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Video capsule endoscopy has an essential role in the diagnosis and management of small bowel bleeding and is the first-line study recommended for this purpose. This article reviews the risk factors for small bowel bleeding, optimal timing for video capsule endoscopy testing, and algorithms recommended for evaluation. Used primarily for the assessment of nonacute gastrointestinal blood loss, video capsule endoscopy has an emerging role for more urgent use in emergency settings and in special populations. Future software incorporation of neural networks to enhance lesion detection will likely result in an augmented role of video capsule endoscopy in small bowel bleeding.

The cause of small intestinal bleeding (SIB) may be elusive despite exhaustive testing. This article describes the current understanding of SIB regarding evaluation, with emphasis on the use of video capsule endoscopy (VCE) as a diagnostic procedure. This article addresses the utility of provocative testing in challenging cases and the performance of endoscopic procedures on active antithrombotic therapy. Specific recommendations accompany this article, including use of antithrombotic agents to stimulate bleeding when clearly indicated; performance of endoscopic procedures on active antithrombotic therapy; and progressive adoption of VCE and device-assisted enteroscopy in the inpatient setting.

Background and Aims Capsule endoscopy (CE) is an important modality for Crohn's disease (CD) diagnosis and follow-up. Endoscopic severity of ulcers is of much significance for prediction of CD course. Deep learning has been proven accurate in detecting ulcers on CE. However, endoscopic classification of ulcers by deep learning has not been attempted. The aim of our study was to develop a deep learning algorithm for the automated grading of CD ulcers on CE. Methods We retrospectively collected CE images of CD ulcers from our CE database. In experiment 1, each ulcer severity was graded by 2 capsule readers based on PillCam CD classification (grade 1-3 from mild to severe), and the inter-reader variability was evaluated. In experiment 2, a consensus reading by 3 capsule readers was used to train an ordinal convolutional neural network (CNN) to automatically grade images of ulcers, and the resulting algorithm was tested against consensus reading. A pretraining stage included training the network on images of normal mucosa and ulcerated mucosa. Results Overall, our dataset included 17,640 CE images from 49 patients; 7391 images with mucosal ulcers and 10,249 normal images. A total of 2598 randomly picked pathological images were further graded from 1 to 3 according to the ulcer severity in the 2 different experiments. In experiment 1, the overall inter-reader agreement occurred in 31% of the images (345/1108). When, and for distinction of grade 1 and 3 - 76% (752/989). In experiment 2, the algorithm was trained on 1242 images. It achieved an overall agreement to consensus reading of 67% (166/248), and 91% (158/173) for distinction of grade 1 and 3. When testing for classification accuracy, the algorithm performance was 0.91 (95% CI, 0.867 - 0.954) for grade 1 versus grade 3 ulcers, 0.78 (95% CI, 0.716-0.844) for 2 versus 3 and 0.624 (95% CI, 0.547-0.701) for 1 versus 2. Conclusions CNN achieved high accuracy in detection of severe CD ulcerations. CNN-assisted CE reading in CD patients can potentially facilitate and improve diagnosis and monitoring these patients.

Background To assess the cost and patient impact of using small bowel and colon video capsule endoscopy (SBC) for scheduled monitoring of Crohn’s disease (CD). Methods An individual-patient, decision-analytic model of the CD care pathway was developed given current practice and expert input. A literature review informed clinical endpoints with data from peer-reviewed literature. Four thousand simulated CD patients were extrapolated from summary patient data from the Project Sonar Database. Two monitoring scenarios were assessed in this population. The first scenario represented common monitoring practice (CMP) for CD (ileocolonoscopy plus imaging), while in the second scenario patients were converted to disease monitoring using SBC. The cost-effectiveness of using SBC was assessed over 20 years. The cost of switching 50% of patients to SBC was assessed over 5 years for a health-plan including 12,000 patients with CD. Uncertainty of results was assessed using probabilistic sensitivity analysis. Results All patient groups showed increased quality of life with SBC versus CMP, with the highest gain in active symptomatic patients. Over 20 years, SBC reduced costs ($313,367 versus $320,015), increased life expectancy (18.15 versus 17.9 years) and increased quality of life (8.7 versus 8.0 QALY), making it a cost-effective option. SBC was cost-effective in 71% of individuals and 78% of populations including 50 patients. A payer implementing SBC in 50% of patients over 5 years could expect a decreased cost of monitoring (–$469 mean per patient) and surgery (–$698), but increased costs for active treatments (+$717). The discounted mean annual cost of care using CMP was $22,681 per patient over 5 years. The annual savings were $1135 per SBC-patient. The total savings for the payer over 5 years were $36.5 million. Conclusion SBC is likely to be a cost-effective and cost-saving strategy for monitoring CD in the US.

The Video Capsule Diagnostic Imaging is a technique for exploring the digestive tract, particularly the small bowel. It is indicated for any unexplained digestive bleeding or as a means of monitoring intestinal polyposis or inflammatory diseases. This videocapsule is not digestible, and the risk of its retention, symptomatic or not, is not negligible following an inflammatory, anastomatous or tumoral stenosis. This retention or blockage is defined by the presence of the Video Capsule in the digestive tract at least two weeks after ingestion. Surgical approach is considered effective to retrieve the retained capsule, treat the pathology responsible and prevent acute complications. We report the case of retention of a video capsule in a young patient with severe anaemia due to inflammatory polyposis of the small bowl, whose removal required surgery to extract the capsule and resect the segment of the small intestine stenosis by the polyps., Highlights • The video Capsule Endoscopy is the most sensitive examination for the detection of inflammatory lesions of the small bowel. • It does not currently allow a biopsy but it is indicated for unexplained or occult digestive bleeding. • Its main limitation is the risk of blockage in a stenosis with or without occlusion. • Surgical approach is considered effective to retrieve the retained capsule, and treat the pathology responsible.

The endoscopic video capsule (EVC), a minimally invasive method of study of the gastrointestinal system indicated in occult gastrointestinal bleeding, has as main complication the retention of endoscopic capsule (CR), currently it is managed with direct extraction using double-balloon enteroscopy; however, when it fails due to its location or associated pathologies, the surgical intervention results in the most successful approach.To evaluate clinical characteristics and management of patients with video capsule endoscopy retention.From January 2001 to December 2018, a retrospective search was carried out in three centers, of patients with CR diagnosis, clinical variables and approach were evaluated, in addition to a critical review of the literature.15 patients with a diagnosis of CR (eight 8 women and seven men), average age 65 (range: 45-77). Seven required surgical management, three endoscopic and five medical management.The CR is a new pathology of low prevalence, the surgical management resulting from a second therapeutic line when the removal of the VCE has not been possible endoscopically, this pathology requires special attention in the patient's medical history and symptoms for diagnosis and management.La videocápsula endoscópica (VCE), método mínimamente invasivo de estudio del sistema gastrointestinal indicado en hemorragia digestiva oculta, tiene como principal complicación la retención de la cápsula endoscópica (RCE). Actualmente se maneja con extracción directa empleando enteroscopia de doble balón; sin embargo, cuando falla por su localización o por patologías asociadas, la intervención quirúrgica resulta el método de mayor éxito.Evaluar las características clínicas y el manejo de pacientes con RCE.De enero de 2001 a diciembre de 2018 se realizó un búsqueda retrospectiva, en tres centros, de pacientes con diagnóstico de RCE. Se evaluaron variables clínicas y de manejo, y además se realizó una revisión crítica de la literatura.Se hallaron 15 pacientes con diagnóstico de RCE (ocho mujeres y siete hombres), con una edad promedio de 65 años (rango: 45-77). Siete requirieron manejo quirúrgico, tres manejo endoscópico y cinco manejo médico.La RCE es una patología nueva de baja prevalencia. El manejo quirúrgico resulta ser una segunda línea terapéutica cuando la extracción de la VCE no ha sido posible endoscópicamente. Para su diagnóstico y manejo, esta patología requiere una especial atención a la historia clínica, los antecedentes y los síntomas de los pacientes.

Wireless capsule endoscope (WCE) is a notable invention introduced in the biomedical industry. It involves swallowing a small disposable video capsule that takes photographic images as it passes through the gastrointestinal (GI) tract. WCE allows physicians to visualize and diagnose disorders covering the full length of the GI tract. Although WCE can provide useful images of the internal GI tract, the identification of the exact location of the detected disease remains unclear. Location information is very crucial for the subsequent treatment of the detected disease either through surgery or through local drug delivery. The huge potential of WCE in future endoscopic practice relies on the successful tracking of the wireless capsule. This paper presents a comprehensive systematic review on the recent developments in WCE localization techniques that have been reported in credible sources, namely, IEEE Xplore, PubMed, Scopus, Science Direct, Springer Link, and Google Scholar. Detailed analysis and systematic comparison are provided to highlight the achievement and future direction of WCE localization. This paper can be a valuable source of reference and guidance for future research in this field.

Introducción y objetivos: La enteroscopia de doble balón es un método endoscópico recientemente introducido que permite la completa visualización, toma de biopsias e instauración de medidas terapéuticas del intestino delgado. Mediante este estudio, se busca describir la experiencia adquirida en nuestra institución con el fin de determinar las características de los pacientes que fueron llevados a esta intervención.Materiales y métodos: Se realizó un estudio descriptivo de corte transversal donde se incluyeron todos los pacientes mayores de 18 ̃años que ingresaron al Hospital Universitario de la Fundación Santa Fe de Bogotá para la realización de enteroscopia de doble balón desde el 01 de enero de 2013 hasta el 31 de diciembre de 2017.Resultados: La muestra recolectada fue de 93 procedimientos en 73 pacientes, la media de edad fue de 57.91 a ̃nos, la proporción de varones y mujeres fue muy similar, y no se presentaron complicaciones graves. Con respecto a la indicación para la realización de la enteroscopia, la más frecuente fue el sangrado digestivo (manifiesto y oculto) en el 49.46% seguida por la diarrea crónica en el 16.13%. La videocápsula endoscópica fue el estudio previo más frecuente (53.76%).Cuarenta y nueve procedimientos fueron realizados por vía anterógrada y 44 fueron realizados por vía retrógrada. El 86.02% de las enteroscopias fueron realizadas con fines diagnósticos y el 13.98% con fines terapéuticos. La enteroscopia normal fue el hallazgo más frecuente (59.68%),seguido por la presencia de úlceras (15.05%).Conclusiones: Nuestros resultados son similares a los mundiales con respecto a las indicaciones,vía de inserción y profundidad, sin presentarse complicaciones graves Introduction and aims: Double-balloon enteroscopy is a recently introduced endoscopic methodthat enables complete visualization of the small bowel, as well as biopsy sampling and thera-peutic interventions in that part of the intestine. The aim of the present study was to describethe experience acquired at our hospital to determine the characteristics of the patients thatunderwent the procedure.Materials and methods:A descriptive, cross-sectional study was conducted on all patientsabove 18 years of age admitted to the Hospital Universitario de la Fundación Santa Fe deBogotá for double-balloon enteroscopy, within the time frame of January 2013 to December2017.Results: The study sample included 93 procedures in 73 patients. Mean patient age was 57.91years, with a similar number of men and women. There were no severe complications. Themost frequent indication for the enteroscopy was gastrointestinal bleeding (overt or occult),presenting in 49.46% of the patients, followed by chronic diarrhea (16.13%). Video capsuleendoscopy was the previous study most frequently performed (53.76%). Anterograde double-balloon enteroscopy was carried out in 49 patients and 44 patients underwent the retrogradeprocedure. A total of 86.02% of the enteroscopies were diagnostic procedures and 13.98% were therapeutic. Normal enteroscopy was the most frequent finding (59.68%), followed bythe presence of ulcers (15.05%). Conclusions: Our results were similar to those reported worldwide, with respect to indications,insertion route, and insertion depth, and there were no severe complications.

The wireless capsule endoscope system allows clinicians to directly observe the image of the inner wall of the human gastrointestinal tract and obtain the most intuitive information at the lesion. Compared with traditional endoscopic detection technology, its painless, non-invasive, safe and convenient, full gastrointestinal detection features make this technology a research focus in the field of medical devices at home and abroad. As a new non-invasive detection technology for gastrointestinal diseases, the working time, image frame rate and image quality of the existing wireless capsule endoscope system cannot fully meet the needs in clinical applications. The cause of these problems lies in the capsule. The internal space of the speculum is limited, and only the button battery can be used as the energy source. Therefore, it is necessary to design a video capsule endoscope based on wireless energy transmission technology. This article is a review of Zhu Zhanquan, Xue Kaifeng, Lu Ruiqi and other scholars.

Video capsule endoscopy became a reality in 2001. This device enabled us to directly view the mucosa of the small intestine for the first time. The main indications for the video capsule remain the detection of small intestinal bleeding and iron deficiency anemia, diagnosis and management of Crohn's disease, and detection of tumors. The device is extraordinarily safe and can be used in the very young to the very old. However, there remain several areas of controversy and difficulty. These are covered in this article and include details of indications and contraindications, whether to prepare patients, whether or not to use simethicone and prokinetics. Detection of location of the capsule remains a major engineering challenge. Reading the videos reliably and quickly remains challenging. However, artificial intelligence and machine learning are already on the horizon to provide assistance. New uses for capsule endoscopy promise more accurate diagnosis and hence improved management of acute gastrointestinal bleeding. The colon capsule may eventually help those who refuse conventional colonoscopy, and robotically controlled capsules may be helpful in screening for serious disease in patients with upper abdominal complaints. The advent of the broadening use of video capsule endoscopy is, though it will be controversial, embraced by some and derided by others; such is the nature of technological development. In the long run, if the use of the video capsule, based on sound evidence-based studies, can be shown to improve the care of our patients and reduce the cost of health care, its use will continue to expand.

The Moroccan education system has undergone several reforms, the latest reform aimed at improving the qualifying training of future teachers by integrating the basis of the teaching profession professionalization; which requires the development of professional competencies. In fact, the future teacher must learn to take a critical look at his classroom practices, to describe his professional gestures and to analyze his teaching practices in order to assess their efficiency. However we can ask the following question: is the future teacher trained in such a way able to question his classroom practices constantly? To answer this question, we developed an analysis grid of teaching practices, which was addressed to primary school trainees, within the city's Regional Center of Education and Training Professions of Fez in Morocco, in order to analyze the teaching practices of a future teacher in full action by peers, this analysis is made based on viewing a video capsule. The processing of the data collected from the grid revealed that the majority of these future teachers have not been able to acquire the capacity to analyze these teaching practices in an efficient manner. The use of the analytical grid has been of crucial importance in determining the profile of future teachers capable of competently exercising their teaching profession.

We describe 2 cases in which video capsule endoscopy was performed remotely using TeleInGEstion Remote Video Capsule Endoscopy (TIGER VCE), given limited access to endoscopy during the COVID-19 pandemic. The patients ingested the CapsoCam capsule during a televisit, and the video was subsequently reviewed remotely by the physician. TIGER VCE was used to diagnose a benign etiology of melena and used to confirm a diagnosis of Crohn's disease before the initiation of biologic therapy. These cases demonstrate the safety and efficacy of TIGER VCE. We feel that this technique may be considered as a standard ingestion technique in the future.

Small bowel (SB) capsule endoscopy (CE) studies provide data on both gastric and SB transit times (GTT and SBTT, respectively).This study aimed to evaluate the influence of demographic and clinical parameters on the GTT and SBTT. Transit times for two generations of capsules (Pillcam SB2 and SB3) were also compared.Consecutive adult patients undergoing CE were included. GTT, SBTT, and cecum arrival rates were calculated and correlated to demographics and clinical characteristics.A total of 332 CE studies were analyzed. Neither GTT nor SBTT were impacted by age or sex. SBTT was prolonged in newly diagnosed Crohn's disease (CD) patients compared with all other patients (303.1±90.3 vs. 243.6±83.6 min, P=0.02 for SB2, 267.8±63 vs. 228.6±72.3, P=0.01 for SB3, respectively). Moreover, CD patients had higher incomplete study rates compared with patients with all other diagnoses (29.4 vs. 7.3%, respectively, P=0.0116) in the SB2 subgroup. Higher cecum arrival rates were achieved by the SB3 capsule compared with SB2 (97 vs. 91%, P=0.04). Patients with prolonged gastric time or patients with incomplete studies had similar demographic and clinical characteristics as others.Age and sex apparently do not influence intestinal kinetics. Newly diagnosed CD patients have relatively prolonged SBTTs. Demographic and clinical parameters cannot predict prolonged GTT or cecum nonarrival.

AIM To quantify the presence of villous atrophy in endoscopic images for improved automation. METHODS There are two main categories of quantitative descriptors helpful to detect villous atrophy: (1) Statistical and (2) Syntactic. Statistical descriptors measure the small intestinal substrate in endoscope-acquired images based on mathematical methods. Texture is the most commonly used statistical descriptor to quantify villous atrophy. Syntactic descriptors comprise a syntax, or set of rules, for analyzing and parsing the substrate into a set of objects with boundaries. The syntax is designed to identify and distinguish three-dimensional structures based on their shape. RESULTS The variance texture statistical descriptor is useful to describe the average variability in image gray level representing villous atrophy, but does not determine the range in variability and the spatial relationships between regions. Improved textural descriptors will incorporate these factors, so that areas with variability gradients and regions that are orientation dependent can be distinguished. The protrusion syntactic descriptor is useful to detect three-dimensional architectural components, but is limited to identifying objects of a certain shape. Improvement in this descriptor will require incorporating flexibility to the prototypical template, so that protrusions of any shape can be detected, measured, and distinguished. CONCLUSION Improved quantitative descriptors of villous atrophy are being developed, which will be useful in detecting subtle, varying patterns of villous atrophy in the small intestinal mucosa of suspected and known celiac disease patients.

Video capsule endoscopy is now the first-line tool in evaluating and diagnosing obscure gastrointestinal bleeding, inflammatory bowel disease, and small bowel neoplasms. Capsule retention is an uncommon but clinically significant complication. How to best retrieve these retained capsules is currently being debated. In this case report, we describe a retained capsule successfully retrieved using double-balloon enteroscopy. This case also highlights the fact that capsule retention can occur even in the absence of signs and symptoms suggestive of intestinal obstruction.

Whether the etiology of potential small-bowel bleeding depends on the age and gender of the patient is not yet fully understood.A total of 1953 patients who underwent video capsule endoscopy (VCE) to evaluate potential small-bowel bleeding and were registered in the Capsule Endoscopy Nationwide Database Registry from 2003 to 2014 were eligible for this study. VCE findings and the etiology of small-bowel bleeding were analyzed by age and gender.The diagnostic yield of VCE was 48.4% (95% CI: 46.2%-50.6%) and the diagnosis rate of etiology of potential small-bowel bleeding was 61.4% (95% CI: 59.2%-63.6%). The etiology of potential small-bowel bleeding depends on the age and gender of the patient. Crohn's disease and small-bowel diverticular diseases were more prevalent etiology of potential small-bowel bleeding in the young adults group ( 40 years) whereas angiodysplasia was revealed to be a most common etiology in elderly group (≥ 60 years), reaching statistical significance (The etiology of potential small-bowel bleeding depends on the age of the patient. Thus, an individualized lesion-specific diagnostic approach based on age might be needed for patients with potential small-bowel bleeding.

Video capsule endoscopy (VCE) is a reliable noninvasive method for examination of small-bowel mucosa. However, it has some limitations. The aim of this article was to review the approach in patients with negative VCE. It is clear that a negative VCE should be interpreted based on the indication. In suspected small bowel bleeding (SSBB), patients with ongoing/recurrent overt bleeding, or occult bleeders who experience significant declines in hemoglobin after a negative VCE should proceed small bowel study; on the other hand, patients with occult SSBB and only mild-moderate anemia should be managed with supportive care. In inflammatory bowel disease, a normal VCE has a very high sensitivity and negative predictive value. In small bowel tumor suspicion there is a high risk of false negative results, so another imaging modality should be considered. In polyposis syndromes, if VCE is negative, patients should continue screening within 2-3 years.

This review presents current data on the potential of enteroscopy — a new dynamically developing method of diagnosing jejunal diseases. Currently, two complementary methods of enteroscopy are being used — video capsule endoscopy and balloon enteroscopy. The article presents a discussion of optical systems for enteroscopy, indications for and advantages and disadvantages of methods of enteroscopy. Video capsule endoscopy is intended for initial visual assessment of jejunal mucosal condition. Depending on the position of the viewing system within the capsule, specialists distinguish between frontal and lateral systems. Balloon enteroscopy complements trials in terms of microsurgical aspects (biopsy sampling, elimination of polyps, extraction of foreign bodies, including the video capsule if it gets trapped in the stenotic portion of the intestinal lumen).