Mucosal Changes in the Small Intestines in Portal Hypertension: First Study Using the Pillcam SB3 Capsule Endoscopy System

Goenka, Mahesh Kumar; Shah, Bhavik; Kumar, Vijay; Jajodia, Surabhi; Goenka, Usha

doi:10.5946/ce.2018.041

Cited by 7 publications

(5 citation statements)

References 34 publications

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“…It is being increasingly diagnosed, due to the advent of video capsule endoscopy and deep enteroscopy. In recent studies, the prevalence of PHE varies around 93-97%, with 8-12% of patients showing evidence of ongoing bleeding [62][63][64]. The findings of PHE are characterized as vascular (red spots, telangiectasia, or varices) and non-vascular or inflammatory (villous edema, erythema, or polyps) changes [64] (Figure 12a-f).…”

Section: Portal Hypertensive Enteropathy (Phe)mentioning

confidence: 99%

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Endoscopy in Management of Portal Hypertension

Shah¹,

Goenka²,

Goenka³

2021

Portal Hypertension - Recent Advances

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Portal hypertension (PH) is a serious consequence of several disease states affecting prehepatic, intrahepatic, or posthepatic portal circulation. Backpressure caused by PH transmits through the collaterals to form varices at various sites. PH also leads to hyperdynamic congestion and altered gastrointestinal mucosal immune response, resulting in portal hypertensive gastropathy (PHG), portal hypertensive enteropathy (PHE), and portal colopathy (PC). These PH associated phenomena may lead to torrential life-threatening bleed or chronic blood loss leading to debilitating chronic anemia. Endoscopy plays a pivotal role in the management of these patients both for diagnostic and therapeutic purpose. The choice of therapeutic strategy depends on many factors: severity of the disease, patient’s clinical performance, and whether it is done as an emergency or as a prophylactic approach. In this chapter, we evaluate the endoscopic management of patients with the gastrointestinal complications of PH.

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Section: Portal Hypertensive Enteropathy (Phe)mentioning

confidence: 99%

“…Treatment options for PHE related bleed include glue or sclerosant for variceal bleeding and APC for non-variceal bleeding. In patients with hemodynamic instability, radiological coil embolization is an option [64].…”

Section: Portal Hypertensive Enteropathy (Phe)mentioning

confidence: 99%

Endoscopy in Management of Portal Hypertension

Shah¹,

Goenka²,

Goenka³

2021

Portal Hypertension - Recent Advances

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“…In fact, OGIB is the most common indication for CE in patients with cirrhosis [ 13 ]. Furthermore, although the bleeding potential of mucosal red spots is uncertain, they are frequently found during CE for investigation of unexplained iron deficiency anemia and can occur as manifestations of several conditions, including portal hypertensive enteropathy and systemic vasculitis [ 11 , 12 ].…”

Section: Introductionmentioning

confidence: 99%

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

Ribeiro

Saraiva

Ferreira

et al. 2021

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Background Capsule endoscopy (CE) is the first line for evaluation of patients with obscure gastrointestinal bleeding. A wide range of small intestinal vascular lesions with different hemorrhagic potential are frequently found in these patients. Nevertheless, reading CE exams is time-consuming and prone to errors. Convolutional neural networks (CNN) are artificial intelligence tools with high performance levels in image analysis. This study aimed to develop a CNN-based model for identification and differentiation of vascular lesions with distinct hemorrhagic potential in CE images. Methods The development of the CNN was based on a database of CE images. This database included images of normal small intestinal mucosa, red spots, and angiectasia/varices. The hemorrhagic risk was assessed by Saurin’s classification. For CNN development, 11,588 images (9525 normal mucosa, 1026 red spots, and 1037 angiectasia/varices) were ultimately extracted. Two image datasets were created for CNN training and testing. Results The network was 91.8% sensitive and 95.9% specific for detection of vascular lesions, providing accurate predictions in 94.4% of cases. In particular, the CNN had a sensitivity and specificity of 97.1% and 95.3%, respectively, for detection of red spots. Detection of angiectasia/varices occurred with a sensitivity of 94.1% and a specificity of 95.1%. The CNN had a frame reading rate of 145 frames/sec. Conclusions The developed algorithm is the first CNN-based model to accurately detect and distinguish enteric vascular lesions with different hemorrhagic risk. CNN-assisted CE reading may improve the diagnosis of these lesions and overall CE efficiency.

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“…Some studies that compared SB2 and SB3 reported that SB3 shows a significantly reduced reading time and a significantly improved detection rate, while other studies have reported no significant differences between SB2 and SB3 [21,23-27]. In addition, some of the polyps classified as PHE in the study by Goenka et al [22] may be tumorous lesions such as adenomas, and not inflammatory changes. Thus, further studies are needed to analyze whether PHE detection is indeed increased with the use of SB3.…”

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confidence: 97%

“…In this issue of Clinical Endoscopy , Goenka et al [22] evaluated the small bowels of patients with PH of various etiologies who had symptoms of unexplained anemia or occult GI bleeding, using the PillCam SB3 CE system, focusing on PHE. Abnormal findings were categorized into vascular (red spots, telangiectasia, or varices) and non-vascular/inflammatory lesions (villous edema, erythema, or polyps).…”

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confidence: 99%