12 types of annotations, and multiple annotation types were observed in the same image. We test validated our AI model with 1396 images, and sensitivity for all 12 types of annotations was about 91%, with 1375 true positives, 659 false positives, and 120 false negatives detected. The highest sensitivity for individual annotations was 97%, and the highest area under the receiver operating characteristic curve was 0.98, but the quality of detection varied depending on the specific annotation. Conclusions Object detection AI model in small bowel CE using YOLO v5 may provide effective and easy‐to‐understand reading assistance. In this SEE‐AI project, we open our dataset, the weights of the AI model, and a demonstration to experience our AI. We look forward to further improving the AI model in the future.

Capsule endoscopy is a valuable tool for diagnosis of the gastrointestinal tract. As a result, active‐control capsule endoscopy, which can be controlled via external stimulation, has emerged as a prominent diagnosis tool, unlike traditional passive capsule endoscopy. However, owing to its rigid cover, the high rotating radii limit its observation range at anchor points, such as polyps. There are also persistent challenges with pass‐through in narrow spaces in the intestines. This study proposes a soft‐shell capsule endoscope (SSCE) to improve this limitation. Experiments ranging from virtual phantoms to ex vivo investigations in the stomach, small intestine, and large intestine were conducted to ensure comprehensive coverage of the entire digestive system by the SSCE. Additionally, in the stomach and intestine experiments, we compared the performances of the SSCE and hard‐shell capsule endoscope (HSCE) to highlight the advantages of the SSCE. The results demonstrate that the SSCE achieves a 37.3% increase in the observable angles through bending motions at the anchor point compared to the HSCE, in addition to increased efficiency of pass‐through in the intestines. This revolutionary innovation is expected to significantly impact and promote high efficiency via pass‐through and the observation area in the clinical application of capsule endoscopy.

Gastrointestinal diseases cause around two million deaths globally. Wireless capsule endoscopy is a recent advancement in medical imaging, but manual diagnosis is challenging due to the large number of images generated. This has led to research into computer-assisted methodologies for diagnosing these images. Endoscopy produces thousands of frames for each patient, making manual examination difficult, laborious, and error-prone. An automated approach is essential to speed up the diagnosis process, reduce costs, and potentially save lives. This study proposes transfer learning-based efficient deep learning methods for detecting gastrointestinal disorders from multiple modalities, aiming to detect gastrointestinal diseases with superior accuracy and reduce the efforts and costs of medical experts. The Kvasir eight-class dataset was used for the experiment, where endoscopic images were preprocessed and enriched with augmentation techniques. An EfficientNet model was optimized via transfer learning and fine tuning, and the model was compared to the most widely used pre-trained deep learning models. The model’s efficacy was tested on another independent endoscopic dataset to prove its robustness and reliability.

Abstract Wireless capsule endoscopy (WCE) enables imaging and diagnostics of the gastrointestinal (GI) tract to be performed without any discomfort. Despite this, several characteristics, including efficacy, tolerance, safety, and performance, make it difficult to apply and modify widely. The use of automated WCE to collect data and perform the analysis is essential for finding anomalies. Medical specialists need a significant amount of time and expertise to examine the data generated by WCE imaging of the patient’s digestive tract. To address these challenges, several computer vision-based solutions have been designed; nevertheless, they do not achieve an acceptable level of accuracy, and more advancements are required. Thus, in this study, we proposed four multi-classification deep learning (DL) models i.e., Vgg-19 + CNN, ResNet152V2, Gated Recurrent Unit (GRU) + ResNet152V2, and ResNet152V2 + Bidirectional GRU (Bi-GRU) and applied it on different publicly available databases for diagnosing ulcerative colitis, polyps, and dyed-lifted polyps using WCE images. To our knowledge, this is the only study that uses a single DL model for the classification of three different GI diseases. We compared the classification performance of the proposed DL classifiers in terms of many parameters such as accuracy, loss, Matthew's correlation coefficient (MCC), recall, precision, negative predictive value (NPV), positive predictive value (PPV), and F1-score. The results revealed that the Vgg-19 + CNN outperforms the three other proposed DL models in classifying GI diseases using WCE images. The Vgg-19 + CNN model achieved an accuracy of 99.45%. The results of four proposed DL classifiers are also compared with recent state-of-the-art classifiers and the proposed Vgg-19 + CNN model has performed better in terms of improved accuracy.

Diaphragm disease (DD) is a rare condition that is associated with the use of nonsteroidal anti-inflammatory drugs. It is characterized by multiple diaphragm-like septa that cause a narrowing of the small bowel lumen. The diagnosis of this disorder can be challenging due to its rarity and its non-specific symptoms, which often suggest other, more probable diseases. We report the case of a 16-year-old boy who presented with iron-deficiency anemia that did not respond to iron supplementation. Despite undergoing endoscopy and computed tomography (CT) enterography, the cause of his condition could not be identified. Capsule endoscopy was attempted, but due to technical difficulties, images could not be obtained. Two years later, the patient's symptoms persisted, prompting further investigation. CT enterography revealed a foreign body in the distal ileum, which was identified as the previously administered capsule. Diagnostic laparoscopy with intraoperative endoscopy was performed to retrieve the capsule. This procedure also revealed multiple short-segment strictures causing luminal narrowing and ulcerations. These were confirmed by histopathology to be lesions associated with DD.

Background: The role of capsule endoscopy in the evaluation of the small bowel is well established, and current guidelines position it as a first-line test in a variety of clinical scenarios. The advent of double-headed capsules further enabled the endoscopic assessment of colonic mucosa and the opportunity for a one-step noninvasive examination of the entire bowel (pan-enteric capsule endoscopy [PCE]). Summary: We reviewed the technical procedure and preparation of patients for PCE, as well as its current clinical applications and future perspectives. In non-stricturing and non-penetrating Crohn’s disease affecting the small bowel and colon, PCE monitors disease activity by assessing mucosal healing, a major treatment outcome, with a higher diagnostic yield than cross-sectional imaging or conventional colonoscopy. Also in ulcerative colitis, double-headed capsules have been used to monitor disease activity noninvasively. Currently, validated scoring systems have been specifically devised for these double-headed capsules and permit a standardized assessment of the inflammatory burden. In suspected mid-lower digestive bleeding, some exploratory studies have demonstrated the feasibility and high diagnostic yield of PCE, which may work as a filter indicating which patients may benefit of further invasive procedures, namely, for planned hemostatic procedures. The possibility of using PCE is also discussed in the context of polyposis syndromes with simultaneous involvement of the small intestine and colon. Key Messages: PCE is a feasible, effective, and safe diagnostic procedure to evaluate the small bowel and colon. It has been increasingly explored in the setting of inflammatory bowel diseases and, more recently, in suspected mid-lower digestive bleeding. PCE is expected to reduce the demand for invasive procedures and expand the scope of noninvasive intestinal evaluation in the coming future.

Objectives Small bowel capsule endoscopy (SBCE) technology detects small bowel lesions. Many factors affect its sensitivity. SBCE is also costly, and patients might not be able to repeat the test when results are equivocal. Instead of repeating the test, reading the results by two endoscopists might provide a better or a cheaper option in the right settings. We studied the sensitivity of SBCE when read by two different physicians and checked if, rather than repeating the examination, rereading the results improved its sensitivity. Furthermore, we studied the effect of small bowel transit time (SBTT) on the diagnostic yield.

Feihong Deng,1,2 Hanyu Wang,1,2 Xuehong Wang1,2 1Department of Gastroenterology, The Second Xiangya Hospital, Central South University, Changsha, Hunan, 410011, People’s Republic of China; 2Research Center of Digestive Disease, Central South University, Changsha, Hunan, 410011, People’s Republic of ChinaCorrespondence: Xuehong Wang, Department of Gastroenterology, the Second Xiangya Hospital, Central South University; Research Center of Digestive Disease, Central South University, Changsha, Hunan, 410011, People’s Republic of China, Email xuehongwang@csu.edu.cnIntroduction: Primary immunodeficiencies (PIDs) are a heterogeneous group of disorders, common variable immunodeficiency disorder (CVID) and X-linked agammaglobulinemia (XLA) are PIDs related to B-cell defect, characterized by reduced levels of immunoglobulins and immune dysregulation. Infections are the most common clinical manifestations, while underlying autoimmune and inflammatory conditions are present in some patients with CVID and XLA, leading to clinical misdiagnosis and diagnostic delay. Chronic diarrhea in patients with CVID and XLA, particularly complicated malabsorption and protein-energy malnutrition, is responsible for poor prognostic outcomes.Methods: In this study, we described three PID adult patients (two with CVID and one with XLA) who presented with varying degrees of chronic diarrhea, weight loss, and protein-energy malnutrition. We suggest that villous blunting of the small intestine under capsule endoscopy may be an endoscopic feature of PID-related enteropathy, thus highlighting the application of capsule endoscopy in patients with CVID and XLA presenting with chronic diarrhea.Conclusion: We also summarize regular Ig supplementation is the basic treatment for CVID and XLA patients, proper enteral nutrition and probiotic therapy can be explored to use to alter gut microbiota and modulate intestinal immune response. However, vedolizumab is not helpful to PID-related enteropathy therapy, as it exacerbates the inflammatory response in extra-intestinal organs and ultimately causes poor clinical outcomes.Keywords: chronic diarrhea, primary immunodeficiencies, villous blunting, capsule endoscopy, vedolizumab therapy

Because of both difficulties in accurate diagnosis and appropriate management, small bowel bleeding due to angiodysplasia remains a challenging and perplexing issue in clinical practice. Advancement in small bowel endoscopy including capsule endoscopy as well as balloon enteroscopy has expanded the domain of endoscopic hemostatic interventions in the small bowel. This has led on to marked improvement in immediate homeostasis rates in patients with small bowel angiodysplasias (SBA) bleeding. However, high recurrent bleeding rates are an important limitation of endoscopic interventions. Therefore, there is an unmet need of an effective therapeutic as well as prophylactic pharmacotherapy that can alter the course of the disease. Long-acting octreotide as well as thalidomide has been used in patients with SBA bleeding with encouraging results, but the evidence on their efficacy is not robust. In news and views of this issue, we discuss a randomized controlled study that investigates the efficacy and safety of thalidomide for the treatment of recurrent bleeding due to SBA. [ABSTRACT FROM AUTHOR]

Introduction: Complicated perianal disease (cPD) may be the sole presentation of Crohn’s disease (CD). The role of small-bowel capsule endoscopy (SBCE) in the diagnostic algorithm of cPD is unclear. We aimed to evaluate the role of SBCE as a diagnostic tool, in patients with cPD, after a negative standard workup for CD. Methods: A multicenter, retrospective, cross-sectional study, in patients with cPD, and negative standard workup for CD (ileocolonoscopy and cross-sectional imaging), who underwent SBCE for suspected CD. Demographics, biomarkers, and the Lewis Score (LS) were recorded and analyzed. An LS ≥ 135 was considered a positive SBCE for diagnosing CD. Results: Ninety-one patients were included: 65 (71.4%) males; median age: 37 (29–51) years; cPD duration: 25.1 (12.5–66.1) months. Positive SBCE: 24/91 (26.4%) patients. Fecal calprotectin (FC) positively correlated with LS (r = 0.81; p < 0.001). FC levels of 100 µg/g and 50 µg/g had a sensitivity of only 40% and 55% to rule out small-bowel CD, with a negative predictive value (NPV) of only 76% and 80%, respectively. Conclusions: SBCE contributed to CD diagnosis in a quarter of patients with cPD after a negative standard workup. FC levels correlated with the degree of inflammation defined by the LS. However, the NPV of FC was low, suggesting that SBCE should be considered for patients with cPD even after a negative standard workup.

We aimed to determine the diagnostic yield and outcome of patients receiving antithrombotic drug therapy subjected to small bowel capsule endoscopy (SBCE) for the investigation of small bowel bleeding (SBB). A multicenter retrospective analysis of collected data from all patients undergoing SBCE for the investigation of SBB from March 2003 to June 2023 was performed. The diagnostic yield of SBCE was defined as the detection of positive findings that could explain the cause of the patient’s bleeding. Rebleeding was defined as evidence of bleeding within 1 year after the index episode. During the study period, 8401 patients underwent SBCE for SBB investigation. Bleeding lesions were detected in 1103/2535 (43.5%) antithrombotic users, compared to 1113/5866 (18.9%) in nonusers (p < 0.00001). Following capsule endoscopy, a therapeutic intervention was possible in 390/2216 (17.5%) patients with a bleeding lesion. Rebleeding occurred in 927 (36.5%) of antithrombotic users (36.5%), compared to 795 (13.5%) of nonusers (13.5%, p < 0.00001). Both the diagnostic yield of SBCE and the rebleeding rates were higher in patients with SBB receiving antithrombotics. Therapeutic intervention was possible in a real-world setting only for a minority of patients with positive findings.

This review discusses the role of capsule endoscopy in diagnosing suspected small bowel bleeding and compares guidelines of the European Society of Gastrointestinal Endoscopy (ESGE), the American College of Gastroenterology (ACG), the American Society for Gastrointestinal Endoscopy (ASGE), the Canadian Association of Gastroenterology (CAG), and the consensus document of 4 Japanese medical societies. European and North American experts recommend capsule endoscopy as a first-line diagnostic modality for suspected small bowel bleeding without life-threatening signs in adult patients when ileocolonoscopy and esophagogastroduodenoscopy failed to be informative. Japanese experts, on the contrary, prefer cross-sectional imaging “from the chest to the pelvis” and consider capsule endoscopy as an alternative.

Abstract Background There is still no consensus on the preferred endoscopic therapy for small bowel angioectasias (SBAs). The aim of this study was to evaluate effectiveness and safety of endoscopic injection sclerotherapy (EIS) for treating recurrent bleeding of SBAs. Methods Sixty-six adult patients diagnosed with SBAs by capsule endoscopy (CE) or double-balloon enterscopy (DBE) examinations were enrolled in this retrospective study from September 2013 to September 2021. The patients were divided into an EIS group (35 cases) and a control group (31 cases) according to whether they underwent EIS treatment. Clinical characteristics, medical histories, lesion characteristics, main laboratory indicators, treatments, and outcomes were collected. The rates of re-bleeding, re-admission, and red blood cell (RBC) transfusion were compared between different groups after discharge. The rates of hospitalization and RBC transfusion were compared between before admission and after discharge in both groups. Odds ratios (ORs) and 95% confidence intervals (CIs) were used in the multivariate logistic regression analysis to assess relative factors for re-bleeding. Results All the rates of re-bleeding, re-admission and RBC transfusion after discharge in the EIS group were significantly lower than those in the control group (all P 0.05). Multivariate logistic regression analysis showed that RBC transfusion before admission (OR, 5.655; 95% CI, 1.007–31.758, P = 0.049) and multiple lesions (≥ 3) (OR, 17.672; 95% CI, 2.246–139.060, P = 0.006) were significant risk factors of re-bleeding, while EIS treatment (OR, 0.037; 95% CI, 0.005–0.260, P

Background/Aims Capsule endoscopy (CE) has shown that low-dose aspirin occasionally causes small bowel (SB) bleeding. We herein evaluated the protective effects of mucoprotective agents (MPAs) on SB bleeding in aspirin users using the nationwide database of claims data from the National Health Insurance Service (NHIS). Methods As CE is an insured procedure, we constructed an aspirin-SB cohort using NHIS claims data, with a maximum follow-up period of 24 months. Patients with anemia, melena, or hematochezia that occurred within 4 weeks before and after performing CE were suspected to have SB bleeding. A Cox proportional hazards regression model was used to determine the risk factors for SB bleeding. Subgroup analyses were conducted among patients who used acid suppressants, such as proton pump inhibitors (PPIs) and histamine-2 receptor antagonists. Results A total of 15,542 aspirin users were included. Anticoagulant use (hazard ratio [HR], 3.22), high Charlson comorbidity index score (≥ 2) (HR, 3.54), and PPI use (HR, 2.85) were significantly associated with SB bleeding, whereas eupatilin use (HR, 0.35) was a preventive factor. SB bleeding occurred more frequently in concurrent users of acid suppressants than in nonusers (1.3% vs. 0.5%). Subgroup analysis revealed that eupatilin significantly reduced the risk of SB bleeding in aspirin users with concurrent use of acid suppressants (HR, 0.23 vs. 2.55). Conclusions Eupatilin was associated with a reduced risk of SB bleeding in both aspirin users and those with concomitant use of acid suppressants. Eupatilin use should be considered for aspirin users, especially for those concomitantly taking acid suppressants.

Introduction: Aortic stenosis (AS) is sometimes associated with gastrointestinal bleeding, and this phenomenon is known as Heyde's syndrome. Such bleeding is most often considered to originate from gastrointestinal angiodysplasias, but the frequency and endoscopic features of such bleeding remain unclear. This study aimed to determine the frequency and endoscopic features of gastrointestinal angiodysplasia in patients with severe AS. Patients and Methods: In this multicenter, retrospective study, we evaluated consecutive patients who underwent transcatheter aortic valve implantation (TAVI) with severe AS from May 2016 to December 2019. We extracted the data on the clinicopathological features according to the status of anemia, the proportion of patients who underwent gastrointestinal endoscopic examinations and demonstrated gastrointestinal angiodysplasia, and identified the endoscopic features associated with such patients. Results: In 325 patients, the rates of moderate/severe anemia (hemoglobin < 11 g/dL) were 52%. Regarding medicine, there were no significant differences between the patients with and without moderate/severe anemia. Patients were examined by esophagogastroduodenoscopy (21%), colonoscopy (12%), and balloon-assisted enteroscopy or small bowel capsule endoscopy (1.5%). Patients with moderate/severe anemia had significantly more angiodysplasia (38.3% vs. 7.7%; p < 0.0001) and active bleeding (23.4% vs. 0%; p < 0.01). Angiodysplasia was detected in 21 patients (stomach, n = 9; small intestine, n = 5, and colon, n = 10). Conclusions: The results suggest, for the first time, that patients with severe AS who underwent TAVI and moderate/severe anemia frequently had gastrointestinal angiodysplasia and active bleeding throughout the entire gastrointestinal tract. [ABSTRACT FROM AUTHOR]

Background: The latest magnet‐controlled capsule endoscopy (MCCE) system can examine the water‐distended stomach, duodenum, and the small bowel. We assessed the use of MCCE as the first diagnostic tool in patients with acute upper gastrointestinal bleeding (AUGIB). Methods: This was a prospective cohort study that enrolled patients admitted with AUGIB from two teaching hospitals. Patients underwent MCCE as the initial diagnostic modality. Our primary endpoint was the diagnostic yield of MCCE. The subsequent care of these patients was guided by MCCE findings. Results: Of 100 enrolled patients, 99 (mean age 54 years, 70.7% men) with a median Glasgow–Blatchford score of 6 (IQR 3–9) underwent MCCE. In three patients, MCCE found active bleeding (two duodenal ulcers and Dieulafoy's lesion). The overall diagnostic yield of MCCE was 95.8% (92 lesions in 96 patients); five in the esophagus (Mallory Weiss tears 2, varices 1, and esophagitis 2), 51 in the stomach (gastric erosions 26, gastric ulcers 14, cancer 3, GIST 3, gastric polyps 3, antral vascular ectasia 1,angiodysplasia 1), 32 in the duodenum (ulcers 28, erosions 3, polyp 1), and four in the small bowel (ulcers 2, an erosion with a nonbleeding vessel 1, Meckel's diverticulum 1). Fifty‐two (52.5%) patients were discharged without endoscopy. Forty‐five (45.5%) patients underwent inpatient esophagogastroduodenoscopy (EGD), which found an antral ulcer and six duodenal ulcers in addition. Conclusions: In stable patients with AUGIB, MCCE can be used as a diagnostic tool. EGD should follow in patients with an inadequate view of the duodenum. [ABSTRACT FROM AUTHOR]

Background: Small bowel disorders present a diagnostic challenge due to the limited accessibility of the small intestine. Accurate diagnosis is made with the aid of specific procedures, like capsule endoscopy or double-ballon enteroscopy, but they are not usually solicited and not widely accessible. This study aims to assess and compare the diagnostic effectiveness of enteroscopy and video capsule endoscopy (VCE) when combined with artificial intelligence (AI) algorithms for the automatic detection of small bowel diseases. Materials and methods: We performed an extensive literature search for relevant studies about AI applications capable of identifying small bowel disorders using enteroscopy and VCE, published between 2012 and 2023, employing PubMed, Cochrane Library, Google Scholar, Embase, Scopus, and ClinicalTrials.gov databases. Results: Our investigation discovered a total of 27 publications, out of which 21 studies assessed the application of VCE, while the remaining 6 articles analyzed the enteroscopy procedure. The included studies portrayed that both investigations, enhanced by AI, exhibited a high level of diagnostic accuracy. Enteroscopy demonstrated superior diagnostic capability, providing precise identification of small bowel pathologies with the added advantage of enabling immediate therapeutic intervention. The choice between these modalities should be guided by clinical context, patient preference, and resource availability. Studies with larger sample sizes and prospective designs are warranted to validate these results and optimize the integration of AI in small bowel diagnostics. Conclusions: The current analysis demonstrates that both enteroscopy and VCE with AI augmentation exhibit comparable diagnostic performance for the automatic detection of small bowel disorders. [ABSTRACT FROM AUTHOR]

Background: Magnetically controlled capsule endoscopy (MCCE) is a non-invasive, painless, comfortable, and safe equipment to diagnose gastrointestinal diseases (GID), partially overcoming the shortcomings of conventional endoscopy and wireless capsule endoscopy (WCE). With advancements in technology, the main technical parameters of MCCE have continuously been improved, and MCCE has become more intelligent. Objectives: The aim of this systematic review was to summarize the research progress of MCCE and artificial intelligence (AI) in the diagnosis and treatment of GID. Data Sources and Methods: We conducted a systematic search of PubMed and EMBASE for published studies on GID detection of MCCE, physical factors related to MCCE imaging quality, the application of AI in aiding MCCE, and its additional functions. We synergistically reviewed the included studies, extracted relevant data, and made comparisons. Results: MCCE was confirmed to have the same performance as conventional gastroscopy and WCE in detecting common GID, while it lacks research in detecting early gastric cancer (EGC). The body position and cleanliness of the gastrointestinal tract are the main factors affecting imaging quality. The applications of AI in screening intestinal diseases have been comprehensive, while in the detection of common gastric diseases such as ulcers, it has been developed. MCCE can perform some additional functions, such as observations of drug behavior in the stomach and drug damage to the gastric mucosa. Furthermore, it can be improved to perform a biopsy. Conclusion: This comprehensive review showed that the MCCE technology has made great progress, but studies on GID detection and treatment by MCCE are in the primary stage. Further studies are required to confirm the performance of MCCE. [ABSTRACT FROM AUTHOR]

Small bowel capsule endoscopy (SBCE) is a convenient and minimally invasive method widely used to evaluate the small intestine. However, especially in the distal ileum, visualization of the intestinal mucosa is frequently hampered by the remaining intestinal contents, making it difficult to detect critical lesions. Although several studies have reported on the efficacy of bowel preparation before SBCE, no standardized protocol has been established. Herein, we determined the optimal preparation method for better visualization of the distal ileum using SBCE. We retrospectively analyzed 259 consecutive patients who had undergone SBCE between July 2009 and December 2019, divided into three groups: Group A (no preparation except overnight fasting), Group B (ingestion of 1–2 L polyethylene glycol 4 h before colonoscopy after overnight fasting and performing SBCE immediately after colonoscopy), and Group C (ingestion of 0.9 L magnesium citrate [MC] before SBCE after overnight fasting). The visibility of the intestinal mucosa in the first 10 min and at the last 10 min during the period of observation of the distal ileum was examined using a scoring system and compared. The visibility of the images captured by SBCE was assessed based on the scoring of the degree of bile/chyme staining, residual fluid and debris, brightness, bubble reduction, and visualized mucosa. The status of intestinal collapse was also assessed. In the first 10 min of observation of the distal ileum, no significant differences were detected among the groups. In the last 10 min, significantly better images were acquired in Group C in terms of bile/chyme staining, brightness, bubble reduction, and visualized mucosa. Bowel preparation using a low-dose MC solution 2 h before SBCE provided significantly higher-quality images of the distal ileum. Further optimization, such as the timing of initiating the preparation, is necessary to determine the optimal regimen for bowel preparation prior to SBCE. [ABSTRACT FROM AUTHOR]

The purpose of this article is to provide an overview of white light colon capsule endoscopy's current clinical application, concentrating on its most recent developments. Second-generation colon capsule endoscopy (CCE2) is approved by the FDA for use as an adjunctive test in patients with incomplete colonoscopy and within Europe in patients at average risk, those with incomplete colonoscopies or those unwilling to undergo conventional colonoscopies. Since the publication of European Society of GI Endoscopy guidelines on the use of CCE, there has been a significant increase in comparative studies on the diagnostic yield of CCE. This paper discusses CCE2 in further detail. It explains newly developed colon capsule system and the current status on the use of CCE, it also provides a comprehensive summary of systematic reviews on the implementation of CCE in colorectal cancer screening from a methodological perspective. Patients with ulcerative colitis can benefit from CCE2 in terms of assessing mucosal inflammation. As part of this review, performance of CCE2 for assessing disease severity in ulcerative colitis is compared with colonoscopy. Finally, an assessment if CCE can become a cost-effective clinical service overall. [ABSTRACT FROM AUTHOR]

Background: Evidence of small-bowel capsule endoscopy (SBCE) for evaluating lesions in Crohn's disease (CD) is lacking. We aimed to clarify the effectiveness and safety of SBCE in a large sample of patients with CD. Methods: This multicenter prospective registration study recorded the clinical information and SBCE results of patients with definitive CD (d-CD) or suspected CD (s-CD). The primary outcomes were the rates of successful assessment of disease activity using SBCE, definitive diagnosis of CD, and adverse events. Secondary outcomes were the assessment of SBCE findings in patients with d-CD and s-CD and factors affecting SBCE incompletion and retention; and tertiary outcomes included the association between clinical disease activity or blood examination, endoscopic disease activity, ileal CD, and the questionnaire assessment of patient acceptance of SBCE. Results: Of 544 patients analyzed, 541 underwent SBCE with 7 (1.3%) retention cases. Of 468 patients with d-CD, 97.6% could be evaluated for endoscopic activity. Of 76 patients with s-CD, 15.8% were diagnosed with 'confirmed CD'. CD lesions were more frequently observed in the ileum and were only seen in the jejunum in 3.4% of the patients. Male sex and stenosis were risk factors for incomplete SBCE, and high C-reactive protein levels and stenosis were risk factors for capsule retention. In L1 (Montreal classification) patients, clinical remission was associated with endoscopic remission but showed low specificity and accuracy. The answers to the acceptability questionnaire showed the minimal invasiveness and tolerability of SBCE. Conclusion: SBCE is practical and safe in patients with CD. [ABSTRACT FROM AUTHOR]

Objective: In this study we aimed to compare the need for further examination with conventional gastroscopy within 1 year after magnetically assisted capsule endoscopy (MCCE) examination between patients with gastrointestinal (GI) symptoms and asymptomatic individuals. Methods: After propensity score matching analysis, 372 patients with GI symptoms and 372 asymptomatic individuals who had undergone MCCE at the First Affiliated Hospital of Sun Yat‐sen University from January 1, 2019 to December 30, 2020 were retrospectively enrolled. Demographic and clinical characteristics of the participants and their MCCE and gastroscopic findings (performed within 1 year after MCCE) were analyzed. Results: Fifty‐one (6.85%) patients underwent further examination with conventional gastroscopy within 1 year after MCCE. Those with GI symptoms were more likely to undergo conventional gastroscopy than those without (9.95% vs 3.76%, P < 0.001). Polyps were the most common finding of MCCE. The rate of conventional gastroscopy in patients with focal lesions was significantly higher than that in those without focal lesions (P < 0.05). However, such rate did not differ in the different age groups (P = 0.106). Conclusions: MCCE is an optimal alternative for gastric examination, especially for large‐scale screening of asymptomatic individuals. Patients with GI symptoms or focal lesions detected by MCCE are more likely to seek further examination with conventional gastroscopy for biopsy or endoscopic treatment than those without. [ABSTRACT FROM AUTHOR]

Background: Capsule endoscopy (CE) is the first-choice exploration in case of overt small bowel bleeding (SBB). An early CE is known to increase diagnostic yield, but long reading times may delay therapeutics. The study evaluates the diagnostic performance of the artificial intelligence tool TOP100 in patients with overt SBB undergoing early CE with Pillcam SB3. Methods: Patients who underwent early CE (up to 14 days from the bleeding episode) for suspected overt SBB were included. One experienced endoscopist prospectively performed standard reading (SR) and a second blind experienced endoscopist performed a TOP100-based reading (TR). The primary endpoint was TR diagnostic accuracy for lesions with high bleeding potential (P2). Results: A total of 111 patients were analyzed. The most common clinical presentation was melena (64%). CE showed angiodysplasias in 40.5% of patients (45/111). In per-patient analysis, TR showed a sensitivity of 90.48% (95% CI 82.09–95.80), specificity of 100% (95% CI 87.23–100) with a PPV of 100% (95% CI 94.01–100), NPV of 77.14% (95% CI 63.58–86.71) and diagnostic accuracy of 92.79 (86.29–96.84). At multivariate analysis, adequate intestinal cleansing was the only independent predictor of concordance between TR and SR (OR 2.909, p = 0.019). The median reading time for SR and TR was 23 min (18.0–26.8) and 1.9 min (range 1.7–2.1), respectively (p < 0.001). Conclusions: TOP100 provides a fast-reading mode for early CE in case of overt small bowel bleeding. It identifies most patients with active bleeding and angiodysplasias, aiding in the prioritization of therapeutic procedures. However, its accuracy in detecting ulcers, varices and P1 lesions seems insufficient. [ABSTRACT FROM AUTHOR]

Simple Summary: Video capsule endoscopy (VCE) is a small, patient-friendly tool used for medical imaging, but it lacks narrow band imaging (NBI), which is crucial for detecting various cancers like esophageal cancer (EC). EC is hard to detect early since it often shows no symptoms, leading to a low 5-year survival rate. NBI enhances mucosal features for early cancer identification, but adding it to VCE isn't feasible due to size constraints. This study successfully developed a method to convert traditional white light images (WLI) from VCE into NBI-like images for esophageal examination. The method performed well, with high similarity scores and improved image quality, offering a promising solution for better cancer detection. Video capsule endoscopy (VCE) is increasingly used to decrease discomfort among patients owing to its small size. However, VCE has a major drawback of not having narrow band imaging (NBI) functionality. The current VCE has the traditional white light imaging (WLI) only, which has poor performance in the computer-aided detection (CAD) of different types of cancer compared to NBI. Specific cancers, such as esophageal cancer (EC), do not exhibit any early biomarkers, making their early detection difficult. In most cases, the symptoms are unnoticeable, and EC is diagnosed only in later stages, making its 5-year survival rate below 20% on average. NBI filters provide particular wavelengths that increase the contrast and enhance certain features of the mucosa, thereby enabling early identification of EC. However, VCE does not have a slot for NBI functionality because its size cannot be increased. Hence, NBI image conversion from WLI can presently only be achieved in post-processing. In this study, a complete arithmetic assessment of the decorrelated color space was conducted to generate NBI images from WLI images for VCE of the esophagus. Three parameters, structural similarity index metric (SSIM), entropy, and peak-signal-to-noise ratio (PSNR), were used to assess the simulated NBI images. Results show the good performance of the NBI image reproduction method with SSIM, entropy difference, and PSNR values of 93.215%, 4.360, and 28.064 dB, respectively. [ABSTRACT FROM AUTHOR]

Background: Intestinal lymphangiectasia (IL) is a rare protein-losing enteropathy caused by disorders of the intestinal lymphatics. There are only a few case reports and case series concerning the VCE (video capsule endoscopy) findings of IL. This work aimed to evaluate the VCE characteristics of small intestinal mucosal abnormalities in patients with IL, and to investigate the relationship between clinical and VCE characteristics. Methods: Consecutive patients with IL who underwent VCE were enrolled in this retrospective study. The cases were classified into the white villi group and non-white villi group according to mucosal abnormalities detected by VCE. Clinical and endoscopic characteristics were investigated and analyzed. Results: A total of 98 patients with IL with a median onset age of 26.3 ± 19.2 years were included. VCE revealed the following small intestinal lesions: (i) white villi type (57/98, 58.2%), i.e.: white-tipped or granular villi, white nodular villi or plaques; (ii) non-white villi type (41/98, 41.8%), i.e.: diffused low and round villi; (iii) complications (46/98, 46.9%), i.e.: bleeding, ulcers, protruding or vesicular-shaped lesions, stenosis and lymphatic leakage. A total of 58.2% (57) and 41.8% (41) of the cases were classified into the white villi and non-white villi groups respectively. The percentage of chylothorax in the white villi group was significantly lower than that in the non-white villi group (12/57 vs. 19/41, p = 0.008). In VCE, there were no significant differences in the involved segments and total detected rate of complications between the white villi and non-white villi groups (p > 0.05), while the detected rate of lymphatic leakage in the white villi group was significantly higher than that in the non-white villi group (31.6% vs. 12.2%, p = 0.026). Conclusions: Our study evaluated the entire small intestinal mucosal abnormalities of IL by VCE, especially endoscopic complications. IL has specific VCE abnormalities in addition to classical endoscopic findings. [ABSTRACT FROM AUTHOR]

Although wireless capsule endoscopy (WCE) detects small bowel diseases effectively, it has some limitations. For example, the reading process can be time consuming due to the numerous images generated per case and the lesion detection accuracy may rely on the operators' skills and experiences. Hence, many researchers have recently developed deep-learning-based methods to address these limitations. However, they tend to select only a portion of the images from a given WCE video and analyze each image individually. In this study, we note that more information can be extracted from the unused frames and the temporal relations of sequential frames. Specifically, to increase the accuracy of lesion detection without depending on experts' frame selection skills, we suggest using whole video frames as the input to the deep learning system. Thus, we propose a new Transformer-architecture-based neural encoder that takes the entire video as the input, exploiting the power of the Transformer architecture to extract long-term global correlation within and between the input frames. Subsequently, we can capture the temporal context of the input frames and the attentional features within a frame. Tests on benchmark datasets of four WCE videos showed 95.1% sensitivity and 83.4% specificity. These results may significantly advance automated lesion detection techniques for WCE images. [ABSTRACT FROM AUTHOR]

The management of pediatric Peutz–Jeghers Syndrome (PJS) focuses on the prevention of intussusception complicating small intestinal (SI) polyposis. This hinges on the accurate appraisal of the polyp burden to tailor therapeutic interventions. Video Capsule Endoscopy (VCE) is an established tool to study SI polyps in children, but an in-depth characterization of polyp burden in this population is lacking. Methods: We performed a retrospective longitudinal cross-sectional analysis of VCE studies in pediatric PJS patients at our institution (CMKC) from 2010 to 2020. Demographic, clinical, and VCE findings reported by three reviewers in tandem were accrued. Polyp burden variables were modeled as functions of patient and study characteristics using linear mixed models adjusted for clustering. Results: The cohort included 15 patients. The total small bowel polyp count and largest polyp size clustered under 30 polyps and <20 mm in size. Luminal occlusion correlated closely with the estimated polyp size. Polyp distribution favored proximal (77%) over distal (66%) small bowel involvement. The adjusted largest polyp size was greater in males. Double Balloon Enteroscopy was associated with a decreased polyp burden. Conclusions: The polyp burden in pediatric PJS patients favors the proximal third of the small intestine, with relatively small numbers and a polyp size amenable to resection through enteroscopy. Male gender and older age were related to an increased polyp burden. [ABSTRACT FROM AUTHOR]

Goals: To explore factors associated with inadequate gastric preparation for MCE. Background: Factors associated with inadequate gastric preparation for magnetically controlled capsule endoscopy (MCE) remains unclear. Study: Data of patients who underwent MCE from June 2021 to July 2022 were prospectively collected. The gastric cleanliness score (GCS) of the six stomach regions (gastric cardia, fundus, body, angulus, antrum, and pylorus) was recorded. Patients with GCS score ≥18 were defined as the adequate preparation. Factors related to inadequate gastric preparation were analyzed using a logistic regression model with estimated odds ratios (OR). Results: The mean GCS score of 211 patients was 17.01 ± 2.82. In the multivariable analysis, proton pump inhibitor (PPI) use (OR 3.57; 95% CI 1.69–7.95; p < 0.01) and premedication time after administering simethicone <30 min (OR 2.86; 95% CI 1.10–7.39; p = 0.03) were independent risk factors for inadequate gastric preparation. Comparing the gastric cleanliness of different locations, the median GCS of the lower stomach [10.00, IQR (9.50, 11.00)] was significantly higher than that of the upper stomach [7.00, IQR (6.00, 8.00)] (p <0.001). Conclusion: PPI use and inadequate premedication time (<30 min) may reduce the quality of gastric preparation for MCE. The type, dose, duration of medication, and discontinuation time of PPIs was well worth further exploration. Appropriate control of the type and time of premedication may be the key to improving overall gastric cleanliness. [ABSTRACT FROM AUTHOR]

Background: Colon capsule endoscopy (CCE) is useful as an alternative examination for patients in whom colonoscopy is difficult. The Japanese Association for Capsule Endoscopy has published a recommended regimen for CCE using castor oil, which is becoming a standard examination method for CCE in Japan. However, castor oil has an unpleasant flavor. Therefore, patient acceptance is not good. Objectives: The aims were to develop a castor oil-filled capsule and evaluate its feasibility and patient acceptance in a retrospective, comparative study. Method: A dissolution study of pig-derived gelatin capsules filled with castor oil was performed using artificial gastric juice. The CCE excretion rates within battery lifetime, CCE examination times, endoscopic colonic cleansing levels, and patient acceptability between CCE boosters with a castor oil-filled capsule and without castor oil were retrospectively compared using medical information, clinical data, and endoscopic findings at Takada Chuo Hospital from September 2016 to August 2019. Results: The castor oil-filled capsules were completely disintegrated at approximately 1–3 min in artificial gastric juice. Bowel preparation with oil-filled capsules and without castor oil was performed in 27 and 24 patients, respectively. CCE excretion rates within battery life were 100% and 91.7% (p = 0.217), small bowel transit times were 115 min and 143 min (p = 0.046), colon transit times were 168 min and 148 min (p = 0.733), and adequate colonic cleansing rates were 85.2% and 86.3% (p = 1.000) in patients using bowel preparation with and without oil-filled capsules, respectively. Regarding acceptance, the taste was not problematic in 85.2%, and tolerability for the next CCE was 96.3%. Conclusions: CCE using a castor oil-filled capsule method achieved high examination performance and sufficient patient tolerability. [ABSTRACT FROM AUTHOR]

An efficient tool to execute painless imaging and examine gastrointestinal tract illnesses of the intestine is also known as wireless capsule endoscopy (WCE). Performance, safety, tolerance, and efficacy are the several concerns that make adaptation challenging and wide applicability. In addition, to detect abnormalities, the great importance is the automatic analysis of the WCE dataset. These issues are resolved by numerous vision-based and computer-aided solutions. But, they want further enhancements and do not give the accuracy at the desired level. In order to solve these issues, this paper presents the detection and classification of WCE infected images by a deep neural network and utilizes a bleed image recognizer (BIR) that associates the MobileNetV2 design to classify the images of WCE infected. For the opening-level evaluation, the BIR uses the MobileNetV2 model for its minimum computation power necessity, and then the outcome is sent to the CNN for more processing. Then, Bi-LSTM with an attention mechanism is used to improve the performance level of the model. Hybrid attention Bi-LSTM design yields more accurate classification outcomes. The proposed scheme is implemented in the Python platform and the performance is evaluated by Cohen's kappa, F1-score, recall, accuracy, and precision. The implementation outcomes show that the introduced scheme achieved maximum accuracy of 0.996 with data augmentation with the dataset of WCE images which provided higher outcomes than the others. [ABSTRACT FROM AUTHOR]

Wireless Body Area Network (WBAN) is a wireless network of short-range communication protocols for remote healthcare monitoring with the possibility of giving freedom of human body movements. Sensor nodes (motes) are usually located under the skin, implanted deep in the body, or ingested, as in the rare case of smart pills for medical and non-medical usage. Since the necessary connections of wearable and implantable devices are wireless, and the components use low batteries, processing and transferring the critical data can deplete the nodes' power. In most cases, it is impossible to exchange or re-power batteries. Holter monitoring, loop recorders, and wireless capsule endoscopy are some of the WBAN's applications for saving and transferring medical data. Wireless capsule endoscopy is the application for image transmission in WBANs, and the image compression in common is a specific segment of capsule endoscopy. Since the better compression of images increases the frame rate and typically improves the diagnosis process, selecting the compression algorithm should be relevant. The considerable scope of this comprehensive study pays attention to the various biomedical data compression approaches in WBANs. This paper focuses on power-efficient schemes of remote healthcare networks. In this survey article, the energy-based biomedical data compression approaches of WBANs and remote healthcare networks are accurately classified based on lossy, lossless, and hybrid techniques; later, a comprehensive comparison of each specific method's power consumption is presented. [ABSTRACT FROM AUTHOR]

Although several devices are available for small bowel capsule endoscopy, few studies have compared their visualization quality and diagnostic yield, despite users reporting subjective differences between them. This study aims to compare two widely used systems (Mirocam® MC1600 and OMOM® HD). Patients who underwent OMOM® HD capsule enteroscopy between August 2022 and February 2023 were prospectively included consecutively (cases). Controls were retrospectively selected from a database of patients who underwent Mirocam® MC1600 enteroscopy between March 2018 and July 2022 in a 1:1 ratio. Controls were matched for potential confounders (age, sex, indication, hospitalization, comorbidities, and opioid prescription). The small bowel cleanliness (global and divided by tertiles), the diagnostic yield (positive findings) and the transit times (TT) were compared. Overall, 214 patients were included (107:107). Global bowel preparation was similar between the OMOM® and Mirocam® groups. However, the average scores for each tertile were significantly higher when the OMOM® HD capsule was used (p < 0.05). Small bowel TT was shorter for OMOM® HD (265 ± 118 versus 307 ± 87 min, p = 0.020), while the diagnostic yield (55.0%) and relative distribution of lesions were similar. This study suggests that capsule characteristics, namely resolution, and illumination, systematically interfere with the perception of preparation quality. However, this did not affect the diagnostic yield. [ABSTRACT FROM AUTHOR]

Since the emergence of artificial intelligence (AI) in medicine, endoscopy applications in gastroenterology have been at the forefront of innovations. The ever-increasing number of studies necessitates the need to organize and classify applications in a useful way. Separating AI capabilities by computer aided detection (CADe), diagnosis (CADx), and quality assessment (CADq) allows for a systematic evaluation of each application. CADe studies have shown promise in accurate detection of esophageal, gastric and colonic neoplasia as well as identifying sources of bleeding and Crohn's disease in the small bowel. While more advanced CADx applications employ optical biopsies to give further information to characterize neoplasia and grade inflammatory disease, diverse CADq applications ensure quality and increase the efficiency of procedures. Future applications show promise in advanced therapeutic modalities and integrated systems that provide multimodal capabilities. AI is set to revolutionize clinical decision making and performance of endoscopy. [ABSTRACT FROM AUTHOR]

Approximately 11% to 14% of subjects with neuroendocrine neoplasms (NENs) have metastatic lesions with unknown primary origin (UPO), with the majority of UPO-NENs found in the small bowel. Herein, we assessed the available literature on UPO-NENs, focusing on clinical presentation and diagnostic techniques to identify the primary site. The identification of the primary tumor is important as it affects the prognosis; however, the clinical presentation can be non-specific in non-functioning forms. In the presence of metastatic disease, the histological sample is fundamental to obtain immunohistochemical markers that might orientate the clinician in the search for the primary tumor through radiology, functional imaging and endoscopic techniques. In summary, multidisciplinary management plays a key role in UPO-NENs, even more than in other NENs. Molecular biology and gene-expression profiling represent areas of great interest which might be developed in the near future for both the diagnosis and the treatment of these neoplasms. [ABSTRACT FROM AUTHOR]

Objectives Small bowel capsule endoscopy (SBCE) technology detects small bowel lesions. Many factors affect its sensitivity. SBCE is also costly, and patients might not be able to repeat the test when results are equivocal. Instead of repeating the test, reading the results by two endoscopists might provide a better or a cheaper option in the right settings. We studied the sensitivity of SBCE when read by two different physicians and checked if, rather than repeating the examination, rereading the results improved its sensitivity. Furthermore, we studied the effect of small bowel transit time (SBTT) on the diagnostic yield. Materials and Methods A retrospective cohort study on capsule endoscopies was conducted between 2018 and 2019 in a tertiary care center in Lebanon. A total of 42 patients with anemia or obscure gastrointestinal bleed were included for SBCE after a negative evaluation with upper and lower gastrointestinal (GI) endoscopy. Two specialists read the results. The second physician was blinded from the first reader's results. We compared the sensitivity of the two readings. SBTT correlation with the diagnostic yield was calculated. Results Out of 42 patients, 18 tested positive in the first reading and 31 in the second reading. The diagnostic yield increased from 43 to 74% (p = 0.0043). Among the 33 patients who had a documented SBTT, longer SBTT correlated with a higher diagnostic yield (odds ratio [OR] > 1), but no statistical significance was demonstrated. Conclusion Within the limitations of this study, we found that rereading capsule endoscopy can be more cost-effective than repeating the test. [ABSTRACT FROM AUTHOR]

The role of video capsule endoscopy (VCE) in inflammatory bowel disease (IBD) has evolved from small bowel to a panenteric evaluation tool over the past two decades. We systematically reviewed the techniques, applications, outcomes, and complications of VCE in IBD. A systematic literature search was performed using PubMed, Embase, and Medline. All relevant original articles involving VCE in IBD were included from 2003 to July 2022. After screening 3,089 citations, finally 201 references were included. The diagnostic yield of VCE in suspected Crohn's disease (CD) was highly variable (6–80%) with excellent sensitivity (77–93%) and specificity (80–89%). The diagnostic yield in known CD was 52 to 88.3% leading to a change in management (26–75%) and disease reclassification with variable retention rates. VCE was superior to small bowel series, computed tomography (CT) and could be better than magnetic resonance enterography (MRE), especially for proximal and superficial lesions. Colon or panenteric VCE has strong correlation to ileo-colonoscopy (IC) and combined magnetic resonance imaging and IC, respectively. The VCE retention rate in CD is higher in known CD which significantly decreases after the negative patency capsule test or CT/MRE. VCE can identify lesions beyond the reach of IC in postoperative CD. Colon Capsule Endoscopy is a noninvasive monitoring tool in ulcerative colitis (UC) having a strong correlation with IC and may uncover small bowel involvement. VCE is specifically useful in IBD-unclassified (IBD-U) which can lead to the diagnosis of CD in 16.7 to 61.5%. Various scoring systems have been established and validated for small bowel CD (Lewis score and capsule endoscopy CD activity index—CECDAI), UC (capsule scoring of UC: Capsule Scoring of Ulcerative Colitis), panenteric evaluation (Capsule Endoscopy Crohn's Disease Activity Index, Elaikim score), and flare prediction (APEX score). Technological advances include double head, three-dimensional reconstruction, sampling system, panoramic view (344 and 360 degree lateral), and panenteric capsule. Artificial intelligence and software like TOP100 and Quickview can help reduce capsule reading time with excellent sensitivity and specificity. VCE in IBD has widespread application in suspected and known small bowel CD, monitoring of UC, postoperative CD, IBD-U, and for panenteric evaluation. Patency capsule testing helps to reduce retention rates significantly. Artificial intelligence and technical advances can help evolve this novel technology. [ABSTRACT FROM AUTHOR]

This study presents a pioneering curved antenna design that is seamlessly integrated into Wireless Capsule Endoscopy (WCE) devices. The proposed antenna features a miniature height of 25 mm, a radius of curvature of only 5.5 mm, and a conductive line width of up to 2 mm, making it an ideal fit for the use in compact WCE applications. The antenna is specifically designed to operate in the ISM5800 band and achieves outstanding performance metrics, such as an S11 of −10 dB and a gain of 5.8 dBi. To evaluate the safety of our design for human usage, we conducted an investigation of the specific absorption rate (SAR) of the Hugo Model antenna in various positions for ISM5800 and compared our findings to the safety limits specified by the Federal Communications Commission (FCC) standards. Our results confirm that the proposed antenna design meets the safety requirements for wireless communication systems in biomedical applications, thereby demonstrating its potential for clinical use. [ABSTRACT FROM AUTHOR]

Objectives: Exercise‐induced gastrointestinal syndrome occurs in dogs and people and might compromise athlete performance by increasing intestinal permeability and causing gastrointestinal erosions. Racing sled dogs often receive acid suppressant prophylaxis which decreases the incidence of gastric erosions induced by exercise. The objectives were to quantify intestinal injury by measuring serum pro‐inflammatory cytokine concentrations before and after exercise and to evaluate gastrointestinal mucosa using video capsule endoscopy after exercise. Materials and Methods: Prospective study of 12 racing Alaskan sled dogs receiving approximately 1 mg/kg omeprazole once daily from the day before the race until race completion. Blood was drawn before and 8 to 10 hours after an endurance race for the quantification of cytokines. Gastrointestinal tract mucosa was assessed with video capsule endoscopy immediately post‐race. Results: Eight of nine dogs (89%; 95% confidence interval 52 to 100%) had gastric erosions; all dogs (100%, 95% confidence interval 63 to 100%) had small intestinal erosions. Most of the dogs (seven of nine) had straw or foreign material present. Cytokine levels were not different from before to after the race. Clinical Significance: Video capsule endoscopy identified gastrointestinal tract mucosal erosions after exercise in all dogs receiving once‐daily omeprazole treatment, though other causes for the lesions besides exercise are possible. [ABSTRACT FROM AUTHOR]

Background and Aim: Endoscopy is important to determine the effectiveness of treatment for Crohn's disease (CD), but searching the entire small intestine is difficult. Thus, we investigated the usefulness of leucine‐rich alpha‐2 glycoprotein (LRG), a new biomarker for predicting mucosal activity, in evaluating the activity of CD small intestinal lesions. This will further determine whether the results of small bowel capsule endoscopy (SBCE) affect the prognosis of patients with CD. Methods: A total of 114 patients with CD who underwent SBCE were included. We analyzed the correlation between LRG and Capsule Endoscopy Crohn's Disease Activity Index (CECDAI). The cutoff value of LRG to achieve mucosal healing was calculated using the receiver operating characteristic curve. Then, we compared the presence or absence of intervention and the relapse rate of patients who could not achieve mucosal healing. Results: The CECDAI correlated with LRG. The calculated LRG value for achieving mucosal healing was ≤11.9. Ninety‐one patients were in clinical remission at the time of SBCE. During the follow‐up period, 17 patients relapsed. As a result of SBCE, when no treatment intervention was performed in the case of CECDAI ≥3.5, the relapse rate was significantly higher than when CECDAI <3.5 or intervention was performed in the case of CECDAI ≥3.5. Conclusions: The results reveal that LRG correlates with the activity of the entire small intestine and that SBCE assessment and therapeutic intervention can influence patient prognosis. [ABSTRACT FROM AUTHOR]