Traditional Endoscopy Research Articles

Exploring the Use of Computed Tomography Enterography in the Evaluation of Small Bowel Disease: A Prospective Study.

Background A major development in noninvasive imaging modalities, computed tomographic enterography (CTE) has a number of benefits over conventional computed tomography (CT) and capsule endoscopy. Through the utilization of multidetector computed tomography (MDCT) technology, CTE expedites the assessment of small bowel diseases, especially in those segments that are not accessible through traditional endoscopy. This study's main goal is to thoroughly evaluate CTE's diagnostic accuracy for a range of small intestinal conditions. Methodology In this investigation, which is a prospective observational study, 40 patients, 25 men and 15 women, with suspected small intestinal disorders and ages ranging from 10 to 70 underwent CTE. To evaluate diagnosis accuracy, a combination of clinical symptoms, imaging data, and histopathological/ultrasonography findings were evaluated. Throughout the research procedure, ethical issues and statistical analysis were incorporated to guarantee validity and adherence to ethical norms. Results The most frequent findings on CTE were bowel thickening and mucosal hyperenhancement, which were seen in 25 (62.5%) and 20 (50%) of the patients, respectively. The majority of patients (65%) exhibited both the ileal and jejunal loops to be adequately distended in grade III. In 35% of the patients, grade II distensibility of the ileal and jejunal loops was seen. Conclusion When it comes to accurately detecting small intestinal disorders, CTE is superior. It evaluates extraintestinal, mural, and intraluminal diseases with efficacy, particularly in places that are difficult to reach. It is essential for directing clinical decisions because of its capacity to assess disease activity prior to endoscopy and see consequences.

New Endoluminal platforms and advancements in technology: Should Gastroenterologists or Surgeons pave the way?

Nowadays, endoscopy has achieved amazing results in the treatment of benign and malignant pathologies, but it has yet to establish itself fully in the sense of an operative endoscopy. It is commonly believed that traditional endoscopy has reached its limits due to the intrinsic characteristics of existing platforms. Numerous robotic endoluminal platforms have been developed to overcome limitations in recent years. Existing robotic endoluminal platforms can be divided into three categories: fully robotic flexible endoscopic, robotic add-on systems, and traditional surgery-based platforms. These platforms are incredible pieces of technology, but in reality, they can only be considered a bridge to a genuinely robotic surgical system. Nowadays, both gastroenterologists and surgeons perform endoscopic procedures all over the world. We believe these platforms, leading to increased manipulation possibilities, may require an increasingly excellent knowledge of surgical techniques to develop their potential fully. Surgeons' unique training and experience push surgeons to take the lead in endoscopic operations over gastroenterologists due to the potential advantages in surgical precision and patient outcomes. However, gastroenterologists deeply understand gastrointestinal disorders and a collaborative effort between them and surgeons can lead to an efficient approach to endoscopic surgery.

Contact neuro-endoscopy-assisted cerebral hematoma evacuation under direct vision.

Neuro-endoscopic hematoma evacuation is a crucial therapeutic approach for intracerebral hemorrhage. Our research team has developed a portable and contact neuro-endoscopy technique to enhance the conventional endoscopy procedure. compared to traditional endoscopy, this innovative approach involves miniaturizing the lens, light source, and camera system. These components are integrated into a stainless steel tube with a diameter of 4 mm, referred to as the portable endoscopy in this study. The portable endoscopy is powered by a USB cable and the video is displayed on a tablet computer. This portable endoscope facilitates easier operation with both hands by a single surgeon.

The Evolution of Spinal Endoscopy: Design and Image Analysis of a Single-Use Digital Endoscope Versus Traditional Optic Endoscope.

Spinal endoscopy has evolved significantly since its inception, offering minimally invasive solutions for various spinal pathologies. This study introduces a promising innovation in spinal endoscopy-a single-use digital endoscope designed to overcome the drawbacks of traditional optic endoscopes. Traditional endoscopes, despite their utility, present challenges such as fragility, complex disinfection processes, weight issues, and susceptibility to mechanical malfunctions. The digital endoscope, with its disposable nature, lighter weight, and improved image quality, aims to enhance surgical procedures and patient safety. The digital endoscope system comprises a 30-degree 1000 × 1000 pixel resolution camera sensor with a 4.3 mm working channel, and LED light sources replacing optical fibers. The all-in-one touch screen tablet serves as the host computer, providing portability and simplified operation. Image comparisons between the digital and optic endoscopes revealed advantages in the form of increased field of view, lesser distortion, greater close-range resolution, and enhanced luminance. The single-use digital endoscope demonstrates great potential for revolutionizing spine endoscopic surgeries, offering convenience, safety, and superior imaging capabilities compared to traditional optic endoscopes.

Comparing Participation and Interim Effectiveness of Endoscopy and Biomarker-Based Screening for Gastric Cancer: A Cluster Randomized Controlled Trial.

Background: To improve compliance with endoscopic screening for gastric cancer (GC), we assessed five biomarkers-pepsinogen I (PG I), pepsinogen II (PG II), PG I/II ratio, helicobacter pylori antibody (HP-Ab), and gastrin 17 (G17) - for secondary GC screening by comparing participation and effectiveness of traditional endoscopy and biomarker-based screening in a randomized trial with baseline results. Methods: Seventy-four communities were randomly assigned to traditional endoscopy arm (TEA) or biomarker-based endoscopy arm (BEA). TEA uses a questionnaire for risk assessment, and BEA combines a questionnaire with biomarker detection. High-risk individuals in both arms underwent endoscopic screening. Participation and interim screening effectiveness in two arms were reported with baseline analysis. Results: In total, 5,798 participants in TEA and 5,158 in BEA were recruited, with a participation rate of 26.9%. BEA showed a significantly lower high-risk rate than TEA (15.2% vs. 38.9%) and a higher endoscopic participation rate for high-risk individuals (64.9% vs. 53.0%). The endoscopic screening results showed that there was no significant difference in detection rate of GC abnormalities between the two arms. Education level, frequent drinking, hot, rough and hard food consumption, family history of GC, and history of reflux esophagitis or gastropathy influenced participation rates in biomarker-based screening. Age group, sex and regular consumption of meat, eggs and milk products were associated with stomach abnormalities.Cumulative incidence and specific death rates did not significantly differ in intention-to-screen and per-protocol analyses. Conclusions: Biomarker-based screening effectively identifies high-risk individuals and increases endoscopic participation, providing value insights for improving screening efficiency as a secondary procedure.

Active distance control in multi-capsule endoscopy via closed loop electromagnetic force between capsules.

Capsule endoscopy offers a non-invasive and patient-friendly method for imaging the gastrointestinal tract, boasting superior tissue accessibility compared to traditional endoscopy and colonoscopy. While advances have led to capsules capable of drug delivery, tactile sensing, and biopsy, size constraints often limit a single capsule from having multifunctionality. In response, we introduce multi-capsule endoscopy, where individually ingested capsules, each with unique functionalities, work collaboratively. However, synchronized navigation of these capsules is essential for this approach. In this paper, we present an active distance control strategy using a closed-loop system. This entails equipping one capsule with a sphere permanent magnet and the other with a solenoid. We utilized a Simulink model, incorporating (i) the peristalsis motion on the primary capsule, (ii) a PID controller, (iii) force dynamics between capsules through magnetic dipole approximation, and (iv) position tracking of the secondary capsule. For practical implementation, Hall effect sensors determined theinter-capsule distance, and a PID controller adjusted the solenoid's current to maintain the desired capsule spacing. Our proof-of-concept experiments, conducted on phantoms and ex vivo bovine tissues, pulled the leading capsule mimicking a typical human peristalsis speed of 1cm/min. Results showcased an inter-capsule distance of 1.94mm ± 0.097mm for radii of curvature at 500mm, 250mm, and 100mm, aiming for a 2-mm capsule spacing. For ex vivo bovine tissue, the achieved distance was 0.97 ± 0.28mm against a target inter-capsule distance of 1mm. Through the successful demonstration of precise inter-capsule control, this study paves the way for the potential of multi-capsule endoscopy in future research.

Оптико-електронні вузько смугові методи для реєстрації та покращення біомедичних зображень при ендоскопії

This article discusses the main narrowband opto-digital methods and technologies for obtaining digital images by endoscopic examination of the abdominal cavity. A review and comparison of the following modern methods of endoscopy IEE (image-enhanced endoscopy) with improved visualization is carried out: NBI (narrow-band imaging), LCI (linked color imaging), Laser-BLI (blue laser imaging) or LED-BLI (blue light imaging), traditional endoscopy using white light WLE (white light endoscopy) or WLI (white light imaging).

Role of Advanced Gastrointestinal Endoscopy in the Comprehensive Management of Neuroendocrine Neoplasms.

Neuroendocrine neoplasms (NENs), also called neuroendocrine tumors (NETs), are relatively uncommon, heterogenous tumors primarily originating in the gastrointestinal tract. With the improvement in technology and increasing use of cross-sectional imaging and endoscopy, they are being discovered with increasing frequency. Although traditionally considered indolent tumors with good prognoses, some NENs exhibit aggressive behavior. Timely diagnosis, risk stratification, and management can often be a challenge. In general, small NENs without local invasion or lymphovascular involvement can often be managed using minimally invasive advanced endoscopic techniques, while larger lesions and those with evidence of lymphovascular invasion require surgery, systemic therapy, or a combination thereof. Ideal management requires a comprehensive and accurate understanding of the stage and grade of the tumor. With the recent advancements, a therapeutic advanced endoscopist can play a pivotal role in diagnosing, staging, and managing this rare condition. High-definition white light imaging and digital image enhancing technologies like narrow band imaging (NBI) in the newer endoscopes have improved the diagnostic accuracy of traditional endoscopy. The refinement of endoscopic ultrasound (EUS) over the past decade has revolutionized the role of endoscopy in diagnosing and managing various pathologies, including NENs. In addition to EUS-directed diagnostic biopsies, it also offers the ability to precisely assess the depth of invasion and lymphovascular involvement and thus stage NENs accurately. EUS-directed locoregional ablative therapies are increasingly recognized as highly effective, minimally invasive treatment modalities for NENs, particularly pancreatic NENs. Advanced endoscopic resection techniques like endoscopic submucosal dissection (ESD), endoscopic submucosal resection (EMR), and endoscopic full-thickness resection (EFTR) have been increasingly used over the past decade with excellent results in achieving curative resection of various early-stage gastrointestinal luminal lesions including NENs. In this article, we aim to delineate NENs of the different segments of the gastrointestinal (GI) tract (esophagus, gastric, pancreatic, and small and large intestine) and their management with emphasis on the endoscopic management of these tumors.

Evaluating clinical diversity and plausibility of synthetic capsule endoscopic images

Wireless Capsule Endoscopy (WCE) is being increasingly used as an alternative imaging modality for complete and non-invasive screening of the gastrointestinal tract. Although this is advantageous in reducing unnecessary hospital admissions, it also demands that a WCE diagnostic protocol be in place so larger populations can be effectively screened. This calls for training and education protocols attuned specifically to this modality. Like training in other modalities such as traditional endoscopy, CT, MRI, etc., a WCE training protocol would require an atlas comprising of a large corpora of images that show vivid descriptions of pathologies, ideally observed over a period of time. Since such comprehensive atlases are presently lacking in WCE, in this work, we propose a deep learning method for utilizing already available studies across different institutions for the creation of a realistic WCE atlas using StyleGAN. We identify clinically relevant attributes in WCE such that synthetic images can be generated with selected attributes on cue. Beyond this, we also simulate several disease progression scenarios. The generated images are evaluated for realism and plausibility through three subjective online experiments with the participation of eight gastroenterology experts from three geographical locations and a variety of years of experience. The results from the experiments indicate that the images are highly realistic and the disease scenarios plausible. The images comprising the atlas are available publicly for use in training applications as well as supplementing real datasets for deep learning.

Upper Gastrointestinal Tract Video Capsule as an Alternative to Oesophago-Gastro-Duodenoscopy in Clinical Practice

Introduction. Upper gastrointestinal (UGI) video capsule endoscopy (VCE) provides a possible alternative to conventional oesophago-gastro-duodenoscopy (OGD). In Ireland, the COVID-19 pandemic led to unprecedented change in endoscopy services, accelerating the need for UGI VCE to help reduce patient exposure but allow the continuation of endoscopy services. We report on using UGI VCE as an alternative to OGD throughout all phases of COVID-related endoscopy adjustments. Aims/Background. Prospective observational study to assess identification of relevant UGI anatomical landmarks on UGI VCE as defined in the British Society of Gastroenterology. Method. Inclusion criteria were: patients with dyspepsia under 40 years of age with no alarm symptoms; known cirrhosis for variceal screening; UGI bleeds with the Blatchford score ≤ 2 . A protocol for preparation and a series of positional movements were adapted for the procedure. Landmarks and pathology detection were evaluated by two independent endoscopists. Results. 127 UGI VCE was performed from June 2020 to December 2021, of which 22 required further evaluation with OGD. The most common indications were dyspepsia and abdominal pain, 71% and 19%, respectively. With the use of the dual-facing camera, clear views of the OGJ in 100% of cases, cardia 100%, fundus 97%, greater curve 99%, lesser curve 98%, incisura angularis 95%, antrum 95%, pylorus 94%, D1/bulb 83%, and D2 82% were obtained. The main findings at UGI VCE were reflux oesophagitis and gastritis, with normal mucosa observed in 48% of cases. Findings suggesting a neoplastic lesion at the OG junction were detected in 1 case. Conclusion. Since June 2020, 81% ( N = 103 ) of a selected cohort of patients referred for UGI endoscopy avoided invasive traditional endoscopy and were successfully managed by VCE, thus reducing endoscopy waiting lists. UGI VCE may serve as a clinical diagnostic tool, used alongside OGD in appropriate cases, to help improve patient services and care delivery.

Query[formula omitted]: Query over queries for improving gastrointestinal stromal tumour detection in an endoscopic ultrasound

Gastrointestinal stromal tumour (GIST) lesions are mesenchymal neoplasms commonly found in the upper gastrointestinal tract, but non-invasive GIST detection during an endoscopy remains challenging because their ultrasonic images resemble several benign lesions. Techniques for automatic GIST detection and other lesions from endoscopic ultrasound (EUS) images offer great potential to advance the precision and automation of traditional endoscopy and treatment procedures. However, GIST recognition faces several intrinsic challenges, including the input restriction of a single image modality and the mismatch between tasks and models. To address these challenges, we propose a novel Query2 (Query over Queries) framework to identify GISTs from ultrasound images. The proposed Query2 framework applies an anatomical location embedding layer to break the single image modality. A cross-attention module is then applied to query the queries generated from the basic detection head. Moreover, a single-object restricted detection head is applied to infer the lesion categories. Meanwhile, to drive this network, we present GIST514-DB, a GIST dataset that will be made publicly available, which includes the ultrasound images, bounding boxes, categories and anatomical locations from 514 cases. Extensive experiments on the GIST514-DB demonstrate that the proposed Query2 outperforms most of the state-of-the-art methods.

Localization of Passively Guided Capsule Endoscopes—A Review

Traditional endoscopy is conducted stationary in the hospital and requires sedation of the patient. Contrary, capsule endoscopy (CE) requires no sedation, and the patients are allowed to leave the hospital for their daily life during the procedure that lasts for several hours. Commercially available capsule endoscopes are passively moved through the gastrointestinal tract (GIT) by peristalsis. For diagnosis and intervention planning, the traveled distance and orientation of the capsules for each video frame would be highly relevant. Nevertheless, commercial capsule endoscope systems do not offer precise localization of the capsules. In the past years, many different scientific localization approaches have been proposed. These methods can be divided into video-, radio frequency-(RF), and magnetic field-based methods. In this review, a requirement profile for a localization method suitable for a commercial capsule endoscopy system is defined. The defined requirements of a localization system for capsule endoscopy are high accuracy, robustness during the daily life of a patient, and integrability with commercial capsule endoscopy systems. Afterward, promising approaches are reviewed and discussed concerning these requirements. It was revealed that the magnetic field- and video-based methods are the most promising methods, and these methods would complement each other very well. Therefore, a hybrid magnetic-field-/video-based method is suggested, which has, to the best of our knowledge, not been proposed so far.

S3435 Jejunal Diverticula: A Lesser Known Cause for Massive Lower GI Bleeding

Introduction: Small bowel diverticula are rare. We describe a case of Jejunal diverticula that caused massive lower GI bleeding requiring surgical intervention. Case Description/Methods: A 77 year old male presented to our ER with sudden onset bright red blood per rectum. The patient first noticed 2 days ago that his stool was dark red followed by red streaking on toilet paper. A few hours later he developed rectal urgency followed by another large bloody bowel movement along with associated diaphoresis, LLQ cramping and presyncope. Past medical history included GERD, BPH, Hypertension and Polycythemia Vera. He had never undergone an EGD and his last screening colonoscopy was normal 5 years ago. Labwork revealed acute anemia with Hb of 7.7 g/dL (baseline 13) and one unit of RBCs was therefore transfused. Emergent EGD and colonoscopy were performed and these were unremarkable apart from sigmoid diverticulosis. The following day massive rectal bleeding recurred and this time a radionuclide bleeding scan was obtained which was positive for active bleeding in small bowel lumen at the LUQ. Interventional Radiology did not feel the area was approachable for embolization. 6 additional units of RBCs were given due to persistent bleeding. General Surgery was called and the patient was taken to OR for exploratory laparotomy with small bowel resection. Diffuse proximal Jejunal diverticulosis was found to be actively bleeding with blood traveling all the way to distal colon. 60 cm of Jejunum was transected 30 cm from the ligament of Treitz. The patient had an unremarkable postoperative recovery with no further episodes of bleeding and stable Hemoglobin on serial CBCs. Discussion: Diverticulosis involving the small bowel, especially the Jejunum, is rare. These lesions have a higher incidence in the elderly and are acquired as a result of increased intraluminal pressure. They are thin and friable due to lack of muscularis layer. Concurrent colonic diverticulosis is common. Traditionally considered to be asymptomatic and incidental findings on imaging or surgical exploration, Jejunal diverticula can uncommonly cause lower GI bleeding. Traditional endoscopy is unhelpful given the lack of accessibility of the small bowel. CT Angiography and Nuclear Medicine bleeding scans may be beneficial to localize bleeding. Hemorrhage is usually brisk, requiring massive blood transfusion to maintain hemodynamics. Unstable patients should undergo emergent laparotomy so that resection of the involved segment can be performed.

The principle of the three-dimensional visual environment of the operating field in rhinosurgery

Traditional endoscopes that create a two-dimensional image cannot provide stereoscopic imagining of the operating field, which does not allow simultaneous synchronization of visual perception with the surgeon's handwork. The operator still achieves in-depth perception through tactile and visual cues, such as the interaction of instruments or the continuous movement of the endoscope. To examine the three-dimensional visual environment for the operating field in endoscopic rhinosinus surgery based on the stereopsis phenomenon. Thanks to multi-spiral computed tomography, we have examined the functional structure features of ram's synonasal region, and described the system of the accessory nasal cavities. We practiced, and compared the techniques of endoscopic rhinosinus surgery using traditional methods versus a three-dimensional visual environment. As a result, we found the advantages of the live surgery in a virtual reality helmet, confirmed by the NASA Task Load Index questionnaire. The use of a virtual reality helmet in rhinosurgery allows the operator to work in a three-dimensional visual environment based on the phenomenon of stereopsis, as a qualitatively improved method of surgical wound videoscopy.

An Alignment Method for Magnetically Actuated Flexible Endoscope in Colonoscopy

Magnetically-actuated flexible endoscopes (MAFE) have been well used in minimally-invasive surgery because they can be remotely steered by a magnetic field thus achieving more flexible visual feedback than traditional endoscopes. By controlling the actuator magnet (AM) mounted on a robotic manipulator, MAFE can be steered to align with the target by visual feedback control. However, the non-linearity of the flexible robot and the magnetic field make the control method of MAFE become difficult. Image changes resulting from MAFE rotation are difficult to predict due to the inability to generate a moment of rotation around the MAFE optical axis. In this paper, we established a kinematics model from robot joints to the MAFE and achieved visual feedback alignment control of the endoscope by proposing a control algorithm to control the magnetic field forces and moments. To study the consuming time and accuracy of the alignment of our control method, we investigated the effect of several factors on the alignment through experiments.

Gastrointestinal Bleeding Secondary to Jejunum GIST, Report Case

The small intestine is by far the most difficult area to study from an endoscopic point of view, since traditional endoscopy only covers up to the 2nd portion of the duodenum and colonoscopy up to the terminal ileum. On rare occasions we find it necessary to use non-traditional endoscopic equipment to be able to study this middle area of the small intestine. Gastrointestinal stromal tumor is one of the neoplastic differential diagnoses found at this level. Given the advancement of genetics associated with immunohistochemistry, we have been able to better evaluate and characterize these lesions of mesenchymal origin. A case of a jejunal gastrointestinal stromal tumor with an initial presentation of melena is presented. Where together gastroenterology, surgery and pathology, the mentioned final diagnosis was reached.

An Intelligent Wired Capsule for the Treatment of Helicobacter pylori

An endoscopic capsule is a miniaturized ingestible video camera used to acquire images of the gastrointestinal tract wirelessly. Being morphologically equivalent to any ingestible pill, they can be simply swallowed. Endoscopic capsules therefore present an inviting alternative to the traditional endoscope for the examination of the gastrointestinal tract as well for therapeutic purposes. Endoscopic capsules are considered a disruptive technology, as they have revolutionized the examination of the gastrointestinal tract in a relatively short time. The implementation of an active locomotion system can improve the performance of a capsule and, in the solution proposed in this paper, allows providing the capsule the needed power for therapeutic purposes. Alternative therapeutic solutions, based on optical solutions and capsule endoscopy can be applied to patients affected by Helicobacter pylori, a bacterium of the stomach that affects about half of the world population, mainly in developing countries. The infection can be asymptomatic or associated with slight symptomatology. In some cases, it can take to major pathologies or death. The literature reports results deriving from recent applications of photodynamic treatments to H. pylori. Specific wavelengths have been found to exhibit photo-killing capabilities toward the bacterium. Some solutions have been proposed based on the use of endoscopic devices and capsules capable of administering photodynamic therapy inside the stomach. The proposed treatments, however, are invasive and insufficient to achieve long-term eradication. In this work, the administration of photodynamic therapy is proposed, aimed at the eradication of H. pylori by means of an active endoscopic capsule with LED emission. The capsule design, in addition to the therapeutic module aimed at administering an appropriate light intensity at specific wavelengths already demonstrated in the literature, integrates an active locomotion system aimed at maximizing the efficiency of the treatment.

SP10.2.1 Use of a cost-efficient Colonoscopy simulation model to improve endoscopy skills

AimsThe use of endoscopic simulators as a learning aid in surgical training has been well established, particularly in those with less experience. In the challenging time of COVID-19, when endoscopic procedures are at a minimum, this can become more valuable. However, their utility for training is countered by the high cost of equipment.We demonstrate a cost-efficient alternative to traditional endoscopy simultators, which can be easily made in any centre.MethodsA polypectomy simulator model was created using a drain-pipe and surgical gloves. Junior doctors were timed in their ability to remove the 3 polyps from within the simulator. The exercise was repeated over 6 sessions over the course of 3 weeks. Means were compared using ANOVA.ResultsThere was a mean relative reduction of 75% in overall time taken to complete the task (p < 0.0001). This improvement was seen for both surgical trainees with previous endoscopy experience (p = 0.005) and FY1 novices (p < 0.0001).ConclusionsIn our group, we have seen improvement in performance across both surgical trainees and novices. In today's era of COVID-19, when direct training opportunities may become more scarce, simple alternatives may become vital in ensuring progression of basic surgical skills such as endoscopy.This cheap polypectomy simulator can be easily re-created across surgical units and can be used as an adjunct to traditional endoscopic training.

Surgical Evacuation of Intracerebral Hemorrhage: The Potential Importance of Timing.

Surgical Evacuation of Intracerebral Hemorrhage: The Potential Importance of Timing.

Prelimenary results of red lesion segmentation in WCE images

Wireless capsule endoscopy (WCE) is a novel imaging technique that can view the entire small bowel in human body. Thus, it is presented as an excellent diagnostic tool for evaluation of gastrointestinal diseases compared with traditional endoscopies. However, the diagnosis by the physicians is tedious since it requires reviewing the video extracted from the capsule and analysing all of its frames. This tedious task has encouraged the researchers to provide automated diagnostic technics for WCE frameworks to detect symptoms of gastrointestinal illness. In this paper, we present the prelimenary results of red lesion detection in WCE images using Dense-Unet deep learning segmentation model. To this end, we have used a dataset containing two subsets of anonymized video capsule endoscopy images with annotated red lesions. The first set, used in this work, has 3,295 non-sequential frames and their corresponding annotated masks. The results obtained by the proposed scheme are promising.