Small bowel enteroscopy � A joint clinical guideline by the Spanish and Portuguese small-bowel study groups

Robles, Enrique Pérez‐Cuadrado; Pinho, Rolando; González-Suárez, Begoña; Mão-de-Ferro, Susana; Chagas, Cristina; Delgado, Pilar; Carretero, Cristina; Figueiredo, Pedro; Rosa, Bruno; García-Lledó, Javier; Nogales, Óscar; Ponte, Ana; Andrade, Patrícia; Juanmartiñena-Fernández, José Francisco; San-Juan-Acosta, Mileidis; Lopes, Sandra; Prieto-Frías, César; Valenzuela, Juan Egea; Caballero, Noemí; Valdivieso-Cortazar, E.; Cardoso, Hélder; Gálvez, Consuelo; Almeida, Nuno; Barrera, Pilar Borque; Rodríguez, Blas José Gómez; Ceballos, Francisco Luis Sánchez; Bernardes, Carlos; Alonso-Aguirre, Pedro; Arias, Federico Argüelles; Saraiva, Miguel Mascarenhas; Martínez, Enrique Pérez‐Cuadrado

doi:10.17235/reed.2020.7020/2020

Cited by 13 publications

(11 citation statements)

References 130 publications

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“…When a lesion is detected by CE, choosing the optimal insertion route for DAE is a pivotal step in patient management. The correct choice helps to minimize the number of endoscopic examinations with no or limited yield and provides a cost-effective & precision approach 15 74 75 76 . The location of a lesion in the SB can be estimated by CE time-based indices, expressed as the time taken for the capsule to reach the lesion divided by the examination’s total transit time (TT).…”

Section: Lesion Localization Indicesmentioning

confidence: 99%

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: Lesion Localization Indicesmentioning

confidence: 99%

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

et al. 2021

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“…The MGIB is a topic of great interest in the gastroenterology practice, being a vastly studied matter, concerning areas such as diagnostic approach, prognosis, treatment and surveillance 1,23,24 . Several factors have been established as potentially influencing the rate of rebleeding 25 ; however, we lack specific knowledge on how to optimize the interpretation of these risk factors to establish the optimal surveillance of MGIB patients.…”

Section: Discussionmentioning

confidence: 99%

“…This recommendation stands despite the controversy that surrounds the efficacy of DAE treatment in MGIB. Indeed, rates of rebleeding after initial DAE hemostasis go up to 52.6%, 24 although it seems that repeating therapeutic DAE may reduce overall rebleeding 8 . Somewhat controversially, the referral for therapeutic DAE was also an independent risk factor for rebleeding.…”

Section: Discussionmentioning

confidence: 99%

RHEMITT score: Predicting the risk of mid gastrointestinal rebleeding after small bowel capsule endoscopy: A prospective validation

Magalhães

Sousa‐Pinto

Carvalho

et al. 2021

J of Gastro and Hepatol

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Background and Aim The RHEMITT score (Renal disease; Heart failure; Endoscopic findings; Major bleeding; Incomplete SBCE; Tobacco; Treatment by enteroscopy) was the first score to accurately predict the individual risk of small bowel rebleeding after capsule endoscopy (SBCE). The aim of the study is on the prospective validation of the RHEMITT score. Methods Cohort of consecutive patients with mid‐gastrointestinal bleeding (MGIB) submitted to SBCE and followed prospectively, during at least 12 months, since 2017 until 2020. Rebleeding was defined as an overt bleeding event (melena or hematochezia) or a hemoglobin decrease of at least 2 g/dL. The RHEMITT score was calculated for each patient and the rebleeding rates compared. The performance of the score was tested by calculating the area under curve of the receiver operator characteristic curve. A rebleeding‐free survival was assessed, corresponding to the period between the date of SBCE and the date of the first post‐SBCE rebleeding event. Results We included 162 patients, 102 (62.9%) were female, with a mean age of 64 years old. The sensitivities and specificities of the score grades for predicting rebleeding were as following: for low‐risk patients, 0% (0–10%) and 28.8% (21.1–36.5%); for intermediate‐risk patients, 23.3% (8.2–38.4%) and 72% (64.3–79.7%); for high‐risk patients, 76.7% (61.6–91.8%) and 99.2% (97.7–100%), corresponding to an area under curve of the receiver operator characteristic of 0.988 (P < 0.001). Kaplan–Meyer plots were statistically different according to the attributed risk (log‐rank P value <0.001; Breslow–Wilcoxon P value <0.001). Conclusion The RHEMITT score performed with excellent discriminative power in predicting rebleeding risk, and we herewith propose a surveillance of MGIB patients guided by the RHEMITT score.

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“…35 Urgent DAE, which is performed within 72 hours from the onset of SSBB, showed not only higher diagnostic yield compared to non-urgent intervention (70%-90% vs. 30%-50%, respectively), but also higher therapeutic performance (28.6%-57.5% vs. 13.0%-50.0%, respectively). 37 Another study reported that DAE within 24 hours in overt SBB showed a higher diagnostic (70%) and therapeutic yield (90%). 20 In a recent meta-analysis of DAE in overt bleeding, early DAE was associated with a significantly higher diagnostic yield (odds ratio, 3.2; 95% confidence interval, 1.9-5.3; P = 0.002), although the definition of early intervention varies among the studies (from during ongoing bleeding to 1 week).…”

Section: Occult Sbbmentioning

confidence: 98%

Use of device-assisted enteroscopy in small bowel disease: an expert consensus statement by the Korean Association for the Study of Intestinal Diseases

et al. 2023

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The introduction of device-assisted enteroscopy (DAE) in the beginning of 21st century has revolutionized the diagnosis and treatment of diseases of the small intestine. In contrast to capsule endoscopy, the other main diagnostic modality of the small bowel diseases, DAE has the unique advantages of observing the region of interest in detail and enabling tissue acquisition and therapeutic intervention. As DAE becomes an essential procedure in daily clinical practice, there is an increasing need for correct guidelines on when and how to perform it and what technical factors should be considered. In response to these needs, the Korean Association for the Study of Intestinal Diseases developed an expert consensus statement on the performance of DAE by reviewing the current evidence. This expert consensus statement particularly focuses on the indications, choice of insertion route, therapeutic intervention, complications, and relevant technical points.

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Small bowel enteroscopy � A joint clinical guideline by the Spanish and Portuguese small-bowel study groups

Cited by 13 publications

References 130 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!

RHEMITT score: Predicting the risk of mid gastrointestinal rebleeding after small bowel capsule endoscopy: A prospective validation

Use of device-assisted enteroscopy in small bowel disease: an expert consensus statement by the Korean Association for the Study of Intestinal Diseases

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