Application Of Capsule Endoscopy Research Articles

Capsule endoscopy: clinical insights, challenges, and evolving perspectives in the 21st century

Capsule endoscopy (CE) is widely employed in clinical practice owing to its minimally invasive nature and high diagnostic accuracy. It is the primary modality for evaluating suspected diseases of the small-bowel, as recommended by guidelines from various countries. Advancements in CE technology have introduced various models for evaluating not only the small-bowel but also the colon, esophagus, stomach, and the entire gastrointestinal tract. Moreover, colon CE enables early detection of colorectal polyps and cancers, as well as surveillance of inflammatory bowel disease. Furthermore, innovative developments, such as magnetically controlled CE, offer enhanced maneuverability, particularly in the stomach. Recent reports highlight the growing use of artificial intelligence in CE, with promising potential for reducing physician burden, and clinical implementation is anticipated. Furthermore, novel CE technologies are expected to enable the diagnosis of gastrointestinal diseases through a less invasive approach in the near future. Key questions/aims: Herewith we provide a comprehensive review of the current status and clinical applications of CE while addressing the challenges that remain in its implementation in practice and highlighting the key areas for future research and development.

Clinical Application and Feasibility of Capsule Endoscopy in Children at a Medical Center in Central Taiwan

Background/PurposeCapsule endoscopy (CE) is a noninvasive examination for excellent visualization of small bowel mucosal lesions. We aimed to evaluate the clinical efficacy and safety of CE in pediatric patients. MethodsFrom April 2014 to December 2022, CE procedures performed in children younger than 18 years of age at Taichung Veteran General Hospital were analyzed retrospectively. ResultsAmong 136 procedures, the completion rate was 95.6% (n=130), with a median age of 14 years old. Suspicion or evaluation of inflammatory bowel diseases (IBD) (41%) was the most common indication for CE. Other common indications of CE were chronic unexplained abdominal pain (35%) and obscure gastrointestinal bleeding or iron deficiency anemia (21%). No procedure-related complications occurred. The diagnosis of those patients with incomplete study were CD with small bowel stricture, graft-versus-host disease and duodenal ulcers. A total of 86 CE procedures showed positive findings, and the overall diagnostic yield rate was 63.2%. Small bowel ulcers (65.12%) were the most common findings. Overall, 26.5% of CE examinations resulted in a new diagnosis and 44.9% of CE exams led to a change in therapy. For patients with IBD, CE findings resulted in an even higher therapeutic change rate of 48.1%. ConclusionsCE is a safe and feasible diagnostic method to study the small intestine in children, especially for IBD. Incomplete study could be an indicator of positive finding and can potentially be a guide to identify the site of possible strictures.

Application of small bowel capsule endoscopy in children with Meckel's diverticulum.

Meckel diverticulum (MD) is an important cause of gastrointestinal bleeding in children. Small bowel capsule endoscopy (SBCE) is a first-line examination method applied to patients with obscure gastrointestinal bleeding, but there are few studies on its application in children with MD. This article aims to provide evidence in favor of the auxiliary diagnosis of MD in children by analyzing its characteristics using SBCE. We retrospectively collected the clinical data of patients with suspected MD. A total of 58 children were included in this study. All 58 children presented overt gastrointestinal bleeding (bloody stool or melena). Capsule endoscopy identified protruding lesions in 2 cases, double-lumen changes in 30 cases (all considered as MD), vascular lesions in 7 cases, intestinal mucosal inflammatory lesions in 3 cases, ulcers or erosion in 3 cases, and no obvious abnormalities in SBCE in 12 cases. Both SBCE and technetium-99 scans were performed for 24 cases, 22 of which were diagnosed MD by their combined results, giving a diagnostic coincidence rate of 91.7%. Eight cases were highly suspected as MD but were negative for the technetium-99 scan and positive for SBCE. SBCE has high accuracy in the diagnosis of MD in children, especially when performed in combination with a technetium-99 scan, which can greatly improve the diagnostic rate of MD in children.

Magneto‐Responsive Polymeric Soft‐Shell‐Based Capsule Endoscopy for High‐Performance Gastrointestinal Exploration via Morphological Shape Control

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

Clinical application of capsule endoscopy in a dog with acute hemorrhagic vomiting

Clinical application of capsule endoscopy in a dog with acute hemorrhagic vomiting

Chronic Diarrhea with Villous Blunting of the Small Intestine Under Capsule Endoscopy in Common Variable Immunodeficiency and X-Linked Agammaglobulinemia: A Case Series.

Primary immunodeficiencies (PIDs) are a heterogeneous group of disorders, common variable immunodeficiency disorder (CVID) and X-linked agammaglobulinemia (XLA) are PIDs related to B-cell defect, characterized by reduced levels of immunoglobulins and immune dysregulation. Infections are the most common clinical manifestations, while underlying autoimmune and inflammatory conditions are present in some patients with CVID and XLA, leading to clinical misdiagnosis and diagnostic delay. Chronic diarrhea in patients with CVID and XLA, particularly complicated malabsorption and protein-energy malnutrition, is responsible for poor prognostic outcomes. In this study, we described three PID adult patients (two with CVID and one with XLA) who presented with varying degrees of chronic diarrhea, weight loss, and protein-energy malnutrition. We suggest that villous blunting of the small intestine under capsule endoscopy may be an endoscopic feature of PID-related enteropathy, thus highlighting the application of capsule endoscopy in patients with CVID and XLA presenting with chronic diarrhea. We also summarize regular Ig supplementation is the basic treatment for CVID and XLA patients, proper enteral nutrition and probiotic therapy can be explored to use to alter gut microbiota and modulate intestinal immune response. However, vedolizumab is not helpful to PID-related enteropathy therapy, as it exacerbates the inflammatory response in extra-intestinal organs and ultimately causes poor clinical outcomes.

Application of capsule endoscopy in patients with chronic and recurrent abdominal pain: Abbreviated running title: capsule endoscopy in abdominal pain.

The incidence of chronic and recurrent abdominal pain increases every year, while the diagnosis is still unsatisfactory even after a number of check-ups. This study aimed to evaluate the diagnosis value of capsule endoscopy in patients suffering from chronic and recurrent abdominal pain. A retrospective case study was performed in 80 chronic and recurrent abdominal pain patients at Xiangyang Central Hospital from January 2013 to November 2017. Meanwhile, diagnoses by capsule endoscopy were collected for analysis. Abnormal findings were found in 54 of 80 (67.5%) patients. The findings in chronic and recurrent abdominal pain patients include small intestinal erosion and congestion, small intestinal ulcers, small intestinal parasites, small intestinal vascular malformations, small intestinal polyps, small intestinal diverticulum, and small intestinal lymphangiectasia. There were no immediate significant side effects without being reported up to 1 month after ingestion of the capsule. The capsule was evacuated by all patients. Capsule endoscopy has a great value in the diagnosis of chronic and recurrent abdominal pain with satisfactory safety and less pain for patients. Inflammatory lesions and ulcers in the small intestine account for the majority of positive findings in these patients.

Elimination of probable praziquantel-resistant Dipylidium caninum with nitroscanate in a mixed-breed dog: a case report

BackgroundPraziquantel is the drug of choice for treating the tapeworm Dipylidium caninum in dogs; however, resistance is possible, and regular, non-targeted administration of praziquantel may select for anthelminthic-resistant populations.MethodsThe zinc sulfate fecal floatation procedure was conducted. Gross visualization was used to identify Dipylidium spp. segments, and capsule endoscopy was used to visualize adult tapeworms within the intestinal tract.ResultsAn 18-month-old spayed female terrier mix was presented due to diarrhea, hematochezia and weight loss. The dog received appropriate anthelmintic therapy for Giardia spp., Ancylostoma spp. and Dipylidium spp. The dog’s clinical signs resolved, and elimination of Ancylostoma spp. was confirmed by subsequent fecal analysis. However, Dipylidium spp. segments were repeatedly present in the stool. Observation of the segments confirmed the presence of adult Dipylidium spp in feces. Treatment with praziquantel and epsiprantel were unsuccessful in eliminating the organism but was apparently successful in flea prevention. A single dose of nitrosconate was administered and eliminated Dipylidium spp. infection in the dog.ConclusionsNitrosconate can be an effective treatment for praziquantel-resistant dipylidiasis in dogs. The novel application of capsule endoscopy confirmed the anthelmintic efficacy of this treatment.Graphical

Application of capsule endoscopy in the management of small intestine angioectasias-case report

Angioectasias lesions are multiple and involve a wide range, gast rointestinal bleeding can occur repeatedly or stop spontaneously, mostly in the colon. We report the real-life case of gastrointestinal bleeding in the small intestine. Small intestinal angioectasias (SBAEs) is a common cause of obscure gastrointestinal bleeding (OGIB). Due to the limited means for small intestine examination, the source cannot be found and missed diagnosis, resulting in delayed treatment. The application of capsule endoscopy not only greatly improves the diagnosis yield but also helps clinicians to formulate the next treatment plan. It is recommended to perform capsule endoscopy for those patients with gastrointestinal bleeding who cannot be identified after conventional gastroenteroscopy.

Clinical Benefits and Challenges in Application of Novel Portable Gastric Capsule Endoscopy for Home Healthcare Patients.

Portable magnetic-assisted capsule endoscopy (MACE) provides satisfactory patient experience and safety with comparable performance in diagnosis of organic lesions when compared to conventional upper gastrointestinal endoscopy. In this study, a total of 58 homecare patients were included for MACE either in the hospital (n = 42) or at home (n = 16), with mean age of 71.1 ± 12.4 years. A total of 55 patients (94.83%) had completed the MACE with diagnosis of reflux esophagitis (43.6%), gastritis (54.5%), erosions (21.8%), fundic polyps (14.5%), peptic ulcers (25.9%), etc. Most patients (n = 47, 85.5%) were satisfied with the experience, and all patients who received MACE at home (n = 15, 100%) appreciated the convenience of endoscopy at home. Less than half of the patients (n = 24, 43.6%) could afford MACE if the expense was not covered by health insurance (USD 714). Time consumption from both traffic and capsule manipulation was also challenging for the physicians, as it took an average of 24.7 min to complete MACE, but it added up to a total of 92.7 min at home, which is about 15 times that of conventional endoscopy in hospital. More efforts are needed to ease the financial burden of patients, and optimization of workflow in community practice may help lift the obstacles revealed in this study.

Medical Capsule Robots: An Overview on wireless capsule endoscope.

Capsule endoscopy (CE) has improved the diagnosis and treatment of the small bowel providing a non-invasive, well tolerated method of as it should be visualizing the upper and lower gastrointestinal tract. The development of Medical Capsule Robots, which has emerged from the science fiction idea of robots touring within the body to diagnose and cure issues. The first ever introduced capsule robot was a pill or capsule endoscope evolved to seize pics of the gastrointestinal tract. Today, varieties of capsule endoscopes are available and are expected to hit the market soon. They are barely large than ordinary oral dosage forms such as tablets or capsules, made of a biocompatible case and have digital circuitry and mechanisms to seize and transmit images.15 years ago, capsule endoscopy (CE) has turn out to be the primary-line investigation system in some small bowel pathologies and scientific practices. The first marketed capsule robotic was a capsule endoscope in general evolved to seize only the pictures of the gastrointestinal tract however Later, these have been advanced to be used as a device to construct micron and sub-micron sized drug shipping structures for target shipping and treatment.Technology is swiftly progressing, assisting in the broadening and improving the benefits and applications of capsule endoscopy.

Capsule Endoscopy for Gastric Evaluation.

Wireless capsule endoscopy was first developed to observe the small intestine. A small capsule can be swallowed and images of gastrointestinal tract are taken with natural movement of peristalsis. Application of capsule endoscopy for observing the stomach has also received much attention as a useful alternative to esophagogastroduodenoscopy, but anatomical characteristics of the stomach have demanded technical obstacles that need to be tackled: clear visualization and active movements that could be controlled. Different methods of controlling the capsule within stomach have been studied and magnetic manipulation is the only system that is currently used in clinical settings. Magnets within the capsule can be controlled with a hand-held magnet paddle, robotic arm, and electromagnetic coil system. Studies on healthy volunteers and patients with upper gastrointestinal symptoms have shown that it is a safe and effective alternative method of observing the stomach. This work reviews different magnetic locomotion systems that have been used for observation of the stomach as an emerging new application of wireless capsule endoscopy.

Expanding the arsenal for medical management of vascular ectasias

In the USA, gastrointestinal bleeding is a common reason for emergency room visits and hospital admission. Indeed, it is the most common discharge diagnosis of all gastrointestinal disorders.1 The treatment of upper and lower gastrointestinal bleeding is now relatively straightforward, owing to the usefulness of endoscopy for both diagnosis and effective endoscopic management. However, occult or overt bleeding from the small bowel still represents a real challenge. The development and widespread application of capsule endoscopy has been instrumental in identifying vascular ectasias (angiodysplasias) as the most common cause of overt small bowel bleeding.

Role of Artificial Intelligence in Video Capsule Endoscopy.

Capsule endoscopy (CE) has been increasingly utilised in recent years as a minimally invasive tool to investigate the whole gastrointestinal (GI) tract and a range of capsules are currently available for evaluation of upper GI, small bowel, and lower GI pathology. Although CE is undoubtedly an invaluable test for the investigation of small bowel pathology, it presents considerable challenges and limitations, such as long and laborious reading times, risk of missing lesions, lack of bowel cleansing score and lack of locomotion. Artificial intelligence (AI) seems to be a promising tool that may help improve the performance metrics of CE, and consequently translate to better patient care. In the last decade, significant progress has been made to apply AI in the field of endoscopy, including CE. Although it is certain that AI will find soon its place in day-to-day endoscopy clinical practice, there are still some open questions and barriers limiting its widespread application. In this review, we provide some general information about AI, and outline recent advances in AI and CE, issues around implementation of AI in medical practice and potential future applications of AI-aided CE.

Diagnosis of Suspected Small Bowel Bleeding by Capsule Endoscopy in Patients with COVID-19.

The current study evaluated the application of small-bowel capsule endoscopy (SBCE) in SARS-CoV-2-infected patients with suspected small bowel bleeding. We analyzed the clinical characteristics, SBCE procedures, examination results, and treatment for cases of suspected small bowel bleeding in two patients with critical COVID-19. SBCE showed active spotting bleeding in the jejunum and ileum with no identifiable lesions in case 1, while multiple small bowel ulcers were detected in case 2. Two patients had relevant changes in their management plans and received specific treatment based on SBCE findings. In summary, SBCE proved to be a non-invasive diagnostic tool for critical COVID-19 patients with suspected small bowel bleeding.

Current status of colon capsule endoscopy.

While both the annual incidence and mortality of colorectal cancer are slowly but steadily decreasing in the United States, the incidence of such malignancy is increasing in Japan. Thus, controlling colorectal cancer in Japan is a major concern. In 2006, colon capsule endoscopy was first introduced by Eliakim et al. First-generation colon capsule endoscopy had a moderate sensitivity for detecting polyps of more than 6mm. Thus, second-generation colon capsule endoscopy was developed to achieve higher sensitivity. Colonoscopy is the gold standard tool for colorectal cancer surveillance. With an improvement in the imaging function, the performance of second-generation colon capsule endoscopy is almost as satisfactory as that of colonoscopy. Certain situations, such as incomplete colonoscopy and contraindication for use of sedation, can benefit from colon capsule endoscopy. Colon capsule endoscopy requires a more extensive bowel preparation than colonoscopy and computed tomography colonography because it requires laxatives not only for bowel cleansing but also for promoting the excretion of the capsule. Another problem with colon capsule endoscopy includes the burden of reading and interpretation and overlook of the lesions. Currently, the development of automatic diagnosis of colon capsule endoscopy using artificial intelligence is still under progress. Although the available guidelines do not support the use of colon capsule endoscopy for inflammatory bowel disease, the possible application of colon capsule endoscopy is ulcerative colitis. This review article summarizes and focuses on the current status of colon capsule endoscopy for colorectal cancer screening and the possibility for its applicability on inflammatory bowel disease.

Primary study on clinical applications of second generation colon capsule endoscopy

Objective To explore the clinical applications of second generation colon capsule endoscopy (CCE-2). Methods From July 2017 to December 2018, at the First Affiliated Hospital, College of Medicine, Zhejiang University, 40 outpatients and hospitalized patients who underwent CCE-2 examination were enrolled. The examination results were analyzed by an expert gastroenterologist with rich experience in small intestinal and colon capsule endoscopy. The stomach, small bowel and colon transit time, the score of colon cleansing quality, the completion rate of colon capsule examination, lesion detection and adverse effects were observed. Chi-square test and Student′t test were used for statistical analysis. Results The whole gastrointestinal tract examination was completed during the capsule running time in 65.0% (26/40) of the patients. The average stomach transit time was (0.92±0.74) h, the small bowel transit time was (3.93±1.51) h and the colon transit time was (4.89±0.61) h. The capsule running time of patients who completed the whole gastrointestinal tract examination was shorter than that of patients who did not complete the whole gastrointestinal tract examination ((9.44 ± 3.53) h vs. (15.47±2.09) h), and the difference was statistically significant (t=6.79, P 0.05). A total of 33 (82.5%) patients had gastrointestinal lesions detected by colon capsule, including three cases of esophageal lesions (inflammation and mass), 21 cases of gastric lesions (chronic gastritis, mucosal protrusion, polyp and ulcer), nine cases of small bowel lesions (polyp, ulcer and vascular malformation) and 19 cases of colonic lesions (diverticulum, polyp, rectitis, mucosal erosion, ulcer and vascular malformation, internal hemorrhoids). Among them, there were 11 patients with two or more lesions. No adverse events occurred during the examination and all the capsules were excreted within 48 hours. Conclusion CCE-2 with high safety and good tolerance can be used for whole gastrointestinal tract examination. Key words: Second generation colon capsule endoscopy; Gastrointestinal examination; Colon cleansing quality; Safety

Colon Capsule Endoscopy for Inflammatory Bowel Disease.

Colon capsule endoscopy was initially introduced in 2006. Since the results of a prospective study to evaluate first-generation colon capsule endoscopy efficacy for the detection of colonic neoplasia were unsatisfactory, second-generation colon capsule endoscopy was developed and reported in 2009. In this review article, we provide an overview of the current state of colon capsule endoscopy for evaluation of inflammatory bowel disease in a clinical setting and describe our clinical experience with this technology and its application. Among the various types of inflammatory bowel diseases, ulcerative colitis is the primary target for application of colon capsule endoscopy. Nevertheless, the initial results of studies using first-generation colon capsule endoscopy to evaluate inflammation were unclear. More recently, second-generation colon capsule endoscopy has provided higher accuracy for assessment of inflammation in patients with ulcerative colitis. Colon capsule endoscopy enables noninvasive observation (with reduced volume preparation) of mucosal inflammation severity in patients with ulcerative colitis.

Automatic detection of blood content in capsule endoscopy images based on a deep convolutional neural network.

Detecting blood content in the gastrointestinal tract is one of the crucial applications of capsule endoscopy (CE). The suspected blood indicator (SBI) is a conventional tool used to automatically tag images depicting possible bleeding in the reading system. We aim to develop a deep learning-based system to detect blood content in images and compare its performance with that of the SBI. We trained a deep convolutional neural network (CNN) system, using 27847 CE images (6503 images depicting blood content from 29 patients and 21344 images of normal mucosa from 12 patients). We assessed its performance by calculating the area under the receiver operating characteristic curve (ROC-AUC) and its sensitivity, specificity, and accuracy, using an independent test set of 10208 small-bowel images (208 images depicting blood content and 10000 images of normal mucosa). The performance of the CNN was compared with that of the SBI, in individual image analysis, using the same test set. The AUC for the detection of blood content was 0.9998. The sensitivity, specificity, and accuracy of the CNN were 96.63%, 99.96%, and 99.89%, respectively, at a cut-off value of 0.5 for the probability score, which were significantly higher than those of the SBI (76.92%, 99.82%, and 99.35%, respectively). The trained CNN required 250s to evaluate 10208 test images. We developed and tested the CNN-based detection system for blood content in CE images. This system has the potential to outperform the SBI system, and the patient-level analyses on larger studies are required.

Evaluation of Small-Bowel Patency in Crohn’s Disease: Prospective Study with a Patency Capsule and Computed Tomography

Background and Purpose: Patency capsule (PC) examination is usually performed – previously to capsule endoscopy – to evaluate small-bowel patency in patients with established Crohn’s disease (CD). The reported PC retention rate is significantly higher than expected. Our aims were to assess small-bowel patency, to determine the precise location of the retained PC in patients with CD, and to determine the false positive rate of evaluation with a radiofrequency identification tag (RFIT) scanner. Methods: This is a prospective single-center study including CD patients with clinical indication for small-bowel capsule endoscopy. PillCam® PC examination was performed on all patients to assess small-bowel patency. On all patients with a positive identification of the PC using an RFIT scanner, 30 h after ingestion, an abdominal CT was performed in order to identify its precise location. Results: Fifty-four patients were included. The PC retention rate, according to evaluation with the RFIT scanner, was 20% (in 11 patients) 30 h after ingestion. These patients were then submitted to abdominal CT, which revealed that there was small-bowel retention in 5 cases (9%). Higher CRP levels, penetrating disease, and a history of abdominal surgery were associated with an increased risk of PC retention (p = 0.007, p = 0.011, and p = 0.033, respectively). On multivariate analysis, there was an independent association between small-bowel PC retention and CRP levels >5 mg/dL (OR = 15.5; p = 0.03). Discussion: The small-bowel PC retention rate (9%) was considerably lower than those found in previous reports. Our results show that, with this protocol, the false-positive cases of RFIT scans or plain abdominal X-rays may be avoided. This may contribute to more extensive application of capsule endoscopy without the risk of small-bowel retention.