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Background: Iron deficiency anemia is the most common cause of anemia worldwide. The differential diagnosis of this entity remains one of the most encountered problems: from thalassemia, neoplasia, malabsorbtion syndrome to chronic kidney disease under hemodialysis. Case report: This case report describes clinical and paraclinical features of a 75-year-old patient with multiple comorbidities and iron deficiency anemia. We emphasize on the importance of endoscopic videocapsule examination for the accurate diagnosis of iron deficiency anemia when other methods fail (endoscopy and colonoscopy), thus revealing the source of bleeding in a small bowel benign polyp. Thus, tumors of the small intestine present as a unique challenging diagnosis. Conclusion: Endoscopic videocapsule, even if expensive, should remain an important tool in the diagnosis of iron deficiency anemia with normal upper GI endoscopy and colonoscopy. Small bowel tumors are seldom considered as a diagnostic hypothesis, but should not be overlooked, especially when alarm symptoms are present (weight loss, melena, hematochesia).

Background: Iron deficiency anemia is the most common cause of anemia worldwide. The differential diagnosis of this entity remains one of the most encountered problems: from thalassemia, neoplasia, malabsorbtion syndrome to chronic kidney disease under hemodialysis. Case report: This case report describes clinical and paraclinical features of a 75-year-old patient with multiple comorbidities and iron deficiency anemia. We emphasize on the importance of endoscopic videocapsule examination for the accurate diagnosis of iron deficiency anemia when other methods fail (endoscopy and colonoscopy), thus revealing the source of bleeding in a small bowel benign polyp. Thus, tumors of the small intestine present as a unique challenging diagnosis. Conclusion: Endoscopic videocapsule, even if expensive, should remain an important tool in the diagnosis of iron deficiency anemia with normal upper GI endoscopy and colonoscopy. Small bowel tumors are seldom considered as a diagnostic hypothesis, but should not be overlooked, especially when alarm symptoms are present (weight loss, melena, hematochesia). [ABSTRACT FROM AUTHOR]

In this work, bioengineering methods that can be used to quantitatively analyze videocapsule endoscopy images that have been acquired from celiac patients versus controls are described. For videocapsule endoscopic analysis, each patient swallows a capsule which contains an imaging device and light source. In celiac and control patients, images are acquired and analyzed at the level of the small intestine. The data used for videocapsule analysis consisted of high resolution images of dimension 576 × 576 pixels, acquired twice per second. The goal of the quantitative analysis is to detect abnormality in celiac patient images as compared with controls. Several types of abnormality can exist at the level of the small intestine in celiac patients. In untreated patients, and often even after treatment with a gluten-free diet, there can be villous atrophy, as well as presence of fissures and a mottled appearance. To detect and discern these abnormalities, several methods of statistical and structural feature extraction and selection are described. It was found that there is a significantly greater variation in image texture and average brightness level in celiac patients as compared with controls (p < 0.05). Celiac patients have a longer dominant period as compared with controls, averaging 6.4 ± 2.6 seconds versus 4.7 ± 1.6 seconds in controls (p = 0.001). This suggests that overall motility is slower in the celiac patients. Furthermore, the mean number of villous protrusions per image was found to be 402.2±15.0 in celiac patients versus 420.8±24.0 in control patients (p < 0.001). The average protrusion width was 14.66±1.04 pixels in celiacs versus 13.91±1.47 pixels in controls (p = 0.01). The mean protrusion height was 3.10±0.26 grayscale levels for celiacs versus 2.70±0.43 grayscale levels for controls (p < 0.001). Thus celiac patients tended to have fewer protrusions, and these were more varied in shape, tending to be blunted, as compared with controls, which more often had fine, uniform protrusions. A variety of computerized methods are now available to quantitate videocapsule images for comparison of celiac versus control patients. Since these methods are based on computer algorithms, they can be automated and there is no variation in the results due to observer bias. These methods readily lend themselves to automation, so that it may be possible to map the entire small intestine for presence of abnormality in real-time. It is also possible to develop an automated, quantitative clinical score which can be displayed with real-time update during the procedure. This would be useful to determine progress in celiac patients on a gluten-free diet, and to better understand the properties of the healing process in these patients. [ABSTRACT FROM AUTHOR]

Background: As measured from videocapsule endoscopy images, the small intestinal mucosa of untreated celiac patients has significantly greater and more varied texture compared to normal patients. Three-dimensional modeling using shape-from-shading principles may further increase classification accuracy. Methods: A sequence of 200 consecutive videocapsule images acquired at a 2s–1 frame rate and 576×576 pixel dimension, were obtained at four locations in the small intestinal lumen of ten patients with biopsy-proven celiac disease and ten control patients. Each two-dimensional image was converted to a three-dimensional architectural approximation by considering the 256 grayscale level to be linearly representative of image depth. From the resulting three-dimensional architecture, distinct luminal protrusions, representative of the macro-architecture, were automatically identified by computer algorithm. The range and number of protrusions per image, and their width and height, were determined for celiacs versus controls and tabulated as mean±SD. Results: The mean number of villous protrusions per image was 402.2±15.0 in celiacs versus 420.8±24.0 in controls (p <0.001). The average protrusion width was 14.7 pixels in celiacs versus 13.9 pixels in controls (p =0.01). The mean protrusion height was 3.10±2.34 grayscale levels for celiacs versus 2.70±0.43 grayscale levels for controls (p <0.001). Thus celiac patients had significantly fewer protrusions on the luminal surface of the small intestine as compared with controls, and these protrusions had greater dimensions, suggesting they are indicative of a mosaic (cobblestone) macro-architectural pattern which is common in celiacs. Conclusions: Shape-from-shading modeling is useful to explore luminal macro-architecture and to detect significant differences in luminal morphology in celiac versus normal patients, which can increase the usefulness of videocapsule studies. [ABSTRACT FROM AUTHOR]

Background & Aims: To further our understanding of capsule endoscopy (CE) in children, we systematically compiled data on indications and outcomes and evaluated the effectiveness of CE on patient management using meta-analyses. Methods: We searched the Medline and PubMed databases (January 2001–May 2010) for English language citations of use of CE in patients ≤18 years old. Duplicate reports and those that included 5 patients or fewer were removed. We analyzed data from 15 source documents with 740 CE procedures in 723 patients. Results: Suspicion or evaluation of inflammatory bowel diseases was the most common indication for CE (54%: 34% for patients suspected to have Crohn''s disease [CD], 16% for patients known to have CD, 1% for patients with ulcerative colitis, and 3% for patients with indeterminate colitis). Completion and retention rates were 86.2% (95% confidence interval [CI], 81.5–90.3) and 2.6% (95% CI, 1.5–4.0), respectively. Retention rates for children that underwent gastric (0.5%) or small bowel (1.9%) CE were similar to those of adults, by indication. For CE, 65.4% of procedures resulted in positive findings (95% CI, 54.8–75.2). Where reported, 69.4% of CE examinations (95% CI, 46.9–87.9) resulted in a new diagnosis and 68.3% (95% CI, 43.6–88.5) led to change in therapy. Conclusions: The relative frequency of CE indications varies among pediatric and adult patients. In pediatric patients, CE is used primarily to evaluate patients with CD — to aid in diagnosis, monitor disease severity, and assist patient management. Retention rates appear to be related to indication, rather than patient age; capsule retention is relatively infrequent for adults and children. [Copyright &y& Elsevier]

Copyright of Der Gastroenterologe is the property of Springer Nature and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Background: The degree of villous atrophy in celiac disease is difficult to assess at endoscopy. We sought to develop a quantitative technique for the evaluation of villous atrophy in endoscopic images.Method: In ten celiac patients as identified by standard endoscopy with biopsy, and ten control patients, standard and videocapsule endoscopic images of the duodenum were digitized. Subimages 7.5 × 7.5 mm(2) in area from random locations within each image were assessed by measuring the length of mucosal fissures per unit area (L), and correlating L with the histologic grade of villous atrophy as determined by modified Marsh criteria.Results: Mean L values for standard endoscopic images were 37.8, 43.3, 64.1, and 83.5 mm for Marsh grades II, IIIa, IIIb, and IIIc, respectively. Mean L values for videocapsule images were 49.1, 50.0, 64.7, and 72.4 mm for Marsh grades II, IIIa, IIIb, and IIIc, respectively. Significant differences in the means existed between celiac images (Marsh scores II-IIIc) versus controls (p < 0.001) for both endoscopic and videocapsule images. There were no significant differences between measurements obtained from endoscopic versus videocapsule images.Conclusions: Quantified image analysis correlates with the histologic grade of villous atrophy, is automated, and lacks observer bias, thus lending itself to standardization. [ABSTRACT FROM AUTHOR]

Abstract: Background: Small bowel endoscopy is critical in revealing an inflammatory bowel disease (IBD) previously undetected and in classifying the IBD patients, i.e. Crohn''s disease or ulcerative colitis. Methods: A prospective paediatric study on the usefulness of wireless capsule endoscopy (WCE) was performed in 117 children (age range: 4–17 years) with established or suspected IBD and compared with non endoscopic imaging tools. All patients underwent upper and lower gastrointestinal endoscopy. Results: In Crohn''s disease patients (CD, n =44), small bowel lesions were revealed by imaging tools in 8 and by WCE in 18 patients, respectively (p <0.01). No small bowel involvement was observed in 29 ulcerative colitis patients by both imaging tools and WCE. Of 26 unclassified IBD, small bowel lesions typical of Crohn''s disease were detected by imaging in 7 and by WCE in 16 (p <0.05). Of 18 patients with suspected IBD, small bowel lesions typical of Crohn''s disease were observed in 9 with WCE, vs. only in 4 with imaging (p <0.01). No cases of capsule retention occurred. Conclusions: WCE is valuable in revealing small bowel lesions in children with a previous diagnosis of CD and unexplained clinical and laboratory data. It is also helpful in unclassified IBD patients. This tool can influence the management and the course of IBD. [Copyright &y& Elsevier]

Abstract: Background: Although videocapsule endoscopy images are helpful in the evaluation of celiac disease, their interpretation is subjective. Quantitative disease markers could assist in determining the extent of villous atrophy and response to treatment. Method: Capsule endoscopy images were acquired from celiac patients with small bowel pathology (N =11) and from control patients (N =10). Image resolution was 576×576 pixels in dimension, 256 grayscale levels, and had a 2s−1 frame rate. Pixel brightness and image texture were measured over 10×10 pixel subimages and then averaged for 56×56 subimages per frame. Measurements were obtained at five locations from proximal to distal small intestine in each patient. At each location, measurements were calculated using 200 consecutive image frames (100s). Mean frame-to-frame pixel brightness, image texture, and periodicity in brightness, an estimate of wall motion or intestinal motility, were computed and used for classification with a nonlinear discriminant function. Results: From pooled data, celiac images had greater texture than did images from control patients (p <0.001) and exhibited more frame-to-frame brightness variation as well (p =0.032). The dominant period of brightness was longer in celiacs (p =0.001), possibly indicating decreased motility. Using the markers for three-dimensional nonlinear classification of celiacs versus controls, sensitivity was 92.7% and specificity was 93.5%. The relationship between dominant period and small intestinal transit time was approximately linear for both celiacs and controls (r 2 =0.42 and r 2 =0.55, respectively). Conclusions: Videocapsule images can be quantified to detect villous atrophy throughout the small intestine, and to distinguish individuals with celiac disease from individuals lacking mucosal atrophy. [ABSTRACT FROM AUTHOR]

Copyright of Colon & Rectum is the property of Lavoisier and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Copyright of Colon & Rectum is the property of Lavoisier and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Abstract: Introduction: Primary intestinal lymphangiectasia (Waldmann''s disease) lead to a protein-losing enteropathy due to lymph leak into intestinal tract. Exegesis: A 28-year-old woman presented a bilateral lower limb lymphedema. Laboratory examination showing lymphopenia, hypoalbuminemia, hypogammaglobulinemia suggested the diagnosis of primary intestinal lymphangiectasia. Gastroscopy was normal and second duodenum biopsies were negative. Videocapsule endoscopy gave evidence of intestinal lymphangiectasia of the small bowel. Conclusion: Videocapsule endoscopy may be proposed to confirm intestinal lymphangiectasia and to precise their localization when gastroscopy is not conclusive. [Copyright &y& Elsevier]

Background: Videocapsule endoscopy images are useful to detect pathologic alterations, including villous atrophy, in the small intestinal mucosa, which is helpful for diagnosing celiac disease. In prior work, quantitative videocapsule analysis was found useful to classify celiac versus control images. However, the effect of dark/extraneous substances on classification efficacy requires remediation., Method: For quantitative analysis, data from the Medtronic SB2 and SB3 systems were pooled. Videocapsule images of the distal duodenum/proximal jejunum were acquired from 13 celiac and 13 control patients. Dark regions, extraneous fluids, and air bubbles were mostly removed by utilizing color masking. Two different red-green-blue (RGB) color masks were constructed from 20 to 30 reference pixels obtained from mucosal and from extraneous regions. Each image pixel was accepted or rejected for subsequent analysis based on whether its distance was closest to a mucosal or to an extraneous reference in RGB space. Four images were then randomly selected from each videoclip for processing (52 images from each group). After masking, celiac versus control images were plotted in a three-space consisting of mean and standard deviation in pixel brightness, and surface area remaining after masking. A linear discriminant function was used for classification. The paradigm was repeated with a second random data set for validation., Results: Masking improved classification of celiac versus control images to nearly 80% accuracy as compared to 70-77% without masking. Celiac disease patients tended to have lesser mean pixel brightness and greater variability in brightness, in accord with prior work, and more masking was needed to remove extraneous features., Conclusions: Color masking is useful to remove dim/extraneous features from videocapsule images and it results in improved classification/assessment to distinguish celiac with villous atrophy from control videocapsule image. This can be helpful to detect and map regions of pathology, to screen for celiac disease, and to determine the efficacy of a gluten free diet., (Copyright © 2019 Elsevier Ltd. All rights reserved.)

Celiac disease is diagnosed in part by finding areas of pathology in the small bowel (SB) mucosa. This can often be difficult because the pathologic alterations, including atrophy of the small intestinal villi, can often be sparse and subtle. Some of the quantitative methods for detecting and measuring the presence of villous atrophy from videocapsule endoscopy (VCE) images are presented and discussed. These methods consist of static features of measurement including texture, gray level, and presence and abundance of fissures contained within each acquired image. The methods also consist of dynamic measurements including spectral analysis, and determining motion from a sequence of endoscopic images as obtained from a VCE clip. Thus far, several methods have been found useful to characterize the SB mucosa of untreated celiac disease patients versus control patients lacking villous atrophy, which have revealed significant differences in texture, frequency, and motion on analysis of VCE. In untreated celiac patients undergoing endoscopy, there tends to be greater magnitude of changes and spatial differences in textural descriptors, longer periodic components, indicating slower periodic activity, and differences in feature location, suggesting alterations in motility at areas of pathology as compared to patients without villous atrophy. Improvements in the quantitative analysis of VCE imaging in celiac patients is important to detect pathology in suspected patients, so that biopsies can be obtained from pertinent regions of the small intestinal mucosa. Improvements are also necessary so that patients with celiac disease can be monitored to evaluate the progress of mucosal healing after onset of treatment., Competing Interests: Conflicts of Interest: The authors have no conflicts of interest to declare.

Background: Videocapsule endoscopy is a relative new method to analyze the gastrointestinal tract for the presence of pathologic features. It is of relevance to detect villous atrophy in the small bowel, which is a defining symptom of celiac disease., Method: In this tutorial, methods to extract and process videocapsule endoscopy data are elucidated. The algorithms, computer code, and paradigms to analyze image series are described in detail. The topics covered include extraction of data, analysis of texture, eigenanalysis, spectral analysis, three-dimensional projection, and estimation of motility. The basic paradigms to implement these processes are provided., Results: Examples of successful quantitative analysis implementations for selected untreated celiac disease patients with villous atrophy versus control patients with normal villi were illustrated. Based on the implementations, it was evident that celiac patients tended to have a rougher small intestinal texture as compared with control patients. From three-dimensional projection, celiac patients exhibited larger surface protrusions emanating from the small intestinal mucosa, which may represent clumps of atrophied villi. The periodicity of small intestinal contractions tends to be slower when villous atrophy is present, and the estimated degree of motility is reduced as compared with control image series. Basis image construction suggested that fissuring and mottling of the mucosal surface is predominant in untreated celiac patients, and mostly absent in controls., Conclusions: Implementation of computerized methods, as described in this tutorial, will likely be useful for the automated detection and measurement of villous atrophy, and to map its extent along the small intestine of celiac patients., (Copyright © 2016 Elsevier Ltd. All rights reserved.)