Diagnosis Of Small Bowel Diseases Research Articles

The role of video capsule endoscopy in the diagnosis of gastrointestinal diseases: experience of the Department of Diagnostic and Operative Endoscopy

Introduction. Video capsule endoscopy (VSE) is a gold standard diagnostic method for small bowel diseases and is widely used in clinical practice. The presented analysis of the VCE results demonstrates the possibilities of this diagnostic tool and is the largest one of the analysis that were recently published in Russia. Aim. To demonstrate the possibilities of video capsule endoscopy in the diagnosis of small bowel diseases. Materials and methods. A total of 300 video capsule endoscopies were performed in patients with suspected and already established small bowel diseases between 2014 and 2022. All patients who underwent a video capsule endoscopy in the settings of the National Medical Research Center of Coloproctology named after A.N. Ryzhikh were over 18 years old. The study cohort included 158 men and 142 women. The average age of patients at the time of the video capsule endoscopy was 42 ± 15.4 years. The patients were recommended a standard preparation regimen: 3 days before the study, a protein diet was prescribed, and the day before, a two-stage administration of a PEGbased drug (“split dose”). To reduce gas production and decrease the amount of foamy intestinal contents, which worsens the quality of the endoscopic image, oral administration of an antifoam agent simethicone was prescribed: 80 mg on the eve of the endoscopy and 80 mg on the day of the endoscopy. Results. The video capsule endoscopy demonstrated high information value in the diagnosis of inflammatory bowel diseases: its sensitivity was 86%, and specificity – 90%. Similar results were obtained during video capsule endoscopy used to diagnose the source of possible bleeding: sensitivity and specificity were 87 and 68%, respectively. Conclusion. Video capsule endoscopy is an effective, safe and well-tolerated tool for diagnosing small bowel diseases. The video capsule endoscopy findings contribute to establishing a correct diagnosis and selecting treatment strategies.

Update: Dünndarmerkrankungen in Computertomographie und Magnetresonanztomographie

Radiological procedures play acrucial role in the diagnosis of small bowel disease. Due to abroad and quite nonspecific spectrum of symptoms, clinical evaluation is often difficult, and endoscopic procedures require significant manpower, are time-consuming and expensive. In contrast, radiologic imaging can provide important information about morphologic and functional variations of the small bowel and help to identify various disease entities, such as inflammation, tumors, vascular problems, and obstruction. The most common radiological modalities in small bowel diagnostics include ultrasound (US), computed tomography (CT), magnetic resonance imaging (MRI), and fluoroscopy. Each of these modalities has its own advantages and limitations, and the choice of imaging modality depends on clinical symptoms and suspected diagnosis in addition to availability. In recent years, significant progress has been made, especially in cross-sectional imaging modalities, as aresult of new and further technical developments. These range from increasing detail resolution to functional and molecular imaging techniques that go far beyond simple morphology. In addition, information technology (IT) applications, which include artificial intelligence and radiomics, are assuming an increasing role. Many of the methods mentioned are still in early stages and need to be further developed for daily practice, but some have already found their way into clinical routine. The aim of this work is to provide areview of the most important disease entities of the small intestine, including new and innovative diagnostic approaches.

The Incidence of Acute Pancreatitis After Device Assisted Enteroscopy: a Systematic Review and Meta-analysis.

The diagnosis of small bowel diseases is challenging and device assisted enteroscopy (DAE) is a technique for visualizing the entire small bowel. DAE is considered as a safe procedure and the reported rate of adverse events associated with DAE in the literature is low. The present study tried to investigate the actual incidence of AP after DAE with a systematic review and meta-analysis of available relevant studies. Studies were searched through the PubMed, EMBASE, and Cochrane library databases. The following data were extracted from all eligible studies: author, country, publication year, publication type, study design, type of DAE used, route of DAE, number of patients with AP after DAE, and number of patients with hyperamylasemia after DAE.A random-effects model with RStudio version 4.2.0 was performed in all analyses. Heterogeneity was assessed using the I2 test. The risk of bias was assessed by the Newcastle-Ottawa Scale criteria and the publication bias was assessed by the Egger test. Twenty three studies involving a total of 11145 patients were included in the analysis. The overall, pooled AP rate after DAE was 1% (95% CI:0-1%). There was significant heterogeneity among the studies (I2 = 65%; P < 0.01).The pooled AP rate was 1% (95% CI:0-2 %)in peroral route group. The pooled proportion of patients having hyperamylasemia after DAE was 29% (95% CI: 16-46%).Among the patients who had hyperamylasemia AP were identified in 2% (95% CI: 0-6%) of patients. The incidence of AP after DAE is about 1%. Hyperamylasemia is a common change in the patients undergoing DAE and only 2% of the patients with hyperamylasemia present with AP.

Impact of a Structured Report Template on the Quality of Multislice Spiral Computed Tomography Scan Reports for Small Bowel Diseases: A Preliminary Study

Background: The application of multislice spiral computed tomography (MSCT) scan has improved the diagnosis of small bowel diseases (SBDs). Objectives: This study aimed to develop a structured report (SR) template for SBDs based on MSCT scans and to compare its value with free-text reports (FTRs) by radiologists with different levels of seniority in radiology. Patients and Methods: A total of 120 SBD cases were confirmed based on the clinical manifestations, surgery, colonoscopy, and pathology. An SR template for small bowel imaging was developed, and six radiologists were divided into inexperienced and experienced groups. Sixty cases with small intestinal MSCT data were available for FTRs and another 60 cases for SRs after training. The report accuracy, satisfaction, and completion time were compared between the two reporting methods. Results: The writing time of SRs was significantly shorter than that of FTRs. By using FTRs, the experienced group showed higher levels of sensitivity for all diseases (i.e., intestinal wall, intestinal peripheral artery, blood vessel, bone, and other abdominal organ diseases) (P &lt; 0.05). The experienced group showed a low misdiagnosis rate for all diseases (P &lt; 0.05), except for bone disease (P = 0.161). By using SRs, the experienced group only showed a low misdiagnosis rate for the intestinal wall disease (P &lt; 0.05). High sensitivity for the intestinal wall disease (P &lt; 0.05) and intestinal peripheral artery disease (P = 0.024), along with improved sensitivity for bone lesions (P &lt; 0.05), was reported in this group. In the inexperienced group, SRs improved sensitivity for all diseases (P &lt; 0.05), except for intestinal wall disease (P &gt; 0.05). The satisfaction scores for both inexperienced and experienced groups improved by using SRs (4 vs. 2.6 for the inexperienced group and 4.1 vs. 3.2 for the experienced group; P &lt; 0.05 for both). Conclusion: The SRs were superior to FTRs in terms of writing efficiency, accuracy, and satisfaction. They could improve the accuracy of inexperienced radiologists in diagnosis and help detect SBDs.

Capsule endoscopy with retention of 4years: A case report.

Introduction and importanceCapsule endoscopy has been widely used in the diagnosis of small bowel diseases. Most CE can be smoothly excreted through the digestive tract. However, very few retention of CE may happen.Case presentationA 64-year-old man had been suffering from intermittent abdominal pain for 10 years. Capsule endoscopy was performed in local hospital 4 years ago. He was initially diagnosed with Crohn's disease and started on treatment. CTE and X-ray film of abdomen showed a suspected capsule endoscopy on the right side of pelvic cavity. Surgery was performed to remove the capsule. After the surgical treatment, no gastrointestinal symptoms relapsed for 9 months.Clinical discussionIt isn't uncommon for capsule endoscopy to be detained in Crohn's disease, because Strictures are the commonest complication of Crohn's disease. In order to prevent intestinal retention of capsule endoscopy, risk assessment should be carried out before capsule endoscopy. If detained CE isn't removed successfully by drug therapy and endoscopic therapy, surgery treatment has to be considered.ConclusionIn the present case, capsule endoscopy was found in the small intestine after 4 years, and the reason is worth pondering. We strongly recommend performing routine CTE, MRE and patency capsule examination before capsule endoscopy for patients suspected of stenosis. Routine abdominal X-ray film after examination is also useful for timely detection of capsule retention.

ID: 3492451 VALIDATION OF A BINARY CLASSIFICATION MODEL USING A DEEP CONVOLUTIONAL NEURAL NETWORK FOR WIRELESS CAPSULE ENDOSCOPY

Manual reading of an entire capsule endoscopy (CE) video is a time-consuming process in the diagnosis of small bowel diseases. Despite introduction of reading models with deep convolutional neural networks (CNN), it is still insufficient for clinical use since most models can only detect a single abnormality or failed to validate with unseen images. Therefore, we developed a binary classification model and tested whether it could suggest images correctly from unseen cases.

Tu1569 SMALL BOWEL ENDOSOCPY IN CHRONIC GRANULOMATOUS DISEASE-ASSOCIATED INFLAMMATORY BOWEL DISEASE

Chronic granulomatous disease (CGD) is a rare immunodeficiency caused by genetic mutations of the NADPH oxidase complex. Dysregulated inflammation of the gastrointestinal (GI) tract leads to CGD-associated inflammatory bowel disease (IBD). Although lower GI tract involvement is the major target of study and therapy, characterization of small bowel disease is scarce and the appropriate modality to diagnose small bowel disease in CGD is unknown. To characterize small bowel disease and evaluate the clinical utility of wireless video capsule endoscopy (VCE) for the diagnosis of small bowel disease in CGD-associated IBD. Patients with genetically confirmed CGD were evaluated for IBD as a part of routine care in an ongoing natural history study from 2010 to present. Based on clinical evaluation, patients underwent radiologic, endoscopic, and/or small bowel evaluation with VCE (PillCam SB3, Medtronic©) when indicated. VCE was performed after at least eight hours of fasting. Anthropometric and laboratory data were analyzed and same-admission radiologic, endoscopic, and VCE findings were compared for their ability to identify and characterize small bowel disease. Thirty patients were evaluated with 18 excluded due to high VCE retention risk. Of the 12 patients with VCE, 67% were male, the median age was 19.5 years old (IQR 8), 75% were white, 17% were mixed race, and 8% were Asian. Patients had p47phox (58%) or gp91phox (42%) genetic mutations. VCE indications included abdominal pain (83%), diarrhea (67%), hematochezia (42%), iron deficiency anemia (8%), and/or elevated C-reactive protein level (CRP; 8%). Of those with imaging (n=11), one showed terminal ileum dilatation whereas the rest were normal. All patients underwent upper endoscopy (EGD) with duodenal erythema (25%), erosions (17%), nodularity (17%), friability (8%), or congestion (8%). Of those who underwent ileoscopy or colonoscopy (n=9), small bowel/terminal ileum findings included erosions (22%), ulcers (11%), and dilatation (11%). All VCEs were abnormal with small bowel findings of erosions (83%), inflammatory changes (erythema, edema, and granularity; 83%), ulcerations (75%), and blood/hematin (50%). Both patients without abdominal pain had disease on VCE, as did all three patients without anemia and all three patients without elevated CRP. Of those with EGD, VCE, and colonoscopy evaluation (n=11), disease was seen in all three modalities in 72.7%, VCE and colonoscopy only in 18.2%, or EGD and VCE only in 9.1%. CGD patients with GI symptoms often have active small bowel disease. In such patients, small bowel disease should be investigated, and therapy should seek to address any small bowel involvement. These interim results support continued exploration and characterization of small bowel disease in CGD and its optimal diagnostic modality.

Computer tomography in the diagnosis of small bowel diseases

Introduction. The relevance of the study is caused by the difficulties in diagnosing diseases of the small bowel (SB). Due to the prevalence and widespread introduction of X-ray computed tomography (CT) into clinical practice, its capabilities in the diagnosis of small bowel diseases are of great interest and potential.&#x0D; Objective. to reveal the possibilities of computed tomography using intravenous bolus contrast enhancement in identifying the symptom of wall thickening of the small bowel and its prognostic significance in various nosologies.&#x0D; Methods. Analysis of the data from MSCT studies performed according to the Protocol for the study of abdominal organs using intravenous bolus contrast enhancement and oral water intake in adult patients from 18 to 87 years of age with small bowel diseases.&#x0D; Results. The article shows the possibilities of multispiral computed tomography performed according to the standard Protocol in detecting thickening of the SB wall. The range of diseases was determined for which thickening of the SB wall was one of the main radiological symptoms of the lesion. The prognostic significance of this radiological symptom is presented. The features of thickening of the intestinal wall in various diseases and other distinctive features that can be used in the differential diagnosis are described.&#x0D; Conclusion. Thickening of the wall is a common sign of SB damage, which is convincingly detected in CT studies with bolus contrast enhancement. In our study, the common causes of thickening of the SB wall in primary disease were: Crohn's disease (37%), lymphoma (20%) and anastomosis (13%). However, we determined thickening of the SB wall as a result of primary tumors (adenocarcinoma, sarcoma) in 7% and as a result of a secondary tumor lesion in 18.6% of cases. The considered diseases were different in the degree of thickening of the intestinal wall (from 6 to 70 mm), its spreading (focal thickening 48%; segmental 52%), number of affected areas (from 1 to 3) of their localization (proximal-middle or distal section), form of the transition area from the affected part of the intestine to the unchanged one (sharply defined or smooth), the presence or absence of symptoms of intestinal obstruction, and the features of contrast enhancement (severity and type).

Changes in performance of small bowel capsule endoscopy based on nationwide data from a Korean Capsule Endoscopy Registry.

Background/AimsCapsule endoscopy (CE) is widely used for the diagnosis of small bowel diseases. The clinical performance and complications of small bowel CE, including completion rate, capsule retention rate, and indications, have been previously described in Korea. This study aimed at estimating the recent changes in clinical performance and complications of small bowel CE based on 17-year data from a Korean Capsule Endoscopy Registry.MethodsCE registry data from 35 hospitals were retrospectively analyzed. Clinical information, including completion rate, capsule retention rate, and indications, was collected and analyzed. In addition, the most recent 5-year data for CE examinations were compared with the previous 12-year data.ResultsA total of 4,650 CE examinations were analyzed. The most common indication for CE was obscure gastrointestinal bleeding (OGIB). The overall incomplete examination rate was 16% and the capsule retention rate was 3%. Crohn’s disease was a risk factor for capsule retention. Inadequate bowel preparation was significantly associated with capsule retention and incomplete examination. An indication other than OGIB was a risk factor for incomplete examination. A recent increasing trend of CE diagnosis of Crohn’s disease was observed. The most recent 5-year incomplete examination rate for CE examinations decreased compared with that of the previous 12 years.ConclusionsThe 17-year data suggested that CE is a useful and safe tool for diagnosing small bowel diseases. The incomplete examination rate of CE decreased with time, and OGIB was consistently the main indication for CE. Inadequate bowel preparation was significantly associated with capsule retention and incomplete examination.

Efficacy of MR enterography in the diagnosis of small bowel disease and crohn's disease

Small bowel disease and crohn’s disease are inflammatory disorders occurs in bowel wall. MR enterography (MRE) of small bowel is becoming gold standard imaging modality in the diagnosis of small bowel diasease and crohn’s disease. This study was performed to assess the sensitivity and apecificity of MR enterography in the diagnosis of small bowel disease and crohn’s disease. A total 100 cases with clinical findings and symptoms of small bowel disease were recruited. The radiological examination was performed by using 1.5 tesla MRI using abdomen coil in supine position & instructed for breathing instructions. Among 100 participants, 56% cases had abnormal and 44% had normal findings by MRE enterography. In the MRE diagnosed abnormal cases, 32.1% cases had tuberculosis to intestine, 28.5% cases diagnosed with crohn’s diasese, 7.14% had small bowel neoplasms, 8.9% cases had ulcerative colitis and 7.14% cases had large bowel disease. The sensitivity and specificity for MR enterography in the diagnosis of crohn’s disese was 77.77% and 97.56% respectively. MR enterography is the efficient non invasive diagnostic modality in the diagnosis of suspected intra luminal, parietal and extra luminal small bowel disease and crohn’s disease.

Demystifying autoimmune small bowel enteropathy.

We reviewed the current 'state of the art' on autoimmune enteropathy and small-bowel mucosal atrophy, with the aim of supporting clinicians in a frequently challenging diagnosis through different therapeutic options and prognosis. The diagnosis of small-bowel diseases has radically changed over the last 10 years. The possibility to 'easily' obtain bioptic samples from the jejunum and ileum by means of the enteroscopic techniques (particularly, device-assisted enteroscopy) and the novel cross-sectional imaging studies have opened the window to new insights on intestinal disorders. Consequentially, the detection of small-bowel mucosal atrophy has become a frequent finding in patients undergoing endoscopic investigation and its differential diagnosis can be challenging at times. Among the 'typical' causes of mucosal atrophy, autoimmune enteropathy has become more frequent than previously thought. However, the final diagnosis of autoimmune enteropathy is a 'puzzle' composed by serological, endoscopic, histological and molecular markers, which should be correctly dealt with in order to reach a certain diagnosis. In conclusion, there is an emerging body of literature about autoimmune enteropathy and small-bowel atrophy. The herein presented practical review on autoimmune enteropathy can be of help to clinicians in their daily practice.

Diagnosis of Obscure Gastrointestinal Bleeding: Capsule Endoscopy or Double Balloon Enteroscopy?

The development of capsule endoscopy (CE) and double balloon enteroscopy (DBE) has significantly enhanced the visualization of the small bowel. CE and DBE have proven to be the choice of investigation for the diagnosis of small bowel disease and is an evident indication for obscure gastrointestinal bleeding (OGIB). CE or DBE respectively are frequent option of professionals for the diagnosis of obscure gastrointestinal bleeding. The purpose of this review is to provide an overview of studies focused on patients with obscure gastrointestinal bleeding with previous CE and/or DBE intervention. Studies show that CE and DBE have similar diagnostic yields for obscure gastrointestinal bleeding. Although with few chances for false negative results, most researches showed good concordance between CE and DBE. However due to its non-invasiveness, safety, patient tolerability and ability to view the entire small bowel, CE can be recommended as a first choice of investigation. DBE, despite being more invasive, is a necessary second choice, which has both diagnostic and therapeutic value, although skilled endoscopist and sedation are required and complications like bleeding, perforation, pancreatitis etc. may occur.

The application value of capsule endoscopy in diagnosing small intestinal carcinoma.

The aim of this study was to explore the clinical value of capsule endoscopy in the diagnosis of small intestine neoplastic lesions. A retrospective analysis was conducted on the clinical data of 108 patients who underwent capsule endoscopic examination in the Endoscopy Center of Xinxiang Central Hospital from February 2010 to January 2014. The characteristics of different small bowel diseases were observed, and the prevalence rates of different small bowel lesions were calculated. Of the included 108 patients who received capsule endoscopic examination, 74 cases showed lesions, with a detection rate of 68.52%. Of these 74 patients, 56 cases (51.85%) suffered from small bowel diseases and 18 cases (16.67%) were manifested with other gastrointestinal lesions. Moreover, obvious lesion was not observed in 34 cases (31.48%). Among the patients with lesions, we observed seven cases of submucosal tumor in small intestines, five cases of small intestinal carcinoma, two cases of small intestinal polyps, two cases of small intestinal roundworm, eight cases of small intestine ulcer, one case of Crohn's disease, 18 cases of enteritis, two cases of small intestine diverticula, four cases of small intestine hemangioma, one case of small intestine vascular malformation, one case of intestinal lymphangiectasia, one case of small intestine compression, two cases of small intestine hemorrhage, and two cases of small intestinal lipoma. Among the patients who showed other gastrointestinal lesions, we observed one case of esophageal diverticula, three cases of gastric erosion, six cases of superficial gastritis, four cases of gastric ulcer, one case of pyloric ulcer, one case of colonic polyps, and two cases of colon tumor. Capsule endoscopy demonstrated a high diagnostic value for various small bowel diseases, including both tumor and inflammatory lesions. Given its simplicity, safety, and reliability, capsule endoscopy was an important examination tool for the diagnosis of small bowel diseases.

Comparison of patients' tolerance between computed tomography enterography and double-balloon enteroscopy.

BackgroundComputed tomography enterography (CTE) and double-balloon enteroscopy (DBE) are widely used in diagnosis of small bowel diseases. Both of these examinations bring discomfort to patients. The aim of this study was to compare patients’ tolerance and preference between CTE and DBE.MethodsFrom August 1, 2014 to December 31, 2016, patients with suspected or known small bowel diseases who underwent both CTE and DBE were prospectively enrolled in our study. They were asked to fill out a questionnaire evaluating discomfort of the procedure after each examination.ResultsOne hundred and seven patients completed our study. Abdominal distension, painfulness, tenesmus, general discomfort, prolonged duration, difficulty in completing the test, and discomfort after the examination were significantly lower with CTE than with DBE (P<0.001, respectively). Mannitol intake (47.7%), bowel preparation (31.9%), and radiation exposure (15.0%) were regarded as the three most intolerable burdens in CTE. Painfulness (38.3%), bowel preparation (26.2%), and invasiveness (16.8%) were considered as the three most unacceptable parts of DBE. More patients (61.7%) preferred to repeat CTE rather than DBE (P<0.001).ConclusionCompared to DBE, CTE was a more tolerable and less burdensome examination and enjoyed higher preference by most patients.

Small bowel malignancy in patients undergoing capsule endoscopy at a tertiary care academic center: Case series and review of the literature.

Background and study aims Small bowel cancer is rare, accounting for < 5 % of all gastrointestinal neoplasms. Capsule endoscopy has become the procedure of choice for non-invasive diagnosis of small bowel diseases. Data on capsule endoscopy diagnosis of small bowel cancer are limited. The objective of the study was to determine the frequency, indications and diagnostic work-up of patients with small bowel malignancy found by capsule endoscopy at a Scottish tertiary center. Patients and methods In this retrospective study, records all patients who underwent small bowel capsule endoscopy at our center over a 10-year period were reviewed for possible malignancy. Further data were gathered on preceding and subsequent investigations, management and outcome of these patients. Results From 1949 studies, small bowel malignancies were diagnosed in only 7 patients (0.36 %; 2F/5M; median age 50, range 34 – 67). The main indication was iron-deficiency anemia (n = 5). Prior to capsule endoscopy, 6 of 7 patients had bidirectional endoscopies and one had gastroscopy. All prior investigations were normal or nondiagnostic. Two of 7 experienced capsule retention. Five of 7 underwent surgery. Four patients died, giving a 5-year survival rate of 42.9 %. Conclusion Small bowel malignancies diagnosed by capsule endoscopy are rare, and the median age of 50 indicates they are more common in relatively younger patients. Capsule endoscopy is effective at diagnosing a rare malignancy when other imaging modalities have failed.

Historical analysis of experience with small bowel capsule endoscopy in a Spanish tertiary hospital

Abstract Introduction Capsule endoscopy was approved by the FDA in 2001. Gastrointestinal bleeding and inflammatory bowel disease are the main indications. It has been available in our hospital since 2004. Methods We retrospectively analysed data from patients who underwent small bowel capsule endoscopy in our hospital from October 2004 to April 2015. Indications were divided into: Obscure gastrointestinal bleeding (occult and overt), inflammatory bowel disease, and other indications. Findings were divided into: Vascular lesions, inflammatory lesions, other lesions, normal studies, and inconclusive studies. Results A total of 1027 out of 1291 small bowel studies were included. Mean patient age was 56.45 years; 471 were men and 556 women. The most common lesion observed was angiectasia, as an isolated finding or associated with other lesions. Findings were significant in up to 80% of studies when the indication was gastrointestinal bleeding, but in only 50% of studies in inflammatory bowel disease. Diagnostic yield was low in the group “other indications”. No major complications were reported. Discussion Small bowel capsule endoscopy has high diagnostic yield in patients with gastrointestinal bleeding, but yield is lower in patients with inflammatory bowel disease. Conclusions Our experience shows that capsule endoscopy is a safe and useful tool for the diagnosis of small bowel disease. The diagnostic yield of the technique in inflammatory bowel disease must be improved.

Small bowel motility assessment based on fully convolutional networks and long short-term memory

Assessment of small bowel’s motility plays an important role in the diagnosis of small bowel disease. Conventional assessment methods rely on hand-designed features or manual guide-line drawing, which results in difficult modeling and high time consumption, thus they are still inefficient and impractical for clinical uses. With the help of deep neural networks, we introduced a semi-automated approach, replacing hand-designed features with automatic feature extraction, and an automated approach, eliminating manual guide-line drawing, to assess small bowel motility by automatically marking cross-sectional diameters on small bowel images, measuring temporal fluctuation of diameter lengths, and evaluating contraction frequency. Experiment results show that proposed methods could estimate small bowel contraction frequency correctly. The difference between predicted diameter lengths and one manually labeled is within reasonable range, and estimated frequency is close to the groundtruth. Therefore, proposed methods can be utilized for diagnosis of small bowel disease, which will assist radiologist in decision-making.

Experiencia de cápsula endoscópica en sangrado de origen obscuro y dolor abdominal crónico recurrente en Pediatría del CMN «20 de Noviembre» del ISSSTE

BackgroundCapsule Endoscopy (CE) is a useful tool in diagnosis of small bowel diseases, enabling to evaluate regions that cannot be reached with other endoscopic procedures to be approach, whether surgical or medical. ObjetiveTo know and describe the principal etiology in the 2 main pediatric indications for the use of endoscopic capsule in a third level hospital. Material and methodsIn this transversal, descriptive and retrospective study, we review the medical files of patients referred to endoscopy with diagnosis of OGIB and CAP. Twenty seven patients, with ages ragging from 4 to 18 years old where studied in the period from 1th January 2008 to 31 December 2014 were included. ResultsWe obtained the following etiological diagnostics in diseases that produce OGIB and CAP: Patients with OGIB27.1% with lymphoid nodular hyperplasia, 13.3% hemangioma, 6.6% vascular dysplasia, 13.3% erosive jejunoileal inflamation, 13.3% ulcerative colitis, 6.6% telangiectasia, 6.6% polyposis, and 6.6% duodenal ulcer. Patients with CAP36.6% polyposis, 18.8% Crhon disease, 9.09% pseudo cecal pseudopolyp, 9.09% vascular ectasia, 9.09% pseudopolyp, 9.09% normal study, 9.09% intestinal limphangiectasia, and 9.09% jejunoileitis.There was only one report of an adverse event in a patient with crhon disease. DiscussionCapsule endoscopy is a diagnostic tool for small bowel disease in pediatric patients with OGIB and CAP, and it helps to determine the etiology of these diseases and helps to stablish the therapeutic approach, weather its surgical o medical.

Análisis histórico de la experiencia en cápsula endoscópica de intestino delgado en un hospital terciario español

IntroductionCapsule endoscopy was approved by the FDA in 2001. Gastrointestinal bleeding and inflammatory bowel disease are the main indications. It has been available in our hospital since 2004. MethodsWe retrospectively analysed data from patients who underwent small bowel capsule endoscopy in our hospital from October 2004 to April 2015. Indications were divided into: Obscure gastrointestinal bleeding (occult and overt), inflammatory bowel disease, and other indications. Findings were divided into: Vascular lesions, inflammatory lesions, other lesions, normal studies, and inconclusive studies. ResultsA total of 1027 out of 1291 small bowel studies were included. Mean patient age was 56.45 years; 471 were men and 556 women. The most common lesion observed was angiectasia, as an isolated finding or associated with other lesions. Findings were significant in up to 80% of studies when the indication was gastrointestinal bleeding, but in only 50% of studies in inflammatory bowel disease. Diagnostic yield was low in the group «other indications». No major complications were reported. DiscussionSmall bowel capsule endoscopy has high diagnostic yield in patients with gastrointestinal bleeding, but yield is lower in patients with inflammatory bowel disease. ConclusionsOur experience shows that capsule endoscopy is a safe and useful tool for the diagnosis of small bowel disease. The diagnostic yield of the technique in inflammatory bowel disease must be improved.

A decision fusion strategy for polyp detection in capsule endoscopy.

Wireless capsule endoscopy (CE) is now routinely used for non-invasive diagnosis of small bowel diseases. But, it still requires manual assessment of the approximately 50,000 study images. Literature has recently investigated automated methods to detect and analyze various anomalies in CE images to improve reading efficiency and reduce variability. We propose such a computer aided diagnosis (CAD) approach to detect small bowel polyps. For supervised classification of polyps, we investigated fusing multiple statistical classifiers based on color, texture and edge features. The combined boosted classifier when evaluated using 1200 CE images outperformed all individual classifiers and achieved a ~90% classification accuracy.