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Diagnostics
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Current and Future Use of Capsule Endoscopy
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Current and Future Use of Capsule Endoscopy

A special issue of Diagnostics (ISSN 2075-4418). This special issue belongs to the section "Biomedical Optics".

Deadline for manuscript submissions: closed (15 December 2022) | Viewed by 18733

Special Issue Editors

Prof. Dr. Anastasios Koulaouzidis

E-Mail Website
Guest Editor
1. Department of Medicine, OUH Svendborg Sygehus, Svendborg, Denmark
2. Surgical Research Unit, OUH, Odense, Denmark
3. Department of Clinical Research, University of Southern Denmark (SDU), Odense, Denmark
Interests: capsule endoscopy; gastroenterology; collagenous colitis; microscopic colitis
Special Issues, Collections and Topics in MDPI journals
Dr. Ervin Toth

E-Mail Website
Guest Editor
Department of Gastroenterology, Skåne University Hospital, Lund University, Malmö, Sweden
Interests: diagnostic and therapeutic gastrointestinal endoscopy; colonoscopy; capsule endoscopy; colorectal cancer
Special Issues, Collections and Topics in MDPI journals

Special Issue Information

Dear Colleagues,

Capsule endoscopy (CE) has achieved disruption mainly by addressing the pain point of drastically improved small bowel diagnosis. For a few years, and despite several iterations of capsule models, CE remained the go-to modality of organised small-bowel services in GI units worldwide, and the niche of private care practices. However, it seems that the dream of its investors, that is, the idea that 'the discomfort of internal gastrointestinal examination may soon be a thing of the past' remained a wishful thought, as the endoscopy units around the world have been challenged by the size of upper and lower GI endoscopies.

However, given than a PubMed search retrieved more than 6000 results, there is an AI/robotics revolution underway, and the painful effects and aftermath of the COVID-19 pandemic seem to have turned the tide for CE technologies. With many plans and developments in the pipeline, we would love to hear what colleagues think about all the new and upcoming aspects, including AI in CE, classification and nomenclature, robotics in CE, home delivery, the remote reading of multimodal capsules, and non-imaging capsules.

Original papers, systematic reviews, and meta-analyses of relevant topics, opinion papers, and case reports are invited.

Prof. Dr. Anastasios Koulaouzidis
Dr. Ervin Toth
Guest Editors

Manuscript Submission Information

Manuscripts should be submitted online at www.mdpi.com by registering and logging in to this website. Once you are registered, click here to go to the submission form. Manuscripts can be submitted until the deadline. All submissions that pass pre-check are peer-reviewed. Accepted papers will be published continuously in the journal (as soon as accepted) and will be listed together on the special issue website. Research articles, review articles as well as short communications are invited. For planned papers, a title and short abstract (about 100 words) can be sent to the Editorial Office for announcement on this website.

Submitted manuscripts should not have been published previously, nor be under consideration for publication elsewhere (except conference proceedings papers). All manuscripts are thoroughly refereed through a single-blind peer-review process. A guide for authors and other relevant information for submission of manuscripts is available on the Instructions for Authors page. Diagnostics is an international peer-reviewed open access semimonthly journal published by MDPI.

Please visit the Instructions for Authors page before submitting a manuscript. The Article Processing Charge (APC) for publication in this open access journal is 2600 CHF (Swiss Francs). Submitted papers should be well formatted and use good English. Authors may use MDPI's English editing service prior to publication or during author revisions.

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Published Papers (5 papers)

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Research

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9 pages, 719 KiB  
Article
Low Colon Capsule Endoscopy (CCE) False Negative Rate for Polyps Excluding Reader Error
by Serhiy Semenov, Conor Costigan, Mohd Syafiq Ismail and Deirdre McNamara
Diagnostics 2023, 13(1), 56; https://doi.org/10.3390/diagnostics13010056 - 25 Dec 2022
Viewed by 1614
Abstract
Background: CCE is a diagnostic tool lacking clinical data on false negative rates. We aimed to assess this rate and the reader/technical error breakdown. Methods: False negative CCEs were identified after comparing to a colonoscopy database. Missed pathology characteristics and study indications/quality were [...] Read more.
Background: CCE is a diagnostic tool lacking clinical data on false negative rates. We aimed to assess this rate and the reader/technical error breakdown. Methods: False negative CCEs were identified after comparing to a colonoscopy database. Missed pathology characteristics and study indications/quality were collated. Cases were re-read by experts and newly identified lesions/pathologies were verified by an expert panel and categorised as reader/technical errors. Results: Of 532 CCEs, 203 had an adequately reported comparative colonoscopy, 45 (22.2%) had missed polyps, and 26/45 (57.8%) reached the colonic section with missed pathology. Of the cases, 22 (84.6%) had adequate bowel preparation. Indications included 13 (50%) polyp surveillance, 12 (46%) GI symptoms, 1 (4%) polyp screening. CCE missed 18 (69.2%) diminutive polyps and 8 (30.8%) polyps ≥ 6 mm, 18/26 (69.2%) of these were adenomas. Excluding incomplete CCE correlates, colonoscopy total and significant polyp yield were 97/184 (52.7%) and 50/97 (51.5%), respectively. CCE total polyp and significant polyp false negative rate was 26.8% (26/97) and 16% (8/50), respectively. Following re-reading, reader and technical error was 20/26 (76.9%) and 6/26 (23.1%). Total and significant missed polyp rates were 20.6% (20/97) and 14% (7/50) for reader error, 6.2% (6/97) and 2% (1/50) for technical error. Conclusions: False negative CCE rate is not insubstantial and should be factored into clinical decision making. Full article
(This article belongs to the Special Issue Current and Future Use of Capsule Endoscopy)
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13 pages, 978 KiB  
Article
Very High Yield of Urgent Small-Bowel Capsule Endoscopy for Ongoing Overt Suspected Small-Bowel Bleeding Irrespective of the Usual Predictive Factors
by Maria Manuela Estevinho, Rolando Pinho, Adélia Rodrigues, Ana Ponte, Edgar Afecto, João Correia and Teresa Freitas
Diagnostics 2022, 12(11), 2685; https://doi.org/10.3390/diagnostics12112685 - 4 Nov 2022
Cited by 4 | Viewed by 2952
Abstract
Evidence for an urgent approach to ongoing overt suspected small-bowel bleeding (SSBB) is scarce. We aimed to analyze our series of urgent small-bowel capsule endoscopies (SBCEs) for ongoing overt SSBB and to identify factors associated with positive findings and outcomes. A retrospective study [...] Read more.
Evidence for an urgent approach to ongoing overt suspected small-bowel bleeding (SSBB) is scarce. We aimed to analyze our series of urgent small-bowel capsule endoscopies (SBCEs) for ongoing overt SSBB and to identify factors associated with positive findings and outcomes. A retrospective study of all SBCEs performed in the first 48 h after admission for overt SSBB between January 2006 and February 2022 was performed. Descriptive and inferential analyses (univariate and multivariable) were performed. Eighty-three urgent SBCEs were performed for overt SSBB. Patients were mostly men (69.2%, median age 68) and were followed for a median of 58.2 months (range 5–176). The diagnostic yield was 80.7%; in 60.2%, blood was detected in the small bowel (SB), while in 50.6%, a bleeding lesion was identified, mostly angioectasia. Patients with diabetes mellitus or taking NSAIDs were more prone to present SB findings, yet the explanatory power was low. Endoscopic or surgical treatments were performed in 28.9% and 19.3%, respectively, with the “non-conservative” therapeutic yield being 56.6%. Rebleeding occurred in 20.5% and was associated in the multivariable analysis with the female gender and anticoagulants use. This cohort of urgent SBCE, the largest from a European center, reinforces the usefulness of SBCE for ongoing overt SSBB management. This prompt performance of this procedure is highly effective, regardless of patients’ features. Full article
(This article belongs to the Special Issue Current and Future Use of Capsule Endoscopy)
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11 pages, 2585 KiB  
Article
Deep Learning Multi-Domain Model Provides Accurate Detection and Grading of Mucosal Ulcers in Different Capsule Endoscopy Types
by Tom Kratter, Noam Shapira, Yarden Lev, Or Mauda, Yehonatan Moshkovitz, Roni Shitrit, Shani Konyo, Offir Ukashi, Lior Dar, Oranit Shlomi, Ahmad Albshesh, Shelly Soffer, Eyal Klang, Shomron Ben Horin, Rami Eliakim, Uri Kopylov and Reuma Margalit Yehuda
Diagnostics 2022, 12(10), 2490; https://doi.org/10.3390/diagnostics12102490 - 14 Oct 2022
Cited by 11 | Viewed by 1727
Abstract
Background and Aims: The aim of our study was to create an accurate patient-level combined algorithm for the identification of ulcers on CE images from two different capsules. Methods: We retrospectively collected CE images from PillCam-SB3′s capsule and PillCam-Crohn’s capsule. ML algorithms were [...] Read more.
Background and Aims: The aim of our study was to create an accurate patient-level combined algorithm for the identification of ulcers on CE images from two different capsules. Methods: We retrospectively collected CE images from PillCam-SB3′s capsule and PillCam-Crohn’s capsule. ML algorithms were trained to classify small bowel CE images into either normal or ulcerated mucosa: a separate model for each capsule type, a cross-domain model (training the model on one capsule type and testing on the other), and a combined model. Results: The dataset included 33,100 CE images: 20,621 PillCam-SB3 images and 12,479 PillCam-Crohn’s images, of which 3582 were colonic images. There were 15,684 normal mucosa images and 17,416 ulcerated mucosa images. While the separate model for each capsule type achieved excellent accuracy (average AUC 0.95 and 0.98, respectively), the cross-domain model achieved a wide range of accuracies (0.569–0.88) with an AUC of 0.93. The combined model achieved the best results with an average AUC of 0.99 and average mean patient accuracy of 0.974. Conclusions: A combined model for two different capsules provided high and consistent diagnostic accuracy. Creating a holistic AI model for automated capsule reading is an essential part of the refinement required in ML models on the way to adapting them to clinical practice. Full article
(This article belongs to the Special Issue Current and Future Use of Capsule Endoscopy)
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12 pages, 1503 KiB  
Article
Fecal Calprotectin for Small Bowel Crohn’s Disease: Is It a Cutoff Issue?
by Cristina Romero-Mascarell, Gloria Fernández-Esparrach, Cristina Rodríguez-De Miguel, Maria Carme Masamunt, Sonia Rodríguez, Jordi Rimola, Miguel Urpí, Gherzon Simon Casanova, Ingrid Ordás, Elena Ricart, Berta Caballol, Agnès Fernández-Clotet, Julià Panés, Josep Llach and Begoña González-Suárez
Diagnostics 2022, 12(9), 2226; https://doi.org/10.3390/diagnostics12092226 - 15 Sep 2022
Cited by 6 | Viewed by 8880
Abstract
(1) Background: Fecal calprotectin (FC) correlates well with colonic inflammatory activity of Crohn’s disease (CD); data about relation of FC and small bowel (SB) lesions are still contradictory. The main aim was to analyze the relationship between FC levels and SB inflammatory activity [...] Read more.
(1) Background: Fecal calprotectin (FC) correlates well with colonic inflammatory activity of Crohn’s disease (CD); data about relation of FC and small bowel (SB) lesions are still contradictory. The main aim was to analyze the relationship between FC levels and SB inflammatory activity in patients with established or suspected Crohn’s disease, assessed by small bowel capsule endoscopy (SBCE) or magnetic resonance enterography (MRE). (2) Methods: Two cohorts of patients were included: 1. Prospective data were collected from patients with established or suspected CD who underwent SBCE and FC (Cohort A); 2. A retrospective cohort of patients who underwent MRE and FC determination (Cohort B). Different cutoffs for FC were tested in both cohorts. (3) Results: 83 patients were included and 66 were finally analyzed. A total of 69.6% had SB lesions seen by SBCE (n = 25) or MRE (n = 21). FC mean levels were 605.74 + 607.07 μg/g (IQ range: 99.00–878.75), being significantly higher in patients with SB lesions compared to patients without lesions (735.91 + 639.70 μg/g (IQ range: 107.75–1366.25) vs. 306.35 + 395.26 μg/g (IQ range: 78.25–411.0), p < 0.005). For cohort A, 25 out of 35 patients had SB lesions and a significant correlation between Lewis Score and FC levels was achieved (R2: 0.34; p = 0.04). FC sensitivity (S), specificity (E), positive predictive value (PPV), and negative predictive values (NPV) for predicting SB lesions were 80%, 50%, 80%, and 50%, respectively, for FC > 100 µg/g. For cohort B, inflammatory SB activity, measured by MaRIA score, was detected in 21 out of 31 patients (67.7%). Patients with positive findings in MRE had significantly higher values of FC than those with no lesions (944.9 + 672.1 µg/g vs. 221 + 212.2 µg/g, p < 0.05). S, E, PPV, and NPV of FC were 89%, 50%, 77.2%, and 71.4% for FC levels > 100 µg/g. The higher sensitivity and specificity of the FC levels for the detection of SB lesions with SBCE and MRE was obtained for an FC cutoff >265 μg/g and >430 μg/g, respectively. (4) Conclusions: FC has a good correlation with the presence of SB lesions, assessed by SBCE and MRE, in patients with established or suspected Crohn’s disease. However, the ideal cutoff is here proven to be higher than previously reported. Multicenter and large prospective studies are needed in order to establish definitive FC cutoff levels. Full article
(This article belongs to the Special Issue Current and Future Use of Capsule Endoscopy)
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Review

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10 pages, 2838 KiB  
Review
An Overview of the Evolution of Capsule Endoscopy Research—Text-Mining Analysis and Publication Trends
by Rebekka Steinmann, Pablo Cortegoso Valdivia, Tanja Nowak and Anastasios Koulaouzidis
Diagnostics 2022, 12(9), 2238; https://doi.org/10.3390/diagnostics12092238 - 16 Sep 2022
Viewed by 2450
Abstract
There has been a steady increase (annual percentage growth rate of 19.2%, average of 18.3 citations per document) in capsule endoscopy (CE) publications from a global, interdisciplinary research community on a growing range of CE applications over the last 20+ years. We here [...] Read more.
There has been a steady increase (annual percentage growth rate of 19.2%, average of 18.3 citations per document) in capsule endoscopy (CE) publications from a global, interdisciplinary research community on a growing range of CE applications over the last 20+ years. We here present the status of CE as a field of research, tracing its evolution over time and providing insight into its potential for diagnostics, prevention and treatment of gastrointestinal (GI) tract diseases. To portray the development of the CE research landscape in the 2000–2021 time span, we analyzed 5764 scientific publications. Analyses were performed using the R language and environment for statistical computing and graphics and VOSviewer, a software developed for scientific literature analysis by scientometricians. The aim of this paper is to provide a wide comprehensive analysis of the trends in CE publications. We thus performed subgroup analysis on the selected papers, including indications, annual percentage growth rate, average citations per document, most publications from research areas/interdisciplinary field of the articles, geography, collaboration networks through institutions, specific clinical keywords and device type. The firm increase in CE publications over the last two decades highlights the overall strength of the technology in GI applications. Furthermore, the introduction to the field of artificial intelligence (AI) tools has been promoting a range of technological advances that keep on affecting the diagnostic potential of CE. Full article
(This article belongs to the Special Issue Current and Future Use of Capsule Endoscopy)
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