Capsule Endoscopy ; Gastrointestinal Hemorrhage/etiology* ; Humans ; Magnetic Phenomena ; Myocardial Infarction/complications*

OBJECTIVE: To evaluate the value of capsule endoscopy in children with small intestinal diseases with hematochezia as the chief complaint. METHODS: A retrospective analysis was performed on the clinical data and capsule endoscopy findings of 93 children with hematochezia who were admitted to Children's Hospital of Fudan University from May 2015 to January 2019 and underwent capsule endoscopy. According to the capsule endoscopy findings of the jejunum and the ileum, they were divided into a positive lesion group with 39 patients and a negative lesion group with 54 patients. Related clinical data and the features of lesion on capsule endoscopy were analyzed for the two groups. RESULTS: There were no significant differences in age, sex, duration of capsule endoscopy, gastric transit time, and small intestinal transit time between the positive lesion and negative lesion groups (P>0.05). The positive lesion group had a significantly lower level of hemoglobin than the negative lesion group (P<0.05). Hemoglobin level was negatively correlated with the rate of positive lesions on capsule endoscopy (r=-0.342, P=0.001). Among the 39 patients with positive lesions on capsule endoscopy, the detection of Meckel's diverticulum was the highest (41%), followed by inflammatory bowel disease (21%). CONCLUSIONS Capsule endoscopy has a certain value in detecting small intestinal diseases, especially diseases in the jejunum and the ileum, in children with lower gastrointestinal hemorrhage.
Capsule Endoscopy ; Child ; Gastrointestinal Hemorrhage ; Humans ; Intestinal Diseases ; Jejunum ; Meckel Diverticulum ; Retrospective Studies

For improved examination of video capsule endoscopy (VCE) and device-assisted enteroscopy (DAE), bowel preparation is an essential issue. Multiple factors like air bubbles, food material in the small bowel, and gastric and small bowel transit time affect the small bowel visualization quality (SBVQ), diagnostic yield (DY) and cecal completion rate (CR). Bowel preparation with polyethylene glycol (PEG) solution enhances SBVQ and DY, but it has no effect on CR. Bowel preparation with PEG solution 2 L is similar to PEG 4 L in SBVQ, DY, and CR. Bowel preparation with fasting or PEG solution combined with anti-foaming agents like simethicone enhance SBVQ, but it has no effect on CR. Bowel preparation with prokinetics is not commonly recommended. Optimal timing for purgative bowel preparation has yet to be established. However, the studies regarding bowel preparation for DAE are not sufficient. European Society of Gastrointestinal Endoscopy (ESGE) recommends 8–12 hours fasting from solid food and 4–6 hours fasting from liquids prior to the antegrade DAE. For retrograde DAE, colonoscopy preparation regimen is recommended. This article reviews the literature and ESGE, 2013 Korean published guidelines regarding bowel preparation for VCE and DAE, following suggestion for optimal bowel preparation for VCE and balloon enteroscopy.
Capsule Endoscopy ; Cathartics ; Colonoscopy ; Endoscopy, Gastrointestinal ; Fasting ; Polyethylene Glycols ; Simethicone

We report a rare case of Meckel's diverticulum in a boy who initially presented with chronic iron deficiency anemia (IDA) without any history of gastrointestinal (GI) bleeding at 8 years-old. Isolated small bowel Crohn's disease was suspected based on findings of small bowel ulcers on capsule endoscopy. At four years from initial presentation, he developed massive GI bleeding. Abdominal computed tomographic angiography and small bowel series revealed findings suggestive of Meckel's diverticulum. Meckel's diverticulum should be suspected in children with unexplained chronic IDA even in the absence of prominent GI bleeding and negative findings on repetitive Meckel's scans. Moreover, Meckel's diverticulum should be included in the differential diagnosis of isolated small bowel Crohn's disease when the disease is limited to a short segment of the distal small bowel, as ulcers and inflammation may result as a consequence of acid secreted from adjacent heterotopic gastric mucosa constituting the Meckel's diverticulum.
Anemia, Iron-Deficiency ; Angiography ; Capsule Endoscopy ; Child* ; Crohn Disease* ; Diagnosis, Differential ; Gastric Mucosa ; Hemorrhage ; Humans ; Inflammation ; Male ; Meckel Diverticulum* ; Ulcer

Capsule endoscopy (CE) is a preferred diagnostic method for analyzing small bowel diseases. However, capsule endoscopes capture a sparse number of images because of their mechanical limitations. Post-procedural management using computational methods can enhance image quality. Additional information, including depth, can be obtained by using recently developed computer vision techniques. It is possible to measure the size of lesions and track the trajectory of capsule endoscopes using the computer vision technology, without requiring additional equipment. Moreover, the computational analysis of CE images can help detect lesions more accurately within a shorter time. Newly introduced deep leaning-based methods have shown more remarkable results over traditional computerized approaches. A large-scale standard dataset should be prepared to develop an optimal algorithms for improving the diagnostic yield of CE. The close collaboration between information technology and medical professionals is needed.
Capsule Endoscopes ; Capsule Endoscopy ; Cooperative Behavior ; Dataset ; Methods

Artificial intelligence is likely to perform several roles currently performed by humans, and the adoption of artificial intelligence-based medicine in gastroenterology practice is expected in the near future. Medical image-based diagnoses, such as pathology, radiology, and endoscopy, are expected to be the first in the medical field to be affected by artificial intelligence. A convolutional neural network, a kind of deep-learning method with multilayer perceptrons designed to use minimal preprocessing, was recently reported as being highly beneficial in the field of endoscopy, including esophagogastroduodenoscopy, colonoscopy, and capsule endoscopy. A convolutional neural network-based diagnostic program was challenged to recognize anatomical locations in esophagogastroduodenoscopy images, Helicobacter pylori infection, and gastric cancer for esophagogastroduodenoscopy; to detect and classify colorectal polyps; to recognize celiac disease and hookworm; and to perform small intestine motility characterization of capsule endoscopy images. Artificial intelligence is expected to help endoscopists provide a more accurate diagnosis by automatically detecting and classifying lesions; therefore, it is essential that endoscopists focus on this novel technology. In this review, we describe the effects of artificial intelligence on gastroenterology with a special focus on automatic diagnosis, based on endoscopic findings.
Ancylostomatoidea ; Artificial Intelligence ; Capsule Endoscopy ; Celiac Disease ; Colonoscopy ; Diagnosis ; Diagnosis, Computer-Assisted ; Endoscopy ; Endoscopy, Digestive System ; Endoscopy, Gastrointestinal ; Gastroenterology ; Helicobacter pylori ; Humans ; Intestine, Small ; Learning ; Methods ; Neural Networks (Computer) ; Pathology ; Polyps ; Stomach Neoplasms

BACKGROUND/AIMS: Capsule endoscopy is a diagnostic method for evaluating the small bowel lumen and can detect undiagnosed lesions. The aim of this study was to evaluate the diagnostic yield and clinical impact of capsule endoscopy in patients with refractory diarrhea-predominant irritable bowel syndrome and functional abdominal pain. METHODS: This study involved a retrospective analysis of prospectively collected data, maintained in a database. Patients with refractory diarrhea-predominant irritable bowel syndrome and functional abdominal pain within the period of March 2012 to March 2014 were included. Capsule endoscopy was used to detect small bowel pathologies in both groups. RESULTS: Sixty-five patients (53.8% female) fulfilled the inclusion criteria and had a mean (±standard deviation) age of 50.9±15.9 years. Clinically significant lesions were detected via capsule endoscopy in 32.5% of the patients in the abdominal pain group and 54.5% of the patients in the diarrhea group. Overall, 48% of patients had small bowel pathologies detected during the capsule endoscopy study. Inflammatory lesions and villous atrophy were the most frequent lesions identified in 16.9% and 15.3% of patients in the abdominal pain and the diarrhea groups, respectively. CONCLUSIONS: Routine use of capsule endoscopy in patients with irritable bowel syndrome should not be recommended. However, in patients with refractory conditions, capsule endoscopy may identify abnormalities.
Abdominal Pain* ; Atrophy ; Capsule Endoscopy* ; Diarrhea ; Humans ; Irritable Bowel Syndrome* ; Methods ; Pathology ; Prospective Studies ; Retrospective Studies

BACKGROUND/AIMS: To evaluate patients with portal hypertension (PH) of varied etiologies for portal hypertensive enteropathy (PHE) using the PillCam SB3 capsule endoscopy (CE) system. METHODS: Consecutive patients with PH presenting with unexplained anemia and/or occult gastrointestinal bleeding were evaluated using the PillCam SB3 CE system. Abnormal findings were categorized as vascular or non-vascular. The patients with ongoing bleeding caused by PHE were treated. The correlation of the CE scores of PHE with the clinical, laboratory, and endoscopic features was determined. RESULTS: Of the 43 patients included in the study, 41 (95.3%) showed PHE findings. These included varices (67.4%), red spots (60.5%), erythema (44.2%), villous edema (46.5%), telangiectasia (16.3%), and polyps (16.3%). The CE scores varied from 0 to 8 (mean±standard deviation, 4.09±1.8). Five patients (11.6%) showed evidence of ongoing or recent bleeding due to PHE. Three of these five patients underwent endotherapy, and one patient underwent radiological coil placement. CONCLUSIONS: The PillCam SB3 CE system revealed a high prevalence of PHE in the patients with PH. Using this system, evidence of bleeding due to PHE was found in a small but definite proportion of the patients.
Anemia ; Capsule Endoscopy* ; Edema ; Erythema ; Fibrosis ; Hemorrhage ; Humans ; Hydrogen-Ion Concentration ; Hypertension, Portal* ; Intestine, Small* ; Polyps ; Prevalence ; Telangiectasis ; Varicose Veins

Unlike wired endoscopy, capsule endoscopy requires additional time for a clinical specialist to review the operation and examine the lesions. To reduce the tedious review time and increase the accuracy of medical examinations, various approaches have been reported based on artificial intelligence for computer-aided diagnosis. Recently, deep learning–based approaches have been applied to many possible areas, showing greatly improved performance, especially for image-based recognition and classification. By reviewing recent deep learning–based approaches for clinical applications, we present the current status and future direction of artificial intelligence for capsule endoscopy.
Artificial Intelligence* ; Capsule Endoscopy* ; Classification ; Diagnosis ; Endoscopy ; Specialization

No abstract available.
Capsule Endoscopy* ; Humans