The future of capsule endoscopy in clinical practice: from diagnostic to therapeutic experimental prototype capsules

Vasilakakis, Michael; Koulaouzidis, Anastasios; Marlicz, Wojciech; Iakovidis, Dimitris K.

doi:10.5114/pg.2019.87528

Cited by 12 publications

(14 citation statements)

References 59 publications

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“…3 Estimated glomerular filtration rate < 60 mg/dL/1.73 m 2 . 4 Aspirin, ticagrelor, prasugrel, clopidogrel or fixed-dose combination aspirin-dipyridamole. ▶ Fig.…”

Section: Older Age (≥ 75 Years)mentioning

confidence: 99%

“…2 Saurin classification (only the higher rating accountable) 3. Bleeding causing a fall in hemoglobin level of ≥ 2 g/dL or leading to transfusion of ≥ 2 units of red blood cells 4. …”

mentioning

confidence: 99%

“…Since its wider adoption in clinical practice, significant progress has been made in several areas including software development, hardware features and clinical indications, while innovative applications of CE never cease to appear 2 3 . Currently, several manufacturers provide endoscopic capsules with more or less similar technological features 4 . Although there is engaging and continuous academic and industry-fueled R&D, promising furtherment of CE technology 4 5 , the current status of clinical CE remains that of by and large an imaging modality.…”

mentioning

confidence: 99%

“…Currently, several manufacturers provide endoscopic capsules with more or less similar technological features 4 . Although there is engaging and continuous academic and industry-fueled R&D, promising furtherment of CE technology 4 5 , the current status of clinical CE remains that of by and large an imaging modality. Clinical relevance of CE images is cornerstone in the decision-making process for medical management.…”

mentioning

confidence: 99%

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Scoring systems in clinical small-bowel capsule endoscopy: all you need to know!

et al. 2021

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Capsule endoscopy (CE) emerged out of the pressing clinical need to image the small bowel (SB) in cases of midgut bleeding and provide an overall comfortable and reliable gastrointestinal (GI) diagnosis 1. Since its wider adoption in clinical practice, significant progress has been made in several areas including software development, hardware features and clinical indications, while innovative applications of CE never cease to appear 2 3. Currently, several manufacturers provide endoscopic capsules with more or less similar technological features 4. Although there is engaging and continuous academic and industry-fueled R&D, promising furtherment of CE technology 4 5, the current status of clinical CE remains that of by and large an imaging modality. Clinical relevance of CE images is cornerstone in the decision-making process for medical management. In one of the larger to date SB CE studies, 4,206 abnormal images were detected in 3,280 patients 6. Thus, CE leads to the identification of a large amount of potential pathology, some of which are pertinent (or relevant) while some (probably the majority) are not.Soon artificial intelligence (AI) is likely to carry out several roles currently performed by humans; in fact, we are witnessing only the first stages of a transition in the clinical adoption of AI-based solutions in several aspects of gastroenterology including CE 7. Until then though, human-based decision-making profoundly impacts patient care and – although not suggested in the updated European Society of Gastrointestinal Endoscopy (ESGE) European curriculum 8 9 – it should be an integral part of CE training. Frequently, interpretation of CE images by experts or at least experienced readers differs. In a tandem CE reading study, expert review of discordant cases revealed a 50 % (13/25 discordant results) error rate by experienced readers, corresponding (in 5/13 cases) to ‘over-classification’ of an irrelevant abnormality 10. Another comparative study showed an ‘over-classification’ of such irrelevant abnormalities in ~10 % of CE readings 11. One thing which has been for a while on the table – in relation to optimizing and/or standardizing CE reporting and subsequent decision-making – is the need for reproducible scoring systems and for a reliable common language among clinicians responsible for further patient’s management.Over the years, several of these scoring systems were developed while others appear in the wake of software and hardware improvements aiming to replace and/or complement their predecessors. This review presents a comprehensive account of the currently available classification/scoring systems in clinical CE spanning from predicting the bleeding potential of identified SB lesions (with emphasis on vascular lesions), and the individual rebleeding risk; scoring systems for the prediction of SB lesions in patients with obscure gastrointestinal bleeding (OGlB), having the potential to improve patient selection and rationalize the use of enteroscopy, with better allocation of resources, optimized diagnostic workflow and tailored treatment. This review also includes scores for reporting the inflammatory burden, the cleansing level that underscores confidence in CE reporting and the mass or bulge question in CE. Essentially, the aim is to become a main text for reference when scoring is required and facilitate the inclusion of -through readiness of access- one of the other in the final report.

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“…3 Estimated glomerular filtration rate < 60 mg/dL/1.73 m 2 . 4 Aspirin, ticagrelor, prasugrel, clopidogrel or fixed-dose combination aspirin-dipyridamole. ▶ Fig.…”

Section: Older Age (≥ 75 Years)mentioning

confidence: 99%

“…2 Saurin classification (only the higher rating accountable) 3. Bleeding causing a fall in hemoglobin level of ≥ 2 g/dL or leading to transfusion of ≥ 2 units of red blood cells 4. …”

mentioning

confidence: 99%

mentioning

confidence: 99%

mentioning

confidence: 99%

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Scoring systems in clinical small-bowel capsule endoscopy: all you need to know!

et al. 2021

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“…We report the case of a patient with episodes of obscure intestinal hemorrhage. Being uncommon, with nonspecific symptoms, SINETs cause diagnostic pitfalls, but images by capsule endoscopy (CE) and enteroscopy allow early diagnosis (Kim et al, 2020;Perez-Cuadrado-Robles et al, 2020;Rondonotti et al, 2020;Vasilakakis et al, 2020;Yoo et al, 2020). Intestinal bleeding of unknown origin is a common symptom of adenocarcinoma and gastrointestinal stromal tumors (GISTs), which may propitiate diagnostic challenges or misdiagnosis with NETs (Yoo et al, 2020).…”

Section: Introductionmentioning

confidence: 99%

Ileal neuroendocrine tumor: diagnosis by endoscopic capsule

Santos

Gonçalves

Grigolli

et al. 2021

ARS med

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The diagnosis of neuroendocrine tumors of the small intestine is usually challenging. They are infrequent, and the clinical course is insidious with nonspecific manifestations. Routine endoscopic and abdominal imaging studies are more often unremarkable. Therefore, distant metastases are frequently detected at the time of diagnosis. The tumor markers chromogranin A, synaptophysin, and neuron-specific enolase, and capsule endoscopy, and device-assisted enteroscopy are useful resources to establish a diagnosis. The aim was to present a case of neuroendocrine tumor of small intestine diagnosed with base in findings of the capsule endoscopy and further open surgery.

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Ingestible light source for intragastric antibacterial phototherapy: a device safety study on a minipig model

Orsini

Busechian

Faraoni

et al. 2022

Photochem Photobiol Sci

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Helicobacter pylori gastric infections are among the most diffused worldwide, suffering from a rising rate of antibiotic resistance. In this context, some of the authors have previously designed an ingestible device in the form of a luminous capsule to perform antibacterial photodynamic inactivation in the stomach. In this study, the light-emitting capsules were tested to verify the safety of use prior to perform clinical efficacy studies. First, laboratory tests measured the capsule temperature while in function and verified its chemical resistance in conditions mimicking the gastric and gut environments. Second, safety tests in a healthy minipig model were designed and completed, to verify both the capsule integrity and the absence of side effects, associated with its illumination and transit throughout the gastrointestinal tract. To this aim, a capsule administration protocol was defined considering a total of 6 animals with n = 2 treated with 8 capsules, n = 2 treated with 16 capsules and n = 2 controls with no capsule administration. Endoscopies were performed in sedated conditions before–after every capsule administration. Biopsies were taken from the corpus and antrum regions, while the gastric cavity temperature was monitored during illumination. The bench tests confirmed a very good chemical resistance and a moderate (about 3 °C) heating of the capsules. The animal trials showed no significant effects on the gastric wall tissues, both visually and histologically, accompanied with overall good animal tolerance to the treatment. The integrity of the administered capsules was verified as well. These encouraging results pose the basis for the definition of successive trials at the clinical level. Graphical abstract

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The future of capsule endoscopy in clinical practice: from diagnostic to therapeutic experimental prototype capsules

Cited by 12 publications

References 59 publications

Scoring systems in clinical small-bowel capsule endoscopy: all you need to know!

Scoring systems in clinical small-bowel capsule endoscopy: all you need to know!

Ileal neuroendocrine tumor: diagnosis by endoscopic capsule

Ingestible light source for intragastric antibacterial phototherapy: a device safety study on a minipig model

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