• Artificial intelligence in gastroenterology
• Capsule endoscopy
• Obscure gastrointestinal bleeding
• Therapeutic capsule endoscopy
• Wireless capsule endoscopy

• Capsule Endoscopy/methods
• Humans
• Gastrointestinal Hemorrhage/etiology
• Gastrointestinal Hemorrhage/diagnostic imaging
• Gastrointestinal Hemorrhage/diagnosis
• Deep Learning
• Gastrointestinal Diseases/diagnosis
• Gastrointestinal Diseases/diagnostic imaging

• Children
• Crohn’s disease
• endoscopy
• inflammatory bowel disease
• pediatrics.
• ulcerative colitis

• Humans
• Child
• Endoscopy, Gastrointestinal/methods
• Endoscopy, Gastrointestinal/trends
• Crohn Disease/diagnosis
• Crohn Disease/therapy
• Inflammatory Bowel Diseases/therapy
• Inflammatory Bowel Diseases/diagnosis
• Colitis, Ulcerative/diagnosis
• Colitis, Ulcerative/therapy
• Capsule Endoscopy/methods

• Gastrointestinal Microbiome/physiology
• Hydrogels/chemistry
• Equipment Design
• Humans
• Magnets/chemistry
• Capsules/chemistry
• Specimen Handling/methods
• Specimen Handling/instrumentation
• Hydrogen-Ion Concentration
• Magnetic Fields

• Capsule endoscopy
• Children
• Crohn's disease
• Inflammatory bowel disease
• Small intestine

• Capsule endoscopy
• Child
• General anesthesia
• Hypoalbuminemia
• Inflammatory bowel disease
• Small bowel transit time

• National Center for Child Health and Development
• Ministry of Health, Labour and Welfare

• CNN
• artificial intelligence (AI) GI organ boundary
• capsule tracking
• computer-aided detection
• gastro-intestinal
• wireless endoscopic capsule

• capsule endoscopy
• children
• double-balloon enteroscopy
• single-balloon enteroscopy

• AdvanCE
• capsule endoscopy
• net
• pediatric endoscopy
• snare

• protein-losing enteropathy
• hypoalbuminemia
• gastrointestinal imaging

• Duodenum/diagnostic imaging
• Humans
• Infant
• Lymphatic System
• Lymphography/methods
• Magnetic Resonance Spectroscopy
• Protein-Losing Enteropathies/diagnostic imaging
• Protein-Losing Enteropathies/etiology
• Retrospective Studies

• T32 GM008562 NIGMS NIH HHS

• Crohn’s disease
• Diagnostic delay
• Pediatric inflammatory bowel disease
• Ulcerative colitis

• Crohn's disease
• capsule endoscopy
• capsule retention
• inflammatory bowel disease
• occult intestinal bleeding
• pan-enteric capsule endoscopy
• small intestine

Artificial neural networks (ANNs) are one of the primary types of artificial intelligence and have been rapidly developed and used in many fields. In recent years, there has been a sharp increase in research concerning ANNs in gastrointestinal (GI) diseases. This state-of-the-art technique exhibits excellent performance in diagnosis, prognostic prediction, and treatment. Competitions between ANNs and GI experts suggest that efficiency and accuracy might be compatible in virtue of technique advancements. However, the shortcomings of ANNs are not negligible and may induce alterations in many aspects of medical practice. In this review, we introduce basic knowledge about ANNs and summarize the current achievements of ANNs in GI diseases from the perspective of gastroenterologists. Existing limitations and future directions are also proposed to optimize ANN’s clinical potential. In consideration of barriers to interdisciplinary knowledge, sophisticated concepts are discussed using plain words and metaphors to make this review more easily understood by medical practitioners and the general public.

• Artificial neural network
• Gastrointestinal disease
• Diagnosis
• Treatment
• Prognosis
• Endoscopy

• Artificial Intelligence
• Gastroenterologists
• Humans
• Neural Networks, Computer
• Prognosis

• Adverse events
• Predictors
• Systematic review and meta-analysis
• Temporal-trend
• Video capsule endoscopy

• Anaemia
• Celiac disease
• Endoscopy
• H. pylori
• Inflammatory bowel disease
• Iron deficiency
• Small bowel

Background: The small bowel has often been considered the mysterious “black hole” of the gastrointestinal tract. With regards to this, the development of the wireless capsule endoscopy (WCE) has represented a turning point. It is a non-invasive technique, enabling an excellent visualization of the small bowel (SB) mucosa without the use of radiation. The WCE was approved by the Food and Drug Administration (FDA) in 2001 for adults and in 2004 for children. The aim of the present review is to provide an update on indications, diagnostic yield, safety and limitations of WCE in children. Even though literature regarding the use of WCE in pediatric age is more limited than in adults,WCE is a useful and safe diagnostic tool for the exploration of the small bowel also in children. The indications for WCE are similar at any age, however the main indication in children is Crohn’s disease (CD), while in the adults is the research of SB bleeding. The main limitation in pediatric age is the possibility for younger children to swallow the capsule. WCE in pediatric is a rapidly advancing technology and has the potential to further transform the evaluation and management of SB disease. (www.actabiomedica.it)

Small bowel capsule endoscopy can detect subtle mucosal lesions in pediatric patients with Crohn’s disease, and our aim was to evaluate its application in established ileocolonic Crohn’s disease. Colonic inflammation was evaluated with the colonic Simple Endoscopic Score for Crohn’s Disease (SES-CD) (excluding the score of the terminal ileum). Small bowel inflammation was evaluated with the Lewis score and/or Capsule Endoscopy Crohn’s Disease Activity Index (CECDAI). A Lewis score <135 was defined as small bowel inactive. A colonic SES-CD of 0 (colonic inactive group) was observed in 22/42 procedures (52.4%), and active small bowel lesions were observed in 11/22 procedures (50.0%). The Lewis score was lower in the colonic inactive group compared to the colonic active group. Correlations between the colonic SES-CD, the Lewis score and CECDAI were weak. The Lewis score and CECDAI in the colonic inactive group had significant correlation with fecal calprotectin levels. We suggest that Crohn’s disease patients without both colonic active lesions and elevation of fecal calprotectin levels may not need to receive small bowel capsule endoscopy due to low incidence of lesions in small bowel.

• Lewis score
• capsule endoscopy
• fecal calprotectin
• pediatric Crohn’s disease

Meckel’s diverticulum (MD) occurs predominantly in children and adolescents. It is rarely diagnosed in adults. Preoperative diagnosis is difficult due to low sensitivity of the radiological imaging studies. The role of video capsule endoscopy (VCE) in the diagnosis of MD is unknown, and the endoscopic patterns are not defined. We will describe four of our cases of MD evaluated with VCE and make a review of the literature focusing on the endoscopic characteristics.

We present four cases of MD confirmed by surgery. They were all adult males with ages going from 18 to 50 years, referred to our service from 2004 to 2018, due to obscure gastrointestinal bleeding (OGIB). They had a history of 1 mo to 10 years of overt and occult bleeding episodes. Laboratory blood test showed an iron-deficiency anemia from 4 to 9 g/dL of hemoglobin that required multiple hospitalizations and blood transfusions in all cases. Repeated upper digestive endoscopies and colonoscopies were negative. Small bowel was examined with VCE, which revealed double lumen images in all cases, one with polyps and three with circumferential ulcers in the diverticulum. However, based on VCE findings, preoperative diagnosis of MD was suggested only in two patients. Capsule was retained in one patient, which was recovered with surgery. The anatomopathological report revealed ulcerated ectopic gastric mucosa in all cases.

VCE is useful for the diagnosis of MD. However, endoscopic characteristics must be recognized in order to establish preoperative diagnosis.

• Meckel’s diverticulum
• Endoscopic features
• Video capsule endoscopy
• Wireless capsule endoscopy
• Review
• Case report

This study aimed at investigating the clinical value of magnetic-guided capsule endoscopy (MGCE) in the diagnosis of gastrointestinal diseases in minors.

Eighty-four minor patients hospitalized in the pediatric department at Ruijin Hospital between June 2015 and January 2018 were enrolled for this study. Following bowel preparation, all patients underwent MGCE. The feasibility, safety, diagnostic yield, and sensitivity of MGCE were analyzed. Patients were followed up for more than 2 weeks.

The main indications for MGCE in minors were Crohn's disease, gastrointestinal bleeding, and abdominal pain. The main causes of gastric disease were gastric inflammatory hyperplasia, exudative gastritis, and polyps. The most common small bowel diseases in minors were Crohn's disease, Henoch-Schonlein purpura, and polyps. The diagnostic yield in the stomach and small intestine was 13.1% and 28.6%, respectively, and the sensitivity was 100% and 96.0%, respectively. No adverse events occurred.

MGCE is a safe, effective, and well-tolerated procedure with good sensitivity and has a potential clinic value for the diagnosis of gastrointestinal diseases in minors.

• capsule endoscopy
• child
• gastroscopy

• Capsule endoscopy
• Children
• Ingestion
• Patency capsule

• GI bleeding
• capsule endoscopy
• jejunal varices
• portal hypertension

• Adolescent
• Caustics
• Child
• Child, Preschool
• Cholangiopancreatography, Endoscopic Retrograde
• Colonoscopy
• Endoscopy, Digestive System
• Endoscopy, Gastrointestinal/standards
• Endosonography
• Europe
• Female
• Foreign Bodies
• Gastroenterology
• Gastrointestinal Diseases/diagnosis
• Gastrointestinal Diseases/therapy
• Gastrointestinal Hemorrhage
• Humans
• Infant
• Infant, Newborn
• Male
• Pediatrics
• Societies

Video capsule endoscopy (VCE) has been applied in the last 15 years in an increasing field of applications. Although many contraindications have been put into perspective, some precautions still have to be considered. Known stenosis of the gastrointestinal tract is a clear contraindication for VCE unless surgery is already scheduled or at least has been considered as an optional treatment modality. In patients with a higher incidence of stenosis, as in an established diagnosis of Crohn’s disease, clinical signs of obstruction, prior radiation or surgical small bowel resection, a preceding test with the self-dissolving patency capsule can override this contraindication. Endoscopic placement of the capsule should be considered in patients with swallowing disorders to avoid aspiration. Esophageal or gastric motility disorders may require endoscopic capsule transport or application of prokinetics if the real-time viewer proofs delayed transit. In pregnant women, VCE should be restricted to urgent cases where diagnosis cannot be postponed after delivery, as data on safety are missing. There is theoretical and clinical evidence that patients with implanted cardiac devices such as a pacemaker, cardioverters or left heart assist devices, can safely undergo VCE in spite of still existing contraindication by manufacturers. Children from the age of 2 years have safely undergone VCE. Although video capsules are not proven safe with magnetic resonance imaging (MRI), first single cases of patients incidentally undergoing MRI with an incorporated capsule have been reported, showing susceptibility artifacts but no signs of clinical harm.

• Video capsule endoscopy
• Contraindications
• Stenosis
• Pacemaker
• Aspiration
• Pregnancy
• Magnetic resonance imaging

• Age Factors
• Capsule Endoscopy
• Constriction, Pathologic
• Contraindications
• Defibrillators, Implantable
• Deglutition Disorders
• Esophageal Motility Disorders
• Female
• Gastrointestinal Diseases/diagnosis
• Heart-Assist Devices
• Humans
• Pacemaker, Artificial
• Pregnancy

Capsule endoscopy (CE) currently plays an important role in Crohn’s disease (CD). It is a noninvasive technique that has led to a breakthrough in the endoscopic diagnosis of diseases of the small intestine. Its superior diagnostic performance and excellent safety profile lead to its considerable acceptance on the part of the patient. This paper reviews current indications of CE in three stages of clinical practice: Suspected CD, unclassified colitis and its extensive role in diagnosed CD. The diagnostic and therapeutic impact of the results of CE on the monitoring of this disease is also reviewed. Knowledge of its applications, the interpretation of its results in an appropriate context and the existence of a validated endoscopic activity index could change the way in which these patients are managed. The definition of mucosal healing and postoperative recurrence by means of endoscopic scoring systems will endow CE with new applications in the management of CD in the near future.

• Capsule endoscopy
• Inflammatory bowel disease
• Crohn’s disease

• Colonoscopy
• Gastrointestinal bleeding
• Hematochezia
• Hemostasis
• Pediatric
• Resuscitation

• Capsule endoscopy
• Children
• Enteroscopy
• Obscure gastrointestinal bleeding

Ascaris lumbricoides infection is rare among children in developed countries. Although large numbers of adult Ascaris in the small intestine can cause various abdominal symptoms, this infection remains asymptomatic until the number of worms in the intestine considerably increases in most cases. Ascaris causing bilious vomiting suggesting ileus is rare, especially in developed countries. A 6-year-old boy who lived in Japan, presented with abdominal colic, bilious vomiting at the pediatric emergency room. He appeared pale, and had no abdominal distention, tenderness, palpable abdominal mass, or findings of dehydration. He experienced bilious vomiting again during a physical examination. Laboratory tests showed mild elevation of white blood cells and C-reactive protein levels. Antigens of adenovirus, rotavirus, and norovirus were not detected from his stool, and stool culture showed normal flora. Ultrasonography showed multiple, round-shaped structures within the small intestine, and a tubular structure in a longitudinal scan of the small intestine. Capsule endoscopy showed a moving worm of Ascaris in the jejunum. Intestinal ascariasis should be considered as a cause of bilious vomiting in children, even at the emergency room in industrial countries. Ultrasound examination and capsule endoscopy are useful for diagnosis of pediatric intestinal ascariasis.

• Ascaris lumbricoides
• Paralytic ileus
• Capsule endoscopy
• Ultrasound
• Bilious vomiting

• Animals
• Antinematodal Agents/therapeutic use
• Ascariasis/complications
• Ascariasis/diagnosis
• Ascariasis/drug therapy
• Ascariasis/parasitology
• Ascaris lumbricoides/drug effects
• Ascaris lumbricoides/isolation & purification
• Capsule Endoscopy
• Child
• Emergency Service, Hospital
• Humans
• Intestinal Diseases, Parasitic/complications
• Intestinal Diseases, Parasitic/diagnosis
• Intestinal Diseases, Parasitic/drug therapy
• Intestinal Diseases, Parasitic/parasitology
• Intestinal Pseudo-Obstruction/parasitology
• Japan
• Jejunum/diagnostic imaging
• Jejunum/drug effects
• Jejunum/parasitology
• Male
• Predictive Value of Tests
• Pyrantel Pamoate/therapeutic use
• Treatment Outcome
• Ultrasonography
• Vomiting/parasitology

• Adolescent
• Capsule Endoscopy
• Child
• Colitis, Ulcerative/diagnosis
• Colitis, Ulcerative/pathology
• Consensus
• Crohn Disease/diagnosis
• Crohn Disease/pathology
• Diagnosis, Differential
• Endoscopy, Digestive System
• Gastrointestinal Tract/pathology
• Humans
• Inflammatory Bowel Diseases/diagnosis
• Inflammatory Bowel Diseases/pathology
• Magnetic Resonance Spectroscopy
• Phenotype

• G0800675 Medical Research Council
• MRF_C0482 MRF

CD is a chronic inflammatory disorder associated to mucosal and transmural inflammation of the bowel wall. It is well known that CD can affect the entire gastrointestinal. Therefore, ileocolonoscopy and biopsies of the terminal ileum as well as of each colonic segment to look for microscopic evidence of CD are the first-line procedures to establish the diagnosis. However, it has been observed that up to 30% of the patients have only small bowel involvement. Evaluation of the small bowel has been made with radiological procedures, barium radiography, and abdominal computed tomography or by ileocolonoscopy or enteroscopy, but they have many recognized limitations. CE is undoubtedly a very useful diagnostic tool proposed to observe small-bowel lesions undetectable by conventional endoscopy or radiologic studies. We review different studies that have been published reporting the use of CE in suspected and evaluation of the extension or the recurrence in CD and also its use in pediatric population and its complications.

Celiac disease can present in children and adults with a variety of manifestations including a rare complication known as ulcerative jejunitis. The latter has been associated with refractory celiac disease in adult onset patients. The objective of this case report is to describe the first pediatric case of ulcerative jejunitis in celiac disease, diagnosed by capsule endoscopy, which was not associated with refractory celiac disease.

The 9 year old girl presented with a history of abdominal pain and vomiting. Laboratory investigations revealed a slightly elevated IgA tissue transglutaminase antibody level in the setting of serum IgA deficiency. Initial upper endoscopy with biopsies was not conclusive for celiac disease. Further investigations included positive IgA anti-endomysium antibody, and positive HLA DQ2 typing. Video capsule endoscopy showed delayed appearance of villi until the proximal to mid jejunum and jejunal mucosal ulcerations. Push enteroscopy with biopsies subsequently confirmed the diagnosis of celiac disease and ulcerative jejunitis. Immunohistochemical studies of the intraepithelial lymphocytes and PCR amplification revealed surface expression of CD3 and CD8 and oligoclonal T cell populations. A repeat capsule study and upper endoscopy, 1 year and 4 years following a strict gluten free diet showed endoscopic and histological normalization of the small bowel.

Ulcerative jejunitis in association with celiac disease has never previously been described in children. Capsule endoscopy was essential to both the diagnosis of celiac disease and its associated ulcerative jejunitis. The repeat capsule endoscopy findings, one year following institution of a gluten free diet, also suggest that ulcerative jejunitis is not always associated with refractory celiac disease and does not necessarily dictate a poor outcome.