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Cheng W, Lin K, Wang L, Wang X, Feng Y, Gu Z, Liu H. Clinical features of magnetically controlled capsule endoscopy in children: A large, retrospective cohort study. J Pediatr Gastroenterol Nutr 2025; 80:733-741. [PMID: 39916493 DOI: 10.1002/jpn3.12472] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/02/2024] [Revised: 12/24/2024] [Accepted: 01/08/2025] [Indexed: 04/02/2025]
Abstract
OBJECTIVE This study aimed to assess the utility of magnetically controlled capsule endoscopy (MCE) in the diagnosis of pediatric gastrointestinal diseases. METHODS A retrospective cohort study was conducted, which collected data from 1040 children (546 males and 494 females; mean age: 11.0 ± 2.6 years) who underwent MCE at Shanghai Children's Hospital between June 2017 and February 2023. Information on gastric visualization, cleanliness, examination times, lesion detection rates, and other parameters were recorded. A 2-week follow-up monitored capsule excretion and adverse reactions. RESULTS Of the 1055 patients, 78 had difficulty swallowing the capsule, and 15 could not swallow even with assistance, which led to their exclusion. The small intestine was successfully examined in 94.5% (206 out of 218) of the 218 children who were able to proceed with the procedure. The remaining 822 underwent esophagus and stomach examinations. The average transit time of the endoscopy capsule in the esophagus, stomach, and small intestine was 5 (3, 9) s, 57.0 (29.0, 102.0) min, and 306.0 (234.0, 500.0) min. In the examined cases, complete small bowel visualization was achieved in 94.5% of the patients. The most common symptoms reported by the patients were abdominal pain (77.9%) and nausea with vomiting (13.5%). Lesion detection rates were 38.8% in the stomach, 21.1% in the duodenum, and 43.1% in the jejunoileum. No complications, such as capsule retention or intestinal obstruction, were observed. CONCLUSION MCE is a feasible and safe method for examining the gastric cavity and small bowel in pediatric patients.
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Affiliation(s)
- Weiwei Cheng
- Department of Digestive Endoscopy Center, Shanghai Children's Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China
| | - Kai Lin
- Department of Digestive Endoscopy Center, Shanghai Children's Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China
| | - Ling Wang
- Department of Digestive Endoscopy Center, Shanghai Children's Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China
| | - Xing Wang
- Department of Digestive Endoscopy Center, Shanghai Children's Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China
| | - Yuling Feng
- Department of Digestive Endoscopy Center, Shanghai Children's Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China
| | - Zhujun Gu
- Department of Digestive Endoscopy Center, Shanghai Children's Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China
| | - Haifeng Liu
- Department of Digestive Endoscopy Center, Shanghai Children's Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China
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Alamro SM, Alanazi MM, Suwayyid WK. Capsule Endoscopy for the Risk Stratification and Management of Acute Upper Gastrointestinal Bleeding in Emergency Departments: A Systematic Review on Triage, Risk Stratification, and Management. Cureus 2024; 16:e71530. [PMID: 39553035 PMCID: PMC11563759 DOI: 10.7759/cureus.71530] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/15/2024] [Indexed: 11/19/2024] Open
Abstract
Gastrointestinal bleeding is a common occurrence in emergency departments. The standard of care for it is an esophagogastroduodenoscopy within 24 hours to diagnose and potentially treat the bleeding. Several tools and pre-endoscopic risk assessment scores are used to help evaluate and manage upper gastrointestinal bleeding. Additionally, capsule endoscopy provides a non-invasive method to visualize the gastrointestinal tract and identify lesions. The aim of this review was to explore the role of capsule endoscopy in the triage, stratification, and management of upper gastrointestinal bleeding patients in the emergency department. Four databases, PubMed, Scopus, Embase, and the Cochrane Library, were searched using keywords related to capsule endoscopy and gastrointestinal bleeding in the emergency department. Studies were included if they assessed the use of capsule endoscopy in emergency settings for managing upper gastrointestinal bleeding. After screening titles, abstracts, and full texts and reviewing bibliographies for relevant articles, data on study design, participant demographics, capsule endoscopy procedure description, and outcomes were collected into a pre-designed spreadsheet. The review focused on the triage, risk stratification, management impact, and safety of capsule endoscopy. The literature search identified 712 records, with 37 studies screened for full-text review, resulting in nine studies included in the review. These studies involved 634 patients and primarily compared capsule endoscopy with standard care in emergency settings. Capsule endoscopy demonstrated potential advantages, including improved identification of high-risk lesions and reduced hospital admissions. Capsule endoscopy effectively detected bleeding and reduced the need for invasive procedures compared to standard practices. Capsule endoscopy also had lower costs relative to traditional triaging methods. The use of capsule endoscopy in the risk stratification and management of upper gastrointestinal bleeding in emergency settings is promising. Its high diagnostic accuracy can enhance patient outcomes by enabling timely and precise diagnosis, reducing the need for invasive procedures. Future research should focus on larger randomized trials to validate capsule endoscopy's efficacy and explore its cost-effectiveness.
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Lim NR, Hong KY, Chung WC. Factors Affecting Diagnostic Yields of Capsule Endoscopy for Obscure Gastrointestinal Bleeding. GASTROINTESTINAL DISORDERS 2024; 6:468-477. [DOI: 10.3390/gidisord6020032] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/05/2025] Open
Abstract
Background/Aims: The purpose of this study was to determine the factors affecting positive diagnostic yields in patients with obscure gastrointestinal bleeding (OGIB) according to the guideline of small bowel capsule endoscopy (SBCE). Method: Patients with a complaint of melena or hematochezia who were admitted were consecutively enrolled. In patients with gastrointestinal bleeding, examination was performed according to the guideline. When OGIB was suspected, SBCE was performed. Patients were categorized into two subgroups based on the SBCE results: a positive group (n = 78) and a negative group (n = 67). Results: The rate of the positive diagnostic yield of SBCE was 53.8% (78/145). In patients over 60 years, the diagnostic yield was 61.5%, which was higher than in patients younger than 60 years (40.7%). In the multivariate analysis, there was a significant difference in the positive diagnostic yield in the patients aged over 60 years (p < 0.01). Factors related to the procedure and clinical characteristics also showed significant differences in the positive predictive rates according to the degree of bowel preparation, small bowel transit time, and transfusion requirements. Conclusions: SBCE could be recommended as a diagnostic tool for OGIB, especially in those with old ages (>60 years) and those who need transfusion, because of its relatively high diagnostic yields in these populations. Proper bowel preparation and a prolonged small bowel transit time may have clinical significance in relation to the positive diagnostic yield of SBCE in patients with OGIB.
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Affiliation(s)
- Na Rae Lim
- Division of Gastroenterology, Department of Internal Medicine, St. Vincent’s Hospital, College of Medicine, The Catholic University of Korea, #93-6 Jungbu-daero, Paldal-gu, Suwon 16247, Republic of Korea
| | - Keep Yung Hong
- Division of Gastroenterology, Department of Internal Medicine, St. Vincent’s Hospital, College of Medicine, The Catholic University of Korea, #93-6 Jungbu-daero, Paldal-gu, Suwon 16247, Republic of Korea
| | - Woo Chul Chung
- Division of Gastroenterology, Department of Internal Medicine, St. Vincent’s Hospital, College of Medicine, The Catholic University of Korea, #93-6 Jungbu-daero, Paldal-gu, Suwon 16247, Republic of Korea
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Martinov Nestorov J, Sokic-Milutinovic A, Pavlovic Markovic A, Krstic M. Could Capsule Endoscopy Be Useful in Detection of Suspected Small Bowel Bleeding and IBD-10 Years of Single Center Experience. Diagnostics (Basel) 2024; 14:862. [PMID: 38732278 PMCID: PMC11083052 DOI: 10.3390/diagnostics14090862] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2024] [Revised: 04/12/2024] [Accepted: 04/14/2024] [Indexed: 05/13/2024] Open
Abstract
A retrospective study in patients who underwent video capsule endoscopy (VCE) between 2006 and 2016 was conducted in the Clinic for gastroenterology and Hepatology, University Clinical Center of Serbia. A total of 245 patients underwent VCE. In 198 patients the indication was obscure gastrointestinal bleeding (OGIB), with 92 patients having overt and the other 106 occult bleeding. The remaining 47 patients underwent VCE due to suspected small bowel (SB) disease (i.e., Von Hippel-Lindau syndrome, familial adenomatous polyposis, Peutz Jeghers syndrome, Crohn's disease, prolonged diarrhea, abdominal pain, congenital lymphangiectasia, protein-losing enteropathy, tumors, refractory celiac disease, etc.). VCE identified a source of bleeding in 38.9% of patients (in the obscure overt group in 48.9% of patients, and in the obscure occult group in 30.2% of patients). The most common findings were angiodysplasias, tumors, Meckel's diverticulum and Crohn's disease. In the smaller group of patients with an indication other than OGIB, 38.3% of patients had positive VCE findings. The most common indication is OGIB, and the best candidates are patients with overt bleeding; patients with IBD should be evaluated in this setting.
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Affiliation(s)
- Jelena Martinov Nestorov
- School of Medicine, University of Belgrade, 11000 Belgrade, Serbia; (A.S.-M.); (A.P.M.); (M.K.)
- Clinic for Gastroenterology and Hepatology, University Clinical Center of Serbia, 11000 Belgrade, Serbia
| | - Aleksandra Sokic-Milutinovic
- School of Medicine, University of Belgrade, 11000 Belgrade, Serbia; (A.S.-M.); (A.P.M.); (M.K.)
- Clinic for Gastroenterology and Hepatology, University Clinical Center of Serbia, 11000 Belgrade, Serbia
| | - Aleksandra Pavlovic Markovic
- School of Medicine, University of Belgrade, 11000 Belgrade, Serbia; (A.S.-M.); (A.P.M.); (M.K.)
- Clinic for Gastroenterology and Hepatology, University Clinical Center of Serbia, 11000 Belgrade, Serbia
| | - Miodrag Krstic
- School of Medicine, University of Belgrade, 11000 Belgrade, Serbia; (A.S.-M.); (A.P.M.); (M.K.)
- Clinic for Gastroenterology and Hepatology, University Clinical Center of Serbia, 11000 Belgrade, Serbia
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Naik DA, Matonis S, Balakrishnan G, Bettinger CJ. Intestinal retentive systems - recent advances and emerging approaches. J Mater Chem B 2023; 12:64-78. [PMID: 38047746 DOI: 10.1039/d3tb01842c] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/05/2023]
Abstract
Intestinal retentive devices (IRDs) are devices designed to anchor within the lumen of the intestines for long-term residence in the gastrointestinal tract. IRDs can enable impactful medical device technologies including sustained oral drug delivery systems, indwelling sensors, or real-time diagnostics. The design and testing of IRDs present a myriad of challenges, including precise deployment of the device at desired intestinal locations, secure anchoring within the gastrointestinal tract to allow for natural function, and safe removal of the IRD at user-defined times. Advancing the state-of-the-art of IRD is an interdisciplinary effort that requires innovations such as new materials, novel anchoring mechanisms, and medical device design with consistent input from clinical practitioners and end-users. This perspective briefly reviews the current state-of-the-art for IRDs and charts a path forward to inform the design of future concepts. Specifically, this article will highlight materials, retention mechanisms, and test beds to measure the efficacy of IRDs and their mechanisms. Finally, potential synergies between IRD and other medical device technologies are presented to identify future opportunities.
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Affiliation(s)
- Durva A Naik
- Materials Science and Engineering, Carnegie Mellon University, 5000 Forbes Avenue, Wean Hall 3325, Pittsburgh, PA 15213, USA.
| | - Spencer Matonis
- Materials Science and Engineering, Carnegie Mellon University, 5000 Forbes Avenue, Wean Hall 3325, Pittsburgh, PA 15213, USA.
| | - Gaurav Balakrishnan
- Materials Science and Engineering, Carnegie Mellon University, 5000 Forbes Avenue, Wean Hall 3325, Pittsburgh, PA 15213, USA.
| | - Christopher J Bettinger
- Materials Science and Engineering, Carnegie Mellon University, 5000 Forbes Avenue, Wean Hall 3325, Pittsburgh, PA 15213, USA.
- Biomedical Engineering, Carnegie Mellon University, 5000 Forbes Avenue, Scott Hall 4N201, Pittsburgh, PA 15213, USA
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Odeyinka O, Alhashimi R, Thoota S, Ashok T, Palyam V, Azam AT, Sange I. The Role of Capsule Endoscopy in Crohn's Disease: A Review. Cureus 2022; 14:e27242. [PMID: 36039259 PMCID: PMC9401636 DOI: 10.7759/cureus.27242] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/25/2022] [Indexed: 12/09/2022] Open
Abstract
Crohn’s disease (CD) is a chronic inflammatory disorder with a predilection for the small bowel. Although awareness of this disorder has increased over the years, it remains a diagnostic challenge for many physicians. This is exacerbated by the rising incidence and high recurrence rate following therapy in certain individuals. It is currently agreed that a multimodality approach is the best one, but with the advent of new modalities, that could be changing. Furthermore, given its impact on the mental health of patients and the cost of treatment, it is pertinent that we arrive at not only convenient but accurate modalities in its diagnosis and management. Among these investigative modalities is the relatively novel capsule endoscopy (CE) that not only provides a more patient-friendly alternative but avoids the need for invasiveness. Asides from its diagnostic capability, its influence on therapy and monitoring of known CD patients following treatment has been shown. This article has reviewed the current literature comparing the relevance of CE with other available modalities in diagnosing CD patients. We explored its therapeutic impact and how it influences monitoring post-treatment in CD. This article also discusses the complications of CE and the possible solutions to these complications in the future.
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Piccirelli S, Mussetto A, Bellumat A, Cannizzaro R, Pennazio M, Pezzoli A, Bizzotto A, Fusetti N, Valiante F, Hassan C, Pecere S, Koulaouzidis A, Spada C. New Generation Express View: An Artificial Intelligence Software Effectively Reduces Capsule Endoscopy Reading Times. Diagnostics (Basel) 2022; 12:diagnostics12081783. [PMID: 35892494 PMCID: PMC9332221 DOI: 10.3390/diagnostics12081783] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2022] [Revised: 07/15/2022] [Accepted: 07/21/2022] [Indexed: 11/16/2022] Open
Abstract
BACKGROUND: Reading capsule endoscopy (CE) is time-consuming. The Express View (EV) (IntroMedic, Seoul, Korea) software was designed to shorten CE video reading. Our primary aim was to evaluate the diagnostic accuracy of EV in detecting significant small-bowel (SB) lesions. We also compared the reading times with EV mode and standard reading (SR). METHODS: 126 patients with suspected SB bleeding and/or suspected neoplasia were prospectively enrolled and underwent SB CE (MiroCam®1200, IntroMedic, Seoul, Korea). CE evaluation was performed in standard and EV mode. In case of discrepancies between SR and EV readings, a consensus was reached after reviewing the video segments and the findings were re-classified. RESULTS: The completion rate of SB CE in our cohort was 86.5% and no retention occurred. The per-patient analysis of sensitivity, specificity, positive predictive value, negative predictive value, and diagnostic accuracy of EV compared to SR were 86%, 86%, 90%, 81%, and 86%, respectively, before consensus. After consensus, they increased to 97%, 100%, 100%, 96%, and 98%, respectively. The median reading time with SR and EV was 71 min (range 26−340) and 13 min (range 3−85), respectively (p < 0.001). CONCLUSIONS: The new-generation EV shows high diagnostic accuracy and significantly reduces CE reading times.
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Affiliation(s)
- Stefania Piccirelli
- Fondazione Poliambulanza Istituto Ospedaliero, 25124 Brescia, Italy; (S.P.); (A.B.); (C.S.)
- Fondazione Policlinico Universitario A. Gemelli IRCCS, Università Cattolica del Sacro Cuore, 00168 Rome, Italy
| | | | | | | | - Marco Pennazio
- Division of Gastroenterology, University City of Health and Science University Hospital, 10121 Turin, Italy;
| | - Alessandro Pezzoli
- Endoscopy Unit, Department of Gastroenterology, Sant’Anna University Hospital, 44121 Ferrara, Italy; (A.P.); (N.F.)
| | - Alessandra Bizzotto
- Fondazione Poliambulanza Istituto Ospedaliero, 25124 Brescia, Italy; (S.P.); (A.B.); (C.S.)
| | - Nadia Fusetti
- Endoscopy Unit, Department of Gastroenterology, Sant’Anna University Hospital, 44121 Ferrara, Italy; (A.P.); (N.F.)
| | | | - Cesare Hassan
- Endoscopy Unit, Department of Gastroenterology, IRCCS Humanitas Research Hospital, 20089 Rozzano, Italy;
| | - Silvia Pecere
- Fondazione Policlinico Universitario A. Gemelli IRCCS, Università Cattolica del Sacro Cuore, 00168 Rome, Italy
- Digestive Endoscopy Unit, Fondazione Policlinico Universitario A. Gemelli IRCCS, 00168 Rome, Italy
- Correspondence:
| | - Anastasios Koulaouzidis
- Department of Medicine, Odense University Hospital Svendborg Sygehus, 5700 Svendborg, Denmark;
- Department of Clinical Research, University of Southern Denmark (SDU), 5230 Odense, Denmark
- Surgical Research Unit, Odense University Hospital, 5000 Odense, Denmark
- Department of Social Medicine and Public Health, Pomeranian Medical University, 70-204 Szczecin, Poland
| | - Cristiano Spada
- Fondazione Poliambulanza Istituto Ospedaliero, 25124 Brescia, Italy; (S.P.); (A.B.); (C.S.)
- Fondazione Policlinico Universitario A. Gemelli IRCCS, Università Cattolica del Sacro Cuore, 00168 Rome, Italy
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8
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Patel A, Vedantam D, Poman DS, Motwani L, Asif N. Obscure Gastrointestinal Bleeding and Capsule Endoscopy: A Win-Win Situation or Not? Cureus 2022; 14:e27137. [PMID: 36017285 PMCID: PMC9392966 DOI: 10.7759/cureus.27137] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/22/2022] [Indexed: 11/05/2022] Open
Abstract
Obscure gastrointestinal bleeding (OGIB) refers to bleeding of uncertain origin that persists or recurs after negative workup using any of the radiologic evaluation modalities. It can be divided into two types based on whether clinically evident bleeding is present, namely, obscure overt and obscure occult bleeding. As the visualization of the bowel mucosa is challenging, capsule endoscopy (CE) is the ideal go-to procedure as the process is wireless, ingestible, small, disposable, and, most importantly, non-invasive. This review article has compiled various studies to shed light on the guidelines for using CE, its structure and procedure, patient preferences, diagnostic yield, cost-effectiveness, and the future. The goal of this review is to show the influence of CE on OGIB on the aspects mentioned earlier.
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Ionescu A, Glodeanu A, Ionescu M, Zaharie S, Ciurea A, Golli A, Mavritsakis N, Popa D, Vere C. Clinical impact of wireless capsule endoscopy for small bowel investigation (Review). Exp Ther Med 2022; 23:262. [PMID: 35251328 PMCID: PMC8892621 DOI: 10.3892/etm.2022.11188] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2021] [Accepted: 11/12/2021] [Indexed: 11/06/2022] Open
Abstract
Wireless capsule endoscopy is currently considered the gold standard in the investigation of the small bowel. It is both practical for physicians and easily accepted by patients. Prior to its development, two types of imaging investigations of the small bowel were available: radiologic and endoscopic. The first category is less invasive and comfortable for patients; it presents the ensemble of the small bowel, but it may imply radiation exposure. Images are constructed based on signals emitted by various equipment and require special interpretation. Endoscopic techniques provide real-time colored images acquired by miniature cameras from inside the small bowel, require interpretation only from a medical point of view, may allow the possibility to perform biopsies, but the investigation only covers a part of the small bowel and are more difficult to accept by patients. Wireless capsule endoscopy is the current solution that overcomes a part of the previous drawbacks: it covers the entire small bowel, it provides real-time images acquired by cameras, it is painless for patients, and it represents an abundant source of information for physicians. Yet, it lacks motion control and the possibility to perform biopsies or administer drugs. However, significant effort has been oriented in these directions by technical and medical teams, and more advanced capsules will surely be available in the following years.
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Affiliation(s)
- Alin Ionescu
- Department of Medical History, University of Medicine and Pharmacy of Craiova, 200349 Craiova, Romania
| | - Adina Glodeanu
- Department of Internal Medicine, University of Medicine and Pharmacy of Craiova, 200349 Craiova, Romania
| | - Mihaela Ionescu
- Department of Medical Informatics and Biostatistics, University of Medicine and Pharmacy of Craiova, 200349 Craiova, Romania
| | - Sorin Zaharie
- Department of Nephrology, University of Medicine and Pharmacy of Craiova, 200349 Craiova, Romania
| | - Ana Ciurea
- Department of Oncology, University of Medicine and Pharmacy of Craiova, 200349 Craiova, Romania
| | - Andreea Golli
- Department of Public Health Management, University of Medicine and Pharmacy of Craiova, 200349 Craiova, Romania
| | - Nikolaos Mavritsakis
- Department of Physical Education and Sport, ‘1 Decembrie 1918’ University, 510009 Alba Iulia, Romania
| | - Didi Popa
- Department of Information and Communication Technology, University of Craiova, 200585 Craiova, Romania
| | - Cristin Vere
- Department of Gastroenterology, University of Medicine and Pharmacy of Craiova, 200349 Craiova, Romania
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Yang SY, Sencadas V, You SS, Jia NZX, Srinivasan SS, Huang HW, Ahmed AE, Liang JY, Traverso G. Powering Implantable and Ingestible Electronics. ADVANCED FUNCTIONAL MATERIALS 2021; 31:2009289. [PMID: 34720792 PMCID: PMC8553224 DOI: 10.1002/adfm.202009289] [Citation(s) in RCA: 49] [Impact Index Per Article: 12.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/30/2020] [Indexed: 05/28/2023]
Abstract
Implantable and ingestible biomedical electronic devices can be useful tools for detecting physiological and pathophysiological signals, and providing treatments that cannot be done externally. However, one major challenge in the development of these devices is the limited lifetime of their power sources. The state-of-the-art of powering technologies for implantable and ingestible electronics is reviewed here. The structure and power requirements of implantable and ingestible biomedical electronics are described to guide the development of powering technologies. These powering technologies include novel batteries that can be used as both power sources and for energy storage, devices that can harvest energy from the human body, and devices that can receive and operate with energy transferred from exogenous sources. Furthermore, potential sources of mechanical, chemical, and electromagnetic energy present around common target locations of implantable and ingestible electronics are thoroughly analyzed; energy harvesting and transfer methods befitting each energy source are also discussed. Developing power sources that are safe, compact, and have high volumetric energy densities is essential for realizing long-term in-body biomedical electronics and for enabling a new era of personalized healthcare.
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Affiliation(s)
- So-Yoon Yang
- Department of Electrical Engineering and Computer Science, Massachusetts Institute of Technology, Cambridge, MA 02139, USA; Koch Institute for Integrative Cancer Research, Massachusetts Institute of Technology, Cambridge, MA 02139, USA; Department of Mechanical Engineering, Massachusetts Institute of Technology, Cambridge, MA 02139, USA
| | - Vitor Sencadas
- Koch Institute for Integrative Cancer Research, Massachusetts Institute of Technology, Cambridge, MA 02139, USA; School of Mechanical, Materials & Mechatronics Engineering, University of Wollongong, Wollongong, NSW 2522, Australia
| | - Siheng Sean You
- Koch Institute for Integrative Cancer Research, Massachusetts Institute of Technology, Cambridge, MA 02139, USA; Department of Mechanical Engineering, Massachusetts Institute of Technology, Cambridge, MA 02139, USA; Division of Gastroenterology, Hepatology and Endoscopy, Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, MA 02115, USA
| | - Neil Zi-Xun Jia
- Koch Institute for Integrative Cancer Research, Massachusetts Institute of Technology, Cambridge, MA 02139, USA
| | - Shriya Sruthi Srinivasan
- Koch Institute for Integrative Cancer Research, Massachusetts Institute of Technology, Cambridge, MA 02139, USA; Department of Mechanical Engineering, Massachusetts Institute of Technology, Cambridge, MA 02139, USA; Division of Gastroenterology, Hepatology and Endoscopy, Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, MA 02115, USA
| | - Hen-Wei Huang
- Koch Institute for Integrative Cancer Research, Massachusetts Institute of Technology, Cambridge, MA 02139, USA; Department of Mechanical Engineering, Massachusetts Institute of Technology, Cambridge, MA 02139, USA; Division of Gastroenterology, Hepatology and Endoscopy, Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, MA 02115, USA
| | - Abdelsalam Elrefaey Ahmed
- Division of Gastroenterology, Hepatology and Endoscopy, Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, MA 02115, USA
| | - Jia Ying Liang
- Koch Institute for Integrative Cancer Research, Massachusetts Institute of Technology, Cambridge, MA 02139, USA; Department of Mechanical Engineering, Massachusetts Institute of Technology, Cambridge, MA 02139, USA; Division of Gastroenterology, Hepatology and Endoscopy, Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, MA 02115, USA
| | - Giovanni Traverso
- Department of Mechanical Engineering, Massachusetts Institute of Technology, Cambridge, MA 02139, USA; Division of Gastroenterology, Hepatology and Endoscopy, Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, MA 02115, USA
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Hong SM, Jung SH, Baek DH. Diagnostic Yields and Clinical Impacts of Capsule Endoscopy. Diagnostics (Basel) 2021; 11:diagnostics11101842. [PMID: 34679540 PMCID: PMC8534535 DOI: 10.3390/diagnostics11101842] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2021] [Revised: 09/28/2021] [Accepted: 09/29/2021] [Indexed: 12/12/2022] Open
Abstract
Observing the entire small bowel is difficult due to the presence of complex loops and a long length. Capsule endoscopy (CE) provides a noninvasive and patient-friendly method for visualizing the small bowel and colon. Small bowel capsule endoscopy (SBCE) has a critical role in the diagnosis of small bowel disorders through the direct observation of the entire small bowel mucosa and is becoming the primary diagnostic tool for small bowel diseases. Recently, colon capsule endoscopy (CCE) was also considered safe and feasible for obtaining sufficient colonic images in patients with incomplete colonoscopy, in the absence of bowel obstruction. This review article assesses the current status of CE in terms of the diagnostic yield and the clinical impact of SBCE in patients with obscure gastrointestinal bleeding, who have known or suspected Crohn's disease, small bowel tumor and inherited polyposis syndrome, celiac disease, and those who have undergone CCE.
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Affiliation(s)
- Seung Min Hong
- Department of Internal Medicine, Pusan National University School of Medicine, Busan 49421, Korea;
- Biomedical Research Institute, Pusan National University Hospital, Busan 49421, Korea
| | - Sung Hoon Jung
- Department of Internal Medicine, Eunpyeong St. Mary’s Hospital, College of Medicine, The Catholic University of Korea, Seoul 03312, Korea;
| | - Dong Hoon Baek
- Department of Internal Medicine, Pusan National University School of Medicine, Busan 49421, Korea;
- Biomedical Research Institute, Pusan National University Hospital, Busan 49421, Korea
- Correspondence: ; Tel./Fax: +82-51-2448180
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12
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Meltzer AC, Limkakeng AT, Gentile NT, Freeman JQ, Hall NC, Vargas NM, Fleischer DE, Malik Z, Kallus SJ, Borum ML, Ma Y, Kumar AB. Risk stratification with video capsule endoscopy leads to fewer hospital admissions in emergency department patients with low-risk to moderate-risk upper gastrointestinal bleed: A multicenter clinical trial. J Am Coll Emerg Physicians Open 2021; 2:e12579. [PMID: 34723247 PMCID: PMC8544929 DOI: 10.1002/emp2.12579] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2021] [Revised: 10/01/2021] [Accepted: 10/01/2021] [Indexed: 12/12/2022] Open
Abstract
OBJECTIVE In US emergency departments (EDs), the physician has limited ability to evaluate for common and serious conditions of the gastrointestinal (GI) mucosa such as a bleeding peptic ulcer. Although many bleeding lesions are self-limited, the majority of these patients require emergency hospitalization for upper endoscopy (EGD). We conducted a clinical trial to determine if ED risk stratification with video capsule endoscopy (VCE) reduces hospitalization rates for low-risk to moderate-risk patients with suspected upper GI bleeding. METHODS We conducted a randomized controlled trial at 3 urban academic EDs. Inclusion criteria included signs of upper GI bleeding and a Glasgow Blatchford score <6. Patients were randomly assigned to 1 of the following 2 treatment arms: (1) an experimental arm that included VCE risk stratification and brief ED observation versus (2) a standard care arm that included admission for inpatient EGD. The primary outcome was hospital admission. Patients were followed for 7 and 30 days to assess for rebleeding events and revisits to the hospital. RESULTS The trial was terminated early as a result of low accrual. The trial was also terminated early because of a need to repurpose all staff to respond to the coronavirus disease 2019 pandemic. A total of 24 patients were enrolled in the study. In the experimental group, 2/11 (18.2%) patients were admitted to the hospital, and in the standard of care group, 10/13 (76.9%) patients were admitted to the hospital (P = 0.012). There was no difference in safety on day 7 and day 30 after the index ED visit. CONCLUSIONS VCE is a potential strategy to decrease admissions for upper GI bleeding, though further study with a larger cohort is required before this approach can be recommended.
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Affiliation(s)
- Andrew C. Meltzer
- School of Medicine and Health SciencesGeorge Washington UniversityWashingtonDistrict of ColumbiaUSA
| | | | - Nina T. Gentile
- School of MedicineTemple UniversityPhiladelphiaPennsylvaniaUSA
| | - Jincong Q. Freeman
- Milken Institute School of Public HealthGeorge Washington UniversityWashingtonDistrict of ColumbiaUSA
| | - Nicole C. Hall
- School of Medicine and Health SciencesGeorge Washington UniversityWashingtonDistrict of ColumbiaUSA
| | - Nataly Montano Vargas
- School of Medicine and Health SciencesGeorge Washington UniversityWashingtonDistrict of ColumbiaUSA
| | | | - Zubair Malik
- School of MedicineTemple UniversityPhiladelphiaPennsylvaniaUSA
| | - Samuel J. Kallus
- School of Medicine and Health SciencesGeorge Washington UniversityWashingtonDistrict of ColumbiaUSA
| | - Marie L. Borum
- School of Medicine and Health SciencesGeorge Washington UniversityWashingtonDistrict of ColumbiaUSA
| | - Yan Ma
- Milken Institute School of Public HealthGeorge Washington UniversityWashingtonDistrict of ColumbiaUSA
| | - Anita B. Kumar
- School of Medicine and Health SciencesGeorge Washington UniversityWashingtonDistrict of ColumbiaUSA
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13
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Lahat A, Veisman I. Capsule Endoscopy in Crohn's Disease-From a Relative Contraindication to Habitual Monitoring Tool. Diagnostics (Basel) 2021; 11:diagnostics11101737. [PMID: 34679435 PMCID: PMC8534609 DOI: 10.3390/diagnostics11101737] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2021] [Revised: 09/03/2021] [Accepted: 09/16/2021] [Indexed: 12/15/2022] Open
Abstract
Crohn’s disease (CD) is a chronic inflammatory disorder that may involve the gastrointestinal tract from the mouth to the anus. Habitual disease monitoring is highly important during disease management, aiming to identify and treat disease exacerbations, in order to avoid immediate and future complications. Currently, ilio-clonoscopy is the gold standard for mucosal assessment. However, the procedure is invasive, involves sedation and allows for visualization of the colon and only a small part of the terminal ileum, while most of the small bowel is not visualized. Since CD may involve the whole length of the small bowel, the disease extent might be underestimated. Capsule endoscopy (CE) provides a technology that can screen the entire bowel in a non-invasive procedure, with minimal side effects. In recent years, this technique has gained in popularity for CD evaluation and monitoring. When CE was first introduced, two decades ago, the fear of possible capsule retention in the narrowed inflamed bowel lumen limited its use in CD patients, and a known CD located at the small bowel was even regarded as a relative contraindication for capsule examination. However, at present, as experience using CE in CD patients has accumulated, this procedure has become one of the accepted tools for disease diagnosis and monitoring. In our current review, we summarize the historic change in the indications and contraindications for the usage of capsule endoscopy for the evaluation of CD, and discuss international recommendations regarding CE’s role in CD diagnosis and monitoring.
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Affiliation(s)
- Adi Lahat
- Chaim Sheba Medical Center, Department of Gastroenterology, Sackler Medical School, Tel Aviv University, Tel Hashomer 52620, Israel;
- Sackler Medical School, Tel Aviv University, Tel Aviv 67011, Israel
- Correspondence:
| | - Ido Veisman
- Chaim Sheba Medical Center, Department of Gastroenterology, Sackler Medical School, Tel Aviv University, Tel Hashomer 52620, Israel;
- Sackler Medical School, Tel Aviv University, Tel Aviv 67011, Israel
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14
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Mei X, Ye D, Zhang F, Di C. Implantable application of polymer‐based biosensors. JOURNAL OF POLYMER SCIENCE 2021. [DOI: 10.1002/pol.20210543] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Affiliation(s)
- Xiangyuan Mei
- Beijing National Laboratory for Molecular Sciences, CAS Key Laboratory of Organic Solids Institute of Chemistry, Chinese Academy of Sciences Beijing China
- School of Chemical Sciences University of Chinese Academy of Sciences Beijing China
| | - Dekai Ye
- Beijing National Laboratory for Molecular Sciences, CAS Key Laboratory of Organic Solids Institute of Chemistry, Chinese Academy of Sciences Beijing China
| | - Fengjiao Zhang
- School of Chemical Sciences University of Chinese Academy of Sciences Beijing China
| | - Chong‐an Di
- Beijing National Laboratory for Molecular Sciences, CAS Key Laboratory of Organic Solids Institute of Chemistry, Chinese Academy of Sciences Beijing China
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15
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Abstract
Video capsule endoscopy has been proven to be a beneficial tool to inspect the gastrointestinal lumen but its true impact may lie in utilization outside of traditional gastroenterology settings such as in the emergency room, the intensive care unit, and outpatient settings. Some advantages of video capsule endoscopy are that its administration does not require special training, patients do not require anesthesia, and videos can be shared with off-site consultants.
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16
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Kou Z, Miller RJ, Singer AC, Oelze ML. High data rate communications in vivo using ultrasound. IEEE Trans Biomed Eng 2021; 68:3308-3316. [PMID: 33793395 PMCID: PMC8570574 DOI: 10.1109/tbme.2021.3070477] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
The emergence of in-body medical devices has provided a means of capturing physiological or diagnostic information and streaming this information outside of the body. Currently, electromagnetic-based communications make up the bulk of in-body medical device communication protocols. Traditional electromagnetic-based solutions are limited in their data rates and available power. Recently, ultrasound was investigated as a communication channel for through-tissue data transmission. To achieve real-time video streaming through tissue, data rates of ultrasound need to exceed 1 Mbps. In a previous study, we demonstrated ultrasound communications with data rates greater than 30 Mbps with two focused ultrasound transducers using a large footprint laboratory system through slabs of lossy tissues. While the form factor of the transmitter is also crucial, it is obvious that a large, focused transducer cannot fit within the size of a small in-body medical device. Several other challenges for achieving high-speed ultrasonic communication through tissue include strong reflections leading to multipath effects and attenuation. In this work, we demonstrate ultrasonic video communications using a mm-scale microcrystal transmitter with video streaming supplied by a camera connected to a Field Programmable Gate Array (FPGA). The signals were transmitted through a tissue-mimicking phantom and through the abdomen of a rabbit in vivo. The ultrasound signal was recorded by an array probe connected to a Verasonics Vantage system and decoded back to video. To improve the received signal quality, we combined the signal from multiple channels of the array probe. Orthogonal frequency division multiplexing (OFDM) modulation was used to reduce the receiver complexity under a strong multipath environment.
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17
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Awadie H, Klein A, Tate D, Jideh B, Bar-Yishai I, Goodrick K, Ahlenstiel G, Bourke MJ. The prevalence of small-bowel polyps on video capsule endoscopy in patients with sporadic duodenal or ampullary adenomas. Gastrointest Endosc 2021; 93:630-636. [PMID: 32717365 DOI: 10.1016/j.gie.2020.07.029] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/10/2020] [Accepted: 07/15/2020] [Indexed: 02/08/2023]
Abstract
BACKGROUND AND AIMS Although sporadic duodenal and/or ampullary adenomas (DAs) are uncommon, they are increasingly diagnosed during upper endoscopy. These patients have a 3- to 7-fold increased risk of colonic neoplasia compared with the normal population. It is unknown, however, whether they also have an increased risk of additional small-bowel (SB) polyps. Our aim was to establish the prevalence of SB polyps in patients with DA. METHODS In a single-center, prospective study, we used video capsule endoscopy (VCE) to investigate the prevalence of SB polyps in patients with a DA compared with patients undergoing VCE for obscure GI bleeding or iron deficiency anemia. RESULTS Over 25 months, 201 patients were enrolled in the study; the mean age was 65 years and 47% were male. There were 101 control patients and 100 cases of DA cases (mean size, 30 mm (range, 10-80 mm)). We did not identify any SB polyps in either group. Colonic polyps were found more frequently in the DA group compared with controls (61% versus 37%, respectively (P =.002)). Advanced colonic adenoma (high-grade dysplasia, >10 mm, villous histology) were found in 18% of the DA group and 5% of the control group (P =.018). CONCLUSION Our data suggest that patients with a DA are not at risk for additional SB polyps and hence do not support screening with VCE. However, colonoscopy is mandatory due to the significantly higher risk of colonic polyps including advanced adenomas. (Clinical trial registration number: NCT02470416.).
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Affiliation(s)
- Halim Awadie
- Department of Gastroenterology and Hepatology, Westmead Hospital, Westmead, New South Wales, Australia
| | - Amir Klein
- Department of Gastroenterology and Hepatology, Westmead Hospital, Westmead, New South Wales, Australia
| | - David Tate
- Department of Gastroenterology and Hepatology, Westmead Hospital, Westmead, New South Wales, Australia
| | - Bilel Jideh
- Department of Gastroenterology and Hepatology, Westmead Hospital, Westmead, New South Wales, Australia
| | - Iddo Bar-Yishai
- Department of Gastroenterology and Hepatology, Westmead Hospital, Westmead, New South Wales, Australia
| | - Kathleen Goodrick
- Department of Gastroenterology and Hepatology, Westmead Hospital, Westmead, New South Wales, Australia
| | - Golo Ahlenstiel
- Department of Gastroenterology and Hepatology, Westmead Hospital, Westmead, New South Wales, Australia; University of Sydney, Sydney, New South Wales, Australia; Blacktown Clinical School, Western Sydney University, Blacktown, New South Wales, Australia
| | - Michael J Bourke
- Department of Gastroenterology and Hepatology, Westmead Hospital, Westmead, New South Wales, Australia; University of Sydney, Sydney, New South Wales, Australia
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18
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Abstract
INTRODUCTION Capsule endoscopy (CE) is an established modality in the diagnostic algorithm of small bowel (SB) pathology. Its use has expanded for investigation of upper and lower gastrointestinal diseases with similar prototypes. AREAS COVERED This review covers the role and recent advances of CE, as a non-invasive investigative tool. EXPERT OPINION The use of upper gastrointestinal CE is useful in patients who require surveillance for varices particularly in the current era of the COVID-19 pandemic. It has also shown high accuracy in the detection of upper gastrointestinal hemorrhage in patients presenting with a suspicion of hemorrhage. Findings on CE help to guide further management by device-assisted enteroscopy. The data on colon CE suggest comparable diagnostic accuracy to colonoscopy for polyp detection; however, more evidence is required in the high-risk group. Crohn's CE has become an integral part of the management of patients with Crohn's disease offering a comparative assessment tool post escalation of therapy. Artificial intelligence within CE has demonstrated similar if not better diagnostic yield compared to the human with a significantly shorter reading time. Artificial intelligence is likely to be in-built within CE reading platforms over the next few years minimizing reporting time and human error.
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Affiliation(s)
| | - Reena Sidhu
- Academic Department of Gastroenterology, Royal Hallamshire Hospital , Sheffield, UK
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19
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Mascarenhas-Saraiva MJ, Mascarenhas-Saraiva M. A case-control study demonstrates an improved visualization when capsule endoscopy is performed after preparation with polyethylene glycol and ascorbic acid. REVISTA ESPANOLA DE ENFERMEDADES DIGESTIVAS 2020; 113:261-268. [PMID: 33213165 DOI: 10.17235/reed.2020.6806/2019] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
BACKGROUND capsule endoscopy is increasingly used to obtain images of the gastrointestinal tract, although the best preparation for this type of exploration remains unclear. AIMS the aim of this study was to compare the results of capsule endoscopy explorations performed after a basic preparation with a clear liquid diet, reduced iron intake and fasting or following preparation with a polyethylene glycol (PEG)/ascorbate solution. METHODS the results obtained from a prospective intervention group that used a PEG/ascorbate solution to prepare for capsule endoscopy were compared with those from a retrospective group of patients who followed a more basic preparation. The quality of visualization was assessed with the Park score, the visualization of the mucosal surface and the cleanliness of the intestinal lumen were assessed. The capsule transit time in different segments of the gastrointestinal tract was also evaluated. RESULTS a significant improvement in the quality of small intestine visualization was observed in individuals prepared with the PEG/ascorbate solution as opposed to the basic preparation. In fact, there were significant differences in the two separate components that contribute to the overall visualization score, with better mucosa visualization and lumen content scores in the intervention group, thus reflecting an improved performance. The presence of diabetes appeared to affect the results of these explorations, at least when using the PEG/ascorbate preparation. CONCLUSIONS preparation with a PEG/ascorbate solution improved the results of capsule endoscopy when compared to a basic preparation, without the inconvenience of the more stringent preparations used for colonoscopies.
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20
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Chang JY, Moon CM, Shim KN, Cheung DY, Lee HS, Lim YJ, Jeon SR, Park SJ, Kim KO, Song HJ, Jang HJ, Kim JH. Positive Fecal Occult Blood Test is a Predictive Factor for Gastrointestinal Bleeding after Capsule Endoscopy in Patients with Unexplained Iron Deficiency Anemia: A Korean Multicenter CAPENTRY Study. Clin Endosc 2020; 53:719-726. [PMID: 33153246 PMCID: PMC7719424 DOI: 10.5946/ce.2019.149] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/30/2019] [Accepted: 06/07/2020] [Indexed: 01/24/2023] Open
Abstract
BACKGROUND/AIMS Capsule endoscopy (CE) is recommended as the primary method for the evaluation of unexplained anemia. This study aimed to assess the diagnostic yield of CE in patients with unexplained iron deficiency anemia (IDA) without overt bleeding, and to evaluate their long-term outcomes and related clinical factors. METHODS Data of patients who underwent CE for the evaluation of IDA were reviewed from a CE registry in Korea. Additional clinical data were collected by the involved investigators of each hospital through a review of medical records. RESULTS Among a total of 144 patients, the diagnostic yield of CE was 34%. Gastrointestinal (GI) bleeding was found in 6.3% (n=9) of the patients (occult bleeding in four patients and overt bleeding in five patients) during a mean follow-up of 17.8 months. Patients with a positive fecal occult blood test (FOBT) result at the initial diagnosis had a higher rate of GI bleeding after CE (p=0.004). In addition, a positive FOBT result was the only independent predictive factor for GI bleeding (hazard ratio, 5.30; 95% confidence interval, 1.41-19.85; p=0.013). CONCLUSION Positive FOBT is a predictive factor for GI bleeding during follow-up after CE in patients with unexplained IDA without overt bleeding. Thus, patients with positive FOBT need to be more closely followed up.
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Affiliation(s)
- Ji Young Chang
- Department of Internal Medicine, Ewha Womans University College of Medicine, Seoul, Korea
| | - Chang Mo Moon
- Department of Internal Medicine, Ewha Womans University College of Medicine, Seoul, Korea
| | - Ki-Nam Shim
- Department of Internal Medicine, Ewha Womans University College of Medicine, Seoul, Korea
| | - Dae Young Cheung
- Department of Internal Medicine, The Catholic University of Korea College of Medicine, Seoul, Korea
| | - Hyun Seok Lee
- Department of Internal Medicine, School of Medicine, Kyungpook National University, Kyungpook National University Hospital, Daegu, Korea
| | - Yun Jeong Lim
- Department of Internal Medicine, Dongguk University Ilsan Hospital, Goyang, Korea
| | - Seong Ran Jeon
- Department of Internal Medicine, Soonchunhyang University College of Medicine, Seoul, Korea
| | - Soo Jung Park
- Department of Internal Medicine and Institute of Gastroenterology, Yonsei University College of Medicine, Seoul, Korea
| | - Kyeong Ok Kim
- Department of Internal Medicine, Yeungnam University College of Medicine, Daegu, Korea
| | - Hyun Joo Song
- Department of Internal Medicine, Jeju National University School of Medicine, Jeju, Korea
| | - Hyun Joo Jang
- Department of Internal Medicine, Hallym University College of Medicine, Hwasung, Korea
| | - Ji Hyun Kim
- Department of Internal Medicine, Busan Paik Hospital, Inje University College of Medicine, Busan, Korea
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21
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Singeap AM, Cojocariu C, Girleanu I, Huiban L, Sfarti C, Cuciureanu T, Chiriac S, Stanciu C, Trifan A. Clinical Impact of Small Bowel Capsule Endoscopy in Obscure Gastrointestinal Bleeding. MEDICINA (KAUNAS, LITHUANIA) 2020; 56:548. [PMID: 33086531 PMCID: PMC7603214 DOI: 10.3390/medicina56100548] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 08/31/2020] [Revised: 10/05/2020] [Accepted: 10/16/2020] [Indexed: 02/05/2023]
Abstract
Background and objectives: The most frequent indications for small bowel capsule endoscopy (SBCE) are obscure gastrointestinal bleeding (OGIB) and iron deficiency anemia (IDA). The aim of this study was to evaluate the diagnostic yield (DY) of SBCE in overt and occult OGIB, as well as its impact on the clinical outcome. Materials and Methods: This study retrospectively included all cases of OGIB investigated by SBCE in a tertiary care referral center, between 1st January 2016 and 31st December 2018. OGIB was defined by overt or occult gastrointestinal bleeding, with negative upper and lower endoscopy. Occult gastrointestinal bleeding was either proved by a fecal test or presumptively incriminated as a cause for IDA. DY was defined as the detection rate for what were thought to be clinically significant findings. DYs for overt and occult bleeding were assessed and compared. Gender, age, hemoglobin levels, NSAID consumption and the use of anticoagulants were recorded. Following SBCE results, individual therapeutic decisions were made, and follow-up data were recorded. Results: 224 SBCE examinations were performed for OGIB, of which 148 were for overt OGIB, and 76 for unexplained IDA. Positive findings were found in 139 patients, resulting in an overall DY for OGIB of 62%, higher in overt OGIB (75%) compared to IDA (37%). The most frequent findings were small bowel angioectasias (62.2% in overt OGIB and 78.5% in IDA). On multivariate logistic regression analysis, only hemoglobin level <10 g/dL and anticoagulants were the variables independently associated with positive findings. All patients received medical, endoscopic or surgical treatment and had good clinical outcome during follow-up. Conclusion: SBCE has a high diagnostic yield and a positive impact on management of patients with OGIB.
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Affiliation(s)
- Ana-Maria Singeap
- Department of Gastroenterology, Faculty of Medicine, “Grigore T. Popa” University of Medicine and Pharmacy, 700115 Iasi, Romania; (A.-M.S.); (I.G.); (L.H.); (C.S.); (T.C.); (S.C.); (A.T.)
- Institute of Gastroenterology and Hepatology, “St. Spiridon” Emergency Hospital, 700111 Iasi, Romania;
| | - Camelia Cojocariu
- Department of Gastroenterology, Faculty of Medicine, “Grigore T. Popa” University of Medicine and Pharmacy, 700115 Iasi, Romania; (A.-M.S.); (I.G.); (L.H.); (C.S.); (T.C.); (S.C.); (A.T.)
- Institute of Gastroenterology and Hepatology, “St. Spiridon” Emergency Hospital, 700111 Iasi, Romania;
| | - Irina Girleanu
- Department of Gastroenterology, Faculty of Medicine, “Grigore T. Popa” University of Medicine and Pharmacy, 700115 Iasi, Romania; (A.-M.S.); (I.G.); (L.H.); (C.S.); (T.C.); (S.C.); (A.T.)
- Institute of Gastroenterology and Hepatology, “St. Spiridon” Emergency Hospital, 700111 Iasi, Romania;
| | - Laura Huiban
- Department of Gastroenterology, Faculty of Medicine, “Grigore T. Popa” University of Medicine and Pharmacy, 700115 Iasi, Romania; (A.-M.S.); (I.G.); (L.H.); (C.S.); (T.C.); (S.C.); (A.T.)
- Institute of Gastroenterology and Hepatology, “St. Spiridon” Emergency Hospital, 700111 Iasi, Romania;
| | - Catalin Sfarti
- Department of Gastroenterology, Faculty of Medicine, “Grigore T. Popa” University of Medicine and Pharmacy, 700115 Iasi, Romania; (A.-M.S.); (I.G.); (L.H.); (C.S.); (T.C.); (S.C.); (A.T.)
- Institute of Gastroenterology and Hepatology, “St. Spiridon” Emergency Hospital, 700111 Iasi, Romania;
| | - Tudor Cuciureanu
- Department of Gastroenterology, Faculty of Medicine, “Grigore T. Popa” University of Medicine and Pharmacy, 700115 Iasi, Romania; (A.-M.S.); (I.G.); (L.H.); (C.S.); (T.C.); (S.C.); (A.T.)
- Institute of Gastroenterology and Hepatology, “St. Spiridon” Emergency Hospital, 700111 Iasi, Romania;
| | - Stefan Chiriac
- Department of Gastroenterology, Faculty of Medicine, “Grigore T. Popa” University of Medicine and Pharmacy, 700115 Iasi, Romania; (A.-M.S.); (I.G.); (L.H.); (C.S.); (T.C.); (S.C.); (A.T.)
- Institute of Gastroenterology and Hepatology, “St. Spiridon” Emergency Hospital, 700111 Iasi, Romania;
| | - Carol Stanciu
- Institute of Gastroenterology and Hepatology, “St. Spiridon” Emergency Hospital, 700111 Iasi, Romania;
| | - Anca Trifan
- Department of Gastroenterology, Faculty of Medicine, “Grigore T. Popa” University of Medicine and Pharmacy, 700115 Iasi, Romania; (A.-M.S.); (I.G.); (L.H.); (C.S.); (T.C.); (S.C.); (A.T.)
- Institute of Gastroenterology and Hepatology, “St. Spiridon” Emergency Hospital, 700111 Iasi, Romania;
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22
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Hong S, Choi SH, Park J, Yoo H, Oh JY, Hwang E, Yoon DH, Kim S. Sensory Adaptation and Neuromorphic Phototransistors Based on CsPb(Br 1-xI x) 3 Perovskite and MoS 2 Hybrid Structure. ACS NANO 2020; 14:9796-9806. [PMID: 32628447 DOI: 10.1021/acsnano.0c01689] [Citation(s) in RCA: 45] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/11/2023]
Abstract
Sensory adaptation is an essential part of biological neural systems for sustaining human life. Using the light-induced halide phase segregation of CsPb(Br1-xIx)3 perovskite, we introduce neuromorphic phototransistors that emulate human sensory adaptation. The phototransistor based on a hybrid structure of perovskite and transition-metal dichalcogenide (TMD) emulates the sensory adaptation in response to a continuous light stimulus, similar to the neural system. The underlying mechanism for the sensory adaptation is the halide segregation of the mixed halide perovskites. The phase separation under visible-light illumination leads to the segregation of I and Br into separate iodide- and bromide-rich domains, significantly changing the photocurrent in the phototransistors. The devices are reversible upon the removal of the light stimulation, resulting in near-complete recovery of the photosensitivity before the phase segregation (sensitivity recovery of 96.65% for 5 min rest time). The proposed phototransistor based on the perovskite-TMD hybrid structure can be applied to other neuromorphic devices such as neuromorphic photonic devices, intelligent sensors, and selective light-detecting image sensors.
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Affiliation(s)
- Seongin Hong
- School of Advanced Materials Science and Engineering, Sungkyunkwan University, Suwon, Gyeonggi-do 16419, Republic of Korea
| | - Seung Hee Choi
- School of Advanced Materials Science and Engineering, Sungkyunkwan University, Suwon, Gyeonggi-do 16419, Republic of Korea
| | - Jongsun Park
- School of Electrical Engineering, Korea University, Seoul 136-713, Republic of Korea
| | - Hocheon Yoo
- Department of Electronic Engineering, Gachon University, 1342 Seongnam-daero, Seongnam 13120, Korea
| | - Joo Youn Oh
- Department of Ophthalmology, Seoul National University College of Medicine, 103, Daehak-ro, Jongno-gu, Seoul 03080, South Korea
- Laboratory of Ocular Regenerative Medicine and Immunology, Biomedical Research Institute, Seoul National University Hospital, 101, Daehak-ro, Jongno-gu, Seoul 03080, South Korea
| | - Euyheon Hwang
- SKKU Advanced Institute of Nanotechnology (SAINT) and Department of Nano Engineering, Sungkyunkwan University, Suwon, Gyeonggi-do 16419, Republic of Korea
| | - Dae Ho Yoon
- School of Advanced Materials Science and Engineering, Sungkyunkwan University, Suwon, Gyeonggi-do 16419, Republic of Korea
| | - Sunkook Kim
- School of Advanced Materials Science and Engineering, Sungkyunkwan University, Suwon, Gyeonggi-do 16419, Republic of Korea
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23
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Lim DH, Jung K, Lee SB, Park IK, Cha HJ, Park JH, Kim BG, Jung SW, In Du Jeong, Kim JH, Kim SE, Moon W, In Park M, Park SJ. Non-steroidal anti-inflammatory drug-induced enteropathy as a major risk factor for small bowel bleeding: a retrospective study. BMC Gastroenterol 2020; 20:178. [PMID: 32513198 PMCID: PMC7282042 DOI: 10.1186/s12876-020-01329-5] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/20/2020] [Accepted: 06/01/2020] [Indexed: 12/21/2022] Open
Abstract
BACKGROUND Small bowel (SB) bleeding accounts for 5% of all gastrointestinal (GI) bleeding cases and 80% of obscure GI bleeding cases. Although angioectasia is the common etiology of SB bleeding, nonsteroidal anti-inflammatory drug (NSAID)-induced SB lesions are also reported as a major cause in studies from Eastern countries. Herein, we assessed the frequency of occurrence of NSAID-induced SB lesions in Korean patients with obscure GI bleeding. METHODS We retrospectively analyzed medical records of all consecutive patients aged ≥18 years who underwent capsule endoscopy from March 2018 to February 2019 at Ulsan University Hospital and Kosin University Gospel Hospital. RESULTS Of the 83 subjects (all Korean; mean age ± standard deviation: 59 ± 18 years; age range: 18-84 years; men: n = 52; women: n = 31), 55 (66.2%) had stool with clear blood and 28 (33.8%) had normal stool with iron deficiency anemia. The detection rate of SB bleeding and lesions using capsule endoscopy was 72.3% (60 of 83 patients). A significantly higher frequency (40 of 51) of ulcerative/erosive lesions than other causes was observed in patients with inactive bleeding but visible SB lesions. As a result, NSAID-induced enteropathy accounted for 30.1% of 83 patients with obscure GI bleeding (25 of the all 60 SB bleeding cases). CONCLUSIONS Contrary to what is reported for patients in Western countries, this study in Korean patients showed an improved diagnostic yield of capsule endoscopy for obscure GI bleeding and that NSAID-induced enteropathy was the most common etiology of SB bleeding. Aggressive small intestine examination is required for patients with unexplained GI bleeding.
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Affiliation(s)
- Doo-Ho Lim
- Department of Internal Medicine, University of Ulsan College of Medicine, Ulsan University Hospital, 877 Bangeojinsunhwando-ro, Dong-gu, Ulsan, 44033, South Korea
| | - Kyoungwon Jung
- Department of Internal Medicine, Kosin University College of Medicine, Kosin University Gospel Hospital, Busan, South Korea
| | - Seung Bum Lee
- Department of Internal Medicine, University of Ulsan College of Medicine, Ulsan University Hospital, 877 Bangeojinsunhwando-ro, Dong-gu, Ulsan, 44033, South Korea.
| | - In Kyu Park
- Department of General Surgery, University of Ulsan College of Medicine, Ulsan University Hospital, Ulsan, South Korea
| | - Hee Jeong Cha
- Department of Pathology, University of Ulsan College of Medicine, Ulsan University Hospital, Ulsan, South Korea
| | - Jae Ho Park
- Department of Internal Medicine, University of Ulsan College of Medicine, Ulsan University Hospital, 877 Bangeojinsunhwando-ro, Dong-gu, Ulsan, 44033, South Korea
| | - Byung Gyu Kim
- Department of Internal Medicine, University of Ulsan College of Medicine, Ulsan University Hospital, 877 Bangeojinsunhwando-ro, Dong-gu, Ulsan, 44033, South Korea
| | - Seok Won Jung
- Department of Internal Medicine, University of Ulsan College of Medicine, Ulsan University Hospital, 877 Bangeojinsunhwando-ro, Dong-gu, Ulsan, 44033, South Korea
| | - In Du Jeong
- Department of Internal Medicine, University of Ulsan College of Medicine, Ulsan University Hospital, 877 Bangeojinsunhwando-ro, Dong-gu, Ulsan, 44033, South Korea
| | - Jae Hyun Kim
- Department of Internal Medicine, Kosin University College of Medicine, Kosin University Gospel Hospital, Busan, South Korea
| | - Sung Eun Kim
- Department of Internal Medicine, Kosin University College of Medicine, Kosin University Gospel Hospital, Busan, South Korea
| | - Won Moon
- Department of Internal Medicine, Kosin University College of Medicine, Kosin University Gospel Hospital, Busan, South Korea
| | - Moo In Park
- Department of Internal Medicine, Kosin University College of Medicine, Kosin University Gospel Hospital, Busan, South Korea
| | - Seun Ja Park
- Department of Internal Medicine, Kosin University College of Medicine, Kosin University Gospel Hospital, Busan, South Korea
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Liaqat A, Khan MA, Sharif M, Mittal M, Saba T, Manic KS, Al Attar FNH. Gastric Tract Infections Detection and Classification from Wireless Capsule Endoscopy using Computer Vision Techniques: A Review. Curr Med Imaging 2020; 16:1229-1242. [PMID: 32334504 DOI: 10.2174/1573405616666200425220513] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2019] [Revised: 01/14/2020] [Accepted: 01/30/2020] [Indexed: 11/22/2022]
Abstract
Recent facts and figures published in various studies in the US show that approximately 27,510 new cases of gastric infections are diagnosed. Furthermore, it has also been reported that the mortality rate is quite high in diagnosed cases. The early detection of these infections can save precious human lives. As the manual process of these infections is time-consuming and expensive, therefore automated Computer-Aided Diagnosis (CAD) systems are required which helps the endoscopy specialists in their clinics. Generally, an automated method of gastric infection detections using Wireless Capsule Endoscopy (WCE) is comprised of the following steps such as contrast preprocessing, feature extraction, segmentation of infected regions, and classification into their relevant categories. These steps consist of various challenges that reduce the detection and recognition accuracy as well as increase the computation time. In this review, authors have focused on the importance of WCE in medical imaging, the role of endoscopy for bleeding-related infections, and the scope of endoscopy. Further, the general steps and highlighting the importance of each step have been presented. A detailed discussion and future directions have been provided at the end.
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Affiliation(s)
- Amna Liaqat
- Department of Computer Science, COMSATS University Islamabad, Wah Cantt, Pakistan
| | | | - Muhammad Sharif
- Department of Computer Science, COMSATS University Islamabad, Wah Cantt, Pakistan
| | - Mamta Mittal
- Department of Computer Science & Engineering, G.B. Pant Govt. Engineering College, New Delhi, India
| | - Tanzila Saba
- Department of Computer and Information Sciences, Prince Sultan University, Riyadh, Saudi Arabia
| | - K Suresh Manic
- Department of Electrical & Computer Engineering, National University of Science & Technology, Muscat, Oman
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Kariya S, Nakatani M, Ono Y, Maruyama T, Ueno Y, Yoshida A, Komemushi A, Tanigawa N. Provocative angiography for lower gastrointestinal bleeding. Jpn J Radiol 2019; 38:248-255. [DOI: 10.1007/s11604-019-00909-0] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2019] [Accepted: 12/02/2019] [Indexed: 12/16/2022]
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Murphy B, Winter DC, Kavanagh DO. Small Bowel Gastrointestinal Bleeding Diagnosis and Management-A Narrative Review. Front Surg 2019; 6:25. [PMID: 31157232 PMCID: PMC6532547 DOI: 10.3389/fsurg.2019.00025] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2019] [Accepted: 04/24/2019] [Indexed: 12/22/2022] Open
Abstract
Background: Small bowel bleeding accounts for 5-10% of all gastrointestinal bleeding. Despite advances in imaging, endoscopy and minimally invasive therapeutic techniques, its diagnosis and treatment remains a challenge and a standardized algorithm for approaching suspected small bowel bleeding remains elusive. Furthermore, the choice of investigation is subject to timing of presentation and accessibility to investigations. The aim of this study was to construct a narrative review of recent literature surrounding the diagnosis and management of small bowel bleeding. Methods: A literature review was conducted examining the database pubmed with the following key words and Boolean operators: occult GI bleed OR mesenteric bleed OR gastrointestinal hemorrhage OR GI hemorrhage AND management. Articles were selected and reviewed based on relevance to the research topic. Where necessary, the full text was sought to further assess relevance. Results: In overt GI bleeding, CT angiography and red cell scintigraphy are both feasible and reliable diagnostic imaging modalities if standard endoscopy is negative. Red cell scintigraphy may be advantageous through detection of lower bleeding rates but it is subject to availability. Overt bleeding and a positive CT angiogram or red cell scan improves the diagnostic yield of formal angiography ± embolization. Video capsule endoscopy or double balloon endoscopy can be considered in occult GI bleeding following normal upper and lower endoscopy. Conclusions: Small bowel bleeding remains a rare but significant diagnostic and therapeutic challenge. Technological advances in diagnostics have aided evaluation but have not broadened the range of therapeutic interventions.
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Affiliation(s)
- B. Murphy
- Department of Colorectal Surgery, University Hospital Tallaght, Dublin, Ireland
- Department of Colorectal Surgery, St. Vincent's University Hospital, Dublin, Ireland
| | - D. C. Winter
- Department of Colorectal Surgery, St. Vincent's University Hospital, Dublin, Ireland
| | - D. O. Kavanagh
- Department of Colorectal Surgery, University Hospital Tallaght, Dublin, Ireland
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Koffas A, Laskaratos FM, Epstein O. Non-small bowel lesion detection at small bowel capsule endoscopy: A comprehensive literature review. World J Clin Cases 2018; 6:901-907. [PMID: 30568944 PMCID: PMC6288513 DOI: 10.12998/wjcc.v6.i15.901] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/09/2018] [Revised: 11/11/2018] [Accepted: 11/24/2018] [Indexed: 02/05/2023] Open
Abstract
Small bowel capsule endoscopy is a minimally-invasive endoscopic investigation that is often used in clinical practice to investigate overt or occult gastrointestinal (GI) bleeding among other clinical indications. International guidance recommends small bowel capsule endoscopy as a first-line investigation to detect abnormalities in the small bowel, when gastroscopy and colonoscopy fail to identify a cause of GI bleeding. It can diagnose with accuracy abnormalities in the small bowel. However, there has been increasing evidence indicating that small bowel capsule endoscopy may also detect lesions outside the small intestine that are within the reach of conventional endoscopy and have been probably missed during prior endoscopic investigations. Such lesions vary from vascular deformities to malignancy and their detection often alters patient management, leading to further endoscopic and/or surgical interventions. The current study attempts to review all available studies in the literature and summarise their relevant findings.
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Affiliation(s)
- Apostolos Koffas
- Gastroenterology Department, University Hospital of Larisa, Mezourlo, Larisa 41110, Greece
| | | | - Owen Epstein
- Centre for Gastroenterology, Royal Free Hospital, Pond St, London NW3 2QG, United Kingdom
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Chetcuti Zammit S, Sanders DS, Sidhu R. A comprehensive review on the utility of capsule endoscopy in coeliac disease: From computational analysis to the bedside. Comput Biol Med 2018; 102:300-314. [PMID: 29980284 DOI: 10.1016/j.compbiomed.2018.06.025] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2018] [Revised: 06/23/2018] [Accepted: 06/24/2018] [Indexed: 11/29/2022]
Abstract
Small bowel capsule endoscopy (SBCE) can identify macroscopic changes of coeliac disease and assess the extent of disease in the small bowel beyond the duodenum. SBCE has a good sensitivity for the detection of coeliac disease in comparison to histology owing to several ideal features such as a high magnification. It also plays a useful role in detecting complications in patients with refractory coeliac disease. Several studies have been carried out on transforming images obtained from small bowel capsule endoscopy to enable the automated detection of features related to coeliac disease. This review discusses the current roles played by small bowel capsule endoscopy in coeliac disease. It identifies future potential roles of this technique and describes in great detail the role of computational analysis in the detection of coeliac disease and how it can be adapted to current available technology.
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Affiliation(s)
- Stefania Chetcuti Zammit
- Academic Department of Gastroenterology, Royal Hallamshire Hospital, Sheffield Teaching Hospitals, Sheffield, UK.
| | - David S Sanders
- Academic Department of Gastroenterology, Royal Hallamshire Hospital, Sheffield Teaching Hospitals, Sheffield, UK
| | - Reena Sidhu
- Academic Department of Gastroenterology, Royal Hallamshire Hospital, Sheffield Teaching Hospitals, Sheffield, UK
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Chetcuti Zammit S, Sanders DS, Sidhu R. Capsule endoscopy for patients with coeliac disease. Expert Rev Gastroenterol Hepatol 2018; 12:779-790. [PMID: 29886766 DOI: 10.1080/17474124.2018.1487289] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Abstract
Coeliac disease is an autoimmune mediated condition in response to gluten. A combination of innate and adaptive immune responses results in villous shortening in the small bowel (SB) that can be morphologically picked up on capsule endoscopy. It is the only imaging modality that can provide mucosal views of the entire SB, while histology is generally limited to the proximal SB. Radiological modalities are not designed to pick up changes in villous morphology. Areas covered: In this review, we provide a comprehensive analysis on the justified use of small bowel capsule endoscopy (SBCE) in the assessment of patients with coeliac disease; compare SBCE to histology, serology, and symptomatology; and provide an overview on automated quantitative analysis for the detection of coeliac disease. We also provide insight into future work on SBCE in relation to coeliac disease. Expert commentary: SBCE has opened up new avenues for the diagnosis and monitoring of patients with coeliac disease. However, larger studies with new and established coeliac disease patients and with greater emphasis on morphological features on SBCE are required to better define the role of SBCE in the setting of coeliac disease.
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Affiliation(s)
| | - David S Sanders
- a Gastroenterology Department , Sheffield Teaching Hospitals , Sheffield , UK
| | - Reena Sidhu
- a Gastroenterology Department , Sheffield Teaching Hospitals , Sheffield , UK
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Saurin JC, Jacob P, Heyries L, Pesanti C, Cholet F, Fassler I, Boulant J, Bramli S, De Leusse A, Rahmi G. Multicenter prospective evaluation of the express view reading mode for small-bowel capsule endoscopy studies. Endosc Int Open 2018; 6:E616-E621. [PMID: 29756020 PMCID: PMC5943700 DOI: 10.1055/a-0587-4788] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/17/2017] [Accepted: 02/02/2018] [Indexed: 12/17/2022] Open
Abstract
BACKGROUND Reducing the reading time of capsule endoscopy films is of high priority for gastroenterologists. We report a prospective multicenter evaluation of an "express view" reading mode (Intromedic capsule system). METHODS Eighty-three patients with obscure gastrointestinal bleeding were prospectively included in 10 centers. All patients underwent small-bowel capsule endoscopy (Intromedic, Seoul, Republic of Korea). Films were read in standard mode, then a second reading was performed in express view mode at a second center. For each lesion, the precise location, nature, and relevance were collected. A consensus reading and review were done by three experts, and considered to be the gold standard. RESULTS The mean reading time of capsule films was 39.7 minutes (11 - 180 minutes) and 19.7 minutes (4 - 40 minutes) by standard and express view mode, respectively ( P < 1 × 10 - 4 ). The consensus review identified a significant lesion in 44/83 patients (53.0 %). Standard reading and express view reading had a 93.3 % and 82.2 % sensitivity, respectively (NS). Consensus review identified 70 significant images from which standard reading and express view reading detected 58 (82.9 %) and 55 (78.6 %), respectively. The informatics algorithm detected 66/70 images (94.3 %) thus missing four small-bowel angiodysplasia. CONCLUSION The express view algorithm allows an important shortening of Intromedic capsule film reading time with a high sensitivity.
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Affiliation(s)
- Jean-Christophe Saurin
- Gastroenterology Department, E. Herriot Hospital, Lyon, France,Corresponding author Jean-Christophe Saurin Gastroenterology DepartmentHôpital E. Herriot5 Place d’Arsonval69437 Lyon Cedex 03France+33-4-78861063
| | | | | | | | | | | | | | - Slim Bramli
- Gastroenterology Department, Avignon, France
| | | | - Gabriel Rahmi
- Gastroenterology Department, Hôpital Européen Georges Pompidou, Assistance Publique Hôpitaux de Paris, Université Paris Descartes, Paris, France
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Zhang L, Shen J, Guo L, Cheng F, Fan Q, Ni K, Xia S, Zhou D. Diagnostic value of OMOM capsule endoscopy for small bowel diseases in adults. Exp Ther Med 2018; 15:3467-3470. [PMID: 29545870 PMCID: PMC5841053 DOI: 10.3892/etm.2018.5864] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2015] [Accepted: 07/27/2017] [Indexed: 12/22/2022] Open
Abstract
The present study aimed to determine the diagnostic yield of OMOM capsule endoscopy for small bowel diseases in adults. A total of 89 patients, including 45 cases of obscure abdominal pain, 22 of chronic diarrhea, 18 of obscure gastrointestinal bleeding and 4 of obscure anemia were enrolled in the present study. The transit time of the endoscopy capsule in the digestive tract was recorded and the testing results were analyzed. All detections were completed except for four capsule retentions and the completion rate was 95.51%. The average transit time of the endoscopy capsule in the esophagus, stomach and small intestine was 62.18±64.23 sec, 67.46±63.13 and 346.53±102.81 min, respectively. Of the 89 patients, 54 (60.67%) were found to have lesions, among which 19 had mucosal erosion (21.35%), 15 had anabrosis (16.85%), 9 were diagnosed with polyps (10.11%), 5 with angiodysplasia (5.62%); furthermore, tumors were identified in 5 patients (5.62%) and ancylostomiasis in 1 patient (1.12%). The results confirmed the feasibility and validity of OMOM capsule endoscopy for diagnosing small bowel diseases in adults.
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Affiliation(s)
- Lili Zhang
- Department of Gastroenterology, Xinghua Hospital, Xinghua, Jiangsu 225700, P.R. China
| | - Junsong Shen
- Department of Gastroenterology, Xinghua Hospital, Xinghua, Jiangsu 225700, P.R. China
| | - Linchun Guo
- Department of Gastroenterology, Xinghua Hospital, Xinghua, Jiangsu 225700, P.R. China
| | - Fenggan Cheng
- Department of Gastroenterology, Xinghua Hospital, Xinghua, Jiangsu 225700, P.R. China
| | - Qi Fan
- Department of Gastroenterology, Xinghua Hospital, Xinghua, Jiangsu 225700, P.R. China
| | - Keqian Ni
- Department of Gastroenterology, Xinghua Hospital, Xinghua, Jiangsu 225700, P.R. China
| | - Shujing Xia
- Department of Gastroenterology, Xinghua Hospital, Xinghua, Jiangsu 225700, P.R. China
| | - Detong Zhou
- Department of Gastroenterology, Xinghua Hospital, Xinghua, Jiangsu 225700, P.R. China
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Zhang M, Peng J, Liu X. Sparse coding with earth mover’s distance for multi-instance histogram representation. Neural Comput Appl 2017. [DOI: 10.1007/s00521-016-2269-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
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Albrecht H, Vetter M, Dauth W, Zoicas F, Neurath MF, Hagel AF. The impact of hospitalization on the performance of capsule endoscopy (CE). Dig Liver Dis 2017; 49:647-650. [PMID: 28258930 DOI: 10.1016/j.dld.2017.02.010] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/10/2016] [Revised: 02/08/2017] [Accepted: 02/09/2017] [Indexed: 12/11/2022]
Abstract
BACKGROUND For proper evaluation of capsule endoscopy (CE), a complete examination is necessary. AIM We evaluated risk factors of an incomplete CE with focus on patient hospitalization. METHODS We retrospectively evaluated 161 consecutive patients who underwent CE between 01.07.2013 and 13.03.2016. Main indications were active bleeding, iron deficiency anemia (IDA), inflammatory bowel disease (IBD), abdominal pain, and familial adenomatous polyposis (FAP). RESULTS We report the results of 103 in-patients and 56 out-patients. Eighty-two patients were male, average age was 58.9 years (range 18-90). Indications for CE were active bleeding (103 patients), IDA and IBD (16 patients), and FAP, abdominal pain and others (eight examinations each). All FAP patients were out-patients, but showed the longest small bowel transit time (SBTT) of 443.6min (p=0.0001). The shortest SBTT was found in out-patients without FAP (267.5min, p<0.05). In the in-patient group, nine endoscopies did not record the entire small bowel (8.7%) due to battery depletion, compared with only one incomplete examination in the out-patients (1.8%, p=0.036). We found pathologic lesions in the last 30min of the SBTT in 43 patients, and this indicates the necessity for complete examination. Thirteen of these 43 patients showed major lesions such as ulcers or angiodysplasia in this last region alone. CONCLUSION In-patients might require special treatment to ensure complete examination, since a considerable amount of pathologies can only be found in the ileum.
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Affiliation(s)
- Heinz Albrecht
- Department of Medicine 1, Friedrich-Alexander-University Erlangen-Nuremberg, Erlangen, Germany
| | - Marcel Vetter
- Department of Medicine 1, Friedrich-Alexander-University Erlangen-Nuremberg, Erlangen, Germany
| | | | - Flavius Zoicas
- Department of Medicine 1, Friedrich-Alexander-University Erlangen-Nuremberg, Erlangen, Germany
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Cianci R, Urgesi R, Tortora A, Amato A, Newton EE, Costamagna G, Riccioni ME. WITHDRAWN: The Role of capsule endoscopy and device assisted enteroscopy for small bowel lesions in hereditary hemorrhagic telangiectasia. Dig Liver Dis 2017:S1590-8658(17)30891-5. [PMID: 28619257 DOI: 10.1016/j.dld.2017.05.014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/26/2016] [Revised: 04/14/2017] [Accepted: 05/15/2017] [Indexed: 12/11/2022]
Abstract
This article has been withdrawn at the request of the author(s) and/or editor. The Publisher apologizes for any inconvenience this may cause. The full Elsevier Policy on Article Withdrawal can be found at https://www.elsevier.com/about/our-business/policies/article-withdrawal.
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Affiliation(s)
- Rossella Cianci
- Department of Internal Medicine, Catholic University, Largo A. Gemelli, 8, 00168, Rome, Italy
| | - Riccardo Urgesi
- Endoscopy Unit, S. Giovanni Addolorata Hospital, Rome, Italy
| | - Annalisa Tortora
- Endoscopy Unit, Catholic University, Largo A. Gemelli, 8, 00168, Rome, Italy
| | - Arianna Amato
- Department of Anaesthesiology, Catholic University, Largo A. Gemelli, 8, 00168, Rome, Italy
| | | | - Guido Costamagna
- Endoscopy Unit, Catholic University, Largo A. Gemelli, 8, 00168, Rome, Italy
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Rossi RE, Conte D, Elli L, Branchi F, Massironi S. Endoscopic techniques to detect small-bowel neuroendocrine tumors: A literature review. United European Gastroenterol J 2017; 5:5-12. [PMID: 28405316 PMCID: PMC5384561 DOI: 10.1177/2050640616658220] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/25/2016] [Accepted: 06/12/2016] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND The diagnosis of small-bowel neuroendocrine tumors (SbNETs) has improved with the advent of video capsule endoscopy (CE) and double-balloon enteroscopy (DBE). The data describing the efficacy of CE/DBE in the detection of SbNETs are scanty. AIM The aim of this article is to review the current evidence on the role of DBE and CE in the diagnosis of SbNETs. MATERIAL AND METHODS A bibliographical search was performed in PubMed using the following keywords: "neuroendocrine tumors and enteroscopy/and capsule endoscopy" and "small bowel neuroendocrine tumors." RESULTS CE and DBE can be complementary and show a similar diagnostic yield. The number of false-negative results has not been established yet because of the "work-up bias" observed in the majority of the studies. CONCLUSIONS DBE and CE appear to be both safe and effective procedures useful in the diagnosis of SbNETs. Further studies are required to clarify their potential complications and relationship with other techniques, particularly nuclear imaging.
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Affiliation(s)
- Roberta Elisa Rossi
- Gastroenterology and Endoscopy Unit, Fondazione IRCCS Ca’ Granda Ospedale Maggiore Policlinico, Italy
- Department of Pathophysiology and Transplantation, Università degli Studi di Milano, Italy
| | - Dario Conte
- Gastroenterology and Endoscopy Unit, Fondazione IRCCS Ca’ Granda Ospedale Maggiore Policlinico, Italy
- Department of Pathophysiology and Transplantation, Università degli Studi di Milano, Italy
| | - Luca Elli
- Gastroenterology and Endoscopy Unit, Fondazione IRCCS Ca’ Granda Ospedale Maggiore Policlinico, Italy
- Center for Prevention and Diagnosis of Celiac Disease, Fondazione IRCCS Ca’ Granda Ospedale Maggiore Policlinico, Italy
| | - Federica Branchi
- Gastroenterology and Endoscopy Unit, Fondazione IRCCS Ca’ Granda Ospedale Maggiore Policlinico, Italy
- Center for Prevention and Diagnosis of Celiac Disease, Fondazione IRCCS Ca’ Granda Ospedale Maggiore Policlinico, Italy
| | - Sara Massironi
- Gastroenterology and Endoscopy Unit, Fondazione IRCCS Ca’ Granda Ospedale Maggiore Policlinico, Italy
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Qiao P, Liu H, Yan X, Jia Z, Pi X. A Smart Capsule System for Automated Detection of Intestinal Bleeding Using HSL Color Recognition. PLoS One 2016; 11:e0166488. [PMID: 27902728 PMCID: PMC5130220 DOI: 10.1371/journal.pone.0166488] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2016] [Accepted: 10/28/2016] [Indexed: 12/22/2022] Open
Abstract
There are no ideal means for the diagnosis of intestinal bleeding diseases as of now, particularly in the small intestine. This study investigated an intelligent intestinal bleeding detection capsule system based on color recognition. After the capsule is swallowed, the bleeding detection module (containing a color-sensitive adsorptive film that changes color when absorbing intestinal juice,) is used to identify intestinal bleeding features. A hue-saturation-light color space method can be applied to detect bleeding according to the range of H and S values of the film color. Once bleeding features are recognized, a wireless transmission module is activated immediately to send an alarm signal to the outside; an in vitro module receives the signal and sends an alarm. The average power consumption of the entire capsule system is estimated to be about 2.1mW. Owing to its simplicity, reliability, and effectiveness, this system represents a new approach to the clinical diagnosis of intestinal bleeding diseases.
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Affiliation(s)
- Panpan Qiao
- Key Laboratory of Biorheological Science and Technology of Ministry of Education, Bioengineering College, Chongqing University, Chongqing, PR China
| | - Hongying Liu
- Key Laboratory of Biorheological Science and Technology of Ministry of Education, Bioengineering College, Chongqing University, Chongqing, PR China
- Chongqing Engineering Research Center of Medical Electronics, Chongqing, PR China
- * E-mail: (HYL); (XTP)
| | - Xueping Yan
- Key Laboratory of Biorheological Science and Technology of Ministry of Education, Bioengineering College, Chongqing University, Chongqing, PR China
| | - Ziru Jia
- Key Laboratory of Biorheological Science and Technology of Ministry of Education, Bioengineering College, Chongqing University, Chongqing, PR China
| | - Xitian Pi
- Key Laboratory of Biorheological Science and Technology of Ministry of Education, Bioengineering College, Chongqing University, Chongqing, PR China
- Key Laboratories for National Defense Science and Technology of innovative micro-nano devices and system technology, Chongqing University, Chongqing, PR China
- * E-mail: (HYL); (XTP)
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Abstract
BACKGROUND Small bowel (SB) capsule endoscopy (CE) studies provide data on both gastric and SB transit times (GTT and SBTT, respectively). AIMS 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. METHODS Consecutive adult patients undergoing CE were included. GTT, SBTT, and cecum arrival rates were calculated and correlated to demographics and clinical characteristics. RESULTS 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. CONCLUSION 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.
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Pitocco D, Rizzi A, Tortora A, Manto A, Zaccardi F, Ghirlanda G, Costamagna G, Riccioni ME. Possible Radio Interference Between Video Capsule Endoscopy and Second-Generation OmniPod Patch Pump. Diabetes Technol Ther 2016; 18:444-445. [PMID: 27333334 DOI: 10.1089/dia.2016.0007] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
Video capsule endoscopy (VCE) is a noninvasive diagnostic tool used to observe the small intestinal mucosa. We report a case of a 57-year-old woman with T2DM, treated with continuous subcutaneous insulin infusion using second-generation OmniPod patch pump, undergoing VCE (Given M2A; VCE Ltd, Yoqneam, Israel) for melena and anemia. During VCE, an abnormal interruption of communication between video capsule and its receiver occurred. Two hours after capsule ingestion, the patient activated the insulin pump infusion through the Personal Diabetes Manager (PDM) because she drank a sugary beverage for the first time after ingestion. Due to this, we decided to repeat VCE after the removal of the insulin pump and PDM: at this time, the capsule recorded for more than 10 h without any interruption. The video capsule and second-generation OmniPod patch pump use the same radio frequency and this may cause interference between these two devices. In patients using second-generation OmniPod patch pump undergoing VCE, we suggest to switch to intravenous insulin infusion or multiple daily injection or to use a different model of VCE, as MiRoCam (Intromedic, Seoul, Korea).
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Affiliation(s)
- Dario Pitocco
- 1 Diabetes Care Unit, Internal Medicine, Policlinico Agostino Gemelli Hospital , Rome, Italy
| | - Alessandro Rizzi
- 1 Diabetes Care Unit, Internal Medicine, Policlinico Agostino Gemelli Hospital , Rome, Italy
| | - Annalisa Tortora
- 2 Digestive Endoscopy Unit, Policlinico Agostino Gemelli Hospital , Rome, Italy
| | - Andrea Manto
- 1 Diabetes Care Unit, Internal Medicine, Policlinico Agostino Gemelli Hospital , Rome, Italy
| | - Francesco Zaccardi
- 1 Diabetes Care Unit, Internal Medicine, Policlinico Agostino Gemelli Hospital , Rome, Italy
| | - Giovanni Ghirlanda
- 1 Diabetes Care Unit, Internal Medicine, Policlinico Agostino Gemelli Hospital , Rome, Italy
| | - Guido Costamagna
- 2 Digestive Endoscopy Unit, Policlinico Agostino Gemelli Hospital , Rome, Italy
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Iijima K, Umezu M, Iwasaki K. Time Series Analysis of the Effectiveness and Safety of Capsule Endoscopy between the Premarketing and Postmarketing Settings: A Meta-Analysis. PLoS One 2016; 11:e0153662. [PMID: 27248140 PMCID: PMC4889146 DOI: 10.1371/journal.pone.0153662] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2015] [Accepted: 04/01/2016] [Indexed: 12/22/2022] Open
Abstract
Background Clinical studies for assessing the effectiveness and safety in a premarketing setting are conducted under time and cost constraints. In recent years, postmarketing data analysis has been given more attention. However, to our knowledge, no studies have compared the effectiveness and the safety between the pre- and postmarketing settings. In this study, we aimed to investigate the importance of the postmarketing data analysis using clinical data. Methods and Findings Studies on capsule endoscopy with rich clinical data in both pre- and postmarketing settings were selected for the analysis. For effectiveness, clinical studies published before October 10, 2015 comparing capsule endoscopy and conventional flexible endoscopy measuring the detection ratio of obscure gastrointestinal bleeding were selected (premarketing: 4 studies and postmarketing: 8 studies) from PubMed (MEDLINE), Cochrane Library, EMBASE and Web of Science. Among the 12 studies, 5 were blinded and 7 were non-blinded. A time series meta-analysis was conducted. Effectiveness (odds ratio) decreased in the postmarketing setting (premarketing: 5.19 [95% confidence interval: 3.07–8.76] vs. postmarketing: 1.48 [0.81–2.69]). The change in odds ratio was caused by the increase in the detection ratio with flexible endoscopy as the control group. The efficacy of capsule endoscopy did not change between pre- and postmarketing settings. Heterogeneity (I2) increased in the postmarketing setting because of one study. For safety, in terms of endoscope retention in the body, data from the approval summary and adverse event reports were analyzed. The incidence of retention decreased in the postmarketing setting (premarketing: 0.75% vs postmarketing: 0.095%). The introduction of the new patency capsule for checking the patency of the digestive tract might contribute to the decrease. Conclusions Effectiveness and safety could change in the postmarketing setting. Therefore, time series meta-analyses could be useful to continuously monitor the effectiveness of medical device in clinical practices.
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Affiliation(s)
- Kazuo Iijima
- Cooperative Major in Advanced Biomedical Sciences, Joint Graduate School of Tokyo Women's Medical University and Waseda University, Tokyo, Japan
| | - Mitsuo Umezu
- Cooperative Major in Advanced Biomedical Sciences, Joint Graduate School of Tokyo Women's Medical University and Waseda University, Tokyo, Japan
- Faculty of Science and Engineering, Waseda University, Tokyo, Japan
| | - Kiyotaka Iwasaki
- Cooperative Major in Advanced Biomedical Sciences, Joint Graduate School of Tokyo Women's Medical University and Waseda University, Tokyo, Japan
- Faculty of Science and Engineering, Waseda University, Tokyo, Japan
- * E-mail:
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Klein A, Dashkovsky M, Gralnek I, Peled R, Chowers Y, Khamaysi I, Har-Noy O, Levi I, Nadler M, Eliakim R, Kopylov U. Bowel preparation in "real-life" small bowel capsule endoscopy: a two-center experience. Ann Gastroenterol 2016; 29:196-200. [PMID: 27064840 PMCID: PMC4805740 DOI: 10.20524/aog.2016.0012] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
Background Video capsule endoscopy (VCE) is an established diagnostic tool for the investigation of small bowel (SB) pathology. Bowel preparation prior to VCE may improve visualization, transit time, and diagnostic yield. We aimed to evaluate the “real-life” experience comparing two different preparation protocols in patients undergoing SB VCE. Methods We performed a retrospective analysis of prospectively collected data from SB VCE procedures, performed in two tertiary care medical centers in Israel. VCE procedures performed at “Sheba Medical Center” used a 2-L polyethylene glycol (PEG) bowel preparation (n=360) while VCEs performed at “Rambam Health Care campus” used a clear liquid diet plus 12-h fast protocol (n=500). A dichotomous preparation scale (adequate, inadequate) was used to classify cleansing quality. Data collection included patient and procedural details. The proportion of VCE procedures with adequate bowel preparation and the overall positive SB findings in the two different bowel preparation protocols were evaluated. Results SB completion rates were higher in the PEG protocol (96% vs. 83%, P<0.001) and SB passage time was significantly faster in the PEG protocol (mean 217±73 vs. 238±77 min, P<0.001). Bowel preparation quality was similar between groups (8% vs. 7% inadequate preparation, P=0.591). Overall positive SB findings were similar between the two groups (57% clear liquid fasting only vs. 51% PEG protocol, P=0.119). Conclusion In this large cohort, a 2-L PEG protocol had similar preparation quality and diagnostic yield compared with clear liquid fasting.
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Affiliation(s)
- Amir Klein
- Gastroenterology, Rambam Health Care Campus, Rappaport Family Faculty of Medicine Technion-Israel Institute of Technology, Haifa (Amir Klein, Marianna Dashkovsky, Ian Gralnek, Ravit Peled, Yehuda Chowers, Iyad Khamaysi), Tel-Aviv, Israel
| | - Marianna Dashkovsky
- Gastroenterology, Rambam Health Care Campus, Rappaport Family Faculty of Medicine Technion-Israel Institute of Technology, Haifa (Amir Klein, Marianna Dashkovsky, Ian Gralnek, Ravit Peled, Yehuda Chowers, Iyad Khamaysi), Tel-Aviv, Israel
| | - Ian Gralnek
- Gastroenterology, Rambam Health Care Campus, Rappaport Family Faculty of Medicine Technion-Israel Institute of Technology, Haifa (Amir Klein, Marianna Dashkovsky, Ian Gralnek, Ravit Peled, Yehuda Chowers, Iyad Khamaysi), Tel-Aviv, Israel
| | - Ravit Peled
- Gastroenterology, Rambam Health Care Campus, Rappaport Family Faculty of Medicine Technion-Israel Institute of Technology, Haifa (Amir Klein, Marianna Dashkovsky, Ian Gralnek, Ravit Peled, Yehuda Chowers, Iyad Khamaysi), Tel-Aviv, Israel
| | - Yehuda Chowers
- Gastroenterology, Rambam Health Care Campus, Rappaport Family Faculty of Medicine Technion-Israel Institute of Technology, Haifa (Amir Klein, Marianna Dashkovsky, Ian Gralnek, Ravit Peled, Yehuda Chowers, Iyad Khamaysi), Tel-Aviv, Israel
| | - Iyad Khamaysi
- Gastroenterology, Rambam Health Care Campus, Rappaport Family Faculty of Medicine Technion-Israel Institute of Technology, Haifa (Amir Klein, Marianna Dashkovsky, Ian Gralnek, Ravit Peled, Yehuda Chowers, Iyad Khamaysi), Tel-Aviv, Israel
| | - Ofir Har-Noy
- Gastroenterology, Chaim Sheba Medical Center, Sackler School of Medicine, Tel-Aviv University, Tel-Aviv (Ofir Har-Noy, Idan Levi, Moshe Nadler, Rami Eliakim, Uri Kopylov), Tel-Aviv, Israel
| | - Idan Levi
- Gastroenterology, Chaim Sheba Medical Center, Sackler School of Medicine, Tel-Aviv University, Tel-Aviv (Ofir Har-Noy, Idan Levi, Moshe Nadler, Rami Eliakim, Uri Kopylov), Tel-Aviv, Israel
| | - Moshe Nadler
- Gastroenterology, Chaim Sheba Medical Center, Sackler School of Medicine, Tel-Aviv University, Tel-Aviv (Ofir Har-Noy, Idan Levi, Moshe Nadler, Rami Eliakim, Uri Kopylov), Tel-Aviv, Israel
| | - Rami Eliakim
- Gastroenterology, Chaim Sheba Medical Center, Sackler School of Medicine, Tel-Aviv University, Tel-Aviv (Ofir Har-Noy, Idan Levi, Moshe Nadler, Rami Eliakim, Uri Kopylov), Tel-Aviv, Israel
| | - Uri Kopylov
- Gastroenterology, Chaim Sheba Medical Center, Sackler School of Medicine, Tel-Aviv University, Tel-Aviv (Ofir Har-Noy, Idan Levi, Moshe Nadler, Rami Eliakim, Uri Kopylov), Tel-Aviv, Israel
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Analysis of Non-Small Bowel Lesions Detected by Capsule Endoscopy in Patients with Potential Small Bowel Bleeding. DIAGNOSTIC AND THERAPEUTIC ENDOSCOPY 2016; 2016:9063293. [PMID: 27092029 PMCID: PMC4820590 DOI: 10.1155/2016/9063293] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/26/2016] [Accepted: 03/13/2016] [Indexed: 02/07/2023]
Abstract
Gastrointestinal (GI) bleeding cases in whom source cannot be identified after conventional upper and lower GI endoscopy are defined as potential small bowel bleeding. We aimed to search for lesions in the reach of conventional endoscopy in patients to whom video capsule endoscopy (VCE) had been applied for potential small bowel bleeding. 114 patients who had VCE evaluation for potential small bowel bleeding between January 2009 and August 2015 were retrospectively evaluated. Mean age of the patients was 55 ± 17 years. Female/male ratio is 39/75. In 58 patients (50.9%) bleeding lesion could be determined. Among these 58 patients 8 patients' lesions were in the reach of conventional endoscopes. Overall these 8 patients comprised 7% of patients in whom VCE was performed for potential small bowel bleeding. Among these 8 patients 5 had colonic lesions (4 angiodysplasia, 1 ulcerated polypoid cecal lesion), 2 had gastric lesions (1 GAVE, 1 anastomotic bleeding), and 1 patient had a bleeding lesion in the duodenal bulbus. Although capsule endoscopy is usually performed for potential small bowel bleeding gastroenterologists should always keep in mind that these patients may be suffering from bleeding from non-small bowel segments and should carefully review images captured from non-small bowel areas.
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Cheung DY, Kim JS, Shim KN, Choi MG. The Usefulness of Capsule Endoscopy for Small Bowel Tumors. Clin Endosc 2016; 49:21-5. [PMID: 26855919 PMCID: PMC4743724 DOI: 10.5946/ce.2016.49.1.21] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/04/2016] [Revised: 01/14/2016] [Accepted: 01/15/2016] [Indexed: 12/16/2022] Open
Abstract
Video capsule endoscopy (VCE) has expanded the range of endoscopic examination of the small bowel. The clinical application of VCE is mainly for obscure gastrointestinal bleeding (OGIB) and small bowel tumor is one of the clinically significant diagnoses of VCE, often requiring subsequent invasive interventions. Small bowel tumors are detected with a frequency of around 4% with VCE in indications of OGIB, iron deficiency anemia, unexplained abdominal pain, and others. Protruding mass with bleeding, mucosal disruption, irregular surface, discolored area, and white villi are suggested as the VCE findings of small bowel tumor. Device assisted enteroscopy (DAE), computed tomography enteroclysis/enterography and magnetic resonance enteroclysis/enterography also have clinical value in small bowel examination and tumor detection, and they can be used with VCE, sequentially or complementarily. Familial adenomatous polyposis, Peutz-Jeghers syndrome, melanoma, lymphoma, and neuroendocrine tumor with hepatic metastasis are the high risk groups for small bowel tumors, and surveillance programs for small bowel tumors are needed. VCE and radiological imaging have value in screening, and in selected cases, DAE can provide more accurate diagnosis and endoscopic treatment. This review describes the usefulness and clinical impact of VCE on small bowel tumors.
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Affiliation(s)
- Dae Young Cheung
- Department of Internal Medicine, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Jin Su Kim
- Department of Internal Medicine, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Ki-Nam Shim
- Department of Internal Medicine, Ewha Womans University School of Medicine, Seoul, Korea
| | - Myung-Gyu Choi
- Department of Internal Medicine, College of Medicine, The Catholic University of Korea, Seoul, Korea
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Min YW, Chang DK. The Role of Capsule Endoscopy in Patients with Obscure Gastrointestinal Bleeding. Clin Endosc 2016; 49:16-20. [PMID: 26855918 PMCID: PMC4743722 DOI: 10.5946/ce.2016.49.1.16] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/05/2015] [Revised: 12/01/2015] [Accepted: 12/01/2015] [Indexed: 12/22/2022] Open
Abstract
Obscure gastrointestinal bleeding (OGIB) accounts for 5% of all gastrointestinal (GI) bleeding cases and is often caused by small bowel lesions. Capsule endoscopy (CE), which allows non-invasive visualization of the small bowel mucosa, has revolutionized the evaluation of OGIB. CE is preferred by both patients and physicians mainly because of its non-invasiveness, and is widely used as the first-line diagnostic modality for OGIB. The diagnostic yield of CE in OGIB has been reported to be in the range of 32% to 83%. Although no direct comparison has been made, a meta-analysis showed similar diagnostic yields between CE and double-balloon enteroscopy (DBE) for OGIB. However, CE could enhance the yield of subsequent DBE and serve as a guide for optimizing the insertion route for DBE. Even after negative CE, selected patients could benefit from second-look CE for OGIB. In terms of outcomes, a favorable clinical impact after CE has been reported in several studies. However, observations indicate that CE might not influence clinical outcomes directly, but rather play a role in selecting patients with OGIB who are likely to benefit from subsequent evaluation and intervention.
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Affiliation(s)
- Yang Won Min
- Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Dong Kyung Chang
- Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
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Chauhan SS, Manfredi MA, Abu Dayyeh BK, Enestvedt BK, Fujii-Lau LL, Komanduri S, Konda V, Maple JT, Murad FM, Pannala R, Thosani NC, Banerjee S. Enteroscopy. Gastrointest Endosc 2015; 82:975-90. [PMID: 26388546 DOI: 10.1016/j.gie.2015.06.012] [Citation(s) in RCA: 59] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/11/2015] [Accepted: 06/11/2015] [Indexed: 12/14/2022]
Abstract
Noninvasive imaging with CT and magnetic resonance enterography or direct visualization with wireless capsule endoscopy can provide valuable diagnostic information and direct therapy. Enteroscopy technology and techniques have evolved significantly and allow diagnosis and therapy deep within the small bowel, previously attainable only with intraoperative enteroscopy. Push enteroscopy, readily available in most endoscopy units, plays an important role in the evaluation and management of lesions located up to the proximal jejunum. Currently available device-assisted enteroscopy systems, DBE, SBE, and spiral enteroscopy each have their technical nuances, clinical advantages, and limitations. Newer, on-demand enteroscopy systems appear promising, but further studies are needed. Despite slight differences in parameters such as procedural times, depths of insertion, and rates of complete enteroscopy, the overall clinical outcomes with all overtube-assisted systems appear to be similar. Endoscopists should therefore master the enteroscopy technology based on institutional availability and their level of technical expertise.
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Koprowski R. Overview of technical solutions and assessment of clinical usefulness of capsule endoscopy. Biomed Eng Online 2015; 14:111. [PMID: 26626725 PMCID: PMC4665909 DOI: 10.1186/s12938-015-0108-3] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2015] [Accepted: 11/23/2015] [Indexed: 12/17/2022] Open
Abstract
The paper presents an overview of endoscopic capsules with particular emphasis on technical aspects. It indicates common problems in capsule endoscopy such as: (1) limited wireless communication (2) the use of capsule endoscopy in the case of partial patency of the gastrointestinal tract, (3) limited imaging area, (4) external capsule control limitations. It also presents the prospects of capsule endoscopy, the most recent technical solutions for biopsy and the mobility of the capsule in the gastrointestinal tract. The paper shows the possibilities of increasing clinical usefulness of capsule endoscopy resulting from technological limitations. Attention has also been paid to the current role of capsule endoscopy in screening tests and the limitations of its effectiveness. The paper includes the author's recommendations concerning the direction of further research and the possibility of enhancing the scope of capsule endoscopy.
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Affiliation(s)
- Robert Koprowski
- Department of Biomedical Computer Systems, Faculty of Computer Science and Materials Science, Institute of Computer Science, University of Silesia, ul. Będzińska 39, 41-200, Sosnowiec, Poland.
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Koprowski R. Overview of technical solutions and assessment of clinical usefulness of capsule endoscopy. Biomed Eng Online 2015. [PMID: 26626725 DOI: 10.1186/s1293801501083] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022] Open
Abstract
The paper presents an overview of endoscopic capsules with particular emphasis on technical aspects. It indicates common problems in capsule endoscopy such as: (1) limited wireless communication (2) the use of capsule endoscopy in the case of partial patency of the gastrointestinal tract, (3) limited imaging area, (4) external capsule control limitations. It also presents the prospects of capsule endoscopy, the most recent technical solutions for biopsy and the mobility of the capsule in the gastrointestinal tract. The paper shows the possibilities of increasing clinical usefulness of capsule endoscopy resulting from technological limitations. Attention has also been paid to the current role of capsule endoscopy in screening tests and the limitations of its effectiveness. The paper includes the author's recommendations concerning the direction of further research and the possibility of enhancing the scope of capsule endoscopy.
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Affiliation(s)
- Robert Koprowski
- Department of Biomedical Computer Systems, Faculty of Computer Science and Materials Science, Institute of Computer Science, University of Silesia, ul. Będzińska 39, 41-200, Sosnowiec, Poland.
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Lim YJ, Lee OY, Jeen YT, Lim CY, Cheung DY, Cheon JH, Ye BD, Song HJ, Kim JS, Do JH, Lee KJ, Shim KN, Chang DK, Park CH, Jang BI, Moon JS, Chun HJ, Choi MG, Kim JO. Indications for Detection, Completion, and Retention Rates of Small Bowel Capsule Endoscopy Based on the 10-Year Data from the Korean Capsule Endoscopy Registry. Clin Endosc 2015; 48:399-404. [PMID: 26473123 PMCID: PMC4604278 DOI: 10.5946/ce.2015.48.5.399] [Citation(s) in RCA: 40] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/07/2014] [Revised: 09/15/2014] [Accepted: 09/23/2014] [Indexed: 12/21/2022] Open
Abstract
Background/Aims Capsule endoscopy (CE) is widely used. However, CE has limitations including incomplete examination, inadequate bowel preparation, and retention. The aim of this study was to estimate the indications for and detection, completion, and retention rates of small intestine CE based on the 10-year data from the Korean Capsule Endoscopy Registry. Methods Twenty-four hospitals participated in this study. Clinical information, such as reasons for CE, method and quality of bowel preparation, and incomplete examination and capsule retention rates, was collected and analyzed. Results A total of 2,914 CEs were registered. The most common reason for CE was obscure gastrointestinal bleeding (59%). Significant lesions were detected in 66% of cases. Positive CE diagnosis occurred in 63% of cases. The preparation method did not significantly affect the quality of bowel preparation for CE. The overall incomplete rate was 33%, and was high in the elderly and those with poor bowel preparation. Capsule retention was 3% and high in patients with small bowel tumors and Crohn's disease and in children under 10 years of age. Conclusions CE is a valuable technique; while the overall detection rate is high, incompletion and retention rates are also relatively high. CE should be carefully considered in the elderly and children less than 10 years of age, as well as in patients with small bowel tumors and Crohn's disease.
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Affiliation(s)
- Yun Jeong Lim
- Department of Internal Medicine, Dongguk University College of Medicine, Goyang, Korea
| | - Oh Young Lee
- Department of Internal Medicine, Hanyang University College of Medicine, Seoul, Korea
| | - Yoon Tae Jeen
- Department of Internal Medicine, Korea University College of Medicine, Seoul, Korea
| | - Chi Yeon Lim
- Department of Medicine, Dongguk University College of Medicine, Gyeongju, Korea
| | - Dae Young Cheung
- Department of Internal Medicine, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Jae Hee Cheon
- Department of Internal Medicine, Yonsei University College of Medicine, Seoul, Korea
| | - Byong Duk Ye
- Department of Internal Medicine, University of Ulsan College of Medicine, Seoul, Korea
| | - Hyun Joo Song
- Department of Internal Medicine, Jeju National University College of Medicine, Jeju, Korea
| | - Jin Su Kim
- Department of Internal Medicine, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Jae Hyuk Do
- Department of Internal Medicine, Chung-Ang University College of Medicine, Seoul, Korea
| | - Kwang Jae Lee
- Department of Internal Medicine, Ajou University School of Medicine, Suwon, Korea
| | - Ki-Nam Shim
- Department of Internal Medicine, Ewha Womans University School of Medicine, Seoul, Korea
| | - Dong Kyung Chang
- Department of Internal Medicine, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Cheol Hee Park
- Department of Internal Medicine, Hallym University College of Medicine, Seoul, Korea
| | - Byung Ik Jang
- Department of Internal Medicine, Yeungnam University College of Medicine, Daegu, Korea
| | - Jeong Seop Moon
- Department of Internal Medicine, Inje University College of Medicine, Seoul, Korea
| | - Hoon Jai Chun
- Department of Internal Medicine, Korea University College of Medicine, Seoul, Korea
| | - Myung-Gyu Choi
- Department of Internal Medicine, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Jin Oh Kim
- Department of Internal Medicine, Soonchunhyang University College of Medicine, Seoul, Korea
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Predictability of capsule endoscopy referred to a tertiary care center for double-balloon enteroscopy. Eur J Gastroenterol Hepatol 2015; 27:1052-6. [PMID: 26049708 DOI: 10.1097/meg.0000000000000401] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
OBJECTIVES Patients with obscure gastrointestinal bleeding with 'positive' findings on video capsule endoscopy (VCE) by gastroenterologists practicing in the community are often referred to tertiary care centers for double-balloon enteroscopy (DBE). Our study explores the degree of concordance between these two procedures performed in two different clinical settings. METHODS Concordance between the procedures was estimated using a κ-coefficient. RESULTS A total of 73 patients with obscure gastrointestinal bleeding were referred to our center for DBE after undergoing VCE elsewhere. Ten of these patients (10/73 or 13.7%) had been found to have bleeding in the small bowel on VCE without any concrete diagnosis. DBE revealed the source of bleeding in 17 of the 22 patients (77.3%) with normal VCE. The referral diagnosis was correct in 31 cases (31/73 or 42.5%). The κ-coefficient for VCE and DBE for the 63 patients was 0.28, suggesting poor agreement between the two procedures. However, most patients with a referral diagnosis of vascular pathology were confirmed to have vascular disease on DBE (19/23 or 82.6%). CONCLUSION Our study shows that there is a poor concordance between capsule endoscopy performed in the community and confirmatory DBE performed at our tertiary care center.
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Gu Y, Xie X, Li G, Sun T, Wang D, Yin Z, Zhang P, Wang Z. Design of Endoscopic Capsule With Multiple Cameras. IEEE TRANSACTIONS ON BIOMEDICAL CIRCUITS AND SYSTEMS 2015; 9:590-602. [PMID: 25376042 DOI: 10.1109/tbcas.2014.2359012] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
Abstract
In order to reduce the miss rate of the wireless capsule endoscopy, in this paper, we propose a new system of the endoscopic capsule with multiple cameras. A master-slave architecture, including an efficient bus architecture and a four level clock management architecture, is applied for the Multiple Cameras Endoscopic Capsule (MCEC). For covering more area of the gastrointestinal tract wall with low power, multiple cameras with a smart image capture strategy, including movement sensitive control and camera selection, are used in the MCEC. To reduce the data transfer bandwidth and power consumption to prolong the MCEC's working life, a low complexity image compressor with PSNR 40.7 dB and compression rate 86% is implemented. A chipset is designed and implemented for the MCEC and a six cameras endoscopic capsule prototype is implemented by using the chipset. With the smart image capture strategy, the coverage rate of the MCEC prototype can achieve 98% and its power consumption is only about 7.1 mW.
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Lipka S, Rabbanifard R, Kumar A, Brady P. A single-center United States experience with bleeding Dieulafoy lesions of the small bowel: diagnosis and treatment with single-balloon enteroscopy. Endosc Int Open 2015; 3:E339-45. [PMID: 26356602 PMCID: PMC4554498 DOI: 10.1055/s-0034-1391901] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/22/2014] [Accepted: 02/23/2015] [Indexed: 02/06/2023] Open
Abstract
INTRODUCTION A Dieulafoy lesion (DL) of the small bowel can cause severe gastrointestinal bleeding, and presents a difficult clinical setting for endoscopists. Limited data exists on the therapeutic yield of treating DLs of the small bowel using single-balloon enteroscopy (SBE). METHODS Data were collected from Tampa General Hospital a 1 018-bed teaching hospital affiliated with University of South Florida in Tampa, Florida. Patients were selected from a database of patients that underwent SBE from January 2010 - August 2013. RESULTS Eight patients were found to have DL an incidence of 2.6 % of 309 SBE performed for obscure gastrointestinal bleeding. 7/8 were identified in the jejunum, with one found in the duodenum. The mean age of patients with DL was 71.5 years old. 6/8 patients were on some form of anticoagulant/antiplatelet agent. The primary modality of therapy employed was electrocautery, multipolar electrocoagulation in seven patients and APC (argon plasma coagulation) in one patient. In three patients, electrocoagulation was unsuccessful and hemostasis was achieved with clip placement. Three patients required repeat SBE with one found to have rebleeding from a failed clip with hemostasis achieved upon reapplication of one clip. CONCLUSION In our United States' experience, SBE offers a reasonable therapeutic approach to treat DL of the small bowel with low rates of rebleeding, no adverse events, and no patient requiring surgery.
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Affiliation(s)
- Seth Lipka
- University of South Florida Morsani College of Medicine, Department of Medicine, Tampa, Florida, United States,Corresponding author Seth Lipka, M.D. 12901 Bruce B. Downs Blvd. MDC 72Tampa, Florida 33612United States(813) 805–9863
| | - Roshanak Rabbanifard
- University of South Florida Morsani College of Medicine, Division of Digestive Diseases and Nutrition, Tampa, Florida, United States
| | - Ambuj Kumar
- University of South Florida Morsani College of Medicine, Department of Medicine, Division of Evidence Based Medicine and Outcomes Research, Tampa, Florida, United States
| | - Patrick Brady
- University of South Florida Morsani College of Medicine, Division of Digestive Diseases and Nutrition, Tampa, Florida, United States
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