Capsule endoscopy (CE) has been increasingly utilised in recent years as a minimally invasive tool to investigate the whole gastrointestinal (GI) tract and a range of capsules are currently available for evaluation of upper GI, small bowel, and lower GI pathology. Although CE is undoubtedly an invaluable test for the investigation of small bowel pathology, it presents considerable challenges and limitations, such as long and laborious reading times, risk of missing lesions, lack of bowel cleansing score and lack of locomotion. Artificial intelligence (AI) seems to be a promising tool that may help improve the performance metrics of CE, and consequently translate to better patient care. In the last decade, significant progress has been made to apply AI in the field of endoscopy, including CE. Although it is certain that AI will find soon its place in day-to-day endoscopy clinical practice, there are still some open questions and barriers limiting its widespread application. In this review, we provide some general information about AI, and outline recent advances in AI and CE, issues around implementation of AI in medical practice and potential future applications of AI-aided CE.

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Introduction: Peutz-Jeghers syndrome (PJS) is an autosomic dominant genetic disorder characterized by mucocutaneous pigmentations and hamartomatous polyps mainly in the small bowel. These polyps may cause intussusceptions and bowel obstruction, that leads to multiple surgeries. Endoscopic removal is a technical challenge because they are difficult polyps. Objective: Describe and evaluate the feasibility, safety and efficacy of the adrenaline injection volume reduction technique (AIVR) for the removal of large and obstructive polyps in PJS. Patients and methods: case-series study (from march 2008 to august 2017). We included 24 patients with clinically diagnosed bowel obstruction (42 polyps); 15 patients had previous surgeries due to obstruction.A single balloon enteroscope(SBE) Olympus SIFQ180, CO2 Olympus UCR pump was used. All enteroscopy studies were performed by the same expert endoscopist: anterograde approach in 21 patients and retrograde(3). 20 studies were performed in an endoscopic suite and 4 in the OR ( 12 years), under anesthesiology surveillance. A Wilson Cook SAS-1-S standard oval snare and an electrosurgical unit ERBE 300D, EndoCut mode,Effect 3, 120 W, COAG Forced 40 W were used. AIVR technique injection of 4 to 8 mL of 1:20.000 adrenaline solution into the head of the polyp at 2 to 4 sites. After injection, an immediate blanching of the head should be noted. Then, 2 to 4 mL of adrenaline is injected into the stalk in 2 or more sites. Three to five minutes is recommended to achieve adequate time for dramatic volume reduction. Pre-and post-AIVR size was determined by measuring the open snare against the polyp. Polyp volume and % volume reduction was calculated determined by standardized equation found in the literature. Results: 42 polypectomies were performed. 26 proximal jejunum, 10 medium jejunum and 6 distal ileum. Size and volume of pre-AIVR polyps were: 3cms/14cc(26 polyps), 4cms/ 34cc(10 polyps), 5cms/65cc(6 polyps) and post-AIVR: 1.5cms/1.8cc(26 polyps), 2.0cms/4cc(10 polyps),3.0cms/14cc(6 polyps). Volume reduction: 87%, 88% and 78% respectively.10 polyps(24%) were multilobed-confluent. In all lesions, volume reduction was successful, determined by snare placementis easily accomplished, as a better visualization of the intestinal lumen and the pedicle. Polypectomy in bloc was technically possible in all lesions.All polyps were hamartomatous.7 patients(29%) presented abdominal pain that resolved spontaneously. Conclusions: Our results shows that AIVR technique is simple, feasible, safe and effective technique for the removal of large polyps in patients with PJS complicated with bowel obstruction. Also,many polyps can be removed, fewer endoscopic sessions.