Clinicians' Guide to Artificial Intelligence in Colon Capsule Endoscopy-Technology Made Simple.

Artificial intelligence (AI) applications have become widely popular across the healthcare ecosystem. Colon capsule endoscopy (CCE) was adopted in the NHS England pilot project following the recent COVID pandemic's impact. It demonstrated its capability to relieve the national backlog in endoscopy. As a result, AI-assisted colon capsule video analysis has become gastroenterology's most active research area. However, with rapid AI advances, mastering these complex machine learning concepts remains challenging for healthcare professionals. This forms a barrier for clinicians to take on this new technology and embrace the new era of big data. This paper aims to bridge the knowledge gap between the current CCE system and the future, fully integrated AI system. The primary focus is on simplifying the technical terms and concepts in machine learning. This will hopefully address the general "fear of the unknown in AI" by helping healthcare professionals understand the basic principle of machine learning in capsule endoscopy and apply this knowledge in their future interactions and adaptation to AI technology. It also summarises the evidence of AI in CCE and its impact on diagnostic pathways. Finally, it discusses the unintended consequences of using AI, ethical challenges, potential flaws, and bias within clinical settings.

The optimal use of colon capsule endoscopes in clinical practice.

Colon capsule endoscopy (CCE) has been available for nearly two decades but has grappled with being an equal diagnostic alternative to optical colonoscopy (OC). Due to the COVID-19 pandemic, CCE has gained more foothold in clinical practice. In this cutting-edge review, we aim to present the existing knowledge on the pros and cons of CCE and discuss whether the modality is ready for a larger roll-out in clinical settings. We have included clinical trials and reviews with the most significant impact on the current position of CCE in clinical practice and discuss the challenges that persist and how they could be addressed to make CCE a more sustainable imaging modality with an adenoma detection rate equal to OC and a low re-investigation rate by a proper preselection of suitable populations. CCE is embedded with a very low risk of severe complications and can be performed in the patient's home as a pain-free procedure. The diagnostic accuracy is found to be equal to OC. However, a significant drawback is low completion rates eliciting a high re-investigation rate. Furthermore, the bowel preparation before CCE is extensive due to the high demand for clean mucosa. CCE is currently not suitable for large-scale implementation in clinical practice mainly due to high re-investigation rates. By a better preselection before CCE and the implantation of artificial intelligence for picture and video analysis, CCE could be the alternative to OC needed to move away from in-hospital services and relieve long-waiting lists for OC.

How a managed service for colon capsule endoscopy works in an overstretched healthcare system.

Lower gastrointestinal diagnostics have been facing significant capacity constraints, which the COVID-19 pandemic has exacerbated due to significant reductions in endoscopy procedures. Colon Capsule Endoscopy (CCE) provides a safe, viable solution to offset ongoing demand and could be a valuable tool for the recovery of endoscopy services post-COVID. NHS Scotland has already begun a country-wide rollout of CCE as a managed service, and NHS England have committed to a pilot scheme of 11,000 capsules via hospital-based delivery. Here, we outline a proven method of CCE delivery that ensures the CCE and results are delivered in an efficient, clinically robust manner with high patient acceptability levels through a managed service. Delivering CCE without a managed service is likely to be slower, more costly, and less effective, limiting the many benefits of CCE as an addition to the standard diagnostic pathway for bowel cancer.

A Flavor of the Future of GI Endoscopy-New Solutions Shape the Field of Modern Gastrointestinal Care.

Gastrointestinal (GI) cancers remain high on the list of the leading causes of death worldwide; however, the recent emergence of new and ongoing global healthcare threats, such as the COVID-19 pandemic, has led to a temporary reduction in elective endoscopic procedures [...].

Scoring Systems for Clinical Colon Capsule Endoscopy-All You Need to Know.

In the constantly developing era of minimal diagnostic invasiveness, the role of colon capsule endoscopy in colonic examination is being increasingly recognised, especially in the context of curtailed endoscopy services due to the COVID-19 pandemic. It is a safe diagnostic tool with low adverse event rates. As with other endoscopic modalities, various colon capsule endoscopy scores allow the standardisation of reporting and reproducibility. As bowel cleanliness affects CCE's diagnostic yield, a few operator-dependent scores (Leighton-Rex and CC-CLEAR scores) and a computer-dependent score (CAC score) have been developed to grade bowel cleanliness objectively. CCE can be used to monitor IBD mucosal disease activity through the UCEIS and the panenteric CECDAIic score for UC and CD, respectively. CCE may also have a role in CRC screening, given similar sensitivity and specificity rates to conventional colonoscopy to detect colonic polyps ≥ 10 mm and CRC. Given CCE's diagnostic yield and reproducible clinical scores with high inter-observer agreements, CCE is fast becoming a suitable alternative to conventional colonoscopy in specific patient populations.

Frontiers of Robotic Gastroscopy: A Comprehensive Review of Robotic Gastroscopes and Technologies.

Upper gastrointestinal (UGI) tract pathology is common worldwide. With recent advancements in robotics, innovative diagnostic and treatment devices have been developed and several translational attempts made. This review paper aims to provide a highly pictorial critical review of robotic gastroscopes, so that clinicians and researchers can obtain a swift and comprehensive overview of key technologies and challenges. Therefore, the paper presents robotic gastroscopes, either commercial or at a progressed technology readiness level. Among them, we show tethered and wireless gastroscopes, as well as devices aimed for UGI surgery. The technological features of these instruments, as well as their clinical adoption and performance, are described and compared. Although the existing endoscopic devices have thus far provided substantial improvements in the effectiveness of diagnosis and treatment, there are certain aspects that represent unwavering predicaments of the current gastroenterology practice. A detailed list includes difficulties and risks, such as transmission of communicable diseases (e.g., COVID-19) due to the doctor-patient proximity, unchanged learning curves, variable detection rates, procedure-related adverse events, endoscopists' and nurses' burnouts, limited human and/or material resources, and patients' preferences to choose non-invasive options that further interfere with the successful implementation and adoption of routine screening. The combination of robotics and artificial intelligence, as well as remote telehealth endoscopy services, are also discussed, as viable solutions to improve existing platforms for diagnosis and treatment are emerging.

Googling on Colonoscopy: A Retrospective Analysis of Search Engine Statistics.

PURPOSE: Colonoscopy is a gold standard for screening and diagnosis of colorectal cancer (CRC). The data from the search engine may reveal what information on coloscopy gains the attention of Internet users. We aimed to investigate Google searches trends and terms related to colonoscopy. PATIENTS AND METHODS: We retrieved statistics searches related to colonoscopy using Google Trends (GT) and Google Ads (GA) for the period from April 2016 to March 2020. The GT data was used for the analysis of time and regional search patterns worldwide. GA data for Australia, Canada, Ireland, New Zealand (NZ), Poland, the United Kingdom (UK), and the United States (US) were used to calculate the search volume of categories of queries related to colonoscopy. RESULTS: Globally, the relative search volume on colonoscopy has increased until the COVID-19 outbreak and revealed seasonal variation: the highest interest was observed in March (CRC awareness month), and the lowest during December (Christmas holidays). The highest number of searches per 1000 Google users-years was done in Poland (59.62) and the lowest in the UK (19.46). Most commonly, Google users searched for details on colonoscopy techniques (Australia, Canada, Ireland, NZ), anesthesia during the procedure (Poland), facility performing colonoscopy (UK, US). In all seven countries, less than 2% of queries concerned with bowel preparation before the procedure. CONCLUSION: Before the COVID-19 pandemic, the interest in colonoscopy has increased among Google users. Google users may underestimate the importance of proper bowel preparation.

Frontiers of Robotic Gastroscopy: A Comprehensive Review of Robotic Gastroscopes and Technologies

Upper gastrointestinal (UGI) tract pathology is common worldwide. With recent advancements in robotics, innovative diagnostic and treatment devices have been developed and several translational attempts made. This review paper aims to provide a highly pictorial critical review of robotic gastroscopes, so that clinicians and researchers can obtain a swift and comprehensive overview of key technologies and challenges. Therefore, the paper presents robotic gastroscopes, either commercial or at a progressed technology readiness level. Among them, we show tethered and wireless gastroscopes, as well as devices aimed for UGI surgery. The technological features of these instruments, as well as their clinical adoption and performance, are described and compared. Although the existing endoscopic devices have thus far provided substantial improvements in the effectiveness of diagnosis and treatment, there are certain aspects that represent unwavering predicaments of the current gastroenterology practice. A detailed list includes difficulties and risks, such as transmission of communicable diseases (e.g., COVID-19) due to the doctor-patient proximity, unchanged learning curves, variable detection rates, procedure-related adverse events, endoscopists"and nurses"burnouts, limited human and/or material resources, and patients"preferences to choose non-invasive options that further interfere with the successful implementation and adoption of routine screening. The combination of robotics and artificial intelligence, as well as remote telehealth endoscopy services, are also discussed, as viable solutions to improve existing platforms for diagnosis and treatment are emerging.

COVID-19, MERS and SARS with Concomitant Liver Injury-Systematic Review of the Existing Literature.

The novel coronavirus SARS-CoV-2 (severe acute respiratory syndrome coronavirus 2) infection has been predominantly linked to respiratory distress syndrome, but gastrointestinal symptoms and hepatic injury have also been reported. The mechanism of liver injury is poorly understood and may result as a consequence of viral hepatitis, systemic inflammatory response, gut barrier and microbiome alterations, intensive care treatment or drug toxicity. The incidence of hepatopathy among patients with coronavirus disease 2019 (COVID-19) is unclear, but studies have reported liver injury in patients with SARS and Middle East respiratory syndrome (MERS). We aimed to systematically review data on the prevalence of hepatic impairments and their clinical course in SARS and MERS Coronaviridae infections. A systematic literature search (PubMed/Embase/Cinahl/Web of Science) according to preferred reporting items for systematic review and meta-analysis protocols (PRISMA) was conducted from database inception until 17/03/2020 for studies that evaluated the incidence of hepatic abnormalities in SARS CoV-1, SARS CoV-2 and MERS infected patients with reported liver-related parameters. A total of forty-three studies were included. Liver anomalies were predominantly mild to moderately elevated transaminases, hypoalbuminemia and prolongation of prothrombin time. Histopathology varied between non-specific inflammation, mild steatosis, congestion and massive necrosis. More studies to elucidate the mechanism and importance of liver injury on the clinical course and prognosis in patients with novel SARS-CoV-2 infection are warranted.