Identification of Ulcers and Erosions by the Novel Pillcam™ Crohn's Capsule Using a Convolutional Neural Network: A Multicentre Pilot Study.

BACKGROUND AND AIMS: Capsule endoscopy is a central element in the management of patients with suspected or known Crohn's disease. In 2017, PillCam™ Crohn's Capsule was introduced and demonstrated to have greater accuracy in the evaluation of extension of disease in these patients. Artificial intelligence [AI] is expected to enhance the diagnostic accuracy of capsule endoscopy. This study aimed to develop an AI algorithm for the automatic detection of ulcers and erosions of the small intestine and colon in PillCam™ Crohn's Capsule images. METHODS: A total of 8085 PillCam™ Crohn's Capsule images were extracted between 2017 and 2020, comprising 2855 images of ulcers and 1975 erosions; the remaining images showed normal enteric and colonic mucosa. This pool of images was subsequently split into training and validation datasets. The performance of the network was subsequently assessed in an independent test set. RESULTS: The model had an overall sensitivity and specificity of 90.0% and 96.0%, respectively. The precision and accuracy of this model were 97.1% and 92.4%, respectively. In particular, the algorithm detected ulcers with a sensitivity of 83% and specificity of 98%, and erosions with sensitivity and specificity of 91% and 93%, respectively. CONCLUSION: A deep learning model capable of automatically detecting ulcers and erosions in PillCam™ Crohn's Capsule images was developed for the first time. These findings pave the way for the development of automatic systems for detection of clinically significant lesions, optimizing the diagnostic performance and efficiency of monitoring Crohn's disease activity.

Infectious Proctitis in Ulcerative Colitis: The Importance of an Accurate Differential Diagnosis.

The authors present the case of a 62-year-old male presenting with a relapse of ulcerative colitis. He had unprotected anal intercourse with other men and his medical record was remarkable for HIV infection. He was admitted to the emergency department with bloody diarrhea, tenesmus, urgency, and recent weight loss. Laboratory workup revealed de novo mild anemia and mild elevation of inflammation parameters. Endoscopic evaluation displayed loss of normal vascular pattern, edema, erythema, exudation, and superficial ulceration in the distal rectum. Biopsies showed chronic proctitis with mild to moderate activity. The patient was treated with intravenous glucocorticoids, but symptoms persisted. Extensive microbial study allowed the identification of multiple infectious agents with potential for infectious proctitis: cytomegalovirus, Chlamydia trachomatis, and Blastocystis hominis. This case highlights the importance of careful microbial investigation, supporting a detailed clinical history, in patients presenting with symptoms of inflammatory bowel disease flare, particularly in risk groups such as that with sexual risk.

Os autores descrevem o caso de um individuo do sexo masculino, com infeção pelo virus da imunodeficiência humana, admitido por agudização de colite ulcerosa. O doente descreve prática de sexo anal desprotegido. No serviço de urgência apresentava-se com queixas de diarreia sanguinolenta, tenesmo, falsas vontades e perda recente de peso. Do estudo efetuado, analiticamente apresentava-se com anemia ligeira de novo, e com elevação ligeira dos parâmetros inflamatorios. A retossigmoid-oscopia flexível realizada apresentava disrupção do normal padrão vascular, edema, eritema, exsudação e ulcerado superficial do reto distal. Foram realizadas biópsias das lesões que demonstraram sinais de proctite crónica com atividade ligeira a moderada. Atendendo à gravidade do quadro, o doente iniciou corticoterapia endovenosa, porém sem resolução dos sintomas. Uma avaliação microbiológica extensa permitiu a identificado de diversos agentes com potencial para causar proctite infeciosa: citomegalovírus, Chlamydia trachomatis e Blastocystis hominis. Este caso realça a importância do estudo micro-biológico, a suportar uma historia clínica detalhada, em doentes que se apresentam com sintomatologia sugestiva de exacerbação de doença inflamatoria intestinal.

Gastric caustic injury after organophosphate poisoning.

An 83-year-old male was brought to the Emergency Room after ingesting an unknown dose of dimethoate, an organophosphate pesticide. He had been previously diagnosed with depression but there were no previous suicide attempts. The admission Glasgow Coma Scale score was 3 and he had miotic pupils and copious oropharyngeal secretions. The patient was hemodynamically stable, mildly tachypneic (respiratory rate 22/minute) and nonfebrile. Laboratory workup revealed a normal complete blood count (Hb 15 g/dl, platelets 178,000/µl), normal liver tests and no coagulopathy. Low acetylcholinesterase levels confirmed organophosphate poisoning. He was admitted to the Intensive Care Unit (ICU) under treatment with obidoxime.

Endoscopic diagnosis of primary and recurrent mantle cell lymphomas.

A 64-year-old male presented to our center with epigastric pain, anorexia, fatigue, weight loss and anemia on a laboratory study. An abdominal ultrasound revealed thickening of the gastric walls. Upper endoscopy demonstrated a 40 mm ulcerated lesion at the incisura angularis. A biopsy of the lesion revealed a lymphocytic infiltrate expressing CD5, CD20 and cyclin D1, typical of mantle-cell lymphoma (MCL).