Artificial intelligence and capsule endoscopy: automatic detection of enteric protruding lesions using a convolutional neural network

Background and aims: capsule endoscopy (CE) revolutionized the study of the small intestine. Nevertheless, reviewing CE images is time-consuming and prone to error. Artificial intelligence algorithms, particularly convolutional neural networks (CNN), are expected to overcome these drawbacks. Protruding lesions of the small intestine exhibit enormous morphological diversity in CE images. This study aimed to develop a CNN-based algorithm for the automatic detection small bowel protruding lesions. Methods: a CNN was developed using a pool of CE images containing protruding lesions or normal mucosa from 1,229 patients. A training dataset was used for the development of the model. The performance of the network was evaluated using an independent dataset, by calculating its sensitivity, specificity, accuracy, positive and negative predictive values. Results: a total of 18,625 CE images (2,830 showing protruding lesions and 15,795 normal mucosa) were included. Training and validation datasets were built with an 80 %/20 % distribution, respectively. After optimizing the architecture of the network, our model automatically detected small-bowel protruding lesions with an accuracy of 92.5 %. CNN had a sensitivity and specificity of 96.8 % and 96.5 %, respectively. The CNN analyzed the validation dataset in 53 seconds, at a rate of approximately 70 frames per second. Conclusions: we developed an accurate CNN for the automatic detection of enteric protruding lesions with a wide range of morphologies. The development of these tools may enhance the diagnostic efficiency of CE (AU)

Ileal Intussusception in an Adult Caused by a Locally Invasive Inflammatory Fibroid Polyp: A Case Report / Invaginación ileal en un adulto secundaria a un pólipo fibroide inflamatorio localmente invasivo: Reporte de un caso

Inflammatory fibroid polyps (IFPs) are rare mesenchymal neoplasms affecting the gastrointestinal tract which are considered benign and noninvasive. We present a case of an invasive IFP in a 46-year-old woman who presented with signs of intestinal obstruction due to ileal intussusception. A segment of the small intestine was resected and subsequently intestinal continuity was restored. A polypoid lesion was found obstructing the lumen. Histopathology revealed a mesenchymal proliferation of spindle and stellate cells, without cytological atypia, arranged in a fibromyxoid stroma. The tumor cells were located in the submucosa but also infiltrated the muscularis propria and the subserosa and were CD34 positive. The molecular study by PCR showed mutation in exon 12 of the PDGFRA gene. IFP is considered a true neoplasm and can also be considered as a potentially invasive lesion

Los pólipos fibroides inflamatorios (PFIs) son considerados como neoplasias mesenquimales inusuales que afectan al tracto gastrointestinal. Son consideradas benignas y generalmente no invasivas. Presentamos un caso de PFI invasivo en una mujer de 46 años que evidenció signos de obstrucción intestinal por invaginación ileal. Se realizó resección de un segmento de intestino delgado y posterior desinvaginación manual del segmento resecado, observándose una lesión polipoide que obstruía la luz. Histológicamente, la lesión estaba constituida por una proliferación mesenquimal de células fusiformes y estrelladas sin atipia citológica, dispuestas en un estroma fibromixoide. Se encontraba localizada en la submucosa, aunque también infiltraba la capa muscular propia y la subserosa. Las células de la lesión fueron positivas para CD34. El estudio molecular mediante PCR demostró mutación en el exón 12 del gen PDGFRA. Actualmente el PFI es considerada una verdadera neoplasia que excepcionalmente tiene carácter invasivo

¿Estamos ante una revolución tecnológica? Enteroscopio motorizado PowerSpiral (PSE): enteroscopia completa por vía oral / No disponible

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Hyper IgM syndrome type 2 presenting as intestinal lymphoid polyposis without recurrent infection

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Pólipo fibrovascular esofágico gigante: informe de caso y cuestiones diagnósticas-terapéuticas / Giant fibrovascular polyp of the esophagus: a case report and diagnostic-therapeutic issues

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Intestinal pseudopolyps in a patient with Crohn's disease and renal transplant - An unexpected diagnosis / Pseudopólipos intestinales en un paciente trasplantado renal y con enfermedad de Crohn - un diagnóstico inesperado

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An unusual case report of inflammatory fibrous polyps in the upper gastrointestinal tract

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Adenocarcinoma of the anal canal with an exceptional immunohistochemistry in a patient with serrated polyposis syndrome: a diagnostic challenge / Adenocarcinoma de canal anal con inmunohistoquímica excepcional en paciente con síndrome de poliposis serrada: un reto diagnóstico

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Adenoma tubular de íleon como causa de sangrado intestinal bajo en lactante menor / Ileal tubular adenoma as a cause of lower gastrointestinal bleeding in infants

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Duodenectomía total con preservación pancreática como tratamiento de la poliposis duodenal / Total duodenectomy with panceratic preservation for duodenal polyposis

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Underwater hybrid endoscopic submucosal dissection in a rectal polyp: a case report of a new application of "underwater endoscopy"

Background: Hybrid endoscopic submucosal dissection (ESD) has been described as an alternative to traditional ESD. This technique is less time consuming, but the en bloc resection rate is lower than in ESD. Similar to endoscopic mucosal resection, the underwater technique could improve preliminary disadvantages of hybrid ESD. Case report: We attempted a mixture resection technique of Hybrid ESD with underwater endoscopic mucosal resection (EMR). Using this approach, an underwater hybrid ESD was successfully performed without adverse events on a 71 year old woman with a 20 mm adenoma. The histologic analysis identified a tubulovillious adenoma with high grade dysplasia and tumor free margins. Discussion: Underwater hybrid ESD could be an alternative to ESD. Moreover the modification of the "underwater method" provides a suitable way to overcome the technical drawbacks of the hybrid ESD

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Polipectomía transanal asistida por robot: ¿tiene alguna indicación? / Robotic Assisted Transanal Polypectomies: Is There Any Indication?

Objetivos: La polipectomía transanal asistida por robot puede tener ventajas respecto a la cirugía laparoscópica transanal convencional. Evaluamos la seguridad, factibilidad y ventajas potenciales de esta técnica. Métodos: Entre febrero de 2014 y octubre de 2015, se realizaron un total de 9 polipectomías transanales en nuestro centro. Realizamos un estudio retrospectivo de datos recogidos prospectivamente referentes a las características de los pacientes, tumores tratados, resultados perioperatorios, informe anatomopatológico y morbimortalidad. Resultados: Fueron tratados 5 hombres y 4 mujeres mediante polipectomía robótica transanal. Las lesiones se encontraban a una distancia media de 6,2 cm respecto al margen anal. La superficie media de las lesiones fue de 15,8 cm2. Todos los procedimientos fueron realizados en posición de litotomía, independientemente de la localización de la lesión. Se realizó cierre del defecto en todos los casos. El sangrado intraoperatorio medio fue de 39,8 mL. El tiempo quirúrgico medio fue de 71,9 min. No se objetivaron complicaciones graves postoperatorias ni reingresos y la estancia mediana fue de 2,5 días. Conclusiones: La polipectomía transanal asistida por robot es útil para tratar lesiones rectales complejas o voluminosas. Nuestra plataforma de acceso transanal permitió un amplio rango de movimientos con los pacientes en litotomía (AU)

Objectives: Robotic assisted transanal polipectomy may have advantages compared with the conventional transanal minimally invasive surgery technique. We evaluate the safety, feasibility and advantages of this technique. Methods: Between February 2014 and October 2015, 9 patients underwent robotic transanal polypectomy. We performed a retrospective study in which we analyse prospectively collected data regarding patient and tumor characteristics, perioperative outcomes, pathological report, morbidity and mortality. Results: A total of 5 male and 4 female patients underwent robotic TAMIS. Lesions were 6,22 cm from the anal verge. Mean size was 15,8 cm2. All procedures were performed in the lithotomy position. Closure of the defect was performed in all cases. Mean blood loss was 39,8 ml. Mean operative time was 71,9 min. No severe postoperative complications or readmissions occured. Median hospital stay was 2,5 days. Conclusions: Robotic TAMIS is useful to treat complex rectal lesions. Our transanal platform allowed a wider range of movements of the robotic arms and to perform all procedures in the lithotomy position (AU)

Cirrosis biliar secundaria a obstrucción de la vía biliar por pólipos hamartomatosos en una paciente con síndrome de Peutz-Jeghers. Reporte de Caso / Biliary cirrhosis secondary to bile duct obstruction by hamartomatous polyps in a patient with Peutz-Jeghers syndrome. Case Report

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