Capsule endoscopy (CE) has been used in clinical examination among people of various ages, while few studies exclusively focused on the young. We aimed to explore its clinical features in young adults and those with obscure gastrointestinal bleeding (OGIB).

A total of 479 young adults aged 18–44 years were analyzed, with median age of 33 years. Primary positive findings of patients were classified into four kinds of lesions, and potential risk of bleeding among patients with OGIB was assessed based on Saurin classification (P0‐2 lesions).

The overall completion rate and diagnostic yield of CE among young adults were 89.77 and 77.04%, respectively. Significant differences were found among overall completion rate/diagnostic yield and inpatient status/CE brand. Positive diagnostic yield among 157 patients with OGIB was 51.59% (P1‐2 lesions), and the significant risk of bleeding was 37.04% (P2 lesions). Among patients with OGIB in which 134 patients with a total of 216 lesions, ulceration was the commonest P2 lesions, followed by angioectasia and telangiectasia. Inpatient rate, completion rate, and diagnostic yield were higher among patients with overt OGIB, and disease categories of overt OGIB were different compared with occult OGIB.

CE is an optimal tool for discovering lesions in young adults and could play a role in evaluating the bleeding risk of young adults with OGIB.

Background and Objectives: Capsule endoscopy (CE) for bowel cleanliness evaluation primarily depends on subjective methods. To objectively evaluate bowel cleanliness, we focused on artificial intelligence (AI)-based assessments. We aimed to generate a large segmentation dataset from CE images and verify its quality using a convolutional neural network (CNN)-based algorithm. Materials and Methods: Images were extracted and divided into 10 stages according to the clean regions in a CE video. Each image was classified into three classes (clean, dark, and floats/bubbles) or two classes (clean and non-clean). Using this semantic segmentation dataset, a CNN training was performed with 169 videos, and a clean region (visualization scale (VS)) formula was developed. Then, measuring mean intersection over union (mIoU), Dice index, and clean mucosal predictions were performed. The VS performance was tested using 10 videos. Results: A total of 10,033 frames of the semantic segmentation dataset were constructed from 179 patients. The 3-class and 2-class semantic segmentation’s testing performance was 0.7716 mIoU (range: 0.7031–0.8071), 0.8627 Dice index (range: 0.7846–0.8891), and 0.8927 mIoU (range: 0.8562–0.9330), 0.9457 Dice index (range: 0.9225–0.9654), respectively. In addition, the 3-class and 2-class clean mucosal prediction accuracy was 94.4% and 95.7%, respectively. The VS prediction performance for both 3-class and 2-class segmentation was almost identical to the ground truth. Conclusions: We established a semantic segmentation dataset spanning 10 stages uniformly from 179 patients. The prediction accuracy for clean mucosa was significantly high (above 94%). Our VS equation can approximately measure the region of clean mucosa. These results confirmed our dataset to be ideal for an accurate and quantitative assessment of AI-based bowel cleanliness.

• Capsule endoscopy
• Gastrointestinal bleeding
• Preparation
• Scoring.
• Small bowel

• Capsule endoscopy
• Enteroscopy
• Small bowel

Non-variceal gastrointestinal bleeding (GIB) is a significant cause of mortality and morbidity worldwide which is encountered in the ambulatory and hospital settings. Hemorrhage form the gastrointestinal (GI) tract is categorized as upper GIB, small bowel bleeding (also formerly referred to as obscure GIB) or lower GIB. Although the etiologies of GIB are variable, a strong, consistent risk factor is use of non-steroidal anti-inflammatory drugs. Advances in the endoscopic diagnosis and treatment of GIB have led to improved outcomes. We present an updated review of the current practices regarding the diagnosis and management of non-variceal GIB, and possible future directions.

• endoscopy
• gastrointestinal bleeding
• guidelines
• hemostasis
• non-steroidal anti-inflammatory drugs
• risk factors

Small bowel vascular lesions, including angioectasia (AE), Dieulafoy’s lesion (DL) and arteriovenous malformation (AVM), are the most common causes of obscure gastrointestinal bleeding. Since AE are considered to be venous lesions, they usually manifest as a chronic, well-compensated condition. Subsequent to video capsule endoscopy, deep enteroscopy can be applied to control active bleeding or to improve anemia necessitating blood transfusion. Despite the initial treatment efficacy of argon plasma coagulation (APC), many patients experience re-bleeding, probably because of recurrent or missed AEs. Pharmacological treatments can be considered for patients who have not responded well to other types of treatment or in whom endoscopy is contraindicated. Meanwhile, a conservative approach with iron supplementation remains an option for patients with mild anemia. DL and AVM are considered to be arterial lesions; therefore, these lesions frequently cause acute life-threatening hemorrhage. Mechanical hemostasis using endoclips is recommended to treat DLs, considering the high re-bleeding rate after primary APC cauterization. Meanwhile, most small bowel AVMs are large and susceptible to re-bleeding therefore, they usually require surgical resection. To achieve optimal diagnostic and therapeutic approaches for each type of small bowel lesion, the differences in their epidemiology, pathology and clinical presentation must be understood.

• Angiodysplasia
• Angioectasia
• Dieulafoy’s lesion
• Arteriovenous malformation
• Obscure gastrointestinal bleeding
• Video capsule endoscopy
• Deep enteroscopy
• Argon plasm coagulation

• Anemia/diagnosis
• Anemia/etiology
• Anemia/therapy
• Angiodysplasia/complications
• Angiodysplasia/diagnosis
• Angiodysplasia/therapy
• Argon Plasma Coagulation
• Capsule Endoscopy
• Gastrointestinal Hemorrhage/diagnosis
• Gastrointestinal Hemorrhage/etiology
• Gastrointestinal Hemorrhage/therapy
• Hemostatic Techniques
• Humans
• Intestine, Small/blood supply
• Intestine, Small/diagnostic imaging
• Iron/administration & dosage
• Treatment Outcome

• Capsule endoscopy
• Crohn’s disease
• angioectasia
• iron deficiency anaemia
• malignancy
• small bowel bleeding

Recurrent obscure gastrointestinal bleeding amongst patients with chronic kidney disease is a challenging problem gastroenterologists are facing and is associated with an extensive diagnostic workup, limited therapeutic options, and high healthcare costs. Small-bowel angiodysplasia is the most common etiology of obscure and recurrent gastrointestinal bleeding in the general population. Chronic kidney disease is associated with a higher risk of gastrointestinal bleeding and of developing angiodysplasia compared with the general population. As a result, recurrent bleeding in this subgroup of patients is more prevalent and is associated with an increased number of endoscopic and radiographic procedures with uncertain benefit. Alternative medical therapies can reduce re-bleeding; however, more studies are needed to confirm their efficacy in this subgroup of patients.

• Obscure gastrointestinal bleeding
• angiodysplasia
• arteriovenous malformations
• chronic kidney disease
• small-bowel bleeding

• Capsule endoscopy
• Predictive factor
• Score

• Diffuse angiodysplasias
• Gastrointestinal cancer
• Iron-deficiency anemia
• Occult blood loss
• Quick diagnosis units

• Aged
• Aged, 80 and over
• Anemia, Iron-Deficiency/epidemiology
• Anemia, Iron-Deficiency/etiology
• Angiodysplasia/complications
• Angiodysplasia/diagnosis
• Endoscopy, Digestive System
• Female
• Follow-Up Studies
• Gastrointestinal Diseases/complications
• Gastrointestinal Diseases/diagnosis
• Gastrointestinal Hemorrhage/etiology
• Gastrointestinal Tract/pathology
• Hemoglobins/analysis
• Humans
• Male
• Middle Aged
• Occult Blood
• Prospective Studies
• Spain

• Anti-angiogenic therapy
• Capsule endoscopy
• Deep enteroscopy
• Gastrointestinal angiodysplasia
• Rebleeding
• Vascular endothelial growth factor

• CT angiogram
• CT enterography
• Small bowel bleeding
• capsule endoscopy
• deep enteroscopy
• double balloon enteroscopy
• intraoperative enteroscopy
• mesenteric angiography
• multiphase CT scan
• obscure gastrointestinal bleeding
• single balloon enteroscopy

AIM: To investigate long-term re-bleeding events after a negative capsule endoscopy in patients with obscure gastrointestinal bleeding (OGIB) and the risk factors associated with the procedure.

METHODS: Patients referred to Hospital Egas Moniz (Lisboa, Portugal) between January 2006 and October 2012 with OGIB and a negative capsule endoscopy were retrospectively analyzed. The following study variables were included: demographic data, comorbidities, bleeding-related drug use, hemoglobin level, indication for capsule endoscopy, post procedure details, work-up and follow-up. Re-bleeding rates and associated factors were assessed using a Cox proportional hazard analysis. The Kaplan-Meier method was used to estimate the cumulative incidence of re-bleeding at 1, 3 and 5 years, and the differences between factors were evaluated.

RESULTS: The study population consisted of 640 patients referred for OGIB investigation. Wireless capsule endoscopy was deemed negative in 113 patients (17.7%). A total of 64.6% of the population was female, and the median age was 69 years. The median follow-up was forty-eight months (interquartile range 24-60). Re-bleeding occurred in 27.4% of the cases. The median time to re-bleeding was fifteen months (interquartile range 2-33). In 22.6% (n = 7) of the population, small-bowel angiodysplasia was identified as the culprit lesion. A univariate analysis showed that age > 65 years old, chronic kidney disease, aortic stenosis, anticoagulant use and overt OGIB were risk factors for re-bleeding; however, on a multivariate analysis, there were no risk factors for re-bleeding. The cumulative risk of re-bleeding at 1, 3 and 5 years of follow-up was 12.9%, 25.6% and 31.5%, respectively. Patients who presented with overt OGIB tended to re-bleed sooner (median time for re-bleeding: 8.5 mo vs 22 mo).

CONCLUSION: Patients with OGIB despite a negative capsule endoscopy have a significant re-bleeding risk; therefore, these patients require an extended follow-up strategy.

• Capsule endoscopy
• Gastrointestinal hemorrhage
• Anemia
• Angiodysplasia
• Risk factors

• capsule endoscopy
• double-balloon enteroscopy
• obscure gastrointestinal bleeding
• predictive facor
• re-bleeding

The small intestine is an uncommon site of gastro-intestinal (GI) bleeding; however it is the commonest cause of obscure GI bleeding. It may require multiple blood transfusions, diagnostic procedures and repeated hospitalizations. Angiodysplasia is the commonest cause of obscure GI bleeding, particularly in the elderly. Inflammatory lesions and tumours are the usual causes of small intestinal bleeding in younger patients. Capsule endoscopy and deep enteroscopy have improved our ability to investigate small bowel bleeds. Deep enteroscopy has also an added advantage of therapeutic potential. Computed tomography is helpful in identifying extra-intestinal lesions. In cases of difficult diagnosis, surgery and intra-operative enteroscopy can help with diagnosis and management. The treatment is dependent upon the aetiology of the bleed. An overt bleed requires aggressive resuscitation and immediate localisation of the lesion for institution of appropriate therapy. Small bowel bleeding can be managed by conservative, radiological, pharmacological, endoscopic and surgical methods, depending upon indications, expertise and availability. Some patients, especially those with multiple vascular lesions, can re-bleed even after appropriate treatment and pose difficult challenge to the treating physician.

• aetiology
• diagnostic approach
• management
• small intestine bleed

• Angiography
• Endoscopy
• Enteroscopy
• Lower gastrointestinal bleeding
• Surgery
• Video capsule endoscopy

• Angiography
• Embolization, Therapeutic/methods
• Endoscopy, Gastrointestinal/methods
• France/epidemiology
• Gastrointestinal Hemorrhage/diagnosis
• Gastrointestinal Hemorrhage/epidemiology
• Gastrointestinal Hemorrhage/etiology
• Gastrointestinal Hemorrhage/therapy
• Hemostasis, Endoscopic/methods
• Humans
• Magnetic Resonance Imaging
• North America/epidemiology
• Tomography, X-Ray Computed

Background/Aim. Usefulness of capsule endoscopy (CE) for diagnosing small-bowel lesions in patients with obscure gastrointestinal bleeding (OGIB) has been reported. Most reports have addressed the clinical features of overt OGIB, with few addressing occult OGIB. We aimed to clarify whether occult OGIB is a definite indication for CE. Methods. We retrospectively compared the cases of 102 patients with occult OGIB and 325 patients with overt OGIB, all having undergone CE. The diagnostic yield of CE and identification of various lesion types were determined in cases of occult OGIB versus overt OGIB. Results. There was no significant difference in diagnostic yield between occult and overt OGIB. The small-bowel lesions in cases of occult OGIB were diagnosed as ulcer/erosive lesions (n = 18, 18%), vascular lesions (n = 11, 11%), and tumors (n = 4, 3%), and those in cases of overt OGIB were diagnosed as ulcer/erosive lesions (n = 51, 16%), vascular lesions (n = 31, 10%), and tumors (n = 20, 6%). Conclusion. CE detection rates and CE identification of various small-bowel diseases do not differ between patients with occult versus overt OGIB. CE should be actively performed for patients with either occult or overt OGIB.

• 360° panoramic side view
• CapsoCam SV1 capsule
• small bowel endoscopy

• Crohn’s disease
• obscure gastrointestinal bleeding
• patency capsule
• small bowel tumors
• small bowel video capsule endoscopy

Video capsule endoscopy has revolutionized our ability to visualize the entire small bowel mucosa. This modality is established as a valuable tool for the diagnosis of obscure gastrointestinal bleeding, Crohn’s disease, small bowel tumors, and other conditions involving the small bowel mucosa. This review includes an overview of the current and potential future clinical applications of small bowel video endoscopy.

• Crohn’s disease
• obscure gastrointestinal bleeding
• patency capsule
• small bowel tumors
• small bowel video capsule endoscopy

• gastric emptying scintigraphy
• gastroparesis
• wireless motility capsule

• Endoscopic surgery

AIM: To explore the feasibility of dual camera capsule (DCC) small-bowel (SB) imaging and to examine if two cameras complement each other to detect more SB lesions.

METHODS: Forty-one eligible, consecutive patients underwent DCC SB imaging. Two experienced investigators examined the videos and compared the total number of detected lesions to the number of lesions detected by each camera separately. Examination tolerability was assessed using a questionnaire.

RESULTS: One patient was excluded. DCC cameras detected 68 positive findings (POS) in 20 (50%) cases. Fifty of them were detected by the “yellow” camera, 48 by the “green” and 28 by both cameras; 44% (n = 22) of the “yellow” camera’s POS were not detected by the “green” camera and 42% (n = 20) of the “green” camera’s POS were not detected by the “yellow” camera. In two cases, only one camera detected significant findings. All participants had 216 findings of unknown significance (FUS). The “yellow”, “green” and both cameras detected 171, 161, and 116 FUS, respectively; 32% (n = 55) of the “yellow” camera’s FUS were not detected by the “green” camera and 28% (n = 45) of the “green” camera’s FUS were not detected by the “yellow” camera. There were no complications related to the examination, and 97.6% of the patients would repeat the examination, if necessary.

CONCLUSION: DCC SB examination is feasible and well tolerated. The two cameras complement each other to detect more SB lesions.

• Small-bowel capsule endoscopy
• Dual camera capsule endoscope
• Feasibility
• Lesion detection
• Diagnostic yield

• Capsule Endoscopes/adverse effects
• Capsule Endoscopes/history
• Capsule Endoscopes/trends
• Celiac Disease/diagnosis
• Colon/pathology
• Crohn Disease/diagnosis
• Endoscopes, Gastrointestinal
• Equipment Design
• Esophagus/pathology
• Gastrointestinal Hemorrhage/diagnosis
• History, 21st Century
• Humans
• Intestinal Diseases/diagnosis
• Intestinal Diseases/pathology
• Intestinal Diseases/therapy
• Intestinal Neoplasms/diagnosis
• Intestine, Small/pathology
• Predictive Value of Tests

• Capsule endoscopy
• Diagnosis
• Feasibility study
• Gastrointestinal hemorrhage

AIM: To retrospectively analyze the fields of application, diagnostic yields and findings of OMOM capsule endoscopy in Chinese patients.

METHODS: A database including 2400 Chinese patients who received OMOM capsule endoscopy in 27 endoscopy centers in China was retrieved from the Jianshan Science and Technology Ltd. OMOM capsule endoscopy database. The patient’s age, gender, fields of application, the potentially relevant findings, pyloric transit time (PTT), small bowel transit time (SBTT), and complete small-bowel examination rate (CSER) were recorded and analyzed.

RESULTS: Two thousand four hundred patients aged 9-91 years (mean, 49 years), of whom 1510 were males (62.9%), underwent 2400 OMOM capsule endoscopy procedures. One thousand two hundred and thirty two (51.3%) were referred with obscure gastrointestinal bleeding (OGIB), 642 (26.8%) with abdominal pain, and 223 (9.3%) with chronic diarrhea. The overall diagnostic yield was 47.7% (1144/2400). The diagnostic yield of OMOM capsule endoscopy in OGIB subgroup was much higher than in the non-OGIB subgroup (62.4% vs 32.1%, P < 0.001). The most common findings of the small bowel in Chinese patients with OGIB were arteriovenous malformation (28.1%) and tumors (18.9%). There was no significant difference in the diagnostic yield between the male and female patients with OGIB. However, the diagnostic yield in patients aged more than 60 was higher than in patients aged less than 60 (69.8% vs 58.9%, P < 0.001). The median PTT was 41 min (range: 1-544 min) and the mean SBTT was 247.2 ± 88.9 min. The overall CSER was 86.8%.

CONCLUSION: The OMOM capsule endoscopy is a valuable tool for small bowel evaluation with good overall diagnostic yield and CSER.

• OMOM capsule endoscopy
• Obscure gastrointestinal bleeding
• Small bowel

AIM: To report the incidence of non-small-bowel bleeding pathologies encountered during double-balloon enteroscopy (DBE) procedures and to analyse their significance.

METHODS: A retrospective study of a prospective DBE database conducted in a tertiary-referral center was conducted. A total of 179 patients with obscure gastrointestinal bleeding (OGIB) referred for DBE from June 2004 to November 2008 were analysed looking for the incidence of non-small-bowel lesions (NSBLs; all and newly diagnosed) encountered during DBE.

RESULTS: There were 228 (150 antegrade and 78 retrograde) DBE procedures performed in 179 patients. The mean number of DBE procedures was 1.27 per patient. The mean age (SD) of the patients was 62 ± 16 years old. There were 94 females (52.5%). The positive yield for a bleeding lesion was 65.9%. Of the 179 patients, 44 (24.6%) had NSBLs (19 of them had dual pathology with small-bowel lesions and NSBLs); 27 (15.1%) had lesions not detected by previous endoscopies. The most common type of missed lesions were vascular lesions.

CONCLUSION: A significant proportion of patients (24.6%) had lesions within reach of conventional endoscopy. Careful repeat examination with gastroscopy and colonoscopy might be required.

• Bleeding
• Obscure gastrointestinal bleeding
• Endoscopy
• Double-balloon enteroscopy

• Adolescent
• Adult
• Aged
• Aged, 80 and over
• Barium Sulfate
• Capsule Endoscopy
• Child
• Contrast Media
• Female
• Fluoroscopy
• Humans
• Intestinal Diseases/diagnosis
• Intestinal Diseases/diagnostic imaging
• Intestine, Small
• Male
• Middle Aged
• Retrospective Studies
• Tomography, X-Ray Computed