Video Capsule Enteroscopy Research Articles

Computer aided villi morphometric quantification in video-capsule enteroscopy: A newly developed software to quantify small bowel atrophy

Background and AimsSmall bowel capsule endoscopy (SBCE) has an established role in patients with non-responsive celiac disease (CeD). A non-invasive method to quantify small bowel atrophy is still lacking. MethodsWe analysed SBCE frames from CeD patients from 2018 to 2020. Histology was the reference standard, with atrophy defined as Marsh-Oberhuber score ≥ 3a. Three regions of interest (ROI) were blindly selected from each frame by an expert gastroenterologist and analysed using a National Institute of Health J image-processing software into a numerical scale. A 3D surface plot macro identified intestinal villi density through isolines plots. ResultsWe acquired 306 ROIs from 57 frames with macroscopic atrophy and 45 with normal mucosa. Frames were classified as atrophic (n = 63) or non-atrophic (n = 39) per Marsh-Oberhuber classification. Median density score significantly differed between atrophic and non-atrophic frames (p < 0.001). The morphometric analysis showed a sensitivity of 77 % and a specificity of 79 % in discriminating between atrophic or non-atrophic mucosa with a 14.10 cut-off (Youden Index) and an overall AUC of 0.805 (CI 95 % 0.712–0.897). ConclusionsOur newly developed SBCE software can effectively quantify villous atrophy. Further studies are needed to validate its applicability in an external cohort.

The diagnosis and surgery of small intestine duplication in 11-years girl

There is presented the clinical report of the diagnosis and surgical treatment of such rare malformation as tubular duplication of the small intestine in an 11-years girl. Clinical manifestations were intense abdominal pain and intestinal bleeding of unknown origin. Video capsule enteroscopy (VCE) made it possible to identify the pathological area and determine its location. The article presents modern ideas about duplication of the small intestine. There are indicated diagnostic methods and signs to allow suspecting this malformation. The possibilities and criteria for VCE in diagnosing subepithelial lesions and identifying the source of intestinal bleeding are described.

Endoscopic and morphological changes in eosinophilic enteritis in children: current concepts and own observations

Eosinophilic enteritis (EoEn) is a rare disease, the key diagnostic method for which is upper endoscopy with biopsies and histological examination. The article presents criteria of the diagnosis of EoEn, the range of detected endoscopic (including video capsule and balloon-assisted enteroscopy) and morphological lesions; emphasis is placed on the specific endoscopic sign of this pathology. Clinical examples with our own endoscopic examinations in children with EoEn are also presented. The article will improve the awareness of gastroenterologists and endoscopists about EoEn for timely diagnosis of the disease and treatment.

Gastrointestinal bleeding caused by a hidden gastrointestinal stromal tumor of the stomach

Gastrointestinal stromal tumors (GISTs) are the most common type of mesenchymal tumor of the gastrointestinal tract. This report presents a case of a large exophytic stomach GIST that was not visible at esophagogastroduodenoscopy (EGD). A 70-year-old female presented to the emergency room with presyncopal symptoms and a history of several episodes of melena. Blood tests revealed severe anemia. She underwent an EGD, which yielded negative results. Subsequently, she was hospitalized and scheduled for ileo-colonscopy and videocapsule enteroscopy (VCE). Abdominal ultrasound showed the presence of a mass in the epigastric region near the liver. Computed tomography (CT) scans confirmed the presence of a mass in the gastric wall that, at endoscopic ultrasound (EUS) exam and biopsy, was diagnosed as a tumor that originated from the muscular layer of the stomach. Surgery was performed to excise the tumor, and the diagnosis of GIST was confirmed by histomorphological and immunohistochemical findings. According to the postoperative assessment, the tumor was classified as high risk, for which the recommended treatment is imatinib.

Endoscopic Manifestations and Clinical Characteristics of Localized Gastric Light-Chain Amyloidosis.

To determine the endoscopic and clinical features of localized gastric amyloid light-chain (AL) amyloidosis, we retrospectively examined the characteristics of nine patients (eight men and one woman) encountered by the hospitals in our network. Lesions were predominantly flat and depressed with surface vascular dilatation (n=5); others were characterized by subepithelial lesions (n=2), mucosal color change (n=1), and a mass-like morphology with swollen mucosal folds (n=1). Colonoscopy (n=7), video capsule enteroscopy (n=2), serum (n=5) and urine immunoelectrophoresis (n=4), and bone marrow examination (n=3) were performed to exclude involvement of organs other than the stomach. As treatment for gastric lesions of AL amyloidosis, one patient each underwent endoscopic submucosal dissection (n=1) and argon plasma coagulation (n=1), while the remaining seven patients underwent no specific treatment. During a mean follow-up of 4.2 years, one patient died 3.2 years after diagnosis, but the cause of death, which occurred in another hospital, was unknown. The remaining eight patients were alive at the last visit. In conclusion, although localized gastric AL amyloidosis can show various macroscopic features on esophagogastroduodenoscopy, flat, depressed lesions with vascular dilatation on the surface are predominant.

Video capsule enteroscopy in the diagnosis of GIST of the ileum

The OBJECTIVE was to show the effectiveness of video capsule and balloon-assisted enteroscopy in the diagnosis of gastrointestinal stromal tumor of the ileum.METHODS AND MATERIALS. A clinical observation of a patient with a suspected tumor of the small intestine is presented. During the examination, video capsule endoscopy of the small intestine was performed using the Given Imaging capsule. In the ileum, mucosal infiltration and fresh blood were found. Conclusion: tumor of the small intestine. The patient underwent resection of the ileum with a tumor. Histological conclusion: malignant gastrointestinal stromal tumor with moderate mitotic activity and single metastasis to the mesenteric lymph node.CONCLUSION. The difficulty in diagnosing tumors of the small intestine is due to the lack of specific clinical symptoms and the complexity of visualizing the neoplasm. In such cases, it is advisable to include video capsule enteroscopy in the diagnostic algorithm, which according to indications can be supplemented with balloon-assisted enteroscopy by oral or transanal access.

Malignant Melanoma of the Gastrointestinal Tract: Symptoms, Diagnosis, and Current Treatment Options.

Malignant melanoma (MM) has become the fifth most frequent cancer in the UK. It is the most common carcinoma to metastasize to the gastrointestinal (GI) tract. MM particularly has an affinity to spread to the small bowel, which is followed by the involvement of the stomach and large intestine. Excellent endoscopic options including video capsule endoscopy and enteroscopy are available for a precise diagnosis of GI involvement by a metastatic MM. The complete surgical resection of GI metastatic MM in carefully selected patients not only provides symptom control, but has also been associated with an increase in overall survival. The approval of BRAF-targeted therapies and immune checkpoint inhibitors has transformed therapeutic approaches for patients with metastatic MM over the past decade. Currently, the overall survival of patients with advanced metastatic MM who have been treated with a combination of immunotherapeutic agents reaches 52% at five years. The role of surgery for patients with the metastatic involvement of the GI tract with MM is evolving in the era of effective systemic treatments.

Diagnostic agreement between video capsule endoscopy and single and double balloon enteroscopy for small bowel bleeding at a tertiary care hospital in Bogota, Colombia

IntroductionVideo capsule endoscopy and balloon-assisted enteroscopy are complementary diagnostic methods in the study of small bowel bleeding, and different factors can affect their diagnostic yield. AimsTo define the level of agreement between video capsule endoscopy and enteroscopy in small bowel bleeding, according to the type of lesion, in a cohort of patients at a tertiary care referral center. Materials and methodsA retrospective study was conducted that included 428 capsule endoscopies performed within the time frame of 2011 and 2019 at our healthcare institution. Seventy-four video capsule endoscopies, followed by enteroscopy, in 71 patients suspected of presenting with small bowel bleeding, were analyzed. ResultsMean patient age was 63.9 ± 13.5 years and 42 patients were women. The two diagnostic procedures were performed. Overall diagnostic yield of positive findings between video capsule endoscopy and enteroscopy was 86.5% vs. 58.1%, respectively (p = 0.0527). Agreement between video capsule endoscopy and enteroscopy for positive pathologic findings was weak (Ik = 0.17, 95% CI: -0.0097-0.3543), but according to lesion type, it was good for inflammatory lesions (Ik = 0.71, 95% CI: 0.5182-0.9119) and moderate for angiectasias (Ik = 0.45, 95% CI: 0.2469-0.6538) and tumors (Ik = 0.40, 95% CI: 0.1217-0.6794). The results between the two methods differed in 38 patients (51.3%). There was complete intestinal capsule retention in one patient (1.4%) and active bleeding in 13 (17.6%). ConclusionsThe present study showed that the two techniques had a similar overall detection rate for small bowel lesions, but the type of lesion was the main factor that could modify diagnostic agreement.

Clinicopathological Features of Small Bowel Tumors Diagnosed by Video Capsule Endoscopy and Balloon-Assisted Enteroscopy: A Single Center Experience.

Background/AimsSmall bowel malignancies often present a diagnostic challenge due to their relative rarity and nonspecific clinical symptoms. However, technical developments in endoscopic instruments, including video capsule endoscopy (VCE) and enteroscopy, have allowed for the visualization of the entire small bowel. This study aimed to investigate the clinicopathological features of small bowel malignant tumors diagnosed by VCE and double-balloon enteroscopy (DBE) in a single tertiary center. MethodsWe retrospectively analyzed VCE and DBE findings from Korea University Guro Hospital from January 2010 through September 2018. ResultsA total of 510 VCE and 126 DBE examinations were performed in 438 patients. Small bowel malignancies were diagnosed in 28 patients (15 males; mean age, 61.0 years; range, 42 to 81 years). Among them, 8 had lymphoma, 8 had primary adenocarcinoma, 7 had gastrointestinal stromal tumor (GIST) and 5 had metastatic cancer. Abdominal pain and obstructive symptoms were the most common findings in metastatic cancers (4/5, 80%). On the other hand, obscure gastrointestinal bleeding was the most common symptom of GIST (6/7, 85.7%) and adenocarcinoma (3/8, 37.5%). ConclusionsApproximately 6% of the patients who underwent either VCE or DBE were diagnosed with small bowel malignancy. These findings demonstrated the different clinical characteristics among small bowel malignancies and merit further study.

Features of the diagnostics and treatment of a rare source of small bowel bleeding — venous malformations of the small bowel with Blue rubber bleb nevus syndrome (Bean’s syndrome)

The aim of the study is to demonstrate the possibilities of enteroscopy in diagnostics of rare source of small bowel bleeding in patient with blue rubber blue nevus syndrome.A 31-years old patient with severe anemia from the early age applied to our Hospital to diagnose the source of gastrointestinal bleeding. Previously performed EGD and colonoscopy didn’t reveal any sources of bleeding. Scintigraphy detected the signs of ongoing intestinal bleeding. Endoscopic methods (videocapsule and balloon-assisted enteroscopy) revealed multiple venous malformations of small bowel, as the source of gastrointestinal bleeding of «unknown source». The patient was performed surgery — resection of segments of small bowel with malformations. The diagnosis was verified morphologically. Postoperative period was without complications. For the first time in several years the patient had a fully restored level of hemoglobin.

Diagnostic agreement between video capsule endoscopy and single and double balloon enteroscopy for small bowel bleeding at a tertiary care hospital in Bogota, Colombia.

Video capsule endoscopy and balloon-assisted enteroscopy are complementary diagnostic methods in the study of small bowel bleeding, and different factors can affect their diagnostic yield. To define the level of agreement between video capsule endoscopy and enteroscopy in small bowel bleeding, according to the type of lesion, in a cohort of patients at a tertiary care referral center. A retrospective study was conducted that included 428 capsule endoscopies performed within the time frame of 2011 and 2019 at our healthcare institution. Seventy-four video capsule endoscopies, followed by enteroscopy, in 71 patients suspected of presenting with small bowel bleeding, were analyzed. Mean patient age was 63.9 ± 13.5 years and 42 patients were women. The two diagnostic procedures were performed. Overall diagnostic yield of positive findings between video capsule endoscopy and enteroscopy was 86.5% vs. 58.1%, respectively (p = 0.0527). Agreement between video capsule endoscopy and enteroscopy for positive pathologic findings was weak (Ik = 0.17, 95% CI: -0.0097-0.3543), but according to lesion type, it was good for inflammatory lesions (Ik = 0.71, 95% CI: 0.5182-0.9119) and moderate for angiectasias (Ik = 0.45, 95% CI: 0.2469-0.6538) and tumors (Ik = 0.40, 95% CI: 0.1217-0.6794). The results between the two methods differed in 38 patients (51.3%). There was complete intestinal capsule retention in one patient (1.4%) and active bleeding in 13 (17.6%). The present study showed that the two techniques had a similar overall detection rate for small bowel lesions, but the type of lesion was the main factor that could modify diagnostic agreement.

Small bowel mucosa‐associated lymphoid tissue lymphoma: A case report and literature review

Small intestine marginal B cell lymphoma of the mucosa‐associated type (MALT lymphoma) is relatively rare compared to gastric mucosa‐associated lymphoma tissue (MALT) lymphoma, and comprised only about less than 10% of primary small intestinal tumor cases. However, with advances in video capsule enteroscopy and balloon‐assisted enteroscopy, more cases of small bowel MALT lymphoma are expected to be discovered via endoscopy. The pathogenesis, endoscopic features, and treatment strategy, including Helicobacter pylori eradication therapy, remain an issue and require further clinical trial or studies to be resolved. Here, we report the case of a 67‐year‐old man with jejunal MALT lymphoma presenting with nearly total obstruction of his bowel lumen. He underwent segmental small bowel resection for the stricture without recurrence.

Negative video capsule enteroscopy – what's the next step?

Negative video capsule enteroscopy – what's the next step?

Negative video capsule enteroscopy – what's the next step?

Video capsule endoscopy (VCE) is a reliable noninvasive method for examination of small-bowel mucosa. However, it has some limitations. The aim of this article was to review the approach in patients with negative VCE. It is clear that a negative VCE should be interpreted based on the indication. In suspected small bowel bleeding (SSBB), patients with ongoing/recurrent overt bleeding, or occult bleeders who experience significant declines in hemoglobin after a negative VCE should proceed small bowel study; on the other hand, patients with occult SSBB and only mild-moderate anemia should be managed with supportive care. In inflammatory bowel disease, a normal VCE has a very high sensitivity and negative predictive value. In small bowel tumor suspicion there is a high risk of false negative results, so another imaging modality should be considered. In polyposis syndromes, if VCE is negative, patients should continue screening within 2–3 years.

Small bowel imaging in Crohn's disease patients.

Crohn’s disease (CD) is a lifelong, chronic inflammatory bowel disorder. The small bowel (SB) is involved to varying extents, and the clinical course may vary from an inflammatory type to a more complicated one with stricture, fistula, and abscess formation. Esophagogastroduodenoscopy and ileocolonoscopy with biopsies are the conventional endoscopic techniques that usually establish the diagnosis. On the other hand, CD may affect SB segments that cannot be reached through these procedures. Video capsule endoscopy and enteroscopy are additional endoscopic techniques that may allow further SB evaluation in such circumstances. Computed tomographic enterography, magnetic resonance enterography, and ultrasonography are radiologic techniques that serve as a crucial adjunct to endoscopic assessment. They enable the assessment of parts of the bowel that may be difficult to reach with conventional endoscopy; this allows for the detection of active inflammation, penetrating or stricturing disease, and the appreciation of extraintestinal complications. Both endoscopic and radiologic modalities play a role in establishing the diagnosis of CD, as well as determining the disease extent, activity and response to therapy. This review is intended to evaluate these modalities in terms of specificity, sensitivity, potential side-effects, and limiting factors. This should serve as a guide to the clinician for establishing the most appropriate and reliable test within a particular clinical context.

Small Bowel Diverticula: Usefulness of the Computed Tomography in a Non-Specific Clinical Presentation

In the majority of cases small bowel diverticula are asymptomatic. As a result, the diagnosis is frequently incidentally made either by radiographic examination or upon laparotomy due to complications. Enteroclysis, Tc-99m scintigraphy, video capsule and double balloon enteroscopy are useful diagnosing small bowel disorders, but their utility in emergency situations is limited.

Hemorragia digestiva baja y hemorragia digestiva de origen oscuro

IntroductionLower gastrointestinal bleeding is a frequent entity, specially in elderly patients with multiple comorbidities. It is usually mild and self-limited, but massive bleeding with hemorrhagic shock can occur. AetiopathogenesisIts most frequent source is the colon, and the most common causes are diverticula and angiodysplasia. DiagnosisThere are severe diagnostic and therapeutic options for its management: colonoscopy, which has both diagnostic and therapeutic capacity; multidetector row CT scan, a fast technique that does not require bowel preparation, and arteriography, which is usually used with a therapeutic intention. TreatmentSurgery is currently relegated to a salvage treatment when bleeding has not been controlled by other means. Obscure gastrointestinal bleedingIs defined as gastrointestinal bleeding whose origin is not objectivated after a conventional study. Its most frequent cause is small bowel angiodysplasia, and it may appear as overt or occult bleeding. The most commonly used diagnostic test are video capsule endoscopy, enteroscopy, and radiographic studies.

Early Implementation of Video Capsule Enteroscopy in Patients with Left Ventricular Assist Devices and Obscure Gastrointestinal Bleeding.

Gastrointestinal bleeding (GIB) is a frequent challenge encountered in patients implanted with a left ventricular assist device (LVAD), affecting approximately 25% of this population. Many patients have no identifiable source of bleeding after routine esophagogastroduodenoscopy and colonoscopy and are labeled as obscure GIB (OGIB). Significant costs and invasive procedures are required to investigate and stop the source of bleeding in these patients. We performed a retrospective analysis at a single tertiary referral center to investigate the diagnostic yield and overall effectiveness of video capsule enteroscopy (VCE) in this population. Eight patients with LVADs underwent nine VCE studies for OGIB. The diagnostic yield was 100%, with intraluminal blood the most common finding. The jejunum was the most common location for pathology detected on VCE. Sixty-seven percent of the studies directly guided further endoscopy with successful cessation of bleeding in 100% of these patients. Finally, after an average follow-up of 46 weeks, the total number of endoscopic procedures and total units of transfused packed red blood cells (pRBC) were significantly less after the patient underwent the VCE study compared with before. Video capsule enteroscopy is a safe and high-yield investigative procedure in this population and should be implemented earlier to improve patient outcomes and reduce costs of care.

Hemorragia digestiva obscura complicada de choque em Testemunha de Jeová

The severe gastrointestinal bleeding in a Jehovah's Witness poses a clinical challenge in which deontological and legal ethical standards are in conflict with the need of an effective and fast‐acting therapeutic approach. We present a case of a Jehovah's Witness, with a written refusal of transfusions, admitted for obscure overt gastrointestinal bleeding and acute severe anemia. The hospitalization was complicated by severe haemorrhage (minimum haemoglobin 3.5g/dL) and shock, without an identified etiology on upper gastrointestinal endoscopy and colonoscopy. An emergent angiography showed a contrast product leak in the jejunal branches of the superior mesenteric artery and a selective arterial embolization was performed. The clinical evolution was favorable, with progressive increase of the haemoglobin level. Jejunal angioectasias and aftoid erosions were observed in a videocapsule enteroscopy performed later. We discuss the ethical dilemma associated with this difficult clinical situation and present demonstrative iconography.

The management of lower gastrointestinal bleeding

Lower gastrointestinal (LGI) bleeding is generally less severe than upper gastrointestinal (UGI) bleeding with spontaneous cessation of bleeding in 80% of cases and a mortality of 2-4%. However, unlike UGI bleeding, there is no consensual agreement about management. Once the patient has been stabilized, the main objective and greatest difficulty is to identify the location of bleeding in order to provide specific appropriate treatment. While upper endoscopy and colonoscopy remain the essential first-line examinations, the development and availability of angiography have made this an important imaging modality for cases of active bleeding; they allow diagnostic localization of bleeding and guide subsequent therapy, whether therapeutic embolization, interventional colonoscopy or, if other techniques fail or are unavailable, surgery directed at the precise site of bleeding. Furthermore, newly developed endoscopic techniques, particularly video capsule enteroscopy, now allow minimally invasive exploration of the small intestine; if this is positive, it will guide subsequent assisted enteroscopy or surgery. Other small bowel imaging techniques include enteroclysis by CT or magnetic resonance imaging. At the present time, exploratory surgery is no longer a first-line approach. In view of the lesser gravity of LGI bleeding, it is most reasonable to simply stabilize the patient initially for subsequent transfer to a specialized center, if minimally invasive techniques are not available at the local hospital. In all cases, the complexity and diversity of LGI bleeding require a multidisciplinary collaboration involving the gastroenterologist, radiologist, intensivist and surgeon to optimize diagnosis and treatment of the patient.