Wireless capsule endoscopy and proximal small bowel lesions in Crohn’s disease

AIM: To investigate the prevalence of proximal small bowel (SB) lesions detected by wireless capsule endoscopy (WCE) in Crohn's disease (CD). METHODS: WCE was performed in 64 patients: 32 with CD of the distal ileum, and 32 controls with iron-deficiency anemia (IDA) or diarrhea. WCE was performed using the Given SB-WCE, followed by small intestine contrast ultrasonography (SICUS). Findings compatible with CD by using WCE included erosions, aphthoid or deep ulcers, and strictures/stenosis. RESULTS: WCE detected proximal SB lesions in 16/32 (50%) patients (14 aphthoid ulcers, 2 deep ulcers, one stricture), which appeared not to be related to clinical parameters [epigastric pain, age, smoking, non-steroidalanti-inflammatory drugs (NSAIDs), IDA]. Among patients with proximal SB lesions, 6 (37%) were smokers, 3 (19%) NSAID users, 3 (19%) had epigastric pain and 4 (25%) had IDA. SICUS detected proximal SB lesions in 3/32 patients (19%) also showing lesions with WCE. No correlations were observed between proximal SB lesions assessed by WCE or by SICUS (χ2 = 1.5, P = 0.2). CONCLUSION: The use of WCE allows the detection of previously unknown upper SB lesions in a high proportion of patients with a previous diagnosis of CD involving the distal ileum.

Role of wireless capsule endoscopy in inflammatory bowel disease

Capsule endoscopy(CE) offers state-of-the-art imaging of the small bowel.In Crohn's disease its clinical role is still uncertain.This report analyses the usefulness of CE in patients with suspected Cronh's disease,in patients with established Crohn's disease(when assessing severity,occult gastrointestinal bleeding and/or as a guide to therapy),in patients with inflammatory bowel disease unclassified(IBDU),and in individuals with ulcerative colitis.The first item in this group is the most important although there is no strong evidence to establish the position of CE in the diagnostic workup.In patients with established Crohn's disease,recently developed activity scores are promising tools for an accurate assessment of severity.As a guide to therapy,CE should be focused on patients with unexplained symptoms when other investigations are inconclusive.In postoperative Crohn's Disease,international consensus recommended considering CE only ifileocolonoscopy is contraindicated or unsuccessful.In the case of IBDU,studies have shown a significant proportion of patients reclassified with Crohn's disease.In this setting,CE could have a role determining small bowel involvement.The role of CE in ulcerative colitis is limited.Some authors advocate CE before colectomy for refractory cases in order to exclude Crohn's disease.In summary,CE offers a new horizon in inflammatory bowel disease,and a better knowledge of mucosal abnormalities that could offer a paradigm shift:changing from symptombased disease activity estimation to direct mucosal healing monitoring.Nevertheless,randomized controlled studies are still needed to provide stronger evidence in this setting.

Detection of small bowel tumor in wireless capsule endoscopy images using an adaptive neuro-fuzzy inference system

Automatic diagnosis tool helps physicians to evaluate capsule endoscopic examinations faster and more accurate.The purpose of this study was to evaluate the validity and reliability of an automatic post-processing method for identifying and classifying wireless capsule endoscopic images, and investigate statistical measures to differentiate normal and abnormal images. The proposed technique consists of two main stages, namely, feature extraction and classification. Primarily, 32 features incorporating four statistical measures(contrast, correlation, homogeneity and energy) calculated from co-occurrence metrics were computed. Then, mutual information was used to select features with maximal dependence on the target class and with minimal redundancy between features. Finally, a trained classifier, adaptive neuro-fuzzy interface system was implemented to classify endoscopic images into tumor, healthy and unhealthy classes. Classification accuracy of 94.2% was obtained using the proposed pipeline. Such techniques are valuable for accurate detection characterization and interpretation of endoscopic images.

Bleeding Detection from Wireless Capsule Endoscopy Images Using Improved Euler Distance in CIELab

Bleeding in the digestive tract is one of the most common gastrointestinal (GI) tract diseases,as well as the complication of some fatal diseases. Wireless capsule endoscopy (WCE),which is widely applied in the clinical field,allows physicians to noninvasively examine the entire GI tract. However,it is very laborious and timeconsuming to detect the huge amount of WCE images,and limits its wider application. It is urgent and necessary to develop the automatic and intelligent computer aided bleeding detection technique. This paper improves the Euler distance with the covariance matrix of image to measure the colour similarity in CIELab colorimetric system,and proposes a novel method of bleeding detection in WCE images. The experiments demonstrate that the bleeding region in WCE images can be correctly recognized and marked out,and the sensitivity of this method is 92%,the specificity is 95%.

QI-BRiCE: Quality Index for Bleeding Regions in Capsule Endoscopy Videos

With the advent in services such as telemedicine and telesurgery,provision of continuous quality monitoring for these services has become a challenge for the network operators.Quality standards for provision of such services are application specic as medical imagery is quite different than general purpose images and videos.This paper presents a novel full reference objective video quality metric that focuses on estimating the quality of wireless capsule endoscopy(WCE)videos containing bleeding regions.Bleeding regions in gastrointestinal tract have been focused in this research,as bleeding is one of the major reasons behind several diseases within the tract.The method jointly estimates the diagnostic as well as perceptual quality of WCE videos,and accurately predicts the quality,which is in high correlation with the subjective differential mean opinion scores(DMOS).The proposed combines motion quality estimates,bleeding regions’quality estimates based on support vector machine(SVM)and perceptual quality estimates using the pristine and impaired WCE videos.Our method Quality Index for Bleeding Regions in Capsule Endoscopy(QI-BRiCE)videos is one of its kind and the results show high correlation in terms of Pearson’s linear correlation coefcient(PLCC)and Spearman’s rank order correlation coefcient(SROCC).An F-test is also provided in the results section to prove the statistical signicance of our proposed method.

Understanding deep learning in capsule endoscopy: Can artificial intelligence enhance clinical practice?

Wireless capsule endoscopy(WCE)enables physicians to examine the gastrointestinal tract by transmitting images wirelessly from a disposable capsule to a data recorder.Although WCE is the least invasive endoscopy technique for diagnosing gastrointestinal disorders,interpreting a WCE study requires significant time effort and training.Analysis of images by artificial intelligence,through advances such as machine or deep learning,has been increasingly applied to medical imaging.There has been substantial interest in using deep learning to detect various gastrointestinal disorders based on WCE images.This article discusses basic knowledge of deep learning,applications of deep learning in WCE,and the implementation of deep learning model in a clinical setting.We anticipate continued research investigating the use of deep learning in interpreting WCE studies to generate predictive algorithms and aid in the diagnosis of gastrointestinal disorders.

Comment on “Artificial intelligence in gastroenterology: A state-ofthe- art review”

Colon capsule endoscopy(CCE)was introduced nearly two decades ago.Initially,it was limited by poor image quality and short battery time,but due to technical improvements,it has become an equal diagnostic alternative to optical colonoscopy(OC).Hastened by the coronavirus disease 2019 pandemic,CCE has been introduced in clinical practice to relieve overburdened endoscopy units and move investigations to out-patient clinics.A wider adoption of CCE would be bolstered by positive patient experience,as it offers a diagnostic investigation that is not inferior to other modalities.The shortcomings of CCE include its inability to differentiate adenomatous polyps from hyperplastic polyps.Solving this issue would improve the stratification of patients for polyp removal.Artificial intelligence(AI)has shown promising results in polyp detection and characterization to minimize incomplete CCEs and avoid needless examinations.Onboard AI appears to be a needed application to enable near-real-time decision-making in order to diminish patient waiting times and avoid superfluous subsequent OCs.With this letter,we discuss the potential and role of AI in CCE as a diagnostic tool for the large bowel.

Double balloon enteroscopy in children:Diagnosis,treatment,and safety

AIM:To assess the feasibility and utility of double balloon enteroscopy(DBE)in the management of small bowel diseases in children. METHODS:Fourteen patients(10 males)with a median age of 12.9 years(range 8.1-16.7)underwent DBE; 5 for Peutz-Jeghers syndrome(PJ syndrome),2 for chronic abdominal pain,4 for obscure gastrointestinal (GI)bleeding,2 with angiomatous malformations(1 blue rubber bleb nevus syndrome)having persistent GI bleeding,and 1 with Cowden's syndrome with multiple polyps and previous intussusception.Eleven procedures were performed under general anesthesia and 3 with deep sedation. RESULTS:The entire small bowel was examined in 6 patients,and a length between 200 cm and 320 cm distal to pylorus in the remaining 8.Seven patients had both antegrade(trans-oral)and retrograde(transanal and via ileostomy)examinations.One patient underwent DBE with planned laparoscopic assistance.The remaining 6 had trans-oral examination only.The median examination time was 118 min(range 95-195). No complications were encountered.Polyps were detected and successfully removed in all 5 patients with PJ syndrome,in a patient with tubulo-villous adenoma of the duodenum,in a patient with significant anemia and occult bleeding,and in a patient with Cowden's syndrome.A diagnosis was made in a patient with multiple angiomata not amenable to endotherapy,and in 1 with a discrete angioma which was treated with argon plasma coagulation.The source of bleeding was identified in a further patient with varices.DBE was normal or revealed minor mucosal friability in the remaining 3 patients.Hence a diagnostic yield of 11/14 with therapeutic success in 9/14 was achieved. CONCLUSION:Double balloon enteroscopy can be a useful diagnostic and therapeutic tool for small bowel disease in children,allowing endo-therapeutic intervention beyond the reach of the conventional endoscope.