Gastrointestinal diseases are complex diseases that occur in the gastrointestinal tract. Common gastrointestinal diseases include chronic gastritis, peptic ulcers, inflammatory bowel disease, and gastrointestinal tumors. These diseases may manifest a long course, difficult treatment, and repeated attacks.

Gastroscopy and mucosal biopsy are the gold standard methods for diagnosing gastric and duodenal diseases, but they are invasive procedures and carry risks due to the necessity of sedation and anesthesia. Recently, several new approaches have been developed, including serological examination and magnetically controlled capsule endoscopy (MGCE). However, serological markers lack lesion information, while MGCE images lack molecular information.

This study proposes combining these two technologies in a collaborative noninvasive diagnostic scheme as an alternative to the standard procedures. We introduce an interpretable framework for the clinical diagnosis of gastrointestinal diseases. Based on collected blood samples and MGCE records of patients with gastrointestinal diseases and comparisons with normal individuals, we selected serum metabolite signatures by bioinformatic analysis, captured image embedding signatures by convolutional neural networks, and inferred the location-specific associations between these signatures.

Our study successfully identified five key metabolite signatures with functional relevance to gastrointestinal disease. The combined signatures achieved discrimination AUC of 0.88. Meanwhile, the image embedding signatures showed different levels of validation and testing accuracy ranging from 0.7 to 0.9 according to different locations in the gastrointestinal tract as explained by their specific associations with metabolite signatures. Overall, our work provides a new collaborative noninvasive identification pipeline and candidate metabolite biomarkers for image auxiliary diagnosis. This method should be valuable for the noninvasive detection and interpretation of gastrointestinal and other complex diseases.

• Convolutional neural networks
• Gastrointestinal diseases
• Machine learning
• Magnetically controlled capsule endoscopy
• Noninvasive detection
• Serum metabolite

• Capsule endoscopy
• Crohn’s disease
• Lewis score
• TOP 100
• software

• Anaemia
• Melenas
• Small bowel capsule endoscopy
• Software

• Performance measures
• quality indicators
• small bowel capsule endoscopy (SBCE)

• Capsule endoscopy
• Enteroscopy
• Small bowel

• blue mode
• capsule endoscopy
• quickview

AIM: To assess the rate of recurrent bleeding of the small bowel in patients with obscure bleeding already undergone capsule endoscopy (CE) with negative results.

METHODS: We reviewed the medical records related to 696 consecutive CE performed from December 2002 to January 2011, focusing our attention on patients with recurrence of obscure bleeding and negative CE. Evaluating the patient follow-up, we analyzed the recurrence rate of obscure bleeding in patient with a negative CE. Actuarial rates of rebleeding during follow-up were calculated, and factors associated with rebleeding were assessed through an univariate and multivariate analysis. A P value of less than 0.05 was regarded as statistically significant. The sensitivity, specificity, and positive and negative predictive values (PPV and NPV) of negative CE were calculated.

RESULTS: Two hundred and seven out of 696 (29.7%) CE studies resulted negative in patient with obscure/overt gastrointestinal bleeding. Overall, 489 CE (70.2%) were positive studies. The median follow-up was 24 mo (range 12-36 mo). During follow-up, recurrence of obscure bleeding was observed only in 34 out of 207 negative CE patients (16.4%); 26 out of 34 with obscure overt bleeding and 8 out of 34 with obscure occult bleeding. The younger age (< 65 years) and the onset of bleeding such as melena are independent risk factors of rebleeding after a negative CE (OR = 2.6703, 95%CI: 1.1651-6.1202, P = 0.0203; OR 4.7718, 95%CI: 1.9739-11.5350, P = 0.0005). The rebleeding rate (CE+ vs CE-) was 16.4% vs 45.1% (χ² test, P = 0.00001). The sensitivity, specificity, and PPV and NPV were 93.8%, 100%, 100%, 80.1%, respectively.

CONCLUSION: Patients with obscure gastrointestinal bleeding and negative CE had a significantly lower rebleeding rate, and further invasive investigations can be deferred.

• Capsule endoscopy
• Enteroscopy
• Anemia
• Obscure gastrointestinal bleeding
• Rebleeding

• Aged
• Capsule Endoscopy
• Female
• Gastrointestinal Hemorrhage/diagnosis
• Gastrointestinal Hemorrhage/etiology
• Gastrointestinal Hemorrhage/pathology
• Humans
• Intestine, Small/pathology
• Male
• Middle Aged
• Multivariate Analysis
• Odds Ratio
• Predictive Value of Tests
• Recurrence
• Reproducibility of Results
• Risk Factors
• Time Factors

• Biomedical Engineering/instrumentation
• Drug Delivery Systems/instrumentation
• Electric Power Supplies
• Equipment Design
• Humans
• Hydrodynamics
• Magnetic Phenomena
• Motion
• Prostheses and Implants
• Telemetry/instrumentation
• Wireless Technology

AIM: To analyze the characteristics of the small intestine of patients with gastrointestinal disorders by capsule endoscopy.

METHODS: Fifty-three patients who underwent MiroCam capsule endoscopy from August 2010 to August 2011 were included in the study. According to clinical data, the patients were classified as having obscure gastrointestinal bleeding, suspected functional gastrointestinal disease, abdominal pain, diarrhea, and abdominal distension. The characteristics of the normal or abnormal small bowel were analyzed.

RESULTS: Of 53 patients, one failed capsule endoscopy due to the absence of signal, and one could not successfully complete the examination procedure for personal reason. The capsule endoscope reached the colon in the remaining 51 cases (96.22%). The average time for the passage of the capsule endoscope to the stomach and small intestine is 69.78 and 513.25 min, respectively. Capsule endoscopy revealed abnormal changes in 48 cases, and the positive rate is 90.57%. For all 51 patients with suspected small bowel disease, the overall positive diagnosis rate of intestinal lesions was 92.15% (47/51), and that of jejunal and ileal lesions was 52.94%, including 12 cases of non-specific inflammation (1 patient diagnosed with Crohn's disease), 3 cases of polyps, 3 cases of unknown mass, 1 case of hyperplasia of lymphoid follicles, 7 cases of intestinal lymphangiectasia, and 1 case of hookworm disease. In addition, 1 case of of reflux esophagitis, 26 cases of chronic gastritis, 7 cases of erosive gastritis, 3 cases of stomach polyps, 5 cases of colon polyps, 3 cases of colitis, and 2 cases of colon melanosis were found. Capsules were removed from the body naturally, and no complications such as obstruction occurred.

CONCLUSION: MiroCam capsule endoscopy is a safe and non-invasive means of revealing small intestinal lesions.

• Capsule endoscopy
• Small bowel disease
• Obscure gastrointestinal bleeding

Wireless capsule endoscopy has been introduced as an innovative, non-invasive diagnostic technique for evaluation of the gastrointestinal tract, reaching places where conventional endoscopy is unable to. However, the output of this technique is an 8 hours video, whose analysis by the expert physician is very time consuming. Thus, a computer assisted diagnosis tool to help the physicians to evaluate CE exams faster and more accurately is an important technical challenge and an excellent economical opportunity.

The set of features proposed in this paper to code textural information is based on statistical modeling of second order textural measures extracted from co-occurrence matrices. To cope with both joint and marginal non-Gaussianity of second order textural measures, higher order moments are used. These statistical moments are taken from the two-dimensional color-scale feature space, where two different scales are considered. Second and higher order moments of textural measures are computed from the co-occurrence matrices computed from images synthesized by the inverse wavelet transform of the wavelet transform containing only the selected scales for the three color channels. The dimensionality of the data is reduced by using Principal Component Analysis.

The proposed textural features are then used as the input of a classifier based on artificial neural networks. Classification performances of 93.1% specificity and 93.9% sensitivity are achieved on real data. These promising results open the path towards a deeper study regarding the applicability of this algorithm in computer aided diagnosis systems to assist physicians in their clinical practice.

AIM: To investigate the potential benefit of Fujinon intelligent chromo endoscopy (FICE)-assisted small bowel capsule endoscopy (SBCE) for detection and characterization of small bowel lesions in patients with obscure gastroenterology bleeding (OGIB).

METHODS: The SBCE examinations (Pillcam SB2, Given Imaging Ltd) were retrospectively analyzed by two GI fellows (observers) with and without FICE enhancement. Randomization was such that a fellow did not assess the same examination with and without FICE enhancement. The senior consultant described findings as P0, P1 and P2 lesions (non-pathological, intermediate bleed potential, high bleed potential), which were considered as reference findings. Main outcome measurements: Inter-observer correlation was calculated using kappa statistics. Sensitivity and specificity for P2 lesions was calculated for FICE and white light SBCE.

RESULTS: In 60 patients, the intra-class kappa correlations between the observers and reference findings were 0.88 and 0.92 (P2), 0.61 and 0.79 (P1), for SBCE using FICE and white light, respectively. Overall 157 lesions were diagnosed using FICE as compared to 114 with white light SBCE (P = 0.15). For P2 lesions, the sensitivity was 94% vs 97% and specificity was 95% vs 96% for FICE and white light, respectively. Five (P2 lesions) out of 55 arterio-venous malformations could be better characterized by FICE as compared to white light SBCE. Significantly more P0 lesions were diagnosed when FICE was used as compared to white light (39 vs 8, P < 0.001).

CONCLUSION: FICE was not better than white light for diagnosing and characterizing significant lesions on SBCE for OGIB. FICE detected significantly more non-pathological lesions. Nevertheless, some vascular lesions could be more accurately characterized with FICE as compared to white light SBCE.

• Endoscopy
• Video-capsule
• Small bowel
• Obscure gastrointestinal bleeding
• Arterio-venous malformation
• Fujinon intelligent chromo endoscopy

Familial adenomatous polyposis (FAP) is a hereditary disorder characterized by polyposis along the gastrointestinal tract. Information on adenoma status below the duodenum has previously been restricted due to its inaccessibility in vivo. Capsule Endoscopy (CE) may provide a useful adjunct in screening for polyposis in the small bowel in FAP patients. This study aims to evaluate the effectiveness of CE in the assessment of patients with FAP, compared to other imaging modalities for the detection of small bowel polyps.

20 consecutive patients with previously diagnosed FAP and duodenal polyps, presenting for routine surveillance of polyps at The Royal Melbourne Hospital were recruited. Each fasted patient initially underwent a magnetic resonance image (MRI) of the abdomen, and a barium small bowel follow-through study. Capsule Endoscopy was performed four weeks later on the fasted patient. An upper gastrointestinal side-viewing endoscopy was done one (1) to two (2) weeks after this. Endoscopists and investigators were blinded to results of other investigations and patient history.

Within the stomach, upper gastrointestinal endoscopy found more polyps than other forms of imaging. SBFT and MRI generally performed poorly, identifying fewer polyps than both upper gastrointestinal and capsule endoscopy. CE was the only form of imaging that identified polyps in all segments of the small bowel as well as the only form of imaging able to provide multiple findings outside the stomach/duodenum.

CE provides important information on possible polyp development distal to the duodenum, which may lead to surgical intervention. The place of CE as an adjunct in surveillance of FAP for a specific subset needs consideration and confirmation in replication studies.

Australian New Zealand Clinical Trials Registry ACTRN12608000616370

• Capsule Endoscopy/methods
• Humans
• Image Processing, Computer-Assisted
• Prospective Studies
• Time Factors

Capsule endoscopy has been widely used since it was approved by the Food & Drug Administration in the USA in 2001. It plays an important role in the investigation of obscure gastrointestinal bleeding, Crohn's disease and complications of coeliac disease, and surveillance of polyposis syndromes in adults. Despite a lag in its use in paediatrics, capsule endoscopy offers an accurate and effective means of investigating the small bowel in children. It has opened up new horizons and provided a noninvasive approach to identify occult lesions in the small bowel. This article reviews the recent advance in clinical applications of capsule endoscopy.

• Capsule endoscopy
• Intestinal diseases
• Clinical application
• Research progress

Despite significant advances over the last decade, mucosal lesions of the small bowel are poorly detected by imaging studies such as CT scan, MRI-enteroclysis and contrast-enhanced abdominal ultrasound. Capsule endoscopy (CE) has dramatically changed the diagnostic approach to intestinal diseases. Moreover, the use of CE can be extended to include other conditions. However, it is difficult to assess the positive influence of CE on patient outcomes in conditions involving a small number of patients, or in critically ill and difficult to examine patients. CE has the advantage of diagnosing intestinal lesions and of directing the use of double balloon enteroscopy (DBE) in order to obtain biopsy specimens. Moreover, CE allows repeated assessment in chronic conditions, especially to detect relapse of an infectious disease.

• Capsule endoscopy
• Non-steroidal anti-inflammatory drugs-enteropathy
• Intestinal diseases

AIM: To assess the practical usefulness and diagnostic yield of capsule endoscopy among healthy individuals.

METHODS: We retrospectively collected and analyzed the clinical data of 114 healthy individuals receiving capsule endoscopy examinations in our hospital from March 2002 to October 2007.

RESULTS: The ratio of successful examination was 99.12% (113/114). Sixty individuals (53.10%) were found with small intestinal diseases of different properties. Forty-three individuals were diagnosed with one kind of small intestinal lesions, 10 with 2 kinds of intestinal lesions, and 7 with 3 kinds of intestinal lesions. Of the 113 individuals, 17 didn't need medical management, 13 needed following up, other examinations or medical interference if necessary, and 30 needed drug interference and following up.

CONCLUSION: Capsule endoscopy can be an alternative modality for diagnosing and screening intestinal diseases, and it is useful for early diagnosis and treatment of small intestinal lesions in asymptomatic people.

• Capsule endoscopy
• Small intestine
• Health care

• capsule endoscopy
• double balloon enteroscopy
• obscure glycemic index bleeding
• crohn's disease
• nonsteroidal anti-inflammatory drugs

• Capsule Endoscopes/adverse effects
• Capsule Endoscopes/trends
• Endoscopy, Gastrointestinal/methods
• Humans
• Intestinal Diseases/diagnosis
• Intestinal Diseases/pathology
• Intestinal Neoplasms/diagnosis
• Intestinal Neoplasms/pathology
• Intestine, Small/pathology
• Risk Factors

• Capsule Endoscopy
• Crohn Disease/diagnosis
• Decision Making
• Female
• Follow-Up Studies
• Gastrointestinal Hemorrhage/diagnosis
• Humans
• Intestine, Small/pathology
• Male
• Middle Aged
• Practice Patterns, Physicians'
• Predictive Value of Tests
• Retrospective Studies
• Sensitivity and Specificity
• Time Factors
• Treatment Outcome

• Disease Progression
• Duodenal Neoplasms/diagnosis
• Duodenal Neoplasms/epidemiology
• Female
• Follow-Up Studies
• Humans
• Ileal Neoplasms/diagnosis
• Ileal Neoplasms/epidemiology
• Incidence
• Jejunal Neoplasms/diagnosis
• Jejunal Neoplasms/epidemiology
• Male
• Neoplasm Staging
• Neuroendocrine Tumors/diagnosis
• Neuroendocrine Tumors/epidemiology
• Prevalence
• Retrospective Studies
• Sex Distribution
• Survival Rate
• Time Factors
• United States/epidemiology

• R01-CA-115825 NCI NIH HHS

The investigation of small bowel morphology is often mandatory in many patients with Crohn’s disease. Traditional radiological techniques (small bowel enteroclysis and small bowel follow-through) have long been the only suitable methods for this purpose. In recent years, several alternative imaging techniques have been proposed. To review the most recent advances in imaging studies of the small bowel, with particular reference to their possible application in Crohn’s disease, we conducted a complete review of the most important studies in which traditional and newer imaging methods were performed and compared in patients with Crohn’s disease. Several radiological and endoscopic techniques are now available for the study of the small bowel; each of them is characterized by a distinct profile of favourable and unfavourable features. In some cases, they may also be used as complementary rather than alternative techniques. In everyday practice, the choice of the technique to be used stands upon its availability and a careful evaluation of diagnostic accuracy, clinical usefulness, safety and cost. The recent development of innovative imaging techniques has opened a new and exciting area in the exploration of the small bowel in Crohn’s disease patients.

• Crohn’s disease
• Small bowel
• Imaging techniques
• Ultrasonography
• Magnetic resonance
• Computed tomography
• Video-capsule endoscopy
• Double-balloon endoscopy

• Capsule Endoscopy
• Crohn Disease/diagnosis
• Crohn Disease/pathology
• Endoscopy, Gastrointestinal
• Humans
• Intestine, Small/diagnostic imaging
• Intestine, Small/pathology
• Magnetic Resonance Imaging
• Radiography
• Ultrasonography

• Adolescent
• Adult
• Contrast Media/administration & dosage
• Echo-Planar Imaging
• Female
• Humans
• Intestinal Diseases/diagnosis
• Intestine, Small/diagnostic imaging
• Magnetic Resonance Imaging/instrumentation
• Magnetic Resonance Imaging/methods
• Male
• Meglumine/administration & dosage
• Middle Aged
• Organometallic Compounds/administration & dosage
• Radiography

AIM: To evaluate the role of capsule endoscopy in determining the route for double-balloon enteroscopy.

METHODS: Twenty patients with negative or equivocal evaluation after capsule endoscopy received double-balloon enteroscopy (under anesthesia with propofol) by oral or anal route. The choice of the insertion route of the endoscope for the first attempt at double-balloon enteroscopy was made according to a time index (the value of the time in minutes for transit of the capsule endoscope from the pylorus to the lesion divided by the value of the time for transit of the capsule endoscope from the pylorus to the cecum). An anal route was indicated when the time index was more than 0.50. A second procedure was undertaken through the alternative route several days later when the lesion of interest was not found during the first one. The accuracy for choosing the route of double-balloon enteroscopy according to the capsule time index was then analyzed.

RESULTS: Five patients with negative evaluation after capsule endoscopy received double-balloon enteroscopy, and a lesion was detected in 1 of these patients when a second procedure by the anal route was performed. Fifteen patients with equivocal evaluation after capsule endoscopy received double-balloon enteroscopy, and the suspected findings were confirmed in 12 (80.0%) of these patients by double-balloon enteroscopy combined with pathological examination. An anal route of the endoscopy at the first attempt with double-balloon enteroscopy was selected on 4 patients (0.99, 0.8, 0.65, and 0.59, respectively), and the lesions were detected in the latter two (with a time index of 0.65 and 0.59, respectively) when a second procedure by the oral route was performed. If the time index of more than 0.75 (with consideration of another report) was used, no further attempts would be needed in these two patients, and the lesions of the other two patients were assumed to be located in the distal ileum and reached by double-balloon endoscopy via anal route exactly.

CONCLUSION: The outcome of capsule endoscopy can direct the choice of routes for double-balloon enteroscopy. A time index of more than 0.75 appears to indicate an anal route as the first procedure.

• Capsule endoscopy
• Double-balloon enteroscopy
• Anal route
• Oral route