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Current and Emerging Technologies & Applications of Endoscopy in Clinical Practice

A special issue of Journal of Clinical Medicine (ISSN 2077-0383). This special issue belongs to the section "Gastroenterology & Hepatopancreatobiliary Medicine".

Deadline for manuscript submissions: closed (5 November 2021) | Viewed by 19844

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
Prof. Wojciech Marlicz

E-Mail Website
Guest Editor
1. Deprtment of Gastroenterology, Pomeranian Medical University, Szczecin, Poland
2. The Centre for Digestive Diseases, Endoklinika, Szczecin, Poland
Interests: capsule endoscopy; liver diseases; internal medicine; irritable bowel syndrome; gastrointestinal diseases
Special Issues, Collections and Topics in MDPI journals
Dr. Tanja Nowak

E-Mail Website
Guest Editor
Medical Affairs, Hamburg, Germany
Interests: video capsule endoscopy; robotic capsule; telemedicine; patient pathways

Special Issue Information

Dear Colleagues,

Minimally invasive diagnostics are fascinating, trendy, and particularly useful, especially in the pandemic and post-COVID-19 era. With an estimated capsule endoscopy (CE) market size that is poised to reach more than $1 billion by 2023, the long-awaited emergence of AI in the field of endoscopy, and the additional strain the pandemic has placed on both the diagnostic and screening of gastrointestinal (GI) procedures, CE is set for a second major leap forward. 

When it first appeared in clinical practice, CE was a real breakthrough, allowing for direct visualization of the small bowel without sedation or the need for a dedicated, fully equipped endoscopy room. However, the dream of replacing conventional equipment for a complete “mouth-to-anus” GI examination never really materialized to date. Moreover, rural/remote areas can never be fully covered in terms of specialist care, and it only takes a global event such as an epidemic to realize how precariously overstretched healthcare systems are.

Therefore, what is next for CE? Automation of CE video reading and the embedding of such technology into a telemedical environment would allow it to meet the criteria of future, personalized diagnosis and treatment and reduce inequalities in healthcare provision. With this Special Issue, we hope to learn more about the daily routines, evidence of (new) indications, patients' profiles, and pathways based on current and new CE settings.

Dr. Anastasios Koulaouzidis
Dr. Wojciech Marlicz
Dr. Tanja Nowak
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. Journal of Clinical Medicine 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.

Keywords

  • digestive endoscopy
  • capsule endoscopy
  • magnetically controlled capsule
  • multifunctional capsule
  • robotic capsule
  • minimally invasive diagnostics
  • tele-medicine
  • e-health
  • e-learning
  • AI
  • capsule platforms
  • research
  • endoscopy diagnosis and treatment

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Published Papers (6 papers)

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Research

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10 pages, 4714 KiB  
Article
Evaluation by a Machine Learning System of Two Preparations for Small Bowel Capsule Endoscopy: The BUBS (Burst Unpleasant Bubbles with Simethicone) Study
by Charles Houdeville, Romain Leenhardt, Marc Souchaud, Guillaume Velut, Nicolas Carbonell, Isabelle Nion-Larmurier, Alexandre Nuzzo, Aymeric Histace, Philippe Marteau and Xavier Dray
J. Clin. Med. 2022, 11(10), 2822; https://doi.org/10.3390/jcm11102822 - 17 May 2022
Cited by 4 | Viewed by 1848
Abstract
Background: Bubbles often mask the mucosa during capsule endoscopy (CE). Clinical scores assessing the cleanliness and the amount of bubbles in the small bowel (SB) are poorly reproducible unlike machine learning (ML) solutions. We aimed to measure the amount of bubbles with ML [...] Read more.
Background: Bubbles often mask the mucosa during capsule endoscopy (CE). Clinical scores assessing the cleanliness and the amount of bubbles in the small bowel (SB) are poorly reproducible unlike machine learning (ML) solutions. We aimed to measure the amount of bubbles with ML algorithms in SB CE recordings, and compare two polyethylene glycol (PEG)-based preparations, with and without simethicone, in patients with obscure gastro-intestinal bleeding (OGIB). Patients & Methods: All consecutive outpatients with OGIB from a tertiary care center received a PEG-based preparation, without or with simethicone, in two different periods. The primary outcome was a difference in the proportions (%) of frames with abundant bubbles (>10%) along the full-length video sequences between the two periods. SB CE recordings were analyzed by a validated computed algorithm based on a grey-level of co-occurrence matrix (GLCM), to assess the abundance of bubbles in each frame. Results: In total, 105 third generation SB CE recordings were analyzed (48 without simethicone and 57 with simethicone-added preparations). A significant association was shown between the use of a simethicone-added preparation and a lower abundance of bubbles along the SB (p = 0.04). A significantly lower proportion of “abundant in bubbles” frames was observed in the fourth quartile (30.5% vs. 20.6%, p = 0.02). There was no significant impact of the use of simethicone in terms of diagnostic yield, SB transit time and completion rate. Conclusion: An accurate and reproducible computed algorithm demonstrated significant decrease in the abundance of bubbles along SB CE recordings, with a marked effect in the last quartile, in patients for whom simethicone had been added in PEG-based preparations, compared to those without simethicone. Full article
(This article belongs to the Special Issue Current and Emerging Technologies & Applications of Endoscopy in Clinical Practice)
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11 pages, 2064 KiB  
Article
PEACE: Perception and Expectations toward Artificial Intelligence in Capsule Endoscopy
by Romain Leenhardt, Ignacio Fernandez-Urien Sainz, Emanuele Rondonotti, Ervin Toth, Cedric Van de Bruaene, Peter Baltes, Bruno Joel Rosa, Konstantinos Triantafyllou, Aymeric Histace, Anastasios Koulaouzidis, Xavier Dray and on behalf of the I-CARE Group
J. Clin. Med. 2021, 10(23), 5708; https://doi.org/10.3390/jcm10235708 - 6 Dec 2021
Cited by 16 | Viewed by 3064
Abstract
Artificial intelligence (AI) has shown promising results in digestive endoscopy, especially in capsule endoscopy (CE). However, some physicians still have some difficulties and fear the advent of this technology. We aimed to evaluate the perceptions and current sentiments toward the use of AI [...] Read more.
Artificial intelligence (AI) has shown promising results in digestive endoscopy, especially in capsule endoscopy (CE). However, some physicians still have some difficulties and fear the advent of this technology. We aimed to evaluate the perceptions and current sentiments toward the use of AI in CE. An online survey questionnaire was sent to an audience of gastroenterologists. In addition, several European national leaders of the International CApsule endoscopy REsearch (I CARE) Group were asked to disseminate an online survey among their national communities of CE readers (CER). The survey included 32 questions regarding general information, perceptions of AI, and its use in daily life, medicine, endoscopy, and CE. Among 380 European gastroenterologists who answered this survey, 333 (88%) were CERs. The mean average time length of experience in CE reading was 9.9 years (0.5–22). A majority of CERs agreed that AI would positively impact CE, shorten CE reading time, and help standardize reporting in CE and characterize lesions seen in CE. Nevertheless, in the foreseeable future, a majority of CERs disagreed with the complete replacement all CE reading by AI. Most CERs believed in the high potential of AI for becoming a valuable tool for automated diagnosis and for shortening the reading time. Currently, the perception is that AI will not replace CE reading. Full article
(This article belongs to the Special Issue Current and Emerging Technologies & Applications of Endoscopy in Clinical Practice)
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14 pages, 1533 KiB  
Article
Endoscopic Resection for Gastric Subepithelial Tumor with Backup Laparoscopic Surgery: Description of a Single-Center Experience
by Wei-Jung Chang, Lien-Cheng Tsao, Hsu-Heng Yen, Chia-Wei Yang, Joseph Lin and Kuo-Hua Lin
J. Clin. Med. 2021, 10(19), 4423; https://doi.org/10.3390/jcm10194423 - 27 Sep 2021
Cited by 2 | Viewed by 2278
Abstract
The aim of this study was to analyze patients who underwent endoscopic resection (ER) for gastric subepithelial tumors (SETs) with a high probability of surgical intervention. Between January 2013 and January 2021, 83 patients underwent ER at the operation theater and 27 patients [...] Read more.
The aim of this study was to analyze patients who underwent endoscopic resection (ER) for gastric subepithelial tumors (SETs) with a high probability of surgical intervention. Between January 2013 and January 2021, 83 patients underwent ER at the operation theater and 27 patients (32.5%) required backup surgery mainly due to incidental perforation or uncontrolled bleeding despite endoscopic repairing. The tumor was predominantly located in the upper-third stomach (81%) with a size ≤ 2 cm (69.9%) and deep to the muscularis propria (MP) layer (92.8%) but there were no significant differences between two groups except tumor exophytic growth as a risk factor in the surgery group (37% vs. 0%, p < 0.0001). Patients in the ER-only group had shorter durations of procedure times (60 min vs. 185 min, p < 0.0001) and lengths of stay (5 days vs. 7 days, p < 0.0001) but with a higher percentage of overall morbidity graded III (0% vs. 7.1%, p = 0.1571). After ER, five patients (6%) had delayed perforation and two (2.4%) required emergent laparoscopic surgery. Neither recurrence nor gastric stenosis was reported during long-term surveillance. Here, we provide a minimally invasive strategy of endoscopic resection with backup laparoscopic surgery for gastric SETs. Full article
(This article belongs to the Special Issue Current and Emerging Technologies & Applications of Endoscopy in Clinical Practice)
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7 pages, 206 KiB  
Article
Risk Factors of Inadequate Bowel Preparation for Screening Colonoscopy
by Efrat L. Amitay, Tobias Niedermaier, Anton Gies, Michael Hoffmeister and Hermann Brenner
J. Clin. Med. 2021, 10(12), 2740; https://doi.org/10.3390/jcm10122740 - 21 Jun 2021
Cited by 16 | Viewed by 4044
Abstract
The success of a colonoscopy in detecting and removing pre-cancerous and cancerous lesions depends heavily on the quality of bowel preparation. Despite efforts, 20–44% of colonoscopy participants have an inadequate bowel preparation. We aimed to assess and compare risk factors for inadequate bowel [...] Read more.
The success of a colonoscopy in detecting and removing pre-cancerous and cancerous lesions depends heavily on the quality of bowel preparation. Despite efforts, 20–44% of colonoscopy participants have an inadequate bowel preparation. We aimed to assess and compare risk factors for inadequate bowel preparation and for the presence of advanced colorectal neoplasms in routine screening practice. In this cross-sectional study, among 8125 participants of screening colonoscopy in Germany with a comprehensive assessment of sociodemographic factors, lifestyle and medical history, we examined factors associated with inadequate bowel preparation and with findings of advanced neoplasms using adjusted log-binomial regression models. Among the identified risk factors assessed, three factors were identified that were significantly associated with inadequate bowel preparation: age ≥ 70 years (adjusted prevalence ratios, aPR, 1.50 95%CI 1.31–1.71), smoking (aPR 1.29 95%CI 1.11–1.50) and abdominal symptoms (aPR 1.14 95%CI 1.02–1.27). The same risk factors were also associated with the prevalence of advanced neoplasms in our study (aPR 1.72, 1.62 and 1.44, respectively). The risk factors associated with inadequate bowel preparation in this study were also associated with a higher risk for advanced neoplasms. Inadequate bowel preparation for colonoscopy might lead to missed colorectal cancer (CRC) precursors and the late diagnosis of CRC. People at high risk of advanced neoplasms are in particular need of enhanced bowel preparation. Full article
(This article belongs to the Special Issue Current and Emerging Technologies & Applications of Endoscopy in Clinical Practice)

Review

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9 pages, 1049 KiB  
Review
An Overview of Robotic Capsules for Drug Delivery to the Gastrointestinal Tract
by Pablo Cortegoso Valdivia, Alexander R. Robertson, Nanne K. H. De Boer, Wojciech Marlicz and Anastasios Koulaouzidis
J. Clin. Med. 2021, 10(24), 5791; https://doi.org/10.3390/jcm10245791 - 10 Dec 2021
Cited by 20 | Viewed by 4028
Abstract
The introduction of capsule endoscopy two decades ago marked the beginning of the “small bowel revolution”. Since then, the rapid evolution of microtechnology has allowed the development of drug delivery systems (DDS) designed to address some of the needs that are not met [...] Read more.
The introduction of capsule endoscopy two decades ago marked the beginning of the “small bowel revolution”. Since then, the rapid evolution of microtechnology has allowed the development of drug delivery systems (DDS) designed to address some of the needs that are not met by standard drug delivery. To overcome the complex anatomy and physiology of the gastrointestinal (GI) tract, several DDS have been developed, including many prototypes being designed, built and eventually produced with ingenious drug-release mechanisms and anchoring systems allowing targeted therapy. This review highlights the currently available systems for drug delivery in the GI tract and discusses the needs, limitations, and future considerations of these technologies. Full article
(This article belongs to the Special Issue Current and Emerging Technologies & Applications of Endoscopy in Clinical Practice)
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14 pages, 1966 KiB  
Review
Scoring Systems for Clinical Colon Capsule Endoscopy—All You Need to Know
by Trevor Tabone, Anastasios Koulaouzidis and Pierre Ellul
J. Clin. Med. 2021, 10(11), 2372; https://doi.org/10.3390/jcm10112372 - 28 May 2021
Cited by 7 | Viewed by 3058
Abstract
In the constantly developing era of minimal diagnostic invasiveness, the role of colon capsule endoscopy in colonic examination is being increasingly recognised, especially in the context of curtailed endoscopy services due to the COVID-19 pandemic. It is a safe diagnostic tool with low [...] Read more.
In the constantly developing era of minimal diagnostic invasiveness, the role of colon capsule endoscopy in colonic examination is being increasingly recognised, especially in the context of curtailed endoscopy services due to the COVID-19 pandemic. It is a safe diagnostic tool with low adverse event rates. As with other endoscopic modalities, various colon capsule endoscopy scores allow the standardisation of reporting and reproducibility. As bowel cleanliness affects CCE’s diagnostic yield, a few operator-dependent scores (Leighton–Rex and CC-CLEAR scores) and a computer-dependent score (CAC score) have been developed to grade bowel cleanliness objectively. CCE can be used to monitor IBD mucosal disease activity through the UCEIS and the panenteric CECDAIic score for UC and CD, respectively. CCE may also have a role in CRC screening, given similar sensitivity and specificity rates to conventional colonoscopy to detect colonic polyps ≥ 10 mm and CRC. Given CCE’s diagnostic yield and reproducible clinical scores with high inter-observer agreements, CCE is fast becoming a suitable alternative to conventional colonoscopy in specific patient populations. Full article
(This article belongs to the Special Issue Current and Emerging Technologies & Applications of Endoscopy in Clinical Practice)
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