Drug-induced entero-colitis due to interleukin-17 inhibitor use; capsule endoscopic findings and pathological characteristics: A case report.

BACKGROUND: Interleukin-17 (IL-17) inhibitors are known to cause exacerbation or new onset of inflammatory bowel disease upon administration. However, few reports have described characteristic endoscopic and histopathologic findings, and no small intestinal lesions have been reported so far. CASE SUMMARY: A woman in her 60s with psoriasis was administered ixekizumab (IXE), an anti-IL-17A antibody, for the treatment of psoriasis. Twenty months after commencing treatment, the patient visited our hospital because of persistent diarrhea. Blood tests performed at the time of the visit revealed severe inflammation, and colonoscopy revealed multiple round ulcers throughout the colon. A tissue biopsy of the ulcer revealed infiltration of inflammatory cells and granuloma-like findings in the submucosal layer. Capsule endoscopy revealed multiple jejunal erosions. After the withdrawal of IXE, the symptoms gradually improved, and ulcer reduction and scarring of the colon were endoscopically confirmed. CONCLUSION: To the best of our knowledge, 17 reports have documented IL-17 inhibitor-induced entero-colitis with endoscopic images, endoscopic findings, and pathological characteristics, including the present case. Nine of these cases showed diffuse loss of vascular pattern, coarse mucosa/ulcer formation in the left colon, and endoscopic findings similar to those of ulcerative colitis. In the remaining eight cases, discontinuous erosions and ulcerations from the terminal ileum to the rectum were seen, with endoscopic findings similar to those of Crohn's disease. In this case, the findings were confirmed by capsule endoscopy, which has not been previously reported.

Magnetic controlled capsule endoscope (MCCE)'s diagnostic performance for H. pylori infection status based on the Kyoto classification of gastritis.

BACKGROUND: Previous studies have shown that the Kyoto classification of gastritis can accurately predict H. pylori infection status on conventional gastroscopy. The aim of this study was to test whether the Kyoto classification of gastritis applies well to magnetic controlled capsule endoscopy (MCCE). METHODS: We consecutively recruited 227 participants who underwent both MCCE and urea breath tests (UBTs). Two physicians who were blinded to the UBT results independently made the diagnosis of H. pylori infection status according to 10 findings listed in the Kyoto classification of gastritis after reviewing MCCE images. We also developed 2 predictive models to assess H. pylori infection status by combining these 10 findings. RESULTS: The MCCE's overall diagnostic accuracy for H. pylori infection status was 80.2%. The sensitivity, specificity and diagnostic odds ratio (DOR) for current infection were 89.4%, 90.1% and 77.1, respectively. Major specific findings were mucosal swelling and spotty redness for current infection, regular arrangement of collecting venules (RAC), streak redness, fundic gland polyp (FGP) for noninfection, and map-like redness for past-infection. In the two prediction models, the area under the curve (AUC) values for predicting noninfection and current infection were 84.7 and 84.9, respectively. CONCLUSIONS: The Kyoto classification of gastritis applied well to MCCE. H. pylori infection status could be accurately assessed on MCCE according to the Kyoto classification of gastritis.

Image Aided Recognition of Wireless Capsule Endoscope Based on the Neural Network.

Wireless capsule endoscopy is an important method for diagnosing small bowel diseases, but it will collect thousands of endoscopy images that need to be diagnosed. The analysis of these images requires a huge workload and may cause manual reading errors. This article attempts to use neural networks instead of artificial endoscopic image analysis to assist doctors in diagnosing and treating endoscopic images. First, in image preprocessing, the image is converted from RGB color mode to lab color mode, texture features are extracted for network training, and finally, the accuracy of the algorithm is verified. After inputting the retained endoscopic image verification set into the neural network algorithm, the conclusion is that the accuracy of the neural network model constructed in this study is 97.69%, which can effectively distinguish normal, benign lesions, and malignant tumors. Experimental studies have proved that the neural network algorithm can effectively assist the endoscopist's diagnosis and improve the diagnosis efficiency. This research hopes to provide a reference for the application of neural network algorithms in the field of endoscopic images.

Robot-assisted magnetic capsule endoscopy; navigating colorectal inclinations.

Purpose: To investigate the interaction of a robot assisted magnetically driven wireless capsule endoscope (WCE) with colonic tissue, as it traverses the colorectal bends in the dorsal and ventral directions, relying only on the feedback from a 3D accelerometer. We also investigate the impact of shell geometry and water insufflation on WCE locomotion.Methods: A 3D printed incline phantom, lined with porcine colon, was used as the experimental platform, for controlled and repeatable results. The tilt angle of WCE was controlled to observe its influence on WCE locomotion. The phantom was placed underwater to observe the effects of water insufflation. The experiments were repeated using the two capsule shell geometries to observe the effect of shell geometry on WCE locomotion.Results: Friction between WCE and intestinal tissue increased when the tilt angle of the WCE was lower than the angle of the incline of the phantom. Increasing the WCE tilt angle to match the angle of the incline reduced this friction. Water insufflation and elliptical capsule shell geometry reduced the friction further.Conclusion: Tilting of the WCE equal to, or more than the angle of the incline improved the WCE locomotion. WCE locomotion was also improved by using elliptical capsule shell geometry and water insufflation.Abbreviations: CRC: colorectal cancer; GI: gastrointestinal; MRI: magnetic resonance imaging; WCE: wireless capsule endoscope.

Safety and efficacy of the endoscopic delivery of capsule endoscopes in adult and pediatric patients: Multicenter Japanese study (AdvanCE-J study).

BACKGROUND AND AIM: We retrospectively determined the safety and efficacy of the endoscopic delivery (ED) of capsule endoscopes. METHODS: We enrolled 10,156 patients who underwent small bowel capsule endoscopy (SBCE), 3182 who underwent patency capsule (PC), and 1367 who underwent colon capsule endoscopy (CCE), at 11 gastroenterological and nine pediatric centers. RESULTS: Small bowel capsule endoscopies, PCs, and CCEs were endoscopically delivered to 546 (5.4%), 214 (6.7%), and 14 (1.0%) patients, respectively. Only mild complications occurred for 21.6% (167/774), including uneventful mucosal damage, bleeding, and abdominal pain. Successful ED of SBCE to the duodenum or jejunum occurred in 91.8% and 90.7% of patients aged <16 years and ≥16 years, respectively (P = 0.6661), but the total enteroscopy rate was higher in the first group (91.7%) than in the second (76.2%, P < 0.0001), for whom impossible ingestion (87.3%) was significantly more common than prolonged lodging in the stomach (64.2%, P = 0.0010). Successful PC and CCE delivery to the duodenum occurred in 84.1% and 28.6%, thereafter the patency confirmation rate and total colonoscopy rate was 100% and 61.5%, respectively. The height, weight, and age cutoff points in predicting spontaneous ingestion were 132 cm, 24.8 kg, and 9 years 2 months, respectively, in patients aged <16 years. Patients aged ≥16 years could not swallow the SBCEs mainly due to dysphagia (75.0%); those who retained it in the esophagus due to cardiac disease (28.6%), etc. and in the stomach due to diabetes mellitus (15.7%), etc. CONCLUSIONS: This large-scale study supports the safety and efficacy of ED in adult and pediatric patients. UMIN000042020.

Small bowel to closest human body surface distance calculation through a custom-made software using CT-based datasets.

Screening of the gastrointestinal tract is imperative for the detection and treatment of physiological and pathological disorders in humans. Ingestible devices (e.g., magnetic capsule endoscopes) represent an alternative to conventional flexible endoscopy for reducing the invasiveness of the procedure and the related patient's discomforts. However, to properly design localization and navigation strategies for capsule endoscopes, the knowledge of anatomical features is paramount. Therefore, authors developed a semi-automatic software for measuring the distance between the small bowel and the closest human external body surface, using CT colonography images. In this study, volumetric datasets of 30 patients were processed by gastrointestinal endoscopists with the dedicated custom-made software and results showed an average distance of 79.29 ± 23.85 mm.

Videolaringoscopia en el abordaje de la vía aérea durante la pandemia de la COVID-19 / Videolaryngoscopy for airway management during the COVID-19 pandemic

Introducción: A finales del año 2019 se reportaron casos de neumonía atípica en Wuhan provocados por un nuevo coronavirus. La intubación endotraqueal puede causar contaminación del personal de salud. Las pautas recientes prefieren la videolaringoscopia porque aumenta las posibilidades de intubación y evita del contacto cercano con el paciente. Objetivos: Describir el abordaje de la vía aérea con videolaringoscopia en pacientes con COVID-19 e identificar las principales complicaciones aparecidas durante la intubación endotraqueal. Métodos: Se realizó un estudio descriptivo, transversal, en el periodo de diciembre de 2020 a febrero de 2021, en el Centro Médico Naval de la Ciudad de México. El universo estuvo conformado por 178 pacientes con COVID-19 que requirieron intubación endotraqueal. Se tomó una muestra de 103 pacientes los cuales fueron atendidos por los médicos cubanos. Resultados: Los pacientes mayores de 60 años representaron el 63,1 por ciento de los casos y el sexo masculino el 65 por ciento El 42,1 por ciento tuvieron un predictor de vía aérea difícil y el 30,1 por ciento, dos o más predictores. Se visualizó completamente la glotis en el 39,8 por ciento de los casos y, parcialmente, en un 57,3 por ciento. La intubación al primer intento se logró en el 73,8 por ciento. Las principales complicaciones encontradas fueron la desaturación (33 por ciento) y la hipotensión arterial (37,9 por ciento). Conclusiones: La videolaringoscopia podría mejorar la visualización de la apertura glótica y la intubación endotraqueal al primer intento. La desaturación y la hipotensión arterial fueron complicaciones que podrían esperarse en los pacientes con la COVID-19 durante este procedimiento(AU)

Introduction: At the end of 2019, cases of atypical pneumonia were reported in Wuhan caused by a new coronavirus. Endotracheal intubation may cause contamination of healthcare personnel. According to recent guidelines, videolaryngoscopy is preferred, because it increases the chances of intubation and avoids close contact with the patient. Objectives: To describe airway management with videolaryngoscopy in patients with COVID-19 and to identify the main complications that appeared during endotracheal intubation. Methods: A descriptive and cross-sectional study was carried out, in the period from December 2020 to February 2021, at the Naval Medical Center in Mexico City. The universe consisted of 178 patients with COVID-19 who required endotracheal intubation. A sample of 103 patients was taken, who were cared for by Cuban doctors. Results: Patients older than 60 years represented 63.1 percent of the cases, while the male sex represented 65 percent. 42.1 percent had one predictor of difficult airway and 30.1 percent had two or more predictors. The glottis was visualized fully in 39.8 percent of cases and partially in 57.3 percent. Intubation on the first attempt was achieved in 73.8 percent. The main complications found were desaturation (33 percent) and arterial hypotension (37.9 percent). Conclusions: Videolaryngoscopy could improve visualization of the glottic opening and endotracheal intubation on the first attempt. Desaturation and hypotension were complications that could be expected in COVID-19 patients during this procedure(AU)

Colon Capsule Endoscopy in the Assessment of Mucosal Healing in Crohn's Disease.

BACKGROUND: Patients with Crohn's disease (CD) undergo frequent endoscopic procedures, with visualization of the gastrointestinal mucosa central to treatment decision-making. Subsequently, a noninvasive alternative to optical colonoscopy (OC) would be welcomed. One such technology is capsule endoscopy, including the PillCam COLON 2 (PCC2), though research validating its use in ileocolonic CD is limited. This study aims to compare PCC2 with ileocolonoscopy (OC) in assessing mucosal CD through use of a standardized scoring system. METHODS: At an Australian tertiary hospital, same-day PCC2 and ileocolonoscopy results of 47 CD patients, with known nonstricturing disease, were prospectively collected and analyzed for correlation and agreement. Deidentified recordings were reported by a single expert gastroenterologist. Mucosal disease was quantified using the Simple Endoscopic Score for Crohn's Disease (SES-CD). The SES-CD results of paired endoscopic modalities were compared in total per bowel segment and per SES-CD variable. RESULTS: Of 47 PCC2 recordings, 68% were complete, fully assessing terminal ileum to rectum, and OC was complete in 89%. Correlation (r) between total SES-CD scores was strongest in the terminal ileum (r = 0.77, P < .001), with the SES-CD variable of "ulcer detection" showing the strongest agreement. The PCC2 (vs OC) identified additional ulcers in the terminal ileum; ascending, transverse, and descending colon; and rectum; scores were 5 (1), 5 (3), 1 (1), 2 (1), and 2 (2), respectively. CONCLUSIONS: The PCC2 shows promise in assessing ileocolonic mucosa, especially in proximal bowel segments, with greater reach of visualization in the small bowel. Given the resource and safety considerations raised by the Coronavirus disease 2019 pandemic, capsule endoscopy has particular significance.This article aims to contribute to the limited body of research surrounding the validity of capsule endoscopy technology in assessing ileocolonic mucosa in Crohn's Disease patients. In doing so, an alternative option for patients enduring frequent endoscopies is given potential.

Population-Based Study of the Clinical Characteristics and Risk Factors of Ischemic Colitis.

BACKGROUND: Ischemic colitis (IC) is a common ischemic disorder of the colon caused by insufficient blood supply to the colonic mucosa. This study aimed to identify the clinical characteristics, comorbidities, and risk factors in patients with IC. METHODS: We performed a retrospective population-based study using electron video-colonoscopy imaging and pathological biopsies from 168 patients diagnosed with IC. A retrospective controlled study was used to analyze differences between a young to middle-aged patient group (78 cases) and an elderly patient group (90 cases) on the basis of clinical characteristics and risk factors. RESULTS: The primary symptoms in the 168 patients with IC were abdominal pain, diarrhea, and hematochezia. White blood cells (WBC), neutrophilic granulocyte percentage (NEUT%), C-reactive protein (CRP), and D-dimer were significantly elevated in elderly patients. The sigmoid colon and descending colon were the most common lesion locations (57.1% and 33.9%, respectively). Hypertension, cerebral infarction, and coronary heart disease were the most common comorbidities in elderly patients, while smoking history was the most common risk factor in young to middle-aged patients. CONCLUSION: The sigmoid colon and descending colon are the most affected locations in IC. Hypertension, diabetes mellitus, and cerebral infarction are the most common risk factors and comorbidities.

Endoluminal Motion Recognition of a Magnetically-Guided Capsule Endoscope Based on Capsule-Tissue Interaction Force.

A magnetically-guided capsule endoscope, embedding flexible force sensors, is designed to measure the capsule-tissue interaction force. The flexible force sensor is composed of eight force-sensitive elements surrounding the internal permanent magnet (IPM). The control of interaction force acting on the intestinal wall can reduce patient's discomfort and maintain the magnetic coupling between the external permanent magnet (EPM) and the IPM during capsule navigation. A flexible force sensor can achieve this control. In particular, by analyzing the signals of the force sensitive elements, we propose a method to recognize the status of the motion of the magnetic capsule, and provide corresponding formulas to evaluate whether the magnetic capsule follows the motion of the external driving magnet. Accuracy of the motion recognition in Ex Vivo tests reached 94% when the EPM was translated along the longitudinal axis. In addition, a method is proposed to realign the EPM and the IPM before the loss of their magnetic coupling. Its translational error, rotational error, and runtime are 7.04 ± 0.71 mm, 3.13 ± 0.47∘, and 11.4 ± 0.39 s, respectively. Finally, a control strategy is proposed to prevent the magnetic capsule endoscope from losing control during the magnetically-guided capsule colonoscopy.

Gastrointestinal endoscopy in children and adults: How do they differ?

Gastrointestinal endoscopy has grown dramatically over the past century, and with subsequent improvements in technology and anaesthesia, it has become a safe and useful tool for evaluation of GI pathology in children. There are substantial differences between paediatric and adult endoscopy beyond size, including: age-related patho-physiology and the different spectrum of diseases in children. Literature on endoscopic procedures in children is sparse but significant. The present review aims at describing the current knowledges on paediatric endoscopy practice and highlights the main areas of differences between paediatric and adult practice.

Novel scheme for non-invasive gut bioinformation acquisition with a magnetically controlled sampling capsule endoscope.

OBJECTIVE: Intestinal flora and metabolites are associated with multiple systemic diseases. Current approaches for acquiring information regarding microbiota/metabolites have limitations. We aimed to develop a precise magnetically controlled sampling capsule endoscope (MSCE) for the convenient, non-invasive and accurate acquisition of digestive bioinformation for disease diagnosis and evaluation. DESIGN: The MSCE and surgery were both used for sampling both jejunal and ileal GI content in the control and antibiotic-induced diarrhoea groups. The GI content was then used for microbiome profiling and metabolomics profiling. RESULTS: Compared with surgery, our data showed that the MSCE precisely acquired data regarding the intestinal flora and metabolites, which was effectively differentiated in different intestinal regions and disease models. Using MSCE, we detected a dramatic decrease in the abundance of Bacteroidetes, Patescibacteria and Actinobacteria and hippuric acid levels, as well as an increase in the abundance of Escherichia-Shigella and the 2-pyrrolidinone levels were detected in the antibiotic-induced diarrhoea model by MSCE. MSCE-mediated sampling revealed specific gut microbiota/metabolites including Enterococcus, Lachnospiraceae, acetyl-L-carnitine and succinic acid, which are related to metabolic diseases, cancers and nervous system disorders. Additionally, the MSCE exhibited good sealing characteristics with no contamination after sampling. CONCLUSIONS: We present a newly developed MSCE that can non-invasively and accurately acquire intestinal bioinformation via direct visualization under magnetic control, which may further aid in disease prevention, diagnosis, prognosis and treatment.

Feeding management before gastrointestinal studies in pigs.

Pigs are used to model humans in gastrointestinal (GI) studies because of their comparable size, physiology and behaviour: both are monogastric omnivores. A porcine surgical model for testing novel, tethered ultrasound capsule endoscopes (USCE) requires a clean, motile small intestine. Recommendations for human GI tract preparation before the mechanically similar process of video capsule endoscopy describe using oral purgatives, while high-carbohydrate drinks are recommended before colorectal surgery. Reports of the GI preparation of pigs exist but lack technical details, that is, administration, efficacy and side effects. This report details feeding a high-energy liquid diet to 11 female pigs undergoing surgery and USCE which was readily accepted and easily administered, and which produced a clean, motile small intestine and caused no detectable physiological/behavioural abnormalities.

Robotic Localization Based on Planar Cable Robot and Hall Sensor Array Applied to Magnetic Capsule Endoscope.

Recently an active locomotive capsule endoscope (CE) for diagnosis and treatment in the digestive system has been widely studied. However, real-time localization to achieve precise feedback control and record suspicious positioning in the intestine is still challenging owing to the limitation of capsule size, relatively large diagnostic volume, and compatibility of other devices in clinical site. To address this issue, we present a novel robotic localization sensing methodology based on the kinematics of a planar cable driven parallel robot (CDPR) and measurements of the quasistatic magnetic field of a Hall effect sensor (HES) array. The arrangement of HES and the Levenberg-Marquardt (LM) algorithm are applied to estimate the position of the permanent magnet (PM) in the CE, and the planar CDPR is incorporated to follow the PM in the CE. By tracking control of the planar CDPR, the position of PM in any arbitrary position can be obtained through robot forward kinematics with respect to the global coordinates at the bedside. The experimental results show that the root mean square error (RMSE) for the estimated position value of PM was less than 1.13 mm in the X, Y, and Z directions and less than 1.14° in the θ and φ orientation, where the sensing space could be extended to ±70 mm for the given 34 × 34 mm2 HES array and the average moving distance in the Z-direction is 40 ± 2.42 mm. The proposed method of the robotic sensing with HES and CDPR may advance the sensing space expansion technology by utilizing the provided single sensor module of limited sensible volume.

Of aortic valve and bleeding: Heyde's syndrome.

An 80-year-old woman with severe aortic stenosis presented with relapsing enterorrhagia and severe anemia. A video capsule pan-endoscopy showed multiple sites of complex mucosal angiodysplasia in the jejunum. Direct hemostatic treatment of accessible angiodysplasia was done with argon plasma coagulation, and the patient was urgently referred for trans-catheter aortic valve replacement (TAVR). At follow-up 1 month and 3 months later, she was doing well with no further episodes of bleeding. Heyde's syndrome is referred to as the association of aortic stenosis, gastrointestinal angiodysplasia, bleeding, and anemia. It is an acquired type2A von Willebrand syndrome caused by the proteolysis and loss of the largest polymers of vWF due to the high shear forces generated through the stenotic aortic valve. The qualitative and quantitative vWF defects play a central role in the angiogenesis and development of gastrointestinal angiodysplasia The vWF abnormalities are closely associated with the hemodynamic severity of the aortic valve stenosis. Valve replacement is the pivotal strategy to achieve the long-term resolution of bleeding recurrences. TAVR is a valuable option particularly in high-risk patients for whom surgical valve replacement is not feasible.

Design and implementation of a novel wireless modular capsule robotic system in pipe.

Capsule endoscopy is a new type of technology in the diagnosis and treatment of digestive diseases, with painless and low invasive features. However, current capsule robots have many problems, such as over-sized, single function and lack of active locomotion control. This study proposed and designed a new wireless modular capsule robotic system in pipe. The modular capsule robots could move forward and backward in the pipe in the axial direction, turn in a bending environment, and achieve the rendezvous and separation action through the three-dimensional rotating magnetic field generated by the three-axis Helmholtz coils. In this paper, the drive system of the three-axis Helmholtz coils, the power supply control system, and the modular capsule robot structure were analyzed and designed respectively. Finally, a series of characterization experiments were carried out to evaluate the motion characteristics of the modular capsule robots, including the influence of the flow environment imitated to human body's gastrointestinal motility, the frequency of the input signal, and the different structure of the robots on the movement characteristics of the modular capsule robot in this study. The study also evaluated the turning characteristics of robots. Experimental results showed that under different circumstances, modular capsule robots had good motion characteristics, and the effectiveness of the modular functionality had also been verified.

Usefulness of panoramic 344°-viewing in Crohn's disease capsule endoscopy: a proof of concept pilot study with the novel PillCam™ Crohn's system.

BACKGROUND: A new capsule endoscopy (CE) system featuring two advanced optics for 344°-viewing and a prolonged operative time has been recently developed for Crohn's disease (CD) patients. Hence, we evaluated, for the first time, the performance of this novel CE and the add-on value of the 344°-viewing in a multi-center real-life setting. METHODS: Consecutive patients with suspected or established CD received the PillCam™ Crohn's System as supplementary diagnostic work-up focused on the small-bowel between June 2017 and June 2018. Technical and clinical data, including the panenteric CE diagnostic yield, the Lewis score and the impact of small-bowel findings on clinical management during a 6-months follow-up (new diagnosis, staging or treatment upgrade) were collected, thereby evaluating the added value of the 344° panoramic-view (lesions detected by camera A and B) over the standard 172°-view (lesions detected by one camera only). RESULTS: Among 41 patients (aged 43 ± 20 years), 73% underwent CE for suspected CD and 27% for established CD. The rate of complete enteroscopy was 90%. No technical failure or retention occurred. Compared to the standard 172° view, the panoramic 344°-view revealed a greater number of patients with a relevant lesion (56.1% vs. 39.0%; P = 0.023), resulting in higher Lewis score (222,8 vs. 185.7; P = 0.031), and improved clinical management (48.8% vs. 31.7%, P = 0.023). CONCLUSIONS: The panoramic 344°-view increases small-bowel CE accuracy, thereby improving the clinical management of CD patients with mild small-bowel active disease. This system should be regarded as a new standard for both small-bowel diagnosis and monitoring in inflammatory bowel diseases.