Search Results (219)

The endoscopic capsule is a miniaturized device used for medical diagnosis, which is less invasive compared to traditional gastrointestinal endoscopy and can reduce patient discomfort. However, it faces challenges in communication transmission, such as high power consumption, serious signal interference, and low data transmission rate. To address these issues, this paper proposes an optimized modulation scheme that is low-cost, low-power, and robust in harsh environments, aiming to improve its transmission rate. The scheme is analyzed in terms of the in-body channel. The analysis and discussion for the scheme in wireless body area networks (WBANs) are divided into three aspects: bit error rate (BER) performance, energy efficiency (EE), and spectrum efficiency (SE), and complexity. These correspond to the following issues: transmission rate, communication quality, and low power consumption. The results demonstrate that the optimized scheme is more suitable for improving the communication performance of endoscopic capsules. Full article

Background/Objectives: Portal hypertension (PH) is a common complication in children with chronic liver diseases. Primary and secondary prophylaxis of variceal bleeding in these patients remains controversial. Our study aims to evaluate the management of gastrointestinal (GI) varices in children with PH in Italy. Methods: A questionnaire was sent to 21 major pediatric hepatology centers. It included 34 questions referring to the medical, endoscopic, radiological, and surgical management of GI varices. Results: Out of 21 centers, 16 returned a completed questionnaire (survey response rate 76%) with a high level of completeness. A total of 1206 children with PH were under follow-up. Splenomegaly associated with hypersplenism was the main indication for endoscopic surveillance in all centers (100%). Primary prophylaxis was performed with endoscopy plus non-selective beta-blockers (NSBBs) in 50%, endoscopy alone in 38%, and NSBBs alone in 12%. All centers managed acute variceal bleeding with endoscopy within 24 h, acid suppression, and octreotide infusion. Secondary prophylaxis of variceal bleeding was conducted using endoscopy (100%) and NSBBs (87%). Transjugular intrahepatic portosystemic shunt (TIPS) was considered a good option when endoscopic treatment failed in 94% of centers. Conclusions: In Italy, there is broad consensus among centers regarding the management of gastrointestinal varices in children with portal hypertension. All participating centers endorsed the use of endoscopic screening for children presenting with clinical signs of portal hypertension. Nonetheless, further research is essential to establish evidence-based guidelines and to improve overall quality of care. Full article

Background: Up to one-third of patients with gastroesophageal reflux disease (GERD) have persistent symptoms despite proton-pump inhibitor (PPI) therapy. E-Gastryal^® + MgAlg (Aurora Biofarma, Italy) is a mucosal protective agent that enhances barrier function against acid and non-acidic reflux. This study assessed its efficacy in combination with omeprazole versus omeprazole alone and as maintenance therapy. Methods: Patients with symptomatic GERD and Grade A reflux esophagitis confirmed by endoscopy were randomized to receive omeprazole 20 mg plus E-Gastryal^® + MgAlg or omeprazole 20 mg alone. The primary endpoint was the number of rescue medications used over 28 days. Secondary endpoints included symptom relief and quality-of-life assessments using the Reflux Symptom Index (RSI), Gastroesophageal Reflux Disease Impact Scale (GIS), GERD-Health-Related Quality of Life (GERD-HRQL), and Global Assessment of Performance (IGAP). Results: Ninety-six patients were included. The combination group used significantly fewer rescue medications (mean: 21 vs. 40.9 tablets; p = 0.002). At week 4, the combination group showed greater improvement in RSI, GIS, and GERD-HRQL scores (p < 0.001). Symptom relief was sustained during weeks 5–26 with E-Gastryal^® + MgAlg alone. Conclusions: E-Gastryal^® + MgAlg combined with omeprazole improves symptom control compared to PPI monotherapy. Continued use as maintenance therapy supports its role in long-term GERD management (NCT04130659). Full article

Depression, anxiety, and perceived stress are common comorbidities in patients with inflammatory bowel disease (IBD) and may negatively influence the disease course. Likewise, severe IBD may contribute to the development or worsening of psychiatric symptoms. Despite the established relevance of the gut–brain axis and frequent use of psychotropic medications in IBD patients, limited evidence exists regarding the effects of psychiatric treatments on gastrointestinal disease activity. Therefore, the aim of this systematic review is to evaluate the effectiveness of psychiatric therapies on gastrointestinal symptoms and disease activity in patients with IBD. The work was conducted in accordance with PRISMA guidelines. Searches were performed across PubMed, Web of Science, and Scopus up to July 2024. Eligible studies evaluated the effectiveness of psychiatric medications—including antidepressants, antipsychotics, anxiolytics, sedative-hypnotics, mood stabilizers, anticonvulsants, and others—on at least one gastrointestinal outcome in patients with IBD. Outcomes included changes in commonly used clinical and endoscopic scores for Crohn’s disease (CD) and ulcerative colitis (UC), number of bowel movements, stool consistency, presence of blood in stool, severity of abdominal pain, as well as in surrogate markers of disease activity following treatment. Out of 8513 initially identified articles, 22 studies involving 45,572 IBD patients met the inclusion criteria. Antidepressants, particularly bupropion, tricyclic antidepressants, selective serotonin reuptake inhibitors (SSRIs), venlafaxine, and duloxetine, were associated with improvements in IBD activity scores, including Crohn’s Disease Activity Index (CDAI) and Simple Endoscopic Score for Crohn’s Disease (SES-CD) for CD, Mayo score and Ulcerative Colitis Endoscopic Index of Severity (UCEIS) for UC. Case reports highlighted potential benefits of pregabalin and lithium carbonate, respectively, showed by the reduction in clinical and endoscopic score of disease activity for pregabalin and improvement of UC symptoms for lithium carbonate, while topiramate showed limited efficacy. Clonidine and naltrexone determined the reductions in clinical and endoscopic score of disease activity, including CDAI and Crohn’s disease endoscopy index severity score (CDEIS) for CD and Disease Activity Index (DAI) for UC. Despite the limited data and study heterogeneity, antidepressants, naltrexone, and clonidine were associated with improvements in IBD activity. Larger, prospective studies are needed to confirm the therapeutic potential of psychiatric medications in modulating IBD activity and to guide integrated clinical management. Full article

Real-time 3D reconstruction in minimally invasive surgery improves depth perception and supports intraoperative decision-making and navigation. However, endoscopic imaging presents significant challenges, such as specular reflections, low-texture surfaces, and tissue deformation. We present a novel, deterministic and iterative stereo-matching method based on adaptive support weights that is tailored to these constraints. The algorithm is implemented in CUDA and C++ to enable real-time performance. We evaluated our method on the Stereo Correspondence and Reconstruction of Endoscopic Data (SCARED) dataset and a custom synthetic dataset using the mean absolute error (MAE), root mean square error (RMSE), and frame rate as metrics. On SCARED datasets 8 and 9, our method achieves MAEs of 3.79 mm and 3.61 mm, achieving 24.9 FPS on a system with an AMD Ryzen 9 5950X and NVIDIA RTX 3090. To the best of our knowledge, these results are on par with or surpass existing deterministic stereo-matching approaches. On synthetic data, which eliminates real-world imaging errors, the method achieves an MAE of 140.06 μm and an RMSE of 251.9 μm, highlighting its performance ceiling under noise-free, idealized conditions. Our method focuses on single-shot 3D reconstruction as a basis for stereo frame stitching and full-scene modeling. It provides accurate, deterministic, real-time depth estimation under clinically relevant conditions and has the potential to be integrated into surgical navigation, robotic assistance, and augmented reality workflows. Full article

Background/Objectives: Gastrointestinal diseases (GID), such as oesophagitis, polyps, and ulcerative colitis, contribute significantly to global morbidity and mortality. Conventional diagnostic methods employing white light imaging (WLI) in wireless capsule endoscopy (WCE) provide limited spectrum information, therefore influencing classification performance. Methods: A new technique called Spectrum Aided Vision Enhancer (SAVE), which converts traditional WLI images into hyperspectral imaging (HSI)-like representations, hence improving diagnostic accuracy. HSI involves the acquisition of image data across numerous wavelengths of light, extending beyond the visible spectrum, to deliver comprehensive information regarding the material composition and attributes of the imaged objects. This technique facilitates improved tissue characterisation, rendering it especially effective for identifying abnormalities in medical imaging. Using a carefully selected dataset consisting of 6000 annotated photos taken from the KVASIR and ETIS-Larib Polyp Database, this work classifies normal, ulcers, polyps, and oesophagitis. The performance of both the original WLI and SAVE transformed images was assessed using advanced deep learning architectures. The principal outcome was the overall classification accuracy for normal, ulcer, polyp, and oesophagitis categories, contrasting SAVE-enhanced images with standard WLI across five deep learning models. Results: The principal outcome of this study was the enhancement of diagnostic accuracy for gastrointestinal disease classification, assessed through classification accuracy, precision, recall, and F1 score. The findings illustrate the efficacy of the SAVE method in improving diagnostic performance without requiring specialised equipment. With the best accuracy of 98% attained using EfficientNetB7, compared to 97% with WLI, experimental data show that SAVE greatly increases classification metrics across all models. With relative improvement from 85% (WLI) to 92% (SAVE), VGG16 showed the highest accuracy. Conclusions: These results confirm that the SAVE algorithm significantly improves the early identification and classification of GID, therefore providing a potential development towards more accurate, non-invasive GID diagnostics with WCE. Full article

Artificial intelligence (AI) is rapidly transforming imaging modalities in inflammatory bowel disease (IBD), particularly in endoscopy and ultrasound. Despite their critical roles, both modalities are challenged by interobserver variability, subjectivity, and accessibility issues. AI offers significant potential to address these limitations by enhancing lesion detection, standardizing disease activity scoring, and supporting clinical decision-making. In endoscopy, deep convolutional neural networks have achieved high accuracy in detecting mucosal abnormalities and grading disease severity, reducing observer dependency and improving diagnostic consistency. AI-assisted colonoscopy systems have also demonstrated improvements in procedural quality metrics, including adenoma detection rates and withdrawal times. Similarly, AI applications in intestinal ultrasound show promise in automating measurements of bowel wall thickness, assessing vascularity, and distinguishing between inflammatory and fibrotic strictures, which are critical for tailored therapy decisions. Video capsule endoscopy has likewise benefited from AI, reducing interpretation times and enhancing the detection of subtle lesions. Despite these advancements, implementation challenges, including dataset quality, standardization, AI interpretability, clinician acceptance, and regulatory and ethical considerations, must be carefully addressed. The current review focuses on the most recent developments in the integration of AI into experimental designs, medical devices, and clinical workflows for optimizing diagnostic accuracy, treatment strategies, and patient outcomes in IBD management. Full article

Background/Objectives: Colorectal cancer (CRC) is the most common gastrointestinal (GI) malignancy, the second leading cause of cancer-related mortality, and the third most prevalent tumor. Around 20% of cases are metastatic or inoperable at diagnosis, often requiring palliative treatment, which may not be feasible in frail patients. Calcium-electroporation, a less invasive alternative, induces cell death via apoptosis, necrosis, and pyroptosis. This study is the first in the United Kingdom to evaluate the efficacy and safety of endoscopic calcium-electroporation in palliating distal CRC. Methods: Frail patients with inoperable left-sided CRC were included. The diagnosis and staging followed standard guidelines, while frailty was assessed using the performance status (PFS), Charlson comorbidity index (CCI), and American Society of Anesthesiologists (ASA) score. Calcium electroporation was performed via a flexible endoscopy usually under sedation, with symptom relief, quality of life (QoL), survival, and adverse events (AE) monitored. Results: Sixteen patients (median age 84.5) underwent 36 treatments with electroporation over 28 months (November 2022 to March 2025). The incidence of common symptoms was rectal bleeding (75%), constipation (25%), and pain (75%). Nine patients had metastases and three had failed conventional treatments. Symptomatic relief and an improved QoL occurred in 86.7%, with transfusion/iron infusion needs reduced by 91.7%. The median cancer-specific survival was 10 months, with a 94% survival rate. No device-related AE was recorded. One patient died after 11 months due to disease progression while two patients passed away from other medical conditions. Conclusions: Endoscopic calcium electroporation is a safe, palliative option effective for tumor reduction and symptomatic relief in frail CRC patients unfit for conventional therapies. Full article

Esophageal fibrotic remodeling is a major complication of chronic inflammation in eosinophilic esophagitis (EoE) and represents one of the main determinants of symptoms in adult patients with EoE, with a remarkable impact on patients’ quality of life and the healthcare system. Esophageal fibrotic remodeling is diagnosed through upper gastrointestinal endoscopy, radiological studies, and a functional luminal imaging probe. However, diagnostic underestimation of esophageal strictures and suboptimal adherence to EoE guidelines still represent limitations of current clinical practice. Combined with medical therapy and/or elimination diets, endoscopic dilation remains the cornerstone treatment for esophageal strictures and rings, offering a safe and effective option for managing obstructive symptoms. Different modalities are available for esophageal endoscopic dilation of EoE, including mechanical and balloon dilators. Mechanical dilators provide tactile feedback during the procedure and exert longitudinal and radial forces. In contrast, balloon dilators apply a purely radial force and enable direct visualization of the esophageal mucosa during the procedure. Both mechanical and balloon dilators are safe and effective, with no single modality demonstrating clear superiority. Consequently, the choice of dilation technique is guided by stricture characteristics, the expertise of the endoscopist, and considerations related to the financial and environmental sustainability of the devices. This review aims to summarize the most relevant evidence on the endoscopic evaluation and dilation of fibrostenotic complications in EoE, also providing practical guidance for clinicians to optimize the endoscopic management of these patients. Full article

Colonoscopy is an essential diagnostic and therapeutic tool in gastroenterology, significantly impacting colorectal cancer (CRC) detection and management. Effective bowel preparation is critical for optimal visualization, directly influencing colonoscopy accuracy and patient outcomes. However, diabetic patients frequently encounter challenges achieving adequate bowel preparation, primarily due to gastroparesis, autonomic neuropathy, altered colonic motility, fluid–electrolyte imbalances, and complexities related to antihyperglycemic medication adjustments. This review aims to evaluate the current literature on bowel preparation efficacy in diabetic patients undergoing colonoscopy, assess existing guidelines from leading gastroenterological societies, and highlight the necessity for detailed, diabetes-specific recommendations. We conducted a comprehensive PubMed search identifying 20 pertinent studies, including randomized controlled trials, meta-analyses, multicenter studies, cohort studies, and reviews. The findings consistently indicate diabetes as an independent predictor of inadequate bowel preparation. Furthermore, an evaluation of guidelines from the European Society of Gastrointestinal Endoscopy (ESGE), the US Multi-Society Task Force, and the Canadian Association of Gastroenterology revealed either absent or insufficiently detailed diabetes-specific recommendations. Given the rising global prevalence of diabetes and CRC, inadequate bowel preparation significantly impacts the quality of colonoscopy, adenoma detection rates, patient safety, and healthcare costs. This review underscores the urgent need for additional research focusing on tailored bowel preparation strategies for diabetic patients. Ultimately, the implementation of standardized, evidence-based protocols designed explicitly for this high-risk group is essential to enhance diagnostic efficacy, improve patient outcomes, and reduce CRC-related morbidity and mortality. Full article

A 3-year-old intact female French Bulldog presented with chronic diarrhea, intermittent vomiting, hyporexia, and weight loss over seven weeks. The blood test results were unremarkable, except for mild hypocholesterolemia. Abdominal ultrasonography revealed intestinal wall thickening, particularly in the muscular layer, with focal loss of wall layering in the distal ileum near the ileocecal junction. Capsule endoscopy revealed mild-to-moderate mucosal irregularities and changes in the ileum, with a reduced luminal diameter caused by irregularly protruding walls, leading to the partial obstruction of the distal ileum. To remove the obstructed segment, surgical resection and anastomosis were performed from the distal ileum to the ileocecal junction, including the ileocolic valve region. Histopathological examination confirmed intestinal smooth muscle hyperplasia with mild infiltration of macrophages, neutrophils, and lymphocytes. As the underlying cause could not be identified, the condition was classified as an idiopathic condition. Postoperatively, long-term management of the clinical symptoms was implemented, including antibiotics, anti-inflammatory medications, and dietary modifications (the elimination of table foods). Over a one-year follow-up period, ultrasonography revealed mild recurrent inflammation and muscular hyperplasia; however, the clinical signs resolved, except for occasional episodes of diarrhea. Full article

Introduction: Congenital duodenal atresia (DA) (Type I) with a fenestrated web can be characterized by a late presentation with a delayed diagnosis. It is even rarer and usually associated with proximal duodenomegaly. Conventional management involves web resection and duodeno–duodeno anastomosis with or without duodenoplasty. We describe our mininvasive surgical strategy and management, detailing the aspects of laparoscopic techniques. Material and Methods: We retrospectively reviewed the medical records of five patients affected by fenestrated duodenal web (DA) with a delayed onset of symptoms and diagnosis who were managed in our Department over a period of 10 years (2013–2023). We analyzed the age of patients at diagnosis, clinical signs and symptoms, associated congenital anomalies, radiological and intraoperative findings, surgical treatment, and outcomes. Diagnostic examinations included ultrasound (US), Upper-Gastrointestinal Study (UGI), and Esophagogastroduodenoscopy (EGDS). Results: Three boys and two girls, median age of 5.5 months (range 3–11 months), were included in this study. Three underwent previous surgery for long-gap esophageal atresia (EA), two of Type A, and one of Type C, requiring a gastrostomy immediately after birth (delayed esophageal repair for prematurity in Type C) and subsequent delayed primary anastomosis. Major associated anomalies were EA (3), anterior ectopic anus (1), cloaca (1), and Type IV laryngeal web (1). An antenatal diagnostic suspicion of duodenal atresia (obstruction) on ultrasound was described in two patients. UGI suggested a fenestrated duodenal web, visualized at ultrasound in two patients. Duodenal dilation was associated in two cases. The symptoms were feeding difficulties, nonbilious vomiting, upper abdominal distension, and poor growth. All presented with a pre-ampullary obstruction. Endoscopic confirmation was only possible in one patient. The older patient underwent an endoscopic resection of a duodenal web. In the other four, we performed a laparoscopic longitudinal antimesenteric duodenal incision, web resection (excision), and transverse suture (closure was performed) without duodenoplasty. Intraduodenal Indocyanine Green (ICG) visualization (under near-infrared light) was used in the last two cases. No postoperative complications were recorded, with a mean hospital stay of 8 days. A contrast study performed at 4 weeks demonstrated an improved proximal duodenal profile; patients tolerated a full diet and remained symptom-free. Conclusions: According to our experience with minimally invasive techniques, laparoscopy and endoscopy are effective and safe, supporting web resection for the management of a duodenal web without tapering of the proximal duodenum. They require advanced technical skills. Intraduodenal-ICG injection during laparoscopic treatment of Type 1 DA allows localization of the duodenal web, confirmation of bowel patency (bowel canalization) and the tightness of suture. Full article

Background and Objectives: Gastric cancer (GC) remains a leading cause of cancer mortality worldwide, and the COVID-19 pandemic posed new barriers in diagnosis and management. This study aimed to assess whether pandemic-related healthcare disruptions resulted in more advanced GC stages at presentation. We additionally examined the role of Helicobacter pylori (H. pylori) across non-cardia GC (NCGC) versus cardia GC (CGC) and evaluated the risk factors of upper gastrointestinal (GI) bleeding. Methods: A retrospective cohort of 121 adult patients with GC was enrolled from a tertiary Gastroenterology Unit in Western Romania, spanning pre-pandemic (March 2018–February 2020), pandemic (March 2020–February 2022), and post-pandemic (March 2022–February 2024) periods. Demographic profiles, TNM staging, histopathology, H. pylori status, and clinical outcomes—including GI bleeding—were extracted from medical records. Results: An increase in advanced GC (Stage III–IVB) was noted in the post-pandemic period (69.4% vs. 53.3% pre-pandemic; p = 0.021). H. pylori positivity remained higher in NCGC (70.6%) compared to CGC (44.6%; overall p = 0.041); however, CGC cases showed a rise in H. pylori prevalence post-pandemic (36.4% to 55.6%). One-year mortality was driven by an advanced stage (hazard ratio [HR] = 2.74, p = 0.002), diagnosis during the COVID-19 pandemic (HR = 1.66, p = 0.010), and age ≥70 years (HR = 1.88, p = 0.043). Conclusions: Our findings demonstrate that delayed diagnostic endoscopy correlated with a higher proportion of advanced GC in the post-pandemic phase. H. pylori was strongly linked to NCGC, though CGC showed an increasing trend in H. pylori prevalence. Patients on antithrombotic agents faced increased GI bleeding risks. Full article

This study aimed to evaluate the efficiency and sensitivity of real-time video capsule endoscopy (RT-VCE) when detecting surgical and nonsurgical gastric lesions in dogs that presented with acute vomiting. Additionally, the patient tolerance and the utility of the RT-VCE data for clinical decision-making were assessed. Eleven client-owned dogs with an acute onset of vomiting were included. Each dog received an antiemetic and antacid before undergoing an RT-VCE (MC1200, MiroCam^®, Intromedic, Seoul, Republic of Korea). We independently reviewed the RT-VCE images to assess the image quality, detect gastric lesions, and make clinical decisions. The time taken to reach a diagnosis and the inter-clinician agreement were evaluated. RT-VCEs were successfully completed in all the dogs, with a mean time to diagnosis of 21.82 ± 15.26 min (range: 1–48 min). Both clinicians reached unanimous agreement on the RT-VCE findings. Five dogs were diagnosed with gastric foreign bodies and underwent surgical removal, while the remaining six were diagnosed with gastritis, a gastric ulcer or erosion, or hemorrhages, which were managed medically. No adverse effects, including vomiting, were observed after the capsule administration. RT-VCE proved to be an effective, accurate, and well-tolerated diagnostic method for evaluating gastric conditions in dogs with acute vomiting. Its rapid diagnostic capability and non-invasive nature make it a valuable modality in emergency veterinary settings. Full article

Inflammatory bowel diseases (IBDs), comprising Crohn’s disease (CD) and ulcerative colitis (UC), are chronic immune-mediated inflammatory diseases of the gastrointestinal (GI) tract with still-elusive etiopathogeneses and an increasing prevalence worldwide. Despite the growing availability of more advanced therapies in the last two decades, there are still a number of unmet needs. For example, the achievement of mucosal healing has been widely demonstrated as a prognostic marker for better outcomes and a reduced risk of dysplasia and cancer; however, the accuracy of endoscopy is crucial for both this aim and the precise and reproducible evaluation of endoscopic activity and the detection of dysplasia. Artificial intelligence (AI) has drastically altered the field of GI studies and is being extensively applied to medical imaging. The utilization of deep learning and pattern recognition can help the operator optimize image classification and lesion segmentation, detect early mucosal abnormalities, and eventually reveal and uncover novel biomarkers with biologic and prognostic value. The role of AI in endoscopy—and potentially also in histology and imaging in the context of IBD—is still at its initial stages but shows promising characteristics that could lead to a better understanding of the complexity and heterogeneity of IBDs, with potential improvements in patient care and outcomes. The initial experience with AI in IBDs has shown its potential value in the differentiation of UC and CD when there is no ileal involvement, reducing the significant amount of time it takes to review videos of capsule endoscopy and improving the inter- and intra-observer variability in endoscopy reports and scoring. In addition, these initial experiences revealed the ability to predict the histologic score index and the presence of dysplasia. Thus, the purpose of this review was to summarize recent advances regarding the application of AI in IBD endoscopy as there is, indeed, increasing evidence suggesting that the integration of AI-based clinical tools will play a crucial role in paving the road to precision medicine in IBDs. Full article