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1.
World J Gastroenterol ; 28(16): 1722-1724, 2022 Apr 28.
Article in English | MEDLINE | ID: covidwho-1862963

ABSTRACT

Colon capsule endoscopy (CCE) was introduced nearly two decades ago. Initially, it was limited by poor image quality and short battery time, but due to technical improvements, it has become an equal diagnostic alternative to optical colonoscopy (OC). Hastened by the coronavirus disease 2019 pandemic, CCE has been introduced in clinical practice to relieve overburdened endoscopy units and move investigations to out-patient clinics. A wider adoption of CCE would be bolstered by positive patient experience, as it offers a diagnostic investigation that is not inferior to other modalities. The shortcomings of CCE include its inability to differentiate adenomatous polyps from hyperplastic polyps. Solving this issue would improve the stratification of patients for polyp removal. Artificial intelligence (AI) has shown promising results in polyp detection and characterization to minimize incomplete CCEs and avoid needless examinations. Onboard AI appears to be a needed application to enable near-real-time decision-making in order to diminish patient waiting times and avoid superfluous subsequent OCs. With this letter, we discuss the potential and role of AI in CCE as a diagnostic tool for the large bowel.


Subject(s)
COVID-19 , Capsule Endoscopy , Colonic Polyps , Colorectal Neoplasms , Gastroenterology , Artificial Intelligence , Capsule Endoscopy/methods , Colonic Polyps/diagnostic imaging , Colonoscopy/methods , Colorectal Neoplasms/diagnosis , Humans
3.
Scand J Gastroenterol ; 57(3): 359-363, 2022 03.
Article in English | MEDLINE | ID: covidwho-1545743

ABSTRACT

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.


Subject(s)
COVID-19 , Capsule Endoscopy , Colorectal Neoplasms , Capsule Endoscopy/methods , Colonoscopy/methods , Colorectal Neoplasms/diagnosis , Delivery of Health Care , Humans , Pandemics , SARS-CoV-2
4.
J Med Virol ; 94(1): 246-252, 2022 01.
Article in English | MEDLINE | ID: covidwho-1544341

ABSTRACT

Recently, the coronavirus disease 2019 (COVID-19) has caused a global pandemic. Several studies indicate that the digestive system can also be affected by the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). Therefore, patients with digestive symptoms should have a capsule endoscopy (CE). COVID-19 patients with gastrointestinal (GI) symptoms who underwent CE were recruited from March 2020 to April 2020. We collected patients' data and performed a prospective follow-up study for 6 months. All 11 COVID-19 cases with GI symptoms who underwent CE presented gastritis. Eight cases (72.7%) had intestinal mucosa inflammation. Among them, two cases showed intestinal ulcers or erosions. Moreover, two cases displayed colonic mucositis. One case was lost during follow-up. At 3-6 months after hospital discharge, five patients underwent CE again, presenting gastrointestinal lesions. Five of the 10 cases had GI symptoms, such as abdominal pain, diarrhea, constipation, and others. Among these five cases, the GI symptoms of three patients disappeared at the last follow-up and two patients still presented diarrhea symptoms. Overall, we observed damaged digestive tract mucosa that could be caused by SARS-CoV-2. Moreover, after discharge, some patients still presented intestinal lesions and GI symptoms.


Subject(s)
COVID-19/complications , COVID-19/pathology , Capsule Endoscopy , Gastrointestinal Diseases/diagnosis , Gastrointestinal Tract/pathology , Adult , Aged , Female , Follow-Up Studies , Gastritis/complications , Gastritis/diagnosis , Gastritis/pathology , Gastrointestinal Diseases/complications , Gastrointestinal Diseases/pathology , Humans , Male , Middle Aged , Prospective Studies
5.
Inflamm Bowel Dis ; 27(Supplement_2): S25-S32, 2021 Nov 15.
Article in English | MEDLINE | ID: covidwho-1522203

ABSTRACT

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.


Subject(s)
Capsule Endoscopy/methods , Colon/diagnostic imaging , Colonoscopy/methods , Crohn Disease/diagnostic imaging , Intestinal Mucosa/diagnostic imaging , Ulcer/diagnostic imaging , Wound Healing , Australia , COVID-19 , Capsule Endoscopes , Colon/drug effects , Humans , Immunosuppressive Agents/therapeutic use , Intestinal Mucosa/drug effects , SARS-CoV-2 , Severity of Illness Index , Treatment Outcome , Ulcer/drug therapy , Wound Healing/drug effects , Wound Healing/physiology
7.
JAMA Netw Open ; 4(7): e2118796, 2021 07 01.
Article in English | MEDLINE | ID: covidwho-1332923

ABSTRACT

Importance: Evaluation of acute gastrointestinal (GI) bleeding using invasive endoscopic procedures comprising the standard of care (SOC)-upper endoscopy and colonoscopy-can expose the endoscopy staff to SARS-CoV-2. Video capsule endoscopy (VCE) does not generate aerosols and only requires 1 person to manage the procedure. Objective: To examine the safety of VCE for the initial evaluation of GI bleeding at the peak of the COVID-19 pandemic to identify signs of active bleeding while minimizing patient and personnel exposure, saving personal protective equipment, and avoiding invasive or unnecessary procedures. Design, Setting, and Participants: A multicenter (UMass Memorial Medical Center and Louisiana State University Health Sciences Center) retrospective cohort study including 146 patients with COVID-19 who received VCE as the first-line diagnostic modality was conducted from March 15 to June 15, 2020, compared with SOC in January 2020 for evaluation of GI bleeding. The association between treatment and outcomes was estimated using multivariable regression adjusting for potential confounders. Propensity score matching was used to verify the results. Main Outcomes and Measures: The primary end point was detection of active bleeding or stigmata of recent bleeding. Secondary end points included the number of patients requiring any invasive procedures, number of additional procedures, rates of rebleeding and rehospitalization, transfusion requirements, and mortality. Results: Among 146 patients, 92 (63.0%) were men; mean (SD) age was 64.93 (14.13) years in the COVID-19 group and 61.33 (13.39) years in the SOC group. Active bleeding or stigmata of recent bleeding was observed in 44 (59.5%) patients in the COVID-19 group compared with 18 (25.0%) in the SOC group (adjusted odds ratio, 5.23; 95% CI, 2.23 to 12.27). Only 36 patients (48.7%) in the COVID-19 group required any invasive procedure during the hospitalization compared with 70 (97.2%) in the SOC group (adjusted odds ratio, 0.01; 95% CI, 0.001 to 0.08). The mean (SD) number of invasive procedures was 0.59 (0.77) per patient in the COVID-19 group compared with 1.18 (0.48) per patient in the SOC group (adjusted difference, -0.54; 95% CI, -0.77 to -0.31). Both approaches appeared to be safe and there was no significant difference in transfusion requirements, rebleeding, rehospitalization, or in-hospital mortality. No mortality was attributed to GI bleeding in either group. Conclusions and Relevance: In this cohort study, first-line diagnostic evaluation of acute GI bleeding using VCE appeared to be a safe and useful alternative to the traditional approach of upper endoscopy and colonoscopy. Use of VCE was associated with increased detection of active bleeding and a reduced number of invasive procedures and unnecessary exposure of personnel to SARS-CoV-2 and use of personal protective equipment.


Subject(s)
COVID-19 , Capsule Endoscopy , Gastrointestinal Hemorrhage/diagnosis , Occupational Exposure , Acute Disease , Aged , COVID-19/prevention & control , COVID-19/transmission , Cohort Studies , Female , Humans , Male , Middle Aged , Retrospective Studies
8.
Intern Med ; 60(15): 2425-2430, 2021 Aug 01.
Article in English | MEDLINE | ID: covidwho-1256191

ABSTRACT

The current study evaluated the application of small-bowel capsule endoscopy (SBCE) in SARS-CoV-2-infected patients with suspected small bowel bleeding. We analyzed the clinical characteristics, SBCE procedures, examination results, and treatment for cases of suspected small bowel bleeding in two patients with critical COVID-19. SBCE showed active spotting bleeding in the jejunum and ileum with no identifiable lesions in case 1, while multiple small bowel ulcers were detected in case 2. Two patients had relevant changes in their management plans and received specific treatment based on SBCE findings. In summary, SBCE proved to be a non-invasive diagnostic tool for critical COVID-19 patients with suspected small bowel bleeding.


Subject(s)
COVID-19 , Capsule Endoscopy , Gastrointestinal Hemorrhage/diagnostic imaging , Humans , Intestine, Small/diagnostic imaging , SARS-CoV-2
10.
11.
Expert Rev Gastroenterol Hepatol ; 15(2): 127-137, 2021 Feb.
Article in English | MEDLINE | ID: covidwho-894508

ABSTRACT

INTRODUCTION: Capsule endoscopy (CE) is an established modality in the diagnostic algorithm of small bowel (SB) pathology. Its use has expanded for investigation of upper and lower gastrointestinal diseases with similar prototypes. AREAS COVERED: This review covers the role and recent advances of CE, as a non-invasive investigative tool. EXPERT OPINION: The use of upper gastrointestinal CE is useful in patients who require surveillance for varices particularly in the current era of the COVID-19 pandemic. It has also shown high accuracy in the detection of upper gastrointestinal hemorrhage in patients presenting with a suspicion of hemorrhage. Findings on CE help to guide further management by device-assisted enteroscopy. The data on colon CE suggest comparable diagnostic accuracy to colonoscopy for polyp detection; however, more evidence is required in the high-risk group. Crohn's CE has become an integral part of the management of patients with Crohn's disease offering a comparative assessment tool post escalation of therapy. Artificial intelligence within CE has demonstrated similar if not better diagnostic yield compared to the human with a significantly shorter reading time. Artificial intelligence is likely to be in-built within CE reading platforms over the next few years minimizing reporting time and human error.


Subject(s)
COVID-19/epidemiology , Capsule Endoscopy , Gastrointestinal Diseases/diagnosis , COVID-19/complications , COVID-19/prevention & control , Capsule Endoscopy/instrumentation , Capsule Endoscopy/methods , Capsule Endoscopy/trends , Gastrointestinal Diseases/etiology , Humans
13.
Clin Med (Lond) ; 20(4): 352-358, 2020 07.
Article in English | MEDLINE | ID: covidwho-592087

ABSTRACT

Many non-emergency clinical services were suspended during COVID-19 pandemic peak. It is essential to develop a plan for restarting services following the peak. It is equally important to protect patients and staff and to use resources and personal protective equipment (PPE) efficiently. The British Society of Gastroenterology Endoscopy Committee and Quality Improvement Programme has produced guidance on how a restart can be safely delivered. Key recommendations include the following: all patients should have need for endoscopy assessed by senior clinicians and prioritised according to criteria we have outlined; once the need for endoscopy is confirmed, patients should undergo telephone screening for symptoms using systematic questionnaires; all outpatients should undergo RT-PCR testing for COVID-19 virus 1-3 days prior to endoscopy; and PPE should be determined by patient risk stratification, the nature of the procedure and the results of testing. While this guidance is tailored to endoscopy services, it could be adapted for any interventional medical discipline.


Subject(s)
Betacoronavirus , Coronavirus Infections/diagnosis , Coronavirus Infections/epidemiology , Endoscopy, Gastrointestinal/standards , Pandemics , Pneumonia, Viral/diagnosis , Pneumonia, Viral/epidemiology , COVID-19 , Capsule Endoscopy/standards , Cholangiopancreatography, Endoscopic Retrograde/standards , Colonoscopy/standards , Endosonography/standards , Humans , Occupational Health , Patient Safety , Personal Protective Equipment , SARS-CoV-2
14.
Colorectal Dis ; 22(6): 621-624, 2020 06.
Article in English | MEDLINE | ID: covidwho-245488

ABSTRACT

AIM: The coronavirus pandemic has led to significant challenges for healthcare delivery across the globe. Non-emergency endoscopic activity in the UK has been postponed, raising concerns of increased delays in the diagnosis of colorectal cancer and a surge in demand once services resume. Measures to mitigate this risk must be considered. METHOD: This paper reviews various investigative modalities for colorectal disease which could be deployed during cessation of colonoscopy services. We focus on colon capsule endoscopy (CCE) due to its relevance during the COVID-19 pandemic and its ability to triage patients effectively to further endoscopic investigations. RESULTS: CT of the abdomen and pelvis has been suggested as a triage tool while access to colonoscopy is limited. However, CT may lead to the spread of COVID-19 as patients attend the hospital, and it exposes them to the risks of radiation. Faecal immunochemistry tests have been demonstrated as a good predictor of colonic pathology and could be safely used to risk stratify patients when prioritizing colonoscopy. CCE is a safe and innovative technology for investigating the colon. Procedures can be carried out in the community and can be conducted safely during the coronavirus pandemic. It has been shown to be an accurate detector of colonic neoplasia and can reduce demand for colonoscopy. CONCLUSION: As colonoscopy services resume, they will probably experience high demand leading to further delays for patients. CCE could be used to reduce the number of patients requiring colonoscopy and triage those requiring further endoscopic investigations appropriately.


Subject(s)
Capsule Endoscopy/methods , Colorectal Neoplasms/diagnosis , Coronavirus Infections/epidemiology , Pneumonia, Viral/epidemiology , Triage/methods , Betacoronavirus , COVID-19 , Colonoscopy/methods , Humans , Immunochemistry/methods , Occult Blood , Pandemics , SARS-CoV-2
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