Small-bowel capsule endoscopy with panoramic view: results of the first multicenter, observational study (with videos).

BACKGROUND AND AIMS: The first small-bowel video-capsule endoscopy (VCE) with 360° panoramic view has been recently developed. This new capsule has a wire-free technology, 4 high frame-rate cameras, and a long-lasting battery life. The present study was aimed at assessing performances and the safety profile of the 360° panoramic-view capsule in a large series of patients from a multicenter clinical practice setting. METHODS: Consecutive patients undergoing a 360° panoramic-view capsule procedure in 7 European Institutions between January 2011 and November 2015 were included. Both technical (ie, technical failures, completion rate) and clinical (ie, indication, findings, retention rate) data were collected by means of a structured questionnaire. VCE findings were classified according to the likelihood to explain reason for referral: P0-low, P1-intermediate and P2-high. RESULTS: Among 172 patients (94 men; median age: 68 years, IQR: 53-75), 142 underwent VCE for obscure (32 overt, 110 occult) GI bleeding (OGIB) and 28 for suspected (17) or established (2) Crohn's disease (CD). Overall, 560 findings were detected; 252 of them were P2. The overall diagnostic yield was 40.1%; 42.2% and 30.0% in patients with OGIB and CD, respectively. The rate of complete enteroscopy was 90.2%. All of the patients but one, who experienced capsule retention (1/172: 0.6%), excreted and retrieved the capsule. VCE failure occurred in 4 of 172 (2.3%) cases for technical problems. CONCLUSION: The present multicenter study, conducted in clinical practice setting and based on a large consecutive series of patients, showed that DY and safety profile of 360° panoramic-view capsule are similar to those of forward-view VCEs

Validation of a new optical diagnosis training module to improve dysplasia characterization in inflammatory bowel disease:a multicenter international study

Background and aims Inflammatory bowel disease (IBD) increases risk of dysplasia and colorectal cancer. Advanced endoscopic techniques allow for the detection and characterization of IBD dysplastic lesions, but specialized training is not widely available. We aim to develop and validate an online training platform to improve the detection and characterization of colonic lesions in IBD: OPTIC-IBD. Methods We designed a web-based learning module that includes surveillance principles, optical diagnostic methods, approach to characterization, classifications of colonic lesions, utilizing still images and videos. We invited gastroenterologists from Canada, Italy, and the UK, with a wide range of experience. Participants reviewed 24 educational videos of IBD colonic lesions, predicted histology, and rated their confidence. The primary endpoint was to improve accuracy in detecting dysplastic lesions following training on the platform. Furthermore, participants were randomized 1:1 to get additional training or not, with a final assessment occurring after 60 days. Diagnostic performance for dysplasia and rater confidence were measured. Results One hundred seventeen participants completed the study and were assessed for the primary endpoint. Diagnostic accuracy improved from 70.8% to 75.0% (p 0.002) following training, with the greatest improvements seen in less experienced endoscopists. Improvements in both accuracy and confidence were sustained after 2 months of assessment, although the group randomized to receive additional training did not improve further. Similarly, participants’ confidence in characterizing lesions significantly improved between pre- and post-course (

KID Project:an internet-based digital video atlas of capsule endoscopy for research purposes

BACKGROUND AND AIMS: Capsule endoscopy (CE) has revolutionized small-bowel (SB) investigation. Computational methods can enhance diagnostic yield (DY); however, incorporating machine learning algorithms (MLAs) into CE reading is difficult as large amounts of image annotations are required for training. Current databases lack graphic annotations of pathologies and cannot be used. A novel database, KID, aims to provide a reference for research and development of medical decision support systems (MDSS) for CE. METHODS: Open-source software was used for the KID database. Clinicians contribute anonymized, annotated CE images and videos. Graphic annotations are supported by an open-access annotation tool (Ratsnake). We detail an experiment based on the KID database, examining differences in SB lesion measurement between human readers and a MLA. The Jaccard Index (JI) was used to evaluate similarity between annotations by the MLA and human readers. RESULTS: The MLA performed best in measuring lymphangiectasias with a JI of 81\u200a\ub1\u200a6\u200a%. The other lesion types were: angioectasias (JI 64\u200a\ub1\u200a11\u200a%), aphthae (JI 64\u200a\ub1\u200a8\u200a%), chylous cysts (JI 70\u200a\ub1\u200a14\u200a%), polypoid lesions (JI 75\u200a\ub1\u200a21\u200a%), and ulcers (JI 56\u200a\ub1\u200a9\u200a%). CONCLUSION: MLA can perform as well as human readers in the measurement of SB angioectasias in white light (WL). Automated lesion measurement is therefore feasible. KID is currently the only open-source CE database developed specifically to aid development of MDSS. Our experiment demonstrates this potential

Personalize, participate, predict, and prevent: 4Ps in inflammatory bowel disease

Inflammatory bowel disease (IBD), which includes Crohn's disease (CD) and ulcerative colitis (UC), is a complex, immune-mediated, disorder which leads to several gastrointestinal and systemic manifestations determining a poor quality of life, disability, and other negative health outcomes. Our knowledge of this condition has greatly improved over the last few decades, and a comprehensive management should take into account both biological (i.e., disease-related, patient-related) and non-biological (i.e., socioeconomic, cultural, environmental, behavioral) factors which contribute to the disease phenotype. From this point of view, the so called 4P medicine framework, including personalization, prediction, prevention, and participation could be useful for tailoring ad hoc interventions in IBD patients. In this review, we discuss the cutting-edge issues regarding personalization in special settings (i.e., pregnancy, oncology, infectious diseases), patient participation (i.e., how to communicate, disability, tackling stigma and resilience, quality of care), disease prediction (i.e., faecal markers, response to treatments), and prevention (i.e., dysplasia through endoscopy, infections through vaccinations, and post-surgical recurrence). Finally, we provide an outlook discussing the unmet needs for implementing this conceptual framework in clinical practice

Prevalence of Microscopic Colitis in subjects undergoing colonoscopy for non-bloody diarrhea: a prospective study

Introduzione: le Coliti Microscopiche, altrimenti note come Colite Collagena e Colite Linfocitica, sono disordini infiammatori cronici del colon che causano diarrea e colpiscono più frequentemente donne in età avanzata e soggetti in terapia farmacologica. Negli ultimi anni la loro incidenza sembra aumentata in diversi paesi occidentali ma la prevalenza in Italia è ancora incerta. Scopo: il presente studio prospettico e multicentrico è stato disegnato per valutare la prevalenza delle CM in pazienti sottoposti a colonscopia per diarrea cronica non ematica. Pazienti e metodi: dal Maggio 2010 al Settembre 2010 sono stati arruolati consecutivamente tutti i soggetti adulti afferenti in due strutture dell’area metropolitana milanese per eseguire una pancolonscopia. Nei soggetti con diarrea cronica non ematica sono state eseguite biopsie multiple nel colon ascendente, sigma e retto nonché in presenza di lesioni macroscopiche. Risultati: delle 8008 colonscopie esaminate 265 sono state eseguite per diarrea cronica; tra queste, 8 presentavano informazioni incomplete, 52 riscontri endoscopici consistenti con altri disordini intestinali (i.e. IBD, tumori, diverticoliti). 205 colonscopie sono risultate sostanzialmente negative, 175 dotate di adeguato campionamento microscopico (M:F=70:105; età mediana 61 anni). L’analisi istologica ha permesso di documentare 38 nuovi casi di CM (M:F=14:24; età mediana 67.5 anni): 27 CC (M:F=10:17; età mediana 69 anni) e 11 CL (M:F=4:7; età mediana 66 anni). In altri 25 casi sono state osservate alterazioni microscopiche prive dei sufficienti requisiti per la diagnosi di CM. Conclusioni: nel presente studio l’analisi microscopica del colon ha identificato la presenza di CM nel 21,7% dei soggetti con diarrea cronica non ematica ed indagine pancolonscopica negativa. Lo studio microscopico del colon è pertanto un passo diagnostico fondamentale per il corretto inquadramento diagnostico delle diarree croniche, specialmente dopo i 60 anni di età. Ampi studi prospettici e multicentrici dovranno chiarire ruolo e peso dei fattori di rischio associati a questi disordini.Background and aim: Microscopic colitis (MC) encompasses Lymphocytic (LC) and Collagenous colitis (CC) and is a chronic, inflammatory condition of the colon causing watery diarrhea. MC is more prevalent in elderly women and in patients taking multiple drugs. The overall incidence of MC appears to have increased in recent years and to be relatively common in subjects with chronic diarrhea; however, the prevalence of this condition in Italy is still unclear. We designed a prospective multicenter study in order to evaluate the prevalence of MC in subjects undergoing colonoscopy for chronic non-bloody diarrhea. Methods: from May 2010 to September 2012, we prospectively enrolled subjects undergoing colonscopy in the metropolitan area of Milan for chronic non-bloody diarrhea. Biopsies were obtained from any macroscopic finding detected in the course of the endoscopic and from ascending, sigmoid colon and rectum. Results: a total of 8008 colonoscopies were performed; of these, 265 were done for non-bloody diarrhea; 8 were not complete, 52 detected relevant endoscopic findings consistent with a specific diagnosis (i.e. IBD, neoplasm, diverticulitis). Colonoscopy was grossly normal in 205 subjects; microscopic analysis was available in 175 cases (M:F=70:105; median age 61 yrs). Histopathologic evaluation revealed MC in 38 patients (M:F=14:24; median age 67.5 yrs): 27 CC (M:F=10:17; mean age 69 yrs), and 11 LC (M:F=4:7; mean age 66 yrs). In 25 subjects we observed non-diagnostic changes, such as a mild increase in intraepithelial lymphocytes or a slight thickening of sub-epithelial collagen. Conclusions: in this study endoscopic biopsies allowed the diagnosis of MC in 21.7% of patients complaining non-bloody diarrhea with a normal colonoscopy. Indeed, the identification of MC is pivotal for the adequate management of chronic diarrhea, especially in elderly people. Larger multicenter prospective studies are warranted to define the real impact of this clinical entity in our country

Accuracy of the Full Spectrum Endoscopy (FUSE) system for assessment of disease activity in Inflammatory Bowel Diseases (IBD) compared to high-definition endoscopy

Introduction: Recently, Full Spectrum Endoscopy (FUSE) was introduced as a novel colonoscopy platform. In contrast to other endoscopy systems illumination with the FUSE system is achieved by Light-Emitting Diodes (LEDs) and not by a xenon light source. Currently, the FUSE-system does not provide high-definition imaging yet. In patients with IBD, precise assessment of disease activity (i.e. mucosal healing) is of paramount importance to predict disease outcome and to guide therapy.Aims: To determine in a comparison study whether FUSE has the potential to assess disease activity in patients with IBD in comparison to a matched cohort of patients undergoing High-Definition White-Light Endoscopy (HD-WLE).Materials &amp; methods: Consecutive patients with IBD (n=34) undergoing FUSE colonoscopy were matched to patients with IBD undergoing HD-WLE at the same endoscopy unit. The mucosal vascular pattern and any mucosal abnormalities were recorded. Inflammation in ulcerative colitis was recorded according to Mayo Ulcerative Endoscopic Score (MUES) and in Crohn´s disease according to Crohn´s Disease Endoscopic Index of Severity (CDEIS). Subsequent to endoscopic characterization targeted biopsies were obtained for histopathological analysis of disease activity.Results: 90 cases were included. Mean age of patients was 37 years (Range 18 to 72 years). 59% of patients had diagnosis of Crohn’s disease and 41% diagnosis of ulcerative colitis. Accuracy of FUSE and HD-WL endoscopy for diagnosis of disease activity in IBD was not statistically significant different (83.8% versus 71.7%). The PPV and NPV for FUSE and HD-WLE did not differ significantly. In the subgroup analysis FUSE and HD-WLE endoscopy yielded in underdiagnosis and overdiagnosis of disease activity in 57% versus 46% and 43% versus 54% of not correctly predicted cases, respectively. Overall, FUSE was more accurate for diagnosis of disease activity in Crohn’s disease patients, while HD-WL endoscopy was more accurate for diagnosis of disease activity in ulcerative colitis.Conclusion: Despite the use of LEDs resulting in a darker image and high-resolution imaging, the FUSE seems to be equally effective to high-definition white-light imaging for diagnosis of disease activity in patients with IBD.</p

Endoscopic Optical Enhancement Technologies in IBD

Optical enhancement technologies are emerging as promising tools to improve diagnosis and clinical management of patients with inflammatory bowel diseases (IBD). The use of dye-based and dye-less chromoendoscopy may improve either characterisation of mucosal inflammation or detection of dysplastic and early neoplastic lesions. Confocal laser endomicroscopy and endocytoscopy both allow for in vivo and real-time microscopic analysis of the tissue. Moreover, the newly introduced molecular imaging has now also become feasible for in vivo diagnosis in IBD. This review focuses on the more recent progresses of advanced endoscopic imaging techniques in the setting of IBD and provides the reader with an updated overview on accepted clinical evidence and ongoing fields of research