Capsule Colonoscopy Research Articles

Nationwide multicenter prospective study on the usefulness, safety, and acceptability of colon capsule endoscopy in Japan

We determined the factors influencing total capsule colonoscopy, adequate cleansing, and detectability of second-generation colon capsule endoscopy (CCE) for colorectal polyps or tumors (CRTs), adverse events, and acceptability. Among 44 Japanese hospitals, 1,006 patients with suspected or documented colorectal diseases who underwent CCE were enrolled prospectively. The total capsule colonoscopy rate was 86.1%. Age younger than 63 years (adjusted odds ratio [aOR], 1.525), male sex (aOR, 1.496), inflammatory bowel disease (aOR, 1.889), lavage intake on Day -1 (aOR, 1.625), ≥1800 mL lavage intake on Day 0 (aOR, 0.595), prokinetics on Day 0 (aOR, 0.608), and ≥30 mL castor oil booster on Day 0 (aOR, 1.734) were significant independent predictors. The overall adequate cleansing rate was 65.5%. Constipation (aOR, 0.527), lavage intake on Day -1 (aOR, 1.822), laxative intake on Day -1 (aOR, 2.616), and ≥1900 mL lavage intake on Day 0 (aOR, 1.449) were significant independent predictors. The detection rates (95% confidence intervals) for patients with CRTs ≥6 mm and ≥10 mm were 92 (84-97) % and 89 (78-96) %, respectively. Inadequate cleansing in the ascending colon (aOR, 0.184), ≥6 mm CRT in the transverse colon (aOR, 4.703), and ≥6 mm CRT in the left-sided colon (aOR, 32.013) were significant independent predictors. CCE retention occurred in two patients (0.20%) requiring endoscopic and surgical interventions. In total, 63% of patients desired CCE for their next colonoscopy. CCE was relatively safe, well tolerated, and useful for detecting colorectal lesions when adequate bowel preparation was made.

MLFA-UNet: A multi-level feature assembly UNet for medical image segmentation

Medical image segmentation is crucial for accurate diagnosis and treatment in medical image analysis. Among the various methods employed, fully convolutional networks (FCNs) have emerged as a prominent approach for segmenting medical images. Notably, the U-Net architecture and its variants have gained widespread adoption in this domain. This paper introduces MLFA-UNet, an innovative architectural framework aimed at advancing medical image segmentation. MLFA-UNet adopts a U-shaped architecture and integrates two pivotal modules: multi-level feature assembly (MLFA) and multi-scale information attention (MSIA), complemented by a pixel-vanishing (PV) attention mechanism. These modules synergistically contribute to the segmentation process enhancement, fostering both robustness and segmentation precision. MLFA operates within both the network encoder and decoder, facilitating the extraction of local information crucial for accurately segmenting lesions. Furthermore, the bottleneck MSIA module serves to replace stacking modules, thereby expanding the receptive field and augmenting feature diversity, fortified by the PV attention mechanism. These integrated mechanisms work together to boost segmentation performance by effectively capturing both detailed local features and a broader range of contextual information, enhancing both accuracy and resilience in identifying lesions. To assess the versatility of the network, we conducted evaluations of MFLA-UNet across a range of medical image segmentation datasets, encompassing diverse imaging modalities such as wireless capsule endoscopy (WCE), colonoscopy, and dermoscopic images. Our results consistently demonstrate that MFLA-UNet outperforms state-of-the-art algorithms, achieving dice coefficients of 91.42%, 82.43%, 90.8%, and 88.68% for the MICCAI 2017 (Red Lesion), ISIC 2017, PH2, and CVC-ClinicalDB datasets, respectively.

A139 EARLY VIDEO CAPSULE ENDOSCOPY VERSUS COLONOSCOPY FOLLOWING NEGATIVE ESOPHAGOGASTRODUDENOSCOPY IN PATIENTS WITH SUSPECTED UPPER GASTROINTESTINAL BLEEDING: PRELIMINARY DATA FROM A RANDOMIZED CONTROLLED TRIAL

Abstract Background Esophagogastroduodenoscopy (EGD) is recommended for initial endoscopic evaluation of patients with suspected upper gastrointestinal bleeding (UGIB). When this is negative, the standard recommendation is to perform a colonoscopy, despite low diagnostic yield of less than 5%. In these patients, the question remains as to whether small bowel investigations would be of higher yield prior to colonoscopy. Aims To compare the diagnostic yield between early video capsule endoscopy (VCE) versus colonoscopy after a negative EGD in patients with suspected UGIB. Methods This is preliminary data from a prospective randomized control trial (RCT) of adult patients with suspected UGIB (melena and hemoglobin drop of more than 20 g/L within 48 hours of admission). Patients at a single centre were enrolled prior to initial EGD; those with negative EGD were included and randomized to either colonoscopy (next day) or early VCE (immediately after EGD). Patients with a confirmed source of bleeding in their group required no further testing, but those without underwent further testing with the alternative (VCE or colonoscopy). We evaluated patient outcomes, including bleeding localization time, hospitalization duration, procedure count, complications and rebleeding rates. Results A total of 19 adult patients have been enrolled, of which 12 had negative EGD and were randomized to either VCE or colonoscopy, with six patients in each arm (Figure 1). In the VCE group, 100% (6/6) of patients had bleeding sources detected by early VCE, with 50% (3/6) of them undergoing endoscopic treatment. In the colonoscopy group, only one patient had a positive finding (1/6), the rest underwent subsequent VCE. The VCE identified the bleeding source in 80% (4/5) of patients with negative colonoscopy. Patient are outlined in Table 1. Conclusions Based on our preliminary data, the diagnostic yield of early and subsequent VCE was higher when compared to colonoscopy after initial negative EGD in patients with suspected UGIB. Table 1. Summary of findings and patient outcomes Funding Agencies Medtronic Canada (Brampton, ON, CA) will provide the video capsule in the treatment group. This is the only equipment funding required in this study.

What Is the Optimal Bowel Preparation for Capsule Colonoscopy and Pan-intestinal Capsule Endoscopy? A Systematic Review and Meta-Analysis

BackgroundThe rate of adequate cleansing (ACR) and complete examinations (CR) are key quality indicators in capsule colonoscopy (CC) and pan-intestinal capsule endoscopy (PCE).AimsTo evaluate the efficacy of bowel preparation protocols regarding ACR and CR.MethodsWe conducted a systematic review and meta-analysis, search terms regarding colon capsule preparation, publication date from 2006/01, and date of search 2021/12, in six bibliographic databases. Multiple steps of the cleansing protocol were assessed: diet, adjunctive laxatives, purgative solution, use of prokinetic agents, and “booster”. The meta-analytical frequency of ACR and CR was estimated, and subgroup analyses performed. Strategies associated with higher ACR and CR were explored using meta-analytical univariable and multivariable regression models.ResultsTwenty-six observational studies and five RCTs included (n = 4072 patients). The pooled rate of ACR was 72.5% (95% C.I. 67.8–77.5%; I2 = 92.4%), and the pooled rate of CR was 83.0% (95% C.I. 78.7–87.7%; I2 = 96.5%). The highest ACR were obtained using a low-fibre diet [78.5% (95% C.I. 72.0–85.6%); I2 = 57.0%], adjunctive laxatives [74.7% (95% C.I. 69.8–80.1%); I2 = 85.3%], and split dose < 4L polyethylene glycol (PEG) as purgative [77.5% (95% C.I. 68.4–87.8%); I2 = 47.3%]. The highest CR were observed using routine prokinetics prior to capsule ingestion [84.4% (95% C.I. 79.9–89.2%); I2 = 89.8%], and sodium phosphate (NaP) as “booster” [86.2% (95% C.I. 82.3–90.2%); I2 = 86.8%]. In univariable models, adjunctive laxatives were associated with higher ACR [OR 1.81 (95% C.I. 1.13; 2.90); p = 0.014]. CR was higher with routine prokinetics [OR 1.86 (95% C.I. 1.13; 3.05); p = 0.015] and split-dose PEG purgative [OR 2.03 (95% C.I. 1.01; 4.09), p = 0.048].ConclusionsMain quality outcomes (ACR, CR) remain suboptimal for CC and PCE. Despite considerable heterogeneity, our results support low-fibre diet, use of adjunctive sennosides, split dose < 4L PEG, and routine prokinetics, while NaP remains the most consistent option as booster.

Socioeconomic differences in expected discomfort from colonoscopy and colon capsule endoscopy

Individual income and educational level are associated with participation rates in colorectal cancer screening. We aimed to investigate the expected discomfort from the endoscopic diagnostic modalities of colonoscopy and colon capsule endoscopy in different socioeconomic groups as a potential barrier for participation. In a randomized clinical trial within the Danish colorectal cancer screening program, we distributed questionnaires to 2031 individuals between August 2020 and December 2022 to investigate the expected procedural and overall discomfort from investigations using visual analogue scales. Socioeconomic status was determined by household income and educational level. Multivariate continuous ordinal regressions were performed to estimate the odds of higher expected discomfort. The expected procedural and overall discomfort from both modalities were significantly higher with increasing educational levels and income, except for procedural discomfort from colon capsule endoscopy between income quartiles. The odds ratios for higher expected discomfort increased significantly with increasing educational level, whereas the differences between income groups were less substantial. Bowel preparation contributed most to expected discomfort in colon capsule endoscopy, whereas in colonoscopy, the procedure itself was the largest contributor. Individuals with prior experiences of colonoscopy reported significantly lower expected overall but not procedural discomfort from colonoscopy. The threshold for acceptable discomfort between subgroups is unknown, but the expected discomfort in colon capsule endoscopy and colonoscopy was higher in higher socioeconomic subgroups, suggesting that expected discomfort is not a significant contributor to the inequalities in screening uptake.

Optimizing Bowel Preparation for Capsule Endoscopy and Colonoscopy: A Patient-Centered Protocol Revision and Application

Objective: This study aimed to evaluate the effectiveness of a modified patient experience-based bowel preparation protocol for capsule endoscopy combined with colonoscopy. Methods: A total of 262 patients who underwent capsule endoscopy combined with colonoscopy in a tertiary hospital in Zhuhai city from July to December 2021 were enrolled in this study. They were divided into the control group (n=141) and the experimental group (n=121) using the random number method. The experimental group used the modified bowel preparation protocol while the control group used the conventional preparation protocol. Post-examination indicators, including sleep quality, gastrointestinal discomfort, nausea, vomiting, abdominal pain, and satisfaction, were compared between the two groups. Results: The data showed that the experimental group’s preparation medication had a better taste and was effective in improving patient symptoms, such as gastrointestinal discomfort, nausea and vomiting, abdominal pain, and sleep quality, compared to the control group. Moreover, both patients and nurses reported greater satisfaction with the experimental group’s bowel preparation time compared to the control group, with statistically significant differences observed (P &lt; 0.05). Conclusions: The modified bowel preparation protocol could improve patient sleep quality, reduce adverse reactions, and increase patient comfort and satisfaction.

A Multiscale Polyp Detection Approach for GI Tract Images Based on Improved DenseNet and Single-Shot Multibox Detector

Small bowel polyps exhibit variations related to color, shape, morphology, texture, and size, as well as to the presence of artifacts, irregular polyp borders, and the low illumination condition inside the gastrointestinal GI tract. Recently, researchers developed many highly accurate polyp detection models based on one-stage or two-stage object detector algorithms for wireless capsule endoscopy (WCE) and colonoscopy images. However, their implementation requires a high computational power and memory resources, thus sacrificing speed for an improvement in precision. Although the single-shot multibox detector (SSD) proves its effectiveness in many medical imaging applications, its weak detection ability for small polyp regions persists due to the lack of information complementary between features of low- and high-level layers. The aim is to consecutively reuse feature maps between layers of the original SSD network. In this paper, we propose an innovative SSD model based on a redesigned version of a dense convolutional network (DenseNet) which emphasizes multiscale pyramidal feature maps interdependence called DC-SSDNet (densely connected single-shot multibox detector). The original backbone network VGG-16 of the SSD is replaced with a modified version of DenseNet. The DenseNet-46 front stem is improved to extract highly typical characteristics and contextual information, which improves the model's feature extraction ability. The DC-SSDNet architecture compresses unnecessary convolution layers of each dense block to reduce the CNN model complexity. Experimental results showed a remarkable improvement in the proposed DC-SSDNet to detect small polyp regions achieving an mAP of 93.96%, F1-score of 90.7%, and requiring less computational time.

Context-aware fusion of transformers and CNNs for medical image segmentation

PurposeLocalization and screening of the target tissue is a main prerequisite of numerous medical procedures, including capsule endoscopy, colonoscopy and histology. Convolutional Neural Networks (CNNs), by stacking convolutional, down-sampling, and up-sampling operators in an encoder-decoder fashion, were the de-facto standard and has shown great promise in recent years. The main deficiency of these models is their local convolutional operators, which degrade accuracy, especially for targets with long-range dependencies. While CNNs excel at local feature extraction, Transformers are known for their ability to capture long-range dependencies. Also, CNN-Transformer models employ complex attention mechanisms for fusion that could increase model complexity and the potential for overfitting and underfitting in many datasets. MethodsIn this paper, we propose an efficient context-aware CNN-Transformer fusion mechanism based on Semi-supervised Spatial and Global Attention mechanism (SSG-Att). Our model is designed to combine the strengths of both models and overcome their limitations. High-level features that are extracted from the two parallel branches are combined and fused using the proposed SSG-Att mechanism. A hybrid loss function is also employed, which is better adapted to the introduced fusion system. ResultsWe evaluated the performance of our proposed model on the Kvasir-SEG, a polyp segmentation and detection dataset, and the Gland segmentation dataset. The experimental results confirmed that the improvements yield a top-performing yet efficient deep fused CNN-Transformer architecture. The proposed model outperformed the best-reported accuracies, achieving improved dice scores of 92.11 ± 1.10 % and 91.16 ± 0.81 on the Kvasir-SEG and GlaS datasets, respectively. ConclusionWe concluded that the proposed context-aware fusion mechanism has the potential to be used in screening and localization applications in a more reliable and accurate operation compared to other state-of-the-art methods.

Recurrent bleeding duodenal and colonic ulcers due to post-transplant lymphoproliferative disorder.

Post-transplant lymphoproliferative disorder (PTLD) is a rare complication of solid organ transplantation as the result of immunosuppressant medications. Epstein-Barr virus (EBV) has been implicated in most of these cases, specifically with B-cell predominant lymphoma. This case report describes a 24-year-old female who presented with recurrent GI bleed within 6months post-orthostatic heart transplant. Endoscopic evaluations including video capsule study, push enteroscopy, and colonoscopy revealed multiple ulcerated lesions in duodenum, jejunum, and colon secondary to Epstein-Barr Virus-associated monomorphic PTLD. Despite continuation of rituximab after discharge, she returned to the hospital for recurrent GI bleed requiring additional endoscopic intervention. PTLD is a devastating disease of the post-transplant population. Due to a high risk of recurrent GI bleeding, patients with PTLD may benefit from careful monitoring by gastroenterology as an outpatient with a low threshold for repeat endoscopic evaluation despite being on immunotherapy or chemotherapy.

S3365 Autoimmune Enteropathy: A Rare Cause of Small Intestinal Villous Atrophy in Adults

Introduction: Autoimmune enteropathy (AIE) is a rare cause of small intestinal villous atrophy. This condition is more frequently diagnosed in children, with only a handful of case series describing its presentation in adults. We present a case of adult-onset AIE in which diagnosis was made based on its unique endoscopic and histologic findings. Case Description/Methods: A 54 year-old previously healthy woman was hospitalized with profuse watery diarrhea, abdominal pain, and weight loss of six months duration. Stool testing was negative for infection. Inflammatory markers were mildly elevated. Computer tomography imaging showed hyperenhancement of the small bowel consistent with enteritis, without evidence of stricture or abscess. She underwent esophagogastroduodenoscopy which revealed diffuse edema of the duodenal mucosa with villous blunting and cracked-earth appearance (Figure A, B). She had normal appearing mucosa of the distal small bowel and colon on video capsule endoscopy and colonoscopy, respectively. Pathology from duodenal biopsies showed chronic active duodenitis characterized by marked villous blunting, reduced goblet and Paneth cells, neutrophilic and lymphocytic infiltration of deep crypts, and basal layer apoptosis (Figure C). Similar findings were seen in random ileal biopsies, while random colon biopsies were normal. Anti-enterocyte antibodies and anti-transglutaminase antibodies were negative. Patient was treated for AIE with intravenous methylprednisolone and she required supplemental parental nutrition. Within days of initiating steroids, her diarrhea had improved and she was transitioned to oral prednisone. Several days later she was weaned off parenteral nutrition and stable for discharge with plans to introduce a thiopurine at follow-up. Discussion: AIE should be suspected in a patient with chronic diarrhea, signs of severe malabsorption, and characteristic histologic features in absence of other causes of villous atrophy such as Celiac disease. Specific histologic features of AIE include absence of goblet cells and Paneth cells and presence of crypt apoptotic bodies in intestinal biopsies. Development of autoantibodies against enterocytes are associated with this condition, but not required for diagnosis. Steroids are the mainstay of therapy and have variable effect. We aim to raise awareness of AIE, as the rarity of this condition can make its diagnosis elusive.Figure 1.: 1A. EGD shows villous blunting and edema of duodenal mucosa. Figure 1B. EGD shows cracked-earth appearance of duodenal mucosa. Figure 1C. Duodenal biopsy reveals chronic active duodenitis characterized by marked villous blunting, reduced goblet and Paneth cells, neutrophilic and lymphocytic infiltration of deep crypts, and basal layer apoptosis.

Effectiveness and Safety of Colonic and Capsule Fecal Microbiota Transplantation for Recurrent Clostridioides difficile Infection

Fecal microbiota transplantation (FMT) emerged as rescue treatment for multiply recurrent Clostridioides difficile infections (rCDIs) nonresponsive to standard therapy. However, estimation of FMT efficacy varies among different protocols and formulations, while placebo-controlled clinical trials have excluded most rCDI patients because of medical comorbidities. This study aimed to determine the safety and effectiveness of capsule FMT (cap-FMT) and colonoscopy FMT (colo-FMT) for rCDI using standardized products in a large, multicenter, prospective, real-world cohort. Clinical outcomes and adverse events after FMT performed for rCDI at 6 sites were captured in a prospective registry. FMT was performed using 1 of 2 standardized formulations of microbiota manufactured by the University of Minnesota Microbiota Therapeutics Program, freeze-dried/encapsulated or frozen-thawed/liquid. The FMT administration route was determined by the treating physician. The rCDI cure rate was assessed at 1 and 2 months. Safety data were collected within the first 72 hours and at 1 and 2 months. Logistic regression was used to investigate factors associated with FMT failure. A total of 301 FMTs were performed in 269 unique patients. Two-thirds were cap-FMT. CDI cure rates were 86% (95% CI, 82%-90%) at 1 month and 81% (95% CI, 75%-86%) at 2 months. There was no difference in the 1-month or 2-month cure rate between cap-FMT and colo-FMT. Cap-FMT recipients were older and less likely to be immunosuppressed or have inflammatory bowel disease. Patient factors of older age and hemodialysis were associated with FMT failure by 2 months on multivariate logistic regression. In addition, post-FMT antibiotic use was associated with FMT failure at 2 months. One serious adverse event was related to colonoscopy (aspiration pneumonia), otherwise no new safety signals were identified. Cap-FMT using freeze-dried capsules has a similar safety and effectiveness profile compared with colo-FMT, without the procedural risks of colonoscopy. Although highly effective overall, patient selection is a key factor to optimizing FMT success.

Clinical presentation, management, screening and surveillance for colorectal cancer during the COVID-19 pandemic

Management of colorectal cancer (CRC) was severely affected by the changes implemented during the pandemic, and this resulted in delayed elective presentation, increased emergency presentation, reduced screening and delayed definitive therapy. This review was conducted to analyze the impact of the coronavirus disease 2019 (COVID-19) pandemic on management of CRC and to identify the changes made in order to adapt to the pandemic. We performed a literature search in PubMed, Medline, Index Medicus, EMBASE, SCOPUS, Reference Citation Analysis (https://www.referencecitationanalysis.com/) and Google Scholar using the following keywords in various combinations: Colorectal cancer, elective surgery, emergency surgery, stage upgrading, screening, surveillance and the COVID-19 pandemic. Only studies published in English were included. To curtail the spread of COVID-19 infection, there were modifications made in the management of CRC. Screening was limited to high risk individuals, and the screening tests of choice during the pandemic were fecal occult blood test, fecal immunochemical test and stool DNA testing. The use of capsule colonoscopy and open access colonoscopy was also encouraged. Blood-based tests like serum methylated septin 9 were also encouraged for screening of CRC during the pandemic. The presentation of CRC was also affected by the pandemic with more patients presenting with emergencies like obstruction and perforation. Stage migration was also observed during the pandemic with more patients presenting with more advanced tumors. The operative therapy of CRC was altered by the pandemic as more emergencies surgeries were done, which may require exteriorization by stoma. This was to reduce the morbidity associated with anastomosis and encourage early discharge from the hospital. There was also an initial reduction in laparoscopic surgical procedures due to the fear of aerosols and COVID-19 infection. As we gradually come out of the pandemic, we should remember the lessons learned and continue to apply them even after the pandemic passes.

Multi-Scale Hybrid Network for Polyp Detection in Wireless Capsule Endoscopy and Colonoscopy Images.

The trade-off between speed and precision is a key step in the detection of small polyps in wireless capsule endoscopy (WCE) images. In this paper, we propose a hybrid network of an inception v4 architecture-based single-shot multibox detector (Hyb-SSDNet) to detect small polyp regions in both WCE and colonoscopy frames. Medical privacy concerns are considered the main barriers to WCE image acquisition. To satisfy the object detection requirements, we enlarged the training datasets and investigated deep transfer learning techniques. The Hyb-SSDNet framework adopts inception blocks to alleviate the inherent limitations of the convolution operation to incorporate contextual features and semantic information into deep networks. It consists of four main components: (a) multi-scale encoding of small polyp regions, (b) using the inception v4 backbone to enhance more contextual features in shallow and middle layers, and (c) concatenating weighted features of mid-level feature maps, giving them more importance to highly extract semantic information. Then, the feature map fusion is delivered to the next layer, followed by some downsampling blocks to generate new pyramidal layers. Finally, the feature maps are fed to multibox detectors, consistent with the SSD process-based VGG16 network. The Hyb-SSDNet achieved a 93.29% mean average precision (mAP) and a testing speed of 44.5 FPS on the WCE dataset. This work proves that deep learning has the potential to develop future research in polyp detection and classification tasks.

CC-CLEAR (Colon Capsule Cleansing Assessment and Report): the novel scale to evaluate the clinical impact of bowel preparation in capsule colonoscopy – a multicentric validation study

Background Colon Capsule Cleansing Assessment and Report (CC-CLEAR) is a novel quantitative bowel preparation scale for colon capsule. Aim The aim of this study is to validate the association between CC-CLEAR’s classification and major CC outcomes: lesion detection rate, surveillance recommendations and post-CC endoscopic treatment. Methods Multicentric cohort of consecutive CCs. An expert’s panel decided post-CC recommendations. Data included CC-CLEAR and Leighton-REX scales. Major CC outcomes were associated with the different cleansing grades. Results From 168 CC’s included, findings were reported in 123 (73.2%), 67 (54.4%) of those being colorectal polyps. CC-CLEAR influenced CC’s lesion detection (OR 1.25 95% IC [1.07–1.46], p-value .004) and polyp detection rate (OR 1.22 95% IC [1.04–1.43], p-value.014). Thirty-two (19%) post-CC colonoscopies were recommended, including 22 (68.75%) with at least one polypectomy. CC-CLEAR was associated with post-CC colonoscopy treatment (OR 1.40 95% IC [1.07–1.84], p-value .015). Regarding surveillance, CC-CLEAR influenced the decision for immediate CC repetition (OR 0.21 95% IC [0.12–0.36], p-value < .001) and the recommendation for CC in 3–5 years’ time (OR 1.47 95% IC [1.50–1.86], p-value < .002). The Leighton–Rex scale was not correlated with major CC outcomes. Conclusion CC-CLEAR impacts major CC outcomes: lesion detection, surveillance recommendations and post-CC endoscopic treatment.

Optimal Noninvasive Colon Cancer Screening Modality in Patients Not Receiving Colonoscopy

Colon cancer is the third most common among cancer deaths in the US for both men and women. The incidence of colonoscopy has been soaring in younger patients, which led to changes in recent United States Preventive Services Task Force (USPSTF) guidelines to reduce the age for screening from 50 years to 45 years. Demand for colonoscopy services is surging due to increased incidences of colorectal cancer (CRC) in the both aging and younger population. Increased referrals have led to an insufficient workforce in hospitals and long waiting lists. Further, results from colonoscopy reveal a low percentage of CRC or another severe bowel disease (SBD). Therefore, colon cancer screening is a growing concern, particularly in patients who otherwise have a very long-life expectancy, and who are most likely to benefit from screening. Another reason to boost CRC screening is to minimize the load on hospitals by reducing the patients that undergo colonoscopy unnecessarily because only a low percentage of CRC occurrence is observed in individuals undergoing colonoscopy. In recent years, there are a variety of screening options available for CRC. Noninvasive alternatives include fecal immunochemical test (FIT), multitarget stool DNA testing (MT-sDNA, available under the brand name Cologuard), computed tomography (CT) colonography (previously called virtual colonoscopy), guaiac-based fecal occult blood testing (gFOBT), and capsule colonoscopy (CC). These tests have varied the degree of evidence supporting their use. This study focuses on the most recent survey and efficacy of noninvasive methods to prevent and detect colorectal cancer (CRC).

Colorectal Cancer Screening: Have We Addressed Concerns and Needs of the Target Population?

Despite the recognized benefits of colorectal cancer (CRC) screening, uptake is still suboptimal in many countries. In addressing this issue, one important element that has not received sufficient attention is population preference. Our review provides a comprehensive summary of the up-to-date evidence relative to this topic. Four OVID databases were searched: Ovid MEDLINE® ALL, Biological Abstracts, CAB Abstracts, and Global Health. Among the 742 articles generated, 154 full texts were selected for a more thorough evaluation based on predefined inclusion criteria. Finally, 83 studies were included in our review. The general population preferred either colonoscopy as the most accurate test, or fecal occult blood test (FOBT) as the least invasive for CRC screening. The emerging blood test (SEPT9) and capsule colonoscopy (nanopill), with the potential to overcome the pitfalls of the available techniques, were also favored. Gender, age, race, screening experience, education and beliefs, the perceived risk of CRC, insurance, and health status influence one’s test preference. To improve uptake, CRC screening programs should consider offering test alternatives and tailoring the content and delivery of screening information to the public’s preferences. Other logistical measures in terms of the types of bowel preparation, gender of endoscopist, stool collection device, and reward for participants can also be useful.

Patient-Reported Outcomes and Preferences for Colon Capsule Endoscopy and Colonoscopy: A Systematic Review with Meta-Analysis.

Colon capsule endoscopy as an alternative to colonoscopy for the diagnosis of colonic disease may serve as a less invasive and more tolerable investigation for patients. Our aim was to examine patient-reported outcomes for colon capsule endoscopy compared to conventional optical colonoscopy including preference of investigation modality, tolerability and adverse events. A systematic literature search was conducted in Web of Science, PubMed and Embase. Search results were thoroughly screened for in- and exclusion criteria. Included studies underwent assessment of transparency and completeness, after which, data for meta-analysis were extracted. Pooled estimates of patient preference were calculated and heterogeneity was examined including univariate meta-regressions. Patient-reported tolerability and adverse events were reviewed. Out of fourteen included studies, twelve had investigated patient-reported outcomes in patients who had undergone both investigations, whereas in two the patients were randomized between investigations. Pooled patient preferences were estimated to be 52% (CI 95%: 41–63%) for colon capsule endoscopy and 45% (CI 95%: 33–57%) for conventional colonoscopy: not indicating a significant difference. Procedural adverse events were rarely reported by patients for either investigation. The tolerability was high for both colon capsule endoscopy and conventional colonoscopy. Patient preferences for conventional colonoscopy and colon capsule endoscopy were not significantly different. Procedural adverse events were rare and the tolerability for colon capsule endoscopy was consistently reported higher or equal to that of conventional colonoscopy.

The Prediction of Inadequate Colon Capsule Cleansing: A Cohort Selection Guided by CC-CLEAR

Introduction: In order to optimize the rate of adequate cleansing in colon capsule, it may be important to identify risk factors that can predict a suboptimal colon preparation. Aim:To define predictive factors for inadequate bowel preparation in colon capsule, according to CC-CLEAR (Colon Capsule CLEansing Assessment and Report). Methods: Retrospective, single center, cohort study. Patients’ demographics, data, and quality of bowel preparation, according to CC-CLEAR, were collected retrospectively. A univariate analysis tested the association between covariables and the outcome, inadequate cleansing. The statistically significant variables were included in multivariable logistic binary regression, and a receiver operating characteristic curve (ROC) assessment was performed. Results: We included 167 consecutive colon capsules. Sixty-eight percent (n = 114) of patients were female, with a mean age of 64 years. The main indication for colon capsule was previous incomplete colonoscopy, in 158 patients (94.6%). The colon capsules cleansing was graded as good or excellent in 96 patients (57.5%) and as inadequate in 71 (42.5%), according to CC-CLEAR. The variables inadequate previous colon cleansing (OR adjusted 41.72 [95% CI 12.57–138.57], p value < 0.001); chronic laxative (OR adjusted 4.86 [95% CI 1.08–21.79], p value = 0.039); antidepressant (OR adjusted 5.00 [95% CI 1.65–15.16], p value = 0.004), and impaired mobility (OR adjusted 5.54 [95% CI 1.17–26.31], p value = 0.031) were independently associated with the outcome inadequate cleansing, after adjusting for confoundment. The model presented an excellent discriminative power towards the outcome variable (AUC ROC 0.937 [CI 95% 0.899–0.975], p value < 0.001). Conclusion: A previous inadequate colon cleansing, the use of chronic laxative and antidepressant, or impaired mobility are predictors of inadequate colon capsule cleansing, as assessed by the CC-CLEAR. These 4 predictors come together as a model enabling an accurate categorization of the patients at major risk of inadequate bowel preparation for capsule colonoscopy, with an excellent discriminative power and performance, which seems useful for the selection of patients for tailored optimization of the colon cleansing protocol.

Extensive mucosal sloughing of the small intestine and colon in a patient with severe COVID‐19

Patients with coronavirus disease 2019 (COVID‐19) primarily cause respiratory symptoms. However, gastrointestinal (GI) symptoms can also occur. The endoscopic characteristics of the GI tract in COVID‐19 patients remain unclear. We herein report a 62‐year‐old male with severe COVID‐19 who needed multidisciplinary treatment, including extracorporeal membrane oxygenation (ECMO). Despite the improvement in his respiratory status, GI bleeding developed. Capsule endoscopy and colonoscopy revealed extensive mucosal sloughing in the lower intestinal tract. Additionally, we performed a comprehensive analysis of the mRNA expression levels of various proinflammatory cytokines in the intestinal mucosal tissues. The results suggested a significant elevation of IL‐6, which could be involved in the pathophysiology of the GI involvement in COVID‐19. Further investigation with more clinical data, including endoscopic findings and molecular analyses, will contribute to a comprehensive understanding of COVID‐19‐associated GI injury.

Diagnostic Accuracy for Per-Patient Polyp Detection of Second-Generation Capsule Endoscopy Compared to Colonoscopy: A Meta-Analysis of Multicenter Studies.

Colon capsule endoscopy (CCE) or capsule colonoscopy can be used as colorectal cancer (CRC) screening option. We intended to analyze the concerning literature that compared second-generation CCE to standard colonoscopy for multicenter studies only. A literature search was performed in PubMed, Embase, and Web of Science. Study characteristics related to our research including sensitivity and specificity for per-patient polyps detection (size: ≥ 10 mm and ≥ 6 mm). Meta-analysis was performed using an open meta-analyst. Our research included five studies, involving a total of 1518 patients, with a total of 1305 analyzed patients. The adequate bowel preparation rate ranged from 70% to 90%. The rates of complete CCE transit fluctuated from 80% to 100%. Our meta-analysis illustrated that mean (95% confidence interval) per-patient sensitivity, specificity, and diagnostic odds ratio were: 0.86 (0.82-0.91) (p < 0.001), 0.88 (0.72-0.96) (p < 0.001), and 50.7 (18.5-138.9) (p < 0.001), respectively, for polyps ≥ 6 mm; and 0.86 (0.8-0.91) (p < 0.001), 0.96 (0.92-0.98) (p < 0.001), and 173.5 (98.4-305.8) (p < 0.001), respectively, for polyps ≥ 10 mm. We concluded that CCE had high sensitivity and specificity for per-patient polyps vs. standard colonoscopy. Nevertheless, the comparatively higher rate of unfinished CCEs limits the utilization of CCE for CRC screening.