Performance Of Capsule Endoscopy Research Articles

Celiac disease as a rare source of recurrent small intestinal bleeding

Aim: study of the effectiveness of endoscopic interventions in complicated celiac disease.Material and methods. An electronic literature search was performed using databases: PubMed, Medline, Cochrane Library. A clinical case of a patient with small intestinal bleeding and celiac disease is described.Results. This literature review includes case reports, retrospective studies, and literature reviews. Presented is a clinical case of a patient who noted periodic discharge of blood from the anal canal for 2 years. According to esophagogastroduodenoscopy, erosive gastritis was detected, complicated by bleeding (the source was not identified) with suspected celiac disease. According to the histological conclusion, celiac disease is excluded. During hospitalization, it was decided to perform capsule endoscopy with balloon-assisted enteroscopy followed by a biopsy. According to the data of a comprehensive endoscopic examination of the small intestine, various defects of the mucous membrane with signs of ongoing bleeding were revealed. Endoscopic clipping of the identified defects was performed and a biopsy was taken. According to the results of histological examination, celiac disease complicated by small intestinal bleeding was diagnosed.Conclusions. The use of endoscopic therapeutic techniques avoids surgical interventions, and preserves the quality of life of the patient.

Highly robust performance of a compact, wide-angle, nano-optic capsule endoscopy camera

The performance of capsule endoscopy, which plays an important role in noninvasive medical diagnostics, has been limited by aberrations and large optical sizes caused by several traditional lenses. We propose a capsule endoscopy camera based on a metalens that distinguishes it from existing technologies in three aspects. First, the camera achieved a high FOV of 160°, enabling a comprehensive examination of internal organs. Second, we achieved a compact design with an optical diameter of 1.6 mm and a length of 1.4 mm to enhance patient comfort. The attainment of exceptional image quality with an MTF of more than 45% at 300 lp/mm is the third advantage of this camera. The theoretical performance of this innovative approach shows great potential to improve diagnostic capabilities.

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.

Small Intestinal Involvement and Genotype-Phenotype Correlation in Familial Adenomatous Polyposis

Background and AimsSmall intestinal involvement in familial adenomatous polyposis (FAP) remains unclarified. We performed capsule endoscopy (CE) and balloon-assisted (BA) endoscopy to analyze small intestinal polyps and their genotype-phenotype correlations in a large cohort of FAP patients. MethodsIn this retrospective study, we performed CE in all 149 FAP patients and BA endoscopy in 74 patients with larger polyps. The prevalence of small intestinal adenoma with high-grade dysplasia and cancer was investigated. Correlation between APC variant and polyp phenotype was analyzed. ResultsMedian patient age was 44 years and 69% were male. Pathogenic germline APC variants were found in 117/136 (86.1%). Overall prevalence and median number of small intestinal polyps were 85.2% (127/149) and 17 (IQR 6-36), respectively. A total of 5318 polyps were detected by CE and all 433 polyps histologically examined were confirmed as adenoma. The number of polyps significantly decreased from the proximal-to-distal tracts. Adenoma with high-grade dysplasia was detected in 26.2% (39/149), and its incidence among the polyps was approximately 1.4% (74/5318). Of these, 14 were intramucosal carcinomas with a prevalence of 5.4% (8/149). The germline APC variant in codon 1251-1580 was significantly correlated with a high number of small intestinal polyps. Multivariate analysis revealed APC variant in codon 1251-1580 and a high number of small intestinal polyps as independent risk factors for adenoma with high-grade dysplasia. Spigelman stage was significantly associated with number of jejunal/ileal polyps and their high-grade dysplasia. ConclusionAmong FAP patients, small intestinal adenoma with high-grade dysplasia was detected in 26.2% and cancer in 5.4%. FAP patients, particularly those with APC variant in codon 1251-1580 and/or high Spigelman stage may require surveillance for small intestinal polyps.

Development of a deep learning-based software for calculating cleansing score in small bowel capsule endoscopy

A standardized small bowel (SB) cleansing scale is currently not available. The aim of this study was to develop an automated calculation software for SB cleansing score using deep learning. Consecutively performed capsule endoscopy cases were enrolled from three hospitals. A 5-step scoring system based on mucosal visibility was trained for deep learning in the training set. Performance of the trained software was evaluated in the validation set. Average cleansing score (1.0 to 5.0) by deep learning was compared to clinical grading (A to C) reviewed by clinicians. Cleansing scores decreased as clinical grading worsened (scores of 4.1, 3.5, and 2.9 for grades A, B, and C, respectively, P < 0.001). Adequate preparation was achieved for 91.7% of validation cases. The average cleansing score was significantly different between adequate and inadequate group (4.0 vs. 2.9, P < 0.001). ROC curve analysis revealed that a cut-off value of cleansing score at 3.25 had an AUC of 0.977. Diagnostic yields for small, hard-to-find lesions were associated with high cleansing scores (4.3 vs. 3.8, P < 0.001). We developed a novel scoring software which calculates objective, automated cleansing scores for SB preparation. The cut-off value we suggested provides a standard criterion for adequate bowel preparation as a quality indicator.

Immune checkpoint inhibitor-induced enteritis assessed using capsule endoscopy.

We performed capsule endoscopy for a patient with immune checkpoint inhibitor-induced enteritis and found multiple erosions or small ulcers in the small intestine. No reports demonstrated the effectiveness of capsule endoscopy for immune checkpoint inhibitor-induced gastrointestinal adverse events, and our case suggests that capsule endoscopy may be useful to evaluate immune checkpoint inhibitor-induced enteritis.

Performance of Capsule Endoscopy and Cross-Sectional Techniques in Detecting Small Bowel Lesions in Patients with Crohn's Disease.

Crohn's disease (CD) can be classified according to endoscopic and cross-sectional imaging characteristics. Information regarding disease extent and phenotype may be provided by advanced endoscopic and imaging techniques. In this study, we compare the ability of capsule endoscopy (CE) and cross-sectional imaging techniques (CST) (MRE/Computer Tomography Enteroscopy [CTE]) in detecting small bowel (SB) lesions. We retrospectively analyzed 102 patients with a diagnosis of CD who underwent both CE and CST. Only patients with at least a 12-month follow-up after CE were included. Sensitivity and specificity for the detection of SB lesions were, respectively, 100% and 83.3% for CE, 55.1% and 80% for CTE, and 60% and 82.3% for MRE. CE detected proximal CD lesions in 73% of patients, whereas MRE and CTE detected proximal lesions in 41% and 16% of patients, respectively (P < 0.001). Positive findings on CE led to management changes in all patients, in a median follow-up period of 58.7 months. During the follow-up period, 26.5% of patients underwent surgery. Multivariate analysis revealed that moderate-to-severe disease at CE was independently correlated with surgery (P = 0.03). CE has a superior sensitivity for detecting CD lesions in the proximal and medium SB compared with CST. In the terminal ileum, MRE and CTE displayed similar performance to CE.

2987 Significance of Small Intestine Search in Dysphagia of Elderly People

INTRODUCTION: Patients suspected of having small bowel disease tend to increase, and even in the elderly, it is often necessary to perform small bowel examination. However, elderly people often have dysphagia and may not be able to perform capsule endoscopy (CE) examination. The use of an advanced capsule endoscope insertion aid and an overtube was used to examine the usefulness of small intestine examination in elderly people with difficult swallowing. METHODS: In this study, patients aged 75 years and older who required small-bowel examination were treated as patients with dysphagia who required device as group A and patients who did not use as group B. We compared clinical data and retrospectively examined the usefulness of CE in elderly people with dysphagia. From July 2015 to April 2019, our hospital performed CE were 273 cases, 247 patients, elderly people over the age of 75 were 154 cases, 139 patients. Group A: 21 cases, 21 patients. Group B: 133 cases, 118 patients. RESULTS: Gender differences are male/female, A group 9/12, B group 62/71. The average age was 85.8 years for A group and 82.3 years for B group (P = 0.0018). Stomach transit time (min): A group average 64.9, B group average 53.9, small intestine transit time (min): A group average 350.4, B group average 349.9. In blood examination, RBC (× 104/μl): A group average 314.8, B group average 331.2, Hgb (g/dl): A group average 9.24, B group average 9.74, Alb (g/dl): A group average 3.08, B group average 3.43 (P = 0.0156), Cre (mg/dl): A group average 1.77, B group average 1.14 (P = 0.0060). Anticoagulant medications were 14 in A group (66.7%) and 74 in B group (55.6%). Mini-Mental State Examination (MMSE): A group 11.1, B group 22.0 (P &lt; 0.0001). In OGIB for inspection purposes, 17 cases were A group (80.9%) and 100 cases were B group (75.2%). The incidence rate was 11 in A group (52.4%) and 78 in B group (58.6%) (P = 0.5890). CONCLUSION: In elderly patients who require small-bowel examination, it was possible to obtain the same finding rate as subjects who can swallow it, using a CE insertion aid together.

A modified magnetic resonance wireless power transfer system for capsule endoscopy

ABSTRACTBackground: The current study presents a fully planar wireless power transfer (WPT) scheme with the aim of providing enough power for capsule endoscopy performance. The method’s implementation on patients is more convenient than that of the previous conventional WPT plans in which a cylindrical wire coil is placed around the patient’s body. In addition to this, while using the present printed power receiver structure, the capsule’s internal space of opens up for other components such as the image sensors and data transmitting components. To improve the efficiency, a two-layer printed coil has been used as the transmitter, a two-layer printed coil as the receiver and a power coil on the transmitter side excited at 13.56 MHz.Results: Applying this method, the efficiency has increased to more than 2% for the proposed structure. Moreover, the effect of the body tissue on power efficiency has been simulated and measured and the maximum specific absorption rate (SAR) value considered for the desired system. Conclusions: The obtained results indicate that the proposed system meets the medical standards requirements.

Clinical utility of the patency capsule: a large volume center experience.

In patients with suspected or known obstructive gastrointestinal pathology, the use of patency capsule (PC) aims to minimize the risk of subsequent retention of the endoscopic capsule. However, its clinical utility is not consensual. The aim was to evaluate the indications, results and safety profile of the PC. Retrospective analysis of PCs (agile patency capsule) conducted between 2011 and 2015. Patency evaluation was performed after 30 hours, with radiological confirmation if PC was detected. We included 369 PCs, 54% female. The average age was 42±16 years. Main indications included suspected Crohn disease (CD) (45%), CD staging (32%), neoplastic diseases (9%), radic enteritis (3%), prior surgery (3%), NSAIDs enteropathy (2%) and anemia (2%). Before the exam 5% of patients were taking constipation-induced medications and 5% reported occlusive symptoms; 38% of patients had previous abdominal surgeries, most often ileal resection due to CD (24%); 42% of patients had previous imaging studies, revealing strictures in 20% and bowel dilation in 11%. Patency capsule was negative (patent gastrointestinal tract) in 73% of cases at 30h and 2% of PCs were fully recovered in the following days. Seven patients (2.5%) showed self-limiting occlusive symptoms during the procedure. All patients with negative PC subsequently performed capsule endoscopy with no cases of retention. History of occlusive symptoms (P=0.023) and strictures in imaging studies (P=0.029) were associated with the detection of the PC at 30 hours. PC is a safe and effective exam. Occlusive symptoms and imaging strictures were significantly associated with the retention. The retention rate was 25%, a similar result to that described in other series but higher than expected for the various indications, suggesting the importance of new research studies.

The impact of hospitalization on the performance of capsule endoscopy (CE)

BackgroundFor proper evaluation of capsule endoscopy (CE), a complete examination is necessary. AimWe evaluated risk factors of an incomplete CE with focus on patient hospitalization. MethodsWe retrospectively evaluated 161 consecutive patients who underwent CE between 01.07.2013 and 13.03.2016. Main indications were active bleeding, iron deficiency anemia (IDA), inflammatory bowel disease (IBD), abdominal pain, and familial adenomatous polyposis (FAP). ResultsWe report the results of 103 in-patients and 56 out-patients. Eighty-two patients were male, average age was 58.9 years (range 18–90). Indications for CE were active bleeding (103 patients), IDA and IBD (16 patients), and FAP, abdominal pain and others (eight examinations each). All FAP patients were out-patients, but showed the longest small bowel transit time (SBTT) of 443.6min (p=0.0001). The shortest SBTT was found in out-patients without FAP (267.5min, p<0.05). In the in-patient group, nine endoscopies did not record the entire small bowel (8.7%) due to battery depletion, compared with only one incomplete examination in the out-patients (1.8%, p=0.036). We found pathologic lesions in the last 30min of the SBTT in 43 patients, and this indicates the necessity for complete examination. Thirteen of these 43 patients showed major lesions such as ulcers or angiodysplasia in this last region alone. ConclusionIn-patients might require special treatment to ensure complete examination, since a considerable amount of pathologies can only be found in the ileum.

小腸カプセル内視鏡が有効だった2隻寄生の日本海裂頭条虫症の1例

A 76-year-old man presented to our hospital because he had noticed a long, white, string-like discharge in his feces. He had a history of eating raw fish. Tapeworm infection was suspected. We performed capsule endoscopy to investigate whether there were parasitic tapeworms. Capsule endoscopy revealed a scolex in the jejunum at 2 hours and 4 minutes, and another scolex at 2 hours and 37 minutes. He was treated with praziquantel (1200 mg) followed by a cathartic (magnesium citrate) . The two tapeworms were successfully expelled. Their lengths were 404 centimeters and 135 centimeters, respectively. After analysis of the expelled tapeworms, we diagnosed the patient with Diphyllobothrium nihonkaiense infection. In our case, capsule endoscopy was useful for evaluation of the number of parasitic tapeworms.

Clinical usefulness of transabdominal ultrasonography prior to patency capsule for suspected small-bowel strictures

Objective: Patency capsule (PC) examination has made it possible to perform capsule endoscopy (CE) in patients with a suspected small-bowel stricture. However, PC has some drawbacks, so we assessed the usefulness of transabdominal ultrasonography (TUS) prior to PC in patients with suspected small-bowel strictures to avoid unnecessary PC examination. Patients and methods: Fifty-two patients who underwent TUS prior to PC were enrolled in this study. TUS findings were classified as follows: intestinal narrowing and distension at the oral side (Type A); extensive bowel wall thickening (Type B); focal bowel wall thickening (Type C) or no abnormality detected (Type D). We evaluated the TUS and PC findings for the detection of small-bowel strictures. Results: Double-balloon endoscopy (DBE) revealed small-bowel strictures in 13 of 50 patients (26%). TUS yielded Type B or C findings in 12 of 13 patients (92%), while PC revealed strictures in all 13 patients. In Crohn’s disease (CD) patients with Type B TUS findings, 8 of 9 (89%) had small-bowel strictures on DBE. However, only two of six non-CD patients (33%) with Type B TUS findings had small-bowel strictures. The incidence of Type B strictures was significantly higher in CD patients. Conclusions: CD patients with Type B TUS findings should not undergo PC or CE because of the high rate of small-bowel strictures. Non-CD patients diagnosed with Type B TUS strictures, as well as patients diagnosed with Type C or D strictures should undergo CE after confirming small-bowel patency using PC.

Investigation of Undetected Small Bowel Tumors on Capsule Endoscopy

AIM : The rate of undetected small bowel tumors when performing capsule endoscopy (CE) has been reported to be 44.1% to 83.3%. The aim of this study was to review the CE findings in patients with small bowel tumors and analyze the cases in which CE failed to detect tumors. METHODS : Twenty-one cases (18 males, 3 females) with small bowel tumors underwent CE and double-balloon enteroscopy at the Dokkyo Medical University Hospital and the Nikko Medical Center from February 2003 to March 2015. CE findings in the 21 patients were retrospectively reviewed on the basis of the lesion shape and location. RESULTS : Of the 21 patients, CE accurately diagnosed tumors in 12 patients (57.1%). However, tumors were not detected in 9 patients because of a poor endoscopic view due to visual obstruction caused by blood, bowel residue, or feces (n=5; 23.8%), the presence of ulcerated lesions (n=3; 14.3%), or angioectasia (n=1; 4.8%). The sources of bleeding were considered to be ulcerated lesions or angioectasia. Of the 9 patients, 7 patients had tumors in the duodenum or the proximal jejunum. CONCLUSION : On CE, small bowel tumors showed atypical features, including a smooth submucosal bulge and the presence of ulcerated lesions and of blood, bowel residue, or feces, probably due to regional transit abnormalities related to the tumor. In such cases, it may be necessary to perform computed tomography, positron emission tomography/computed tomography, other examinations, or repeat CE after performing colonic irrigation to remove bowel residue.

Long-Term Outcomes of NSAID-Induced Small Intestinal Injury Assessed by Capsule Endoscopy in Korea: A Nationwide Multicenter Retrospective Study.

Background/AimsWe evaluated the long-term outcome and clinical course of patients of nonsteroidal anti-inflammatory drug (NSAID)-induced small intestinal injury by performing capsule endoscopy (CE).MethodsA multicenter retrospective study was conducted using data collected from the CE nationwide database registry, which has been established since 2002.ResultsA total of 140 patients (87 males; mean age, 60.6±14.8 years) from the CE nationwide database registry (n=2,885) were diagnosed with NSAID-induced small intestinal injury and enrolled in our study. Forty-nine patients (35.0%) presented with a history of aspirin use and an additional 49 (35.0%) were taking NSAIDs without aspirin. The most prominent findings after performing CE were multiple ulcerations (n=82, 58.6%) and erosions or aphthae (n=32, 22.9%). During the follow-up period (mean, 15.9±19.0 months; range, 0 to 106 months), NSAID-induced small intestinal injury only recurred in six patients (4.3%). Older age and hypertension were positive predictive factors for recurrence.ConclusionsThese results suggest that the recurrence of NSAID-induced small bowel injury was not frequent in the presence of conservative treatment. Therefore, the initial diagnosis using CE and the medication history are important.

PTU-017 The Use Of Small Bowel Capsule Endoscopy In The Octogenarians Group; The Edinburgh Experience

IntroductionOver the last 13 years, the clinical use of capsule endoscopy (CE) has revolutionised the investigation pathways for the small-bowel. Although non-invasive (as procedure), there are reports of capsule aspiration...

A case of &lt;i&gt;Diphyllobothrium nihonkaiense&lt;/i&gt; infection identified by capsule endoscopy

A 40-year-old man presented to our hospital with the complaint of long white string-like discharges from the anal. No significant abnormality was noted on physical examination. He had history of diabetes mellitus, thus, the laboratory tests revealed a markedly increased HbA1c level (13.3%) . The serum IgE level was slightly increased (645 IU/ml) . Other laboratory values were within normal range. He gave a history of eating raw Oncorhynchus masou 2 months earlier, and had been diagnosed as having Diphyllobothrium nihonkaiense by evaluation of the expelled proglottids. Therefore, vermifuge treatment with gastrografin was started, however, we could not identify the tape worm and no proglottids were excreted. Therefore, the patient was kept under observation, and 16 months later, he presented again with the same complaint. We performed capsule endoscopy to confirm whether the scolices could be found in the bowel ; this examination revealed scolices of Diphyllobothrium nihonkaiense attached to the jejunal wall, as well as numerous freely floating proglottids in the small intestine. Praziquantel (20 mg/kg) was administered, followed by administration of a cathartic 2 hours later, and the worm was expelled successfully. It was considered that capsule endoscopy was very useful for the diagnosis of the parasites in this case.

Clinical value of capsule endoscopy in obscure gastrointestinal bleeding

Objective Assessed the efficiency of capsule endoscopy in obscure gastrointestinal bleeding （OGIB） diagnosis and the reference value of diagnosis results in further clinical treatment, analyzed how capsule endoscopy results can affect patients＇ prognosis. Methods 307 consecutive patients who under- went capsule endoscopy for OGIB from June 2002 to October 2010 were enrolled. Follow-up data were ob- tained by reviewing medical records, capsule endoscopy database and contacting the patients or their relatives by telephone. We set validation criteria to calculate the capsule endoscopy inspection sensitivity, specificity, positive predictive value, negative predictive value, the accuracy. And by comparing the clinical treatment and prognosis of capsule endoscopy-positive patients with those of capsule endoscopy-negative ones, we ana- lyzed bow capsule endoscopy results can guide clinical treatment and its effect on prognosis. Results Among the patients who perform capsule endoscopy for OGIB, 307 patients follow-up data were available, with a medium follow-up of 52. 0 （range 13 -112, interquartile range 33 -74 ） months. In this study, the diagnostic yield of capsule endoscopy is 65.8% , and the accuracy is 84. 8%. Sensitivity, specificity, posi- tive predictive value and negative predictive value of capsule endoscopy were 81.7% , 91.4% , 95.2% and 70. 5%, respectively. The effective intervention rate of specific treatments in capsule endoscopy-postive pa- tients was 94. 5%, while the total effective intervention rate was 94. 7%. Conclusion Capsule endoscopy for OGIB is an effective and safe method with excellent tolerability as well as high diagnostic yield and accu- racy, able to effectively guide the clinicians to proper diagnosis and treatment, thus greatly improving the prognosis of these patients. Key words: Capsule endoscopes ; Diagnosis ; Early intervention; Prognosis ; Obscure gastro-intestinal bleeding

A Case of Parasite Invasion of the Intestinal Tract: A Missed Diagnosis in Irritable Bowel Syndrome

Irritable bowel syndrome (IBS) is a gastrointestinal disorder characterized by chronic abdominal pain and altered bowel habits in the absence of any organic cause. As the clinical manifestations are very diverse and associated with nonspecific symptoms, research seeking to identify organic causes to rule out IBS and to enable differential diagnosis is required. A 24-year-old man was referred to our hospital for specialized management of IBS. He had a 7-month history of intermittent epigastric and lower abdominal pain. On the basis of clinical examination, he was diagnosed with IBS and administered medication at a primary clinic. However, his symptoms did not improve after treatment. We performed capsule endoscopy at our hospital and identified a parasite (Ancylostoma duodenale) in the proximal jejunum. We therefore report a case of parasitic infection found by additional examination while evaluating symptoms associated with a previous diagnosis of refractory IBS.

Gastrointestinal: Capsule endoscopy assists in the complete deworming of parasites

A 67-year-old man presented with the complaint of ribbon-like substances in the feces. In the beginning of August 2010, he was referred to our hospital for treatment of parasitic worm infection. The patient did not have symptoms such as diarrhea, anemia, or weight loss; the results of physical and hematological examinations and of thoracoabdominal radiography were normal. Although he did not have a history of parasitic worm infection and had never traveled abroad, he had eaten raw salmon 1 month ago. On the first day of the hospital visit, the patient was diagnosed with diphyllobothriasis after examination of the helminth eggs found in the feces. After diatrizoic acid swallow on the second day, the presence of the worm body was confirmed by colonoscopy, and the worm body was extirpated from the anus by using grasping forceps. Although approximately 1 m of the worm body together with most of the neck portion was successfully extirpated, removal of the scolex was not confirmed. On the fourth day, after obtaining the patient’s consent, we performed capsule endoscopy because of possible incomplete deworming. Capsule endoscopy confirmed parasitization by a cestode and detected the scolex attached to the jejunal mucosa (Figure 1). Parasite-specific drugs, i.e., praziquantel and magnesium citrate, were administered, and complete deworming was subsequently confirmed by microscopic identification of the scolex (Figure 2). The worm body was pathologically confirmed as Diphyllobothrium nihonkaiense by performing trichrome and carmine staining (Figure 3). For the successful treatment of diphyllobothriasis, it is essential to remove the scolex of the parasite. The use of capsule endoscopy now allows for (1) easy capture of images of parasites, such as that of the scolex of Diphyllobothrium nihonkaiense, in the small intestine, which was previously considered difficult; and (2) provides information critical for therapeutic decision making before administering anthelmintics.