What's new in capsule endoscopy?

Articles on capsule endoscopy selected by the iCARE Scientific Committee members.
Selected papers November 2024

Does FIT have a role in the detection of small bowel pathology: a prospective study.
Oka P, Johnson CM, McAlindon M, SidhuR. Ther Adv Gastrointest Endosc. 2024;17:26317745241301553. Published 2024 Nov 26. doi:10.1177/26317745241301553.

Background: The faecal immunochemical test (FIT) is an immunoassay used to detect human blood in the stool. The role of FIT as a screening tool for small bowel pathology remains unclear.
Objectives: This study aimed to investigate the role of FIT in predicting small bowel pathology in patients with iron deficiency anaemia (IDA).

Diverticular bleeding in the third part of the duodenum as a cause of overt obscure gastrointestinal bleeding.
Hamada Y, Nakagawa H. JGH Open. 2024;8(11):e70051. Published 2024 Nov 27. doi:10.1002/jgh3.70051

A 65-year-old man with a history of chronic renal failure and ischemic heart disease who was receiving aspirin therapy was admitted for recurrent melena. Initial evaluation revealed severe anemia. Other than a diverticulum in the third part of the duodenum, the findings of upper and lower gastrointestinal endoscopies and computed tomography were unremarkable.

A Case of Olmesartan-associated Gastritis Observed Over Time.
Fujisawa M, Yoshizaki T, Urakami S, et al. Intern Med. Published online November 28, 2024. doi:10.2169/internalmedicine.4551-24

A 61-year-old woman who had been taking olmesartan for 7 years complained of epigastric pain, diarrhea, loss of appetite, and weight loss. Esophagogastroduodenoscopy revealed roughened mucosa and erosions in the stomach and duodenum.

The Role of Small-Bowel Endoscopy in the Diagnosis and Management of Small-Bowel Neuroendocrine Tumours.
Bosch EM, Laskaratos FM, Sodergren M, Faiz O, Humphries A. J Clin Med. 2024;13(22):6877. Published 2024 Nov 15. doi:10.3390/jcm13226877

Neuroendocrine tumours (NETs) are relatively rare neoplasms but represent one of the most frequent types of primary small-bowel tumours.

Magnetic Actuation for Wireless Capsule Endoscopy in a Large Workspace Using a Mobile-Coil System.
Li X, Zeng D, Xu H, Zhang Q, Liao B. Micromachines (Basel). 2024;15(11):1373. Published 2024 Nov 14. doi:10.3390/mi15111373

Current wireless capsule endoscopy (WCE) is limited in the long examination time and low flexibility since the capsule is passively moved by the natural peristalsis. Efforts have been made to facilitate the active locomotion of WCE using magnetic actuation and localization technologies.

Meckel's diverticulum as a cause of gastrointestinal bleeding.
Gao C, Chuai S, Liang Z, Ye C, Qi X. Rev Esp Enferm Dig. Published online November 26, 2024. doi:10.17235/reed.2024.10936/2024

Meckel's diverticulum, the most common congenital anomaly of the gastrointestinal tract, is often asymptomatic. Lack of complete resorption of the omphalomesenteric duct is an important cause of Meckel's diverticulum. Gastrointestinal (GI) bleeding is a major complication of Meckel's diverticulum.

Management of retained endoscopy capsule: a case series and literature review.
Palm PH, Patrick MM, Cruz CA, Navaneethan U, Caycedo A, Ferrara M. J Surg Case Rep. 2024;2024(11):rjae749. Published 2024 Nov 25. doi:10.1093/jscr/rjae749

Video capsule endoscopy has become the gold standard for the evaluation of small bowel pathology. Capsular retention remains the most significant risk of this intervention.

Assessing the Impact of a Structured Capsule Endoscopy Training Program Using a New Validated Assessment Tool.
LimaCapela T, Gonçalves JC, Ferreira AI, et al. J Gastroenterol Hepatol. Published online November 25, 2024. doi:10.1111/jgh.16823.

Background and aim: We aimed to develop and validate a simple capsule endoscopy (CE) training assessment tool, the Capsule Endoscopy Training Assessment (CETA), and prospectively use it to analyze the learning progression achieved by participants in our CE training program.

Clinical value of capsule endoscopy, CT enterography and enteroscopy in the diagnosis of suspected small bowel bleeding.
Xiong Y, Jin R, Chen S, et al. Surg Endosc. Published online November 22, 2024. doi:10.1007/s00464-024-11405-6

Background: Fewer studies have been conducted on the diagnostic value of capsule endoscopy, CT enterography and enteroscopy in suspected small bowel bleeding. This study aimed at analyzing the diagnostic and clinical value of capsule endoscopy, CT enterography and enteroscopy for suspected small bowel bleeding.

Sudden-onset gastrointestinal bleeding in a young adult: diagnostic and therapeutic challenges of a Dieulafoy's lesion in the jejunum.
Tripathi S, Narayanagowda R, Das SAP, Jain S, Nundy S. Surg Case Rep. 2024;10(1):269. Published 2024 Nov 22. doi:10.1186/s40792-024-02064-9

Background: A Dieulafoy's lesion in the jejunum is at an uncommon site but may be the cause of massive gastrointestinal bleeding. It is characterized by a large, tortuous submucosal artery that erodes the overlying epithelium and presents diagnostic and therapeutic challenges due to its atypical location and presentation.

Blue Rubber Bleb Nevus Syndrome Causing Small Bowel Bleeding.
Romanello D, De Meo E, Molinario F, Rotunno S, Valente C. Dig Dis Sci. Published online November 18, 2024. doi:10.1007/s10620-024-08752-8

A 79-year-old man with fatigue and melena was diagnosed with severe iron-deficiency anemia.

Severe Gastrointestinal Bleeding Due to Painless Intermittent Ileal Intussusception-A Case Report.
Fehring L, Krüger S, Sass S, et al. Clin Case Rep. 2024;12(11):e9571. Published 2024 Nov 15. doi:10.1002/ccr3.9571

The diagnosis and management of small bowel bleeding (SBB) can be a clinical challenge. Advances in video capsule endoscopy, balloon-assisted enteroscopy, and multiphasic computed tomography allow for localization and therapeutic intervention.

Combined [18F]-FDG PET-MR Imaging: A promising tool for diagnostics of small bowel Crohn's disease.
Mattila J, Kallio J, Löyttyniemi E, Nuutila P, Koffert J. Dig Dis. Published online November 13, 2024. doi:10.1159/000542379

Introduction Diagnostics of small bowel Crohn's disease (CD) can be difficult. Combined positron emission tomography-magnetic resonance enterography (PET-MRE) can be used to evaluate intestinal metabolism, but clinical use has been limited due to accessibility, costs, absence of standardized methods and diagnostic thresholds.

Clinical factors influencing patency capsule excretion and confirmation in patients with intestinal patency.
Ikegami S, Yamamura T, Nakamura M, et al. Rev Esp Enferm Dig. Published online November 7, 2024. doi:10.17235/reed.2024.10706/2024

Introduction: The PillCam™ patency capsule is useful in preventing capsule endoscope retention; however, visual confirmation of patency capsule excretion is challenging for many patients.

Establishing an AI model and application for automated capsule endoscopy recognition based on convolutional neural networks (with video).
Chen J, Xia K, Zhang Z, Ding Y, Wang G, Xu X. BMC Gastroenterol. 2024;24(1):394. Published 2024 Nov 6. doi:10.1186/s12876-024-03482-7

Background: Although capsule endoscopy (CE) is a crucial tool for diagnosing small bowel diseases, the need to process a vast number of images imposes a significant workload on physicians, leading to a high risk of missed diagnoses.

Long-term follow-up of children with Crohn's disease and small bowel mucosal lesions detected through video capsule endoscopy.
Jaakkola T, Merras-Salmio L, Nikkonen A, Kolho KL. J Pediatr Gastroenterol Nutr. Published online November 1, 2024. doi:10.1002/jpn3.12397

Objectives: We report disease outcomes of pediatric Crohn's disease (CD) affecting the proximal small bowel (SB) and detected through video capsule endoscopy (VCE).

Pro-motility Preparation Protocol May Reduce the Rates of Failed Patency Capsule Among Patients with Crohn's Disease in Clinical Remission.
Ukashi O, Dotan A, Borkovsky T, et al. Dig Dis Sci. 2024;69(11):4178-4186. doi:10.1007/s10620-024-08670-9

Background: Patency capsule (PC) ingestion is commonly used to minimize capsule retention in high-risk patients with Crohn's disease (CD). However, false-positive rates remain high, precluding the use of video capsule endoscopy (VCE).

Unusual case report of bifocal gastrointestinal stromal tumor in the first jejunal loop uncovered by severe hemorrhage.
Touati MD, Bouzid A, Othmane MRB, Belhadj A, Chebbi F, Saidani A. Int J Surg Case Rep. 2024;124:110334. doi:10.1016/j.ijscr.2024.110334

Introductionand importance:Gastrointestinal stromal tumors (GISTs) are raremesenchymal tumors, constituting 1 % of gastrointestinal tumors. Jejunal GISTsare even rarer.

Selected papers October 2024

Long-term follow-up of children with Crohn's disease and small bowel mucosal lesions detected through video capsule endoscopy.
Jaakkola T, Merras-Salmio L, Nikkonen A, Kolho KL. J Pediatr Gastroenterol Nutr. Published online November 1, 2024. doi:10.1002/jpn3.12397

Objectives: We report disease outcomes of pediatric Crohn's disease (CD) affecting the proximal small bowel (SB) and detected through video capsule endoscopy (VCE).

Exploring the feasibility of home-delivered capsule endoscopy with 5G support: innovations and carbon footprint insights.
Jalayeri Nia G, Conway C, Ward F, et al. BMJ Open Gastroenterol. 2024;11(1):e001500. Published 2024 Oct 31. doi:10.1136/bmjgast-2024-001500

Introduction: Colorectal cancer (CRC) poses a significant global health threat, necessitating early detection. Traditional diagnostic tools like optical colonoscopy have limitations prompting our '5G-SUCCEEDS' initiative to explore a novel approach involving remote colon capsule endoscopy (CCE).

Capsule robots for the monitoring, diagnosis, and treatment of intestinal diseases.
Wei X, Xi P, Chen M, et al. Mater Today Bio. 2024;29:101294. Published 2024 Oct 9. doi:10.1016/j.mtbio.2024.101294

Current evidence suggests that the intestine as the new frontier for human health directly impacts both our physical and mental health.

Clinical assessment of small bowel capsule endoscopy in pediatric patients.
Li L, Zhan X, Li J, et al. Front Med (Lausanne). 2024;11:1455894. Published 2024 Oct 16. doi:10.3389/fmed.2024.1455894.

Introduction: Small bowel capsule endoscopy is a first-line examination method for small bowel diseases, which can find small intestinal lumen and mucosal lesions.

Gastrointestinal Angiodysplasia Resolution After Transcatheter Aortic Valve Implantation.
Goltstein LCMJ, Rooijakkers MJP, Thierens NDE, et al. JAMA Netw Open. 2024;7(10):e2442324. Published 2024 Oct 1. doi:10.1001/jamanetworkopen.2024.42324

Importance: Heyde syndrome is the cooccurrence of aortic stenosis and gastrointestinal bleeding secondary to vascular lesions, including angiodysplasias.

String used for oesophageal capsule endoscopy: help or hindrance?
McAlindon ME. Eur J Gastroenterol Hepatol. 2024;36(12):1470–1471. doi:10.1097/MEG.0000000000002837

The role of videocapsule endoscopy in the diagnosis and follow-up of celiac disease: a scoping review.
Rossi RE, Poletti V, Masoni B, et al. Expert Rev Gastroenterol Hepatol. Published online November 4, 2024. doi:10.1080/17474124.2024.2422372

Introduction: Videocapsule endoscopy (VCE) may be a complementary tool in the diagnosis of celiac disease (CD) in cases with equivocal findings and in the follow-up of complicated cases.

Multiple Small Bowel Cavernous Hemangiomatosis: Case Report and Literature Review.
Ré F, Carrabetta S, Merlo E, Bisagni P. Medicina (Kaunas). 2024;60(10):1664. Published 2024 Oct 10. doi:10.3390/medicina60101664

A 79 year old female individual presented to the hospital and complained of 1 month melena and anemia due to chronic gastrointestinal bleeding because of cavernous hemangiomatosis of the small bowel.

Bowel cleansing quality evaluation in colon capsule endoscopy: what is the reference standard?
Schelde-Olesen B, Koulaouzidis A, Deding U, et al. Therap Adv Gastroenterol. 2024;17:17562848241290256. Published 2024 Oct 23. doi:10.1177/17562848241290256

Background: The diagnostic accuracy of colon capsule endoscopy (CCE) depends on a well-cleansed bowel. Evaluating the cleansing quality can be difficult with a substantial interobserver variation.

Unusual partners: a rare cause of small bowel bulges and a common cause of anemia.
Ferreira AI, Xavier S, Rosa B, Cotter J. Rev Esp Enferm Dig. Published online October 24, 2024. doi:10.17235/reed.2024.10846/2024

A 67-year-old female, without prior medical history, presented to the emergency department due to dizziness and asthenia, where iron deficiency anemia, without visible blood loss, was identified.

A web-based platform for studying the impact of artificial intelligence in video capsule endoscopy.
Apostolidis G, Kakouri A, Dimaridis I, et al. Health Informatics J. 2024;30(4):14604582241296072. doi:10.1177/14604582241296072

Objective: Integrating artificial intelligence (AI) solutions into clinical practice, particularly in the field of video capsule endoscopy (VCE), necessitates the execution of rigorous clinical studies.

Colon capsule endoscopy: A bitter pill?
Jardine R, Ibrahim H, Turvill JL, Watson ANJM. Colorectal Dis. Published online October 21, 2024. doi:10.1111/codi.17208

Prediction of significant lesions on capsule endoscopy in patients with suspected small bowel bleeding – External validation of SSB Capsule Dx score.
Capela TL, Cúrdia Gonçalves T, Rosa B, Cotter J. Dig Dis. Published online October 17, 2024. doi:10.1159/000536109

Introduction: Deciding which patients with suspected small bowel bleeding (SSB) would benefit most from small bowel capsule endoscopy (SBCE) is challenging.

A Multi-task Neural Network for Image Recognition in Magnetically Controlled Capsule Endoscopy.
Xu T, Li YY, Huang F, et al. Dig Dis Sci. Published online October 15, 2024. doi:10.1007/s10620-024-08681-6

Background and aims: Physicians are required to spend a significant amount of reading time of magnetically controlled capsule endoscopy. However, current deep learning models are limited to completing a single recognition task and cannot replicate the diagnostic process of a physician.

Pro-motility Preparation Protocol May Reduce the Rates of Failed Patency Capsule Among Patients with Crohn's Disease in Clinical Remission.
Ukashi O, Dotan A, Borkovsky T, et al. Dig Dis Sci. Published online October 9, 2024. doi:10.1007/s10620-024-08670-9

Background: Patency capsule (PC) ingestion is commonly used to minimize capsule retention in high-risk patients with Crohn's disease (CD). However, false-positive rates remain high, precluding the use of video capsule endoscopy (VCE).

Jejunal Dieulafoy's lesion – An exceptionally rare and challenging culprit of gastrointestinal bleeding.
Gonçalves JC, Magalhães J, Moreira MJ, Cotter J. Rev Esp Enferm Dig. Published online October 4, 2024. doi:10.17235/reed.2024.10785/2024

A 78-year-old male presented to the emergency department with melena. He was hemodynamically stable but displayed a hemoglobin level of 5.8g/dL necessitating blood transfusion.

Computer aided villi morphometric quantification in video-capsule enteroscopy: A newly developed software to quantify small bowel atrophy.
Nandi N, Topa M, Rimondi A, et al. Dig Liver Dis. Published online October 1, 2024. doi:10.1016/j.dld.2024.09.008

Background and aims: Small 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.

Selected papers September 2024

Clinical approach to the diagnosis and management of small bowel bleeding.
Bhattarai S, Algarin Perneth S, Padilla Zambrano H, Leggett CL. Minerva Med. Published online September 26, 2024.

The diagnosis and management of small bowel bleeding (SBB) can be a clinical challenge. Advances in video capsule endoscopy, balloon-assisted enteroscopy, and multiphasic computed tomography allow for localization and therapeutic intervention.

Refractory Iron-Deficiency Anemia and Vascular Malformation Concomitant with Aortic Stenosis: Heyde Syndrome.
Hirata R, Nishi T, Nakamura M, Tago M. Am J Case Rep. 2024;25:e944440. Published 2024 Sep 26.

Background: Heyde syndrome is characterized by anemia due to angiodysplasia, aortic valve stenosis, and acquired von Willebrand syndrome. However, the awareness regarding Heyde syndrome in clinical practice is low. We report the case of an older woman with severe refractory iron-deficiency anemia and severe aortic stenosis who was diagnosed with Heyde syndrome.

Novel ultrasound capsule endoscopy for gastrointestinal scanning: An in vivo animal study.
Chen YZ, Qiu XO, Wang L, et al. Endosc Ultrasound. 2024;13(4):253–258.

Background and objectives: EUS is an important modality for diagnosis and assessment of gastrointestinal (GI) subepithelial lesions. However, EUS is invasive and operator-dependent and requires sedation in most cases. The newly developed ultrasound capsule endoscopy (USCE) system, with both white-light and ultrasound imaging modalities, is a minimally invasive method for superficial and submucosal imaging of the esophagus.

Recurrence rates and risk factors in obscure gastrointestinal bleeding.
Onishi S, Iwashita T, Tezuka Y, et al. DEN Open. 2024;5(1):e70011. Published 2024 Sep 9.

Obscure gastrointestinal bleeding (OGIB), defined in 2010, involves bleeding from the GI tract that remains unexplained after standard diagnostic procedures. OGIB, which accounts for about 5% of all GI bleeds, poses diagnostic and management challenges, particularly due to the anatomical features of the small intestine.

Risk factors of delayed upper gastrointestinal transit in capsule endoscopy.
He XL, Chen HM, Xue HB. Scand J Gastroenterol. Published online September 4, 2024.

Objective: The purpose was to investigate the risk factors for delayed upper gastrointestinal transit (DUGT) in small bowel capsule endoscopy (SBCE) and to improve the efficacy of SBCE.

Herein, we describe a case of olmesartan-associated sprue-like enteropathy, in which improvement in villous atrophy was confirmed using small bowel capsule endoscopy.

Background: Methanogens are associated with gut dysmotility in animal models but have not been robustly studied in humans. The WMC assesses regional transit time (TT) and pH in the GI tract. Aims: To study the segmental TT and pH among patients with SIBO or IMO utilizing WMC.

MoPill a novel gastrointestinal positioning system (GPS): New technology to navigate the alimentary tract highway.
Sarosiek I, Espino K, Lembo A, McCallum RW. Neurogastroenterol Motil. 2024;36(9):e14864.

Background: Evaluation of gut motility in clinical practice is currently limited. A novel medical system (MoPill™) consisting of a capsule that wirelessly transmits radiofrequency signals to assess motility via 3D location, was used to conduct this study.

Clinical validation and accuracy assessment of the Capsule Endoscopy-Crohn's Disease index (CE-CD).
Arcos-Machancoses JV, Kapoor A, Schluckebier D, Thomson M. J Pediatr Gastroenterol Nutr. 2024;79(3):721–728.

Objectives: To compare the recently proposed Capsule Endoscopy-Crohn's Disease index (CE-CD) to pre-existing capsule endoscopy (CE) scores, to measure its precision and accuracy to predict adverse clinical outcomes in children with Crohn's disease (CD).

Pan-Enteric Capsule Endoscopy: Current Applications and Future Perspectives.
Rosa B, Andrade P, Lopes S, et al. GE Port J Gastroenterol. 2023;31(2):89–100. Published 2023 Oct 16.

Background: The role of capsule endoscopy in the evaluation of the small bowel is well established, and current guidelines position it as a first-line test in a variety of clinical scenarios. The advent of double-headed capsules further enabled the endoscopic assessment of colonic mucosa and the opportunity for a one-step noninvasive examination of the entire bowel (pan-enteric capsule endoscopy [PCE]).