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Resumen En pacientes sin una causa clara de sangrado gastrointestinal luego de una endoscopia digestiva alta y baja, la causa se encontrará en el intestino delgado hasta en el 77 % de los casos. Ante el excelente rendimiento diagnóstico de la videocápsula endoscópica (VCE) para el estudio de este segmento del tracto gastrointestinal, surge la duda de si debería ser el método diagnóstico inicial de este grupo de pacientes con posible sangrado del intestino delgado (PSID) o si la realización de una nueva endoscopia alta y baja o algún método alternativo de estudio del intestino delgado debería serlo. En esta revisión se evalúa y evidencia el rendimiento diagnóstico superior y la mayor seguridad de la VCE como abordaje inicial de pacientes con PSID en relación con otros métodos. Sin embargo, se pone en tela de juicio la mejor costo-efectividad de este abordaje en nuestro medio, que en otros ha sido claramente demostrada. Abstract When neither upper nor lower gastrointestinal endoscopy can find a clear cause of gastrointestinal bleeding, it will eventually be found in the small intestine in up to 77% of cases. Given the excellent diagnostic performance of video capsule endoscopy for studying this segment of the gastrointestinal tract, the question of whether it should become the initial diagnostic method for patients with possible bleeding from the small intestine arises. The alternatives are to perform additional upper and lower endoscopic procedures or to use some alternative method of studying the small intestine. This review documents and evaluates the superior diagnostic performance and greater safety of videocapsule endoscopy as the initial approach for possible bleeding from the small intestine and compares it with other methods. However, the cost-effectiveness of this approach, clearly demonstrated elsewhere, is questioned in our setting.

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.

AIM to show on the results of our study the influence of the quality of preparationfor videocapsule endoscopy (VCE) on the accuracy of diagnosis of diseases of the small and large intestine. MATERIALS AND METHOD. During the period from September 2014 to December 2016, a videocapsule study was performed on 100 patients of treatment at the State Scientific Center of Coloproctology. Final data processing was carried out based on the results of a survey of 96 patients (52 men and 44 women aged 18 to 78 years). To adequately prepare patients for the study, we used a specific scheme with the use of a «splitdose» of intestinal cleansers based on polyethylene glycol and stimulation solutions. The quality of preparation of the small and / or large intestine for the study was assessed according to the scale of Leighton J.A., Rex D.K. RESULTS. The completeness of the study and the full examination (the ability to visualize all the sections of the small and / or large intestine) are important criteria for conducting the VCE. In our study, a complete study of the small and large intestine was performed in 87 (91 %)patients, and a full study was performed in 86 (90 %) of 96 patients. In the study of the small and large intestine using small intestine or large intestinal videocapsules, in 87 (91 %) patients the intestinal preparation was rated «good» or «excellent». CONCLUSION. The experience of our study showed that in order to obtain reliable and informative results, careful follow-up of the methodology of preparation for the study should be done.

Background The most feared complication of videocapsule endoscopy (VCE) is retention in the intestine. It is estimated to occur in 1.4% of cases but the risk factors are not well known. Aims To determine the prevalence of VCE retention at a tertiary care centre as well the associated risk factors. Methods Retrospective study between 2016 and 2019. All patients at a tertiary care centre undergoing VCE were recruited. The patients with an incomplete endoscopy report or who were unable to complete VCE were excluded. Clinical and endoscopic information was compiled from patients’ medical charts as well as the indications and results of the endoscopic procedure. VCE retention, evaluated by radiography or CT scan, was defined as persistence of the videocapsule in the gastrointestinal tract for ≥14 days or the need for an intervention for removal. Results In total, 126 patients underwent VCE (average age: 66±16, 52% female). There was 6% of patients with Crohn’s disease, and 40% of patients had a previous abdominal surgery. The indications for endoscopy were: iron deficient anemia (48%), gastrointestinal bleeding (32%), suspicion/follow up of IBD (10%), and other (11%). The VCE findings (n=146) were: angiodysplasia (30%), inflammation (30%), normal (20%), polyp (5%), and other (15%). 77% of results were not previously found by conventional endoscopy or imaging. The prevalence of VCE retention was 1.6%. The patient risk factors for retention were Crohn’s disease (OR 19.67; 95CI 1.09–354.11; p Conclusions VCE retention remains a rare complication. There is increased risk of retention in patients with known Crohn’s disease or recent use of corticosteroids. Funding Agencies None

Background Videocapsule endoscopy (VCE) and double-balloon enteroscopy (DBE) are two endoscopic exams that permit the investigation of the small intestinal mucosa. There exists few studies that compare the diagnostic performance and results between these two diagnostic modalities. Aims To compare the diagnostic performance between VCE and DBE. Methods Retrospective study between 2016 and 2019. All patients at a tertiary care centre undergoing both VCE and DBE were recruited. Clinical and endoscopic information was compiled from patients’ medical charts as well as the indications and results of the two endoscopic exams. The patients with an incomplete endoscopy report or who were unable to complete both VCE and DBE were excluded. The results of both VCE and DBE were compared using univariate analysis. Results In total, 126 patients underwent VCE. Of those patients, 15 further underwent DBE (average age: 69±17, 53% female). In total, 11 patients underwent upper DBE, 3 patients underwent lower DBE, and one patient underwent both upper and lower DBE. The indications for endoscopy were: gastrointestinal bleeding (47%), iron deficient anemia (40%), and other (13%). The VCE findings were: angiodysplasia (35%), inflammation (35%), polyp/neoplasia (20%), and other (10%). The DBE findings were: angiodysplasia (41%), normal (35%), polyp/neoplasia (12%), stenosis (6%) and other (6%). In 53% of cases there was at least one finding concordant between VCE and DBE. In only 20% of cases, DBE found a new lesion that was not seen by VCE. In comparison, 33% of DBE exams were normal despite a positive findings by VCE. The discordance between exams was possibly due to the delay between both exams (average 125 days). Conclusions In over half of cases, there is at least one lesion consistent between both endoscopic modalities. DBE finds a new lesion that was not seen by VCE in only 20% of cases. Therefore, VCE should be the first choice in the investigation of the small intestine mucosa even though both exams seem to be complementary. Funding Agencies None

Background. Celiac disease is one of the most common diseases in the world. Capsule endoscopy is an alternative way to visualize the entire small intestine without invasiveness to the patient. It is useful to characterize celiac disease, but hours are need to manually analyze the retrospective data of a single patient. Computer-aided quantitative analysis by a deep learning method helps in alleviating the workload during analysis of the retrospective videos. Method. Capsule endoscopy clips from 6 celiac disease patients and 5 controls were preprocessed for training. The frames with a large field of opaque extraluminal fluid or air bubbles were removed automatically by using a pre-selection algorithm. Then the frames were cropped and the intensity was corrected prior to frame rotation in the proposed new method. The GoogLeNet is trained with these frames. Then, the clips of capsule endoscopy from 5 additional celiac disease patients and 5 additional control patients are used for testing. The trained GoogLeNet was able to distinguish the frames from capsule endoscopy clips of celiac disease patients vs controls. Quantitative measurement with evaluation of the confidence was developed to assess the severity level of pathology in the subjects. Results. Relying on the evaluation confidence, the GoogLeNet achieved 100% sensitivity and specificity for the testing set. The t-test confirmed the evaluation confidence is significant to distinguish celiac disease patients from controls. Furthermore, it is found that the evaluation confidence may also relate to the severity level of small bowel mucosal lesions. Conclusions. A deep convolutional neural network was established for quantitative measurement of the existence and degree of pathology throughout the small intestine, which may improve computer-aided clinical techniques to assess mucosal atrophy and other etiologies in real-time with videocapsule endoscopy.

Background & Aims. Considering the ability of anti-TNF alpha drugs to lower the burden intestinal inflammation in patients with inflammatory bowel disease (IBD), and the similarity between IBD and ankylosing spondylitis (AS) regarding inflammatory intestinal involvement, we aimed to investigate the impact of anti-TNF alpha biologic therapy on subclinical intestinal inflammation in AS patients. Methods. Between January 2008 and December 2013, 38 AS patients and 23 controls were enrolled in the study and investigated with small bowel videocapsule endoscopy examination and ileocolonoscopy. Each tertile of the small bowel (proximal, mid and distal) was assessed by calculating the Lewis score based on the image stream. Results. The Lewis scores were significantly higher in the AS group compared to controls (580.9 ± 818 vs. 81 ± 121, pvs. 790 ± 1038, p = 0.015), its proximal and distal tertiles (238 ± 154 vs. 560 ± 543, p = 0.021, and 140 ± 189 vs. 300 ± 220, p = 0.027, respectively). The Lewis score was also lower in patients receiving Adalimumab/Infliximab compared to those on Etanercept for the entire bowel and its distal tertile (262 ± 165 vs. 380 ± 148, p = 0.069 and 62 ± 101 vs. 273 ± 236, p = 0.060, respectively). Conclusion. Anti-TNF alpha therapy in patients with AS reduces the subclinical intestinal inflammation, but the magnitude seems to depend upon the class anti-TNF alpha agent used (Clinical Trials. gov NCT00768950).

Background: videocapsule endoscopy (VCE) is currently the most sensitive diagnostic tool to detect early small bowel inflammation. A Lewis score (LS) of ≥ 135 as the cutoff value for the presence of significant inflammatory activity in patients undergoing VCE for suspected Crohn’s disease (CD) has been suggested as a useful tool for the diagnosis of CD. The aim of this study was to evaluate the diagnostic and prognostic accuracy of the LS in patients with suspected CD undergoing VCE. Methods: a retrospective single-center study was performed that included patients who underwent VCE for suspected CD between January 2010 and December 2015. Inflammatory activity was assessed with the LS. Patients were grouped according to the criteria of the International Conference on Capsule Endoscopy (ICCE) for the definition of suspected CD; group 1: patients not fulfilling ICCE and group 2: patients with ≥ 2 ICCE criteria. Results: one hundred and ninety-one patients were included, 61% were female and the mean age was 39 ± 14 years. VCE detected significant inflammatory activity (LS ≥ 135) in 81 patients (42%); 24 patients from group 1 (32%) and 57 patients from group 2 (50%) (p = 0.014). During a mean follow-up period of 41 ± 21 months (12-79), a CD diagnosis was determined in 60 patients (31%); 55 patients with LS ≥ 135 (92%) and five patients with LS < 135 (5%) (p < 0.001). The LS showed a good diagnostic accuracy with an AUROC of 0.93 (p < 0.001). During the first year after diagnosis, there was a significant association between a higher LS and the need for immunomodulatory therapy, biological therapy, bowel resection surgery or hospital admission due to a CD flare-up. Conclusions: the LS (cutoff ≥ 135) is very useful in the diagnosis of CD in patients undergoing VCE. Moreover, higher values of this score was associated with prognostic variables.

The purpose of this study was to implement principal component analysis (PCA) on videocapsule endoscopy (VE) images to develop a new computerized tool for celiac disease recognition. Three PCA algorithms were implemented for feature extraction and sparse representation. A novel strip PCA (SPCA) with nongreedy L1-norm maximization is proposed for VE image analysis. The extracted principal components were interpreted by a non-parametric k-nearest neighbor (k-NN) method for automated celiac disease classification. A benchmark dataset of 460 images (240 from celiac disease patients with small intestinal villous atrophy versus 220 control patients lacking villous atrophy) was constructed from the clinical VE series. It was found that the newly developed SPCA with nongreedy L1-norm maximization was most efficient for computerized celiac disease recognition, having a robust performance with an average recognition accuracy of 93.9 percent. Furthermore, SPCA also has a reduced computation time as compared with other methods. Therefore, it is likely that SPCA will be a helpful adjunct for the diagnosis of celiac disease.

Background and Objective Videocapsule endoscopy (VCE) is a relatively new technique for evaluating the presence of villous atrophy in celiac disease patients. The diagnostic analysis of video frames is currently time-consuming and tedious. Recently, computer-aided diagnosis (CAD) systems have become an attractive research area for diagnosing celiac disease. However, the images captured from VCE are susceptible to alterations in light illumination, rotation direction, and intestinal secretions. Moreover, textural features of the mucosal villi obtained by VCE are difficult to characterize and extract. This work aims to find a novel deep learning feature learning module to assist in the diagnosis of celiac disease. Methods In this manuscript, we propose a novel deep learning recalibration module which shows significant gain in diagnosing celiac disease. In this recalibration module, the block-wise recalibration component is newly employed to capture the most salient feature in the local channel feature map. This learning module was embedded into ResNet50, Inception-v3 to diagnose celiac disease using a 10-time 10-fold cross-validation based upon analysis of VCE images. In addition, we employed model weights to extract feature points from training and test samples before the last fully connected layer, and then input to a support vector machine (SVM), k-nearest neighbor (KNN), and linear discriminant analysis (LDA) for differentiating celiac disease images from heathy controls. Results Overall, the accuracy, sensitivity and specificity of the 10-time 10-fold cross-validation were 95.94%, 97.20% and 95.63%, respectively. Conclusions A novel deep learning recalibration module, with global response and local salient factors is proposed, and it has a high potential for utilizing deep learning networks to diagnose celiac disease using VCE images.

Background/aims Videocapsule endoscopy (VCE) and double-balloon endoscopy (DBE) allow deep exploration in patients with suspected small bowel pathology. VCE is often performed as an initial small bowel examination to explore whether an intervention by DBE is indicated and to determine insertion route. The study aim was to evaluate the correlation between DBE and VCE in patients with obscure or overt bleeding or anemia, as well as intervention frequency, and complications. Methods Retrospective observational study. Results DBE procedures (n=205) showed small bowel lesions in 64% cases. Antegrade DBE showed positive results in 79% cases, mostly angiodysplasias (63%). Retrograde DBE showed positive results in 22% cases. An intervention was performed in 64% of DBE procedures. The major complication rate was 0.5%, which was one case of perforation. Pancreatitis did not occur. The overall diagnostic agreement was 66% among the 134 DBEs with preceded VCE. Conclusions In cases of overt or occult bleeding or anemia, DBE was positive in 64%, with only a few complications. Positive correlation was 66% among initially performed VCEs and DBEs. Owing to the time-consuming and invasive character of DBE, performing VCE before DBE might still be clinically relevant.

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.

Gastrointestinal bleeding (GIB) is a very common condition at all ages, with high rates of morbidity and mortality, especially in case of acute presentation. The optimal management of acute GIB requires a timely overview of vital signs and clinical presentation to stabilize the patient if necessary and set up the most adequate diagnostic and therapeutic approach, based on the suspected etiology. Endoscopy plays a major role both in diagnosis and treatment of acute GIB, as allows the application of several hemostasis techniques during the diagnostic session, which should preferably be performed within 24 hours from the acute event. The hemostasis technique should be chosen based on type, etiology of the bleeding and the operator preference and expertise. Nevertheless, several challenging cases need the cooperation of radiology especially in the diagnostic phase, and even in the therapeutic phase for those bleedings in which medical and endoscopic techniques have failed. Imaging diagnostic techniques include mainly CT angiography, scintigraphy with labeled erythrocytes and arteriography. This last technique plays also a therapeutic role in case arterial embolization is needed. Only those patients in which the previous techniques have failed, both in diagnosis and treatment, are candidates for emergency surgery. (www.actabiomedica.it)

Мета роботи — вивчити роль капсульної ендоскопії у визначенні лікувальної тактики при тонкокишкових кровотечах.Матеріали і методи. Проаналізовано результати діагностики та лікування в хірургічному та проктологічному стаціонарах КЗ КОР «Київська обласна клінічна лікарня» 167 пацієнтів з тонкокишковими кровотечами. Пацієнтів розподілили на дві групи: основну — 98 (62 (65,2 %) чоловіки та 36 (34,8 %) жінок, середній вік — (45,3 ± 1,3) року) хворих, пролікованих у період з травня 2013 р. до грудня 2015 р., яким проводили діагностику та лікування за розробленим нами діагностично­лікувальним алгоритмом, та групу порівняння — 69 (34 (49,2 %) чоловіки та 35 (50,8 %) жінок, середній вік — (46,7 ± 1,3) року) хворих, пролікованих у період з квітня 2000 р. до грудня 2013 р., яким проводили діагностику та лікування за традиційною схемою (езофагогастродуоденоскопія, відеоколоноскопія, контрастна рентгенографія тонкої кишки, гемостатична та інфузійна терапія). Залежно від клінічної картини кожну групу розподіляли на три підгрупи. В основній групі до І підгрупи було залучено 22 (22,45 %) пацієнти з клінічними ознаками кровотечі, яка триває (мелена, кривава блювота), до II підгрупи — 29 (29,59 %) із зупиненою кровотечею, до III підгрупи — 47 (47,96 %) з рецидивною кровотечею та хронічною анемією невстановленого генезу (за даними попередніх інструментальних обстежень), у групі порівняння — відповідно 34 (49,28 %), 19 (27,54 %) та 16 (23,19 %) пацієнтів.Результати та обговорення. В основній групі за допомогою капсульної ендоскопії джерело кровотечі виявлено у 91 (89,4 %) пацієнта, тоді як у групі порівняння за допомогою традиційного алгоритму на доопераційному етапі — лише у 10 (14,5 %). В основній групі виконано 14 (14,3 %) оперативних втручань (9 (9,18 %) планових і 5 (5,1 %) в ургентному порядку), у групі порівняння — 53 (76,8 %) (13 (24,53 %) планових та 40 (75,47 %) в ургентному порядку).Висновки. Відеокапсульна ендоскопія дала змогу виявити джерело кровотечі в усіх пацієнтів з клінічними ознаками кровотечі, яка триває, у 93,1 % — без наявних клінічних ознак кровотечі, яка триває, та у 89,4 % — з рецидивною кровотечею та хронічною анемією невстановленого генезу. Застосування капсульної ендоскопії дало змогу знизити рівень оперативних втручань відповідно на 62,69; 45,92 та 25,0 %, ургентних оперативних втручань – на 70,37; 59,89 і 51,9 %., Цель работы — изучить роль капсульной эндоскопии в определении лечебной тактики при тонкокишечных кровотечениях.Материалы и методы. Проанализированы результаты диагностики и лечения в хирургическом и проктологическом стационарах КЗ КОР «Киевская областная клиническая больница» 167 пациентов с тонкокишечными кровотечениями. Пациентов распределили на две группы: основную — 98 (62 (65,2 %) мужчины и 36 (34,8 %) женщин, средний возраст — (45,3 ± 1,3) года) больных, пролеченных в период с мая 2013 г. по декабрь 2015 г., которым проводили диагностику и лечение по разработанному нами лечебно­диагностическому алгоритму, и группу сравнения — 69 (34 (49,2 %) мужчин и 35 (50,8 %) женщин, средний возраст — (46,7 ± 1,3) года) больных, пролеченных в период с апреля 2000 г. по декабрь 2013 г., которым проводили диагностику и лечение по традиционной схеме (эзофагогастродуоденоскопия, видеоколоноскопия, контрастная рентгенография тонкой кишки, гемостатическая и инфузионная терапия). В зависимости от клинической картины каждую группу распределили на три подгруппы. В основной группе в І подгруппу вошли 22 (22,45 %) пациента с клиническими признаками длящегося кровотечения (мелена, кровавая рвота), во II подгруппу — 29 (29,59 %) с остановленным кровотечением, в III подгруппу — 47 (47,96 %) с рецидивным кровотечением и хронической анемией неустановленного генеза (по данным предыдущих инструментальных обследований), в группе сравнения — соответственно 34 (49,28 %), 19 (27,54 %) и 16 (23,19 %) пациентов.Результаты и обсуждение. В основной группе с помощью капсульной эндоскопии источник кровотечения выявлен у 91 (89,4 %) пациента, тогда как в группе сравнения с помощью традиционного алгоритма на дооперационном этапе — лишь у 10 (14,5 %). В основной группе выполнено 14 (14,3 %) оперативных вмешательств, из них 9 (9,18 %) плановых и 5 (5,1 %) в ургентном порядке, в группе сравнения — 53 (76,8 %), из них 13 (24,53) плановых и 40 (75,47 %) в ургентном порядке.Выводы. Видеокапсульная эндоскопия позволила выявить источник кровотечения у всех пациентов с клиническими признаками продолжающегося кровотечения, у 93,1 % — без видимых клинических признаков продолжающегося кровотечения и у 89,4 % — с рецидивным кровотечением и хронической анемией неустановленного генеза. Применение капсульной эндоскопии позволило снизить уровень оперативных вмешательств соответственно на 62,69; 45,92 и 25,0 %, ургентных оперативных вмешательств — на 70,37; 59,89 и 51,9 %., The aim — to study the role of capsule endoscopy in determination of small bowel bleeding management.Materials and methods. The study was based on 167 patients’ treatment results for intestinal bleeding at surgical and proctological departments. Patients were divided into two groups: the main one — 98 (62 (65.2 %) men and 36 (34.8 %) women, the average age 45.3 ± 1.3 years) patients treated since May 2013 to December 2015, whom were diagnosed and treated according to our new medical diagnostic algorithm, and the comparison group included 69 (34 (49.2 %) men and 35 (50.8 %) women, mean age (46.7 ± 1.3) years) patients treated during the period from April 2000 to December 2013, whom were diagnosed and treated according to the traditional scheme (esophagogastroduodenoscopy, videocolonoscopy, contrast X­ray of the small intestine, haemostatic and infusion therapy). Depending on the clinical signs, each group was divided into three subgroups. In the main group, 22 (22.45 %) patients with clinical signs of persistent bleeding (melena, bloody vomiting) entered the I subgroup, 29 (29.59 %) with stopped bleeding in the II subgroup, 47 (47.96 %) with recurrent bleeding and chronic anaemia of unknown origin (according to previous examinations), respectively in the comparison group 34 (49.28 %), 19 (27.54 %) and 16 (23.19 %) patients.Results and discussion. In the main group, with a capsule endoscopy, a source of bleeding was detected in 91 (89.4 %) patients. In the comparison group — the source of bleeding with the help of a traditional algorithm at the preoperative stage was detected in only 10 (14.5 %) patients. 14 (14.3 %) surgical interventions were performed in the main group, 9 (9.18 %) were planned and 5 (5.1 %) — in urgent order, in the comparison group — 53 (76.8 %), among them 13 (24.53) were planned and 40 (75.47 %) — in urgent order.Conclusions. Videocapsule endoscopy detected a source of bleeding in all patients with ongoing bleeding signs, in 93.1 % of patients without bleeding signs, and 89.4 % in patients with recurrent bleeding and chronic anaemia of unknown ethology. The use of capsular endoscopy made it possible to reduce the level of surgical interventions by 62.69, 45.92 and 25.0 %, and urgent surgical interventions by 70.37, 59.89 and 51.9 %, respectively.

Resumen: Desde que inició la toma de biopsias a través de métodos endoscópicos para el diagnóstico de enfermedad celíaca (EC), se ha intentado describir distintos marcadores macroscópicamente visibles que sugirieran o confirmaran la presencia de atrofia vellositaria en la zona estudiada. Algunos de estos signos son altamente específicos pero su sensibilidad es baja por lo que, por si solos, tienen escaso valor en el algoritmo diagnóstico. El objetivo de esta revisión es analizar la evidencia científica existente sobre la utilidad de las nuevas tecnologías y técnicas endoscópicas en la identificación de marcadores de atrofia vellositaria en el diagnóstico y seguimiento de la enfermedad celíaca Método. Se llevó a cabo una revisión descriptiva de bibliografía donde se buscaron artículos originales en las bases de datos Pubmed y LILACS en el periodo 2006-2016. Resultados. El valor de la cromoendoscopía digital para la búsqueda de marcadores endoscópicos de atrofia vellositaria ha sido escasamente estudiado La sensibilidad de NBI con magnificación se estima entre 83 y 95%. Los únicos trabajos con OBI e I-Scan evidenciaron especificidad y sensibilidad perfectas, pero únicamente en pacientes con alta probabilidad de ser celiacos o portadores de atrofia severa. Con respecto a la microscopía endoscópica, la endocitoscopía no parece mejorar el desempeño de la endoscopía de manera significativa, sin embargo, con solo dos trabajos con bajo número de pacientes, la endomicroscopía laser confocal ha mostrado mayor sensibilidad en la detección de marcadores de atrofia. La VCE tiene alta especificidad (95-100%) pero menor sensibilidad (89%) y su mayor utilidad se encuentra en objetivar alteraciones que están más allá del alcance de la endoscopía tradicional y valorar su extensión. No existen trabajos que evalúen específicamente su presencia con enteroscopía doble balón, balón único o espiral. Conclusiones. Algunas de las nuevas técnicas y tecnologías parecen ser altamente específicas pero poco sensibles en la detección de marcadores endoscópicos de atrofia vellositaria. Son necesarios más estudios para determinar el valor de técnicas de microscopía endoscópica como herramienta diagnóstica a futuro. Abstract: Since endoscopic methods are used for biopsying the duodenum at diagnosis or follow-up in celiac disease, attempts have been made to find macroscopically visible markers that suggest or confirm the presence of villous atrophy in the studied area. Some of these signs are highly specific but their sensitivity is low so that, if alone, they have little value in the diagnostic algorithm. The objective of this review is to analyze the existing scientific evidence on the usefulness of new technologies and endoscopic techniques in the identification of markers of villous atrophy in the diagnosis and follow-up of celiac disease. Method. A descriptive review of literature was conducted, where original articles were sought in Pubmed and LILACS databases in the period 2006-2016. Results. The value of digital chromoendoscopy for the search of endoscopic markers of villous atrophy has barely been studied. Sensitivity of NBI with magnification is estimated between 83 and 95%. The only studies with OBI and I-Scan showed perfect specificity and sensitivity, but only in patients with high probability of being celiac or with severe atrophy. Regarding endoscopic microscopy, endocytoscopy does not seem to improve performance in a significant way, however, with only two studies with a small number of patients, confocal laser endomicroscopy has shown greater sensitivity in the detection of atrophy markers. The VCE has high specificity (100%) but low sensitivity and its greatest utility is finding alterations that are beyond the scope of traditional endoscopy and assess its extent. There are no studies that specifically evaluate the presence of the same signs with double balloon enteroscopy, single balloon or spiral. Conclusions. Some of the new techniques and technologies appear to be highly specific but less sensitive in the detection of endoscopic markers of villous atrophy. More studies are needed to determine the value of endoscopic microscopy techniques as a diagnostic tool in the future. Resumo: Desde o início das biópsias através de métodos endoscópicos para o diagnóstico de CD, uma tentativa foi feita para descrever diferentes marcadores macroscopicamente visíveis que sugerem ou confirmam a presença de atrofia vilosa na área estudada. Alguns desses sinais são altamente específicos, mas sua sensibilidade é baixa, por si só, eles têm pouco valor no algoritmo de diagnóstico. O objetivo desta revisão é analisar a evidência científica existente sobre a utilidade de novas tecnologias e técnicas endoscópicas na identificação de marcadores de atrofia vilosa no diagnóstico e monitoramento da doença celíaca. Método. Foi realizada uma revisão descritiva da literatura onde os artigos originais foram pesquisados nas bases de dados Pubmed e LILACS no período 2006-2016. Resultados. O valor da cromoendoscopia digital para a busca de marcadores endoscópicos de atrofia vilosa foi mal estudado. A sensibilidade do NBI com ampliação é estimada entre 83 e 95%. O único trabalho com OBI e I-Scan mostrou especificidade e sensibilidade perfeita, mas apenas em pacientes com alta probabilidade de serem celíacos ou portadores de atrofia grave. Em relação à microscopia endoscópica, a endocitoscopia não parece melhorar o desempenho da endoscopia de forma significativa, no entanto, com apenas dois estudos com um número reduzido de pacientes, a endomicroscopia confocal laser mostrou maior sensibilidade na detecção de marcadores de atrofia. O VCE tem alta especificidade (95-100%), mas menor sensibilidade (89%) e sua maior utilidade é objetivar alterações que estão além do alcance da endoscopia tradicional e avaliam sua extensão. Não há estudos que avaliem especificamente sua presença com balão duplo, bola única ou enteroscopia espiral. Conclusões. Algumas das novas técnicas e tecnologias parecem ser altamente específicas, mas não muito sensíveis na detecção de marcadores endoscópicos de atrofia vilosa. Mais estudos são necessários para determinar o valor das técnicas de microscopia endoscópica como ferramenta de diagnóstico no futuro.

Celiac disease (CD) is a common and chronic disorder requiring a long-life gluten-free diet. There is evidence that asymptomatic or subclinical presentation of CD has increased in the last decades, so that several cases are diagnosed during adulthood or even in the elderly. Celiac disease patients are at an increased risk of developing malignancies, particularly when the disease is diagnosed in the elderly. We describe a case of a challenging diagnosis of small bowel adenocarcinoma which developed in a patient with CD discovered only in the elderly. We also performed a systematic review of the literature. A tailored follow-up in a sub-group of CD patients at an increased risk of developing intestinal adenocarcinoma could be implemented.Abbreviations: CD: Celiac disease; GP: General Practitioner; FOBT: faecal occult blood test; EMA: anti-endomysial antibodies; tTG: anti-tissue transglutaminase antibodies; Hgb: hemoglobin; VCE: videocapsule endoscopy.

Summary Background To date, there are no large studies on videocapsule endoscopy in systemic sclerosis (SSc). Consequently, the prevalence and features of gastrointestinal mucosal abnormalities in SSc have not been determined. Aims To determine both prevalence and characteristics of gastrointestinal mucosal abnormalities in unselected patients with SSc, using videocapsule endoscopy. To predict which SSc patients are at risk of developing potentially bleeding gastrointestinal vascular mucosal abnormalities. Methods Videocapsule endoscopy was performed on 50 patients with SSc. Results Prevalence of gastrointestinal mucosal abnormalities was 52%. Potentially bleeding vascular mucosal lesions were predominant, including: watermelon stomach (34.6%), gastric and/or small intestinal telangiectasia (26.9%) and gastric and/or small intestinal angiodysplasia (38.5%). SSc patients with gastrointestinal vascular mucosal lesions more often exhibited: limited cutaneous SSc (P = 0.06), digital ulcers (P = 0.05), higher score of nailfold videocapillaroscopy (P = 0.0009), anaemia (P = 0.02), lower levels of ferritin (P

Celiac disease is a clinically heterogeneous disease characterized by an inadequate immunological response when patients with specific genetic phenotypes are exposed to gluten. This article presents a case of a young woman diagnosed in Gastroenterology Department of “ St. Andrew Apostle” Emergency Hospital of Constanta with celiac disease after multiple admissions into the hospital for unspecific symptoms such as pallor, fatigue, pirosis, weight loss and 1-2 soft stools/day. The history with period irregularities and infertility without a known cause, a recent unexplained bone fracture, the muscle weakness, neuropsychiatric symptoms characterized by sleep disturbances and irritability correlated with the biological features characterized by moderate feriprive anemia, Ca and Mg decreased level, thyroid autoimmune impairment and gastrointestinal symptoms raised the suspicion of an autoimmune disorder with multiple targets. The videcapsule endoscopy (VCE) revealed the specific pattern of the celiac disease: villous atrophy of jejunum, scalloping, absent folds and cobblestone mucosal pattern. Results were correlated with immunology tests results. The patient was transferred on a gluten free diet and the clinical and VCE controlsrevealed the healing of the jejunum mucosa. The VCE can be the tool for positive diagnosis of an unusual and heterogeneous celiac disease in patients with various symptoms without an apparent cause.