Returning to digestive endoscopy normality will be slow and must include novelty and telemedicine

Koulaouzidis, Anastasios; Marlicz, Wojciech; Wenzek, Hagen; Koulaouzidis, George; Eliakim, Rami; Tóth, Ervin

doi:10.1016/j.dld.2020.05.048

Cited by 19 publications

(22 citation statements)

References 12 publications

(9 reference statements)

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“…2 Any history of gastrointestinal bleeding or intracranial bleeding, i. e., epidural hematoma, subdural hematoma, subarachnoid haemorrhage, or intracerebral or intraventricular hemorrhage. 3 Estimated glomerular filtration rate < 60 mg/dL/1.73 m 2 . 4 Aspirin, ticagrelor, prasugrel, clopidogrel or fixed-dose combination aspirin-dipyridamole.…”

Section: Older Age (≥ 75 Years)mentioning

confidence: 99%

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Scoring systems in clinical small-bowel capsule endoscopy: all you need to know!

et al. 2021

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Capsule endoscopy (CE) emerged out of the pressing clinical need to image the small bowel (SB) in cases of midgut bleeding and provide an overall comfortable and reliable gastrointestinal (GI) diagnosis 1. Since its wider adoption in clinical practice, significant progress has been made in several areas including software development, hardware features and clinical indications, while innovative applications of CE never cease to appear 2 3. Currently, several manufacturers provide endoscopic capsules with more or less similar technological features 4. Although there is engaging and continuous academic and industry-fueled R&D, promising furtherment of CE technology 4 5, the current status of clinical CE remains that of by and large an imaging modality. Clinical relevance of CE images is cornerstone in the decision-making process for medical management. In one of the larger to date SB CE studies, 4,206 abnormal images were detected in 3,280 patients 6. Thus, CE leads to the identification of a large amount of potential pathology, some of which are pertinent (or relevant) while some (probably the majority) are not.Soon artificial intelligence (AI) is likely to carry out several roles currently performed by humans; in fact, we are witnessing only the first stages of a transition in the clinical adoption of AI-based solutions in several aspects of gastroenterology including CE 7. Until then though, human-based decision-making profoundly impacts patient care and – although not suggested in the updated European Society of Gastrointestinal Endoscopy (ESGE) European curriculum 8 9 – it should be an integral part of CE training. Frequently, interpretation of CE images by experts or at least experienced readers differs. In a tandem CE reading study, expert review of discordant cases revealed a 50 % (13/25 discordant results) error rate by experienced readers, corresponding (in 5/13 cases) to ‘over-classification’ of an irrelevant abnormality 10. Another comparative study showed an ‘over-classification’ of such irrelevant abnormalities in ~10 % of CE readings 11. One thing which has been for a while on the table – in relation to optimizing and/or standardizing CE reporting and subsequent decision-making – is the need for reproducible scoring systems and for a reliable common language among clinicians responsible for further patient’s management.Over the years, several of these scoring systems were developed while others appear in the wake of software and hardware improvements aiming to replace and/or complement their predecessors. This review presents a comprehensive account of the currently available classification/scoring systems in clinical CE spanning from predicting the bleeding potential of identified SB lesions (with emphasis on vascular lesions), and the individual rebleeding risk; scoring systems for the prediction of SB lesions in patients with obscure gastrointestinal bleeding (OGlB), having the potential to improve patient selection and rationalize the use of enteroscopy, with better allocation of resources, optimized diagnostic workflow and tailored treatment. This review also includes scores for reporting the inflammatory burden, the cleansing level that underscores confidence in CE reporting and the mass or bulge question in CE. Essentially, the aim is to become a main text for reference when scoring is required and facilitate the inclusion of -through readiness of access- one of the other in the final report.

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Section: Older Age (≥ 75 Years)mentioning

confidence: 99%

“…2 Saurin classification (only the higher rating accountable) 3. Bleeding causing a fall in hemoglobin level of ≥ 2 g/dL or leading to transfusion of ≥ 2 units of red blood cells 4.…”

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confidence: 99%

Scoring systems in clinical small-bowel capsule endoscopy: all you need to know!

et al. 2021

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“…The scoring in particular domains of a tool is available in Supplementary Table 1 Discussion CE has become a well-established technology for identifying SB pathology and is the pivotal modality in investigation pathways for midgut bleeding, Crohn's disease, and SB polyposis syndromes [3,14,15]. Moreover, the recent COVID-19 pandemic and the mature emergence of artificial intelligence has re-▶ ▶ newed interest among healthcare providers about wire-free, distance-respecting modalities [16,17]. However, despite advances in technology [18,19], the challenge of accurate lesion localization within the featureless structure of the SB tract remains very much alive.…”

Section: Reviewmentioning

confidence: 99%

Capsule endoscopy transit-related indicators in choosing the insertion route for double-balloon enteroscopy: a systematic review

Valdivia

Skonieczna-Żydecka

Pennazio³

et al. 2021

Endosc Int Open

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Background and study aims When capsule endoscopy (CE) detects a small bowel (SB) target lesion that may be manageable with enteroscopy, the selection of the insertion route is critical. Time- and progression-based CE indices have been proposed for localization of SB lesions. This systematic review analysed the role of CE transit indicators in choosing the insertion route for double-balloon enteroscopy (DBE). Methods A comprehensive literature search identified papers assessing the role of CE on the choice of the route selection for DBE. Data on CE, criteria for route selection, and DBE success parameters were retrieved and analyzed according to the PRISMA statement. Risk of bias was assessed through the STROBE assessment. The primary outcome evaluated was DBE success rate in reaching a SB lesion, measured as the ratio of positive initial DBE to the number of total DBE. Results Seven studies including 262 CEs requiring subsequent DBE were selected. Six studies used time-based indices and one used the PillCam Progress indicator. SB lesions were identified and insertion route was selected according to a specific cut-off, using fixed landmarks for defining SB transit except for one study in which the mouth-cecum transit was considered. DBE success rate was high in all studies, ranging from 78.3 % to 100 %. Six of seven studies were high quality. Conclusions The precise localization of SB lesions remains an open issue, and larger studies are required to determine the most accurate index for selecting the DBE insertion route. In the future, 3 D localization technologies and tracking systems will be essential to accomplish this tricky task.

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“…The impact of suspended elective endoscopy procedures at this time of the current COVID-19 pandemic could significantly affect gastrointestinal health [ 94 , 95 ]. With this in mind, the new consensus guidance using the modified Delphi process aimed to facilitate a rapid and safe reopening of global endoscopy services has been recently developed [ 94 ].…”

Section: Endoscopy Services In the Covid-19 Era: Call For Innovatimentioning

confidence: 99%

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

Marlicz

Ren

Robertson

et al. 2020

Cancers

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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.

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Returning to digestive endoscopy normality will be slow and must include novelty and telemedicine

Cited by 19 publications

References 12 publications

Scoring systems in clinical small-bowel capsule endoscopy: all you need to know!

Scoring systems in clinical small-bowel capsule endoscopy: all you need to know!

Capsule endoscopy transit-related indicators in choosing the insertion route for double-balloon enteroscopy: a systematic review

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

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