MR1: ESGE recommends small-bowel capsule endoscopy as the first-line examination, before consideration of other endoscopic and radiological diagnostic tests for suspected small-bowel bleeding, given the excellent safety profile of capsule endoscopy, its patient tolerability, and its potential to visualize the entire small-bowel mucosa.Strong recommendation, moderate quality evidence. MR2: ESGE recommends small-bowel capsule endoscopy in patients with overt suspected small-bowel bleeding as soon as possible after the bleeding episode, ideally within 48 hours, to maximize the diagnostic and subsequent therapeutic yield.Strong recommendation, high quality evidence. MR3: ESGE does not recommend routine second-look endoscopy prior to small-bowel capsule endoscopy in patients with suspected small-bowel bleeding or iron-deficiency anemia.Strong recommendation, low quality evidence. MR4: ESGE recommends conservative management in those patients with suspected small-bowel bleeding and high quality negative small-bowel capsule endoscopy.Strong recommendation, moderate quality evidence. MR5: ESGE recommends device-assisted enteroscopy to confirm and possibly treat lesions identified by small-bowel capsule endoscopy.Strong recommendation, high quality evidence. MR6: ESGE recommends the performance of small-bowel capsule endoscopy as a first-line examination in patients with iron-deficiency anemia when small bowel evaluation is indicated.Strong recommendation, high quality evidence. MR7: ESGE recommends small-bowel capsule endoscopy in patients with suspected Crohn's disease and negative ileocolonoscopy findings as the initial diagnostic modality for investigating the small bowel, in the absence of obstructive symptoms or known bowel stenosis.Strong recommendation, high quality evidence. MR8: ESGE recommends, in patients with unremarkable or nondiagnostic findings from dedicated small-bowel cross-sectional imaging, small-bowel capsule endoscopy as a subsequent investigation if deemed likely to influence patient management.Strong recommendation, low quality evidence. MR9: ESGE recommends, in patients with established Crohn's disease, the use of a patency capsule before small-bowel capsule endoscopy to decrease the capsule retention rate.Strong recommendation, moderate quality evidence. MR10: ESGE recommends device-assisted enteroscopy (DAE) as an alternative to surgery for foreign bodies retained in the small bowel requiring retrieval in patients without acute intestinal obstruction.Strong recommendation, moderate quality evidence. MR11: ESGE recommends DAE-endoscopic retrograde cholangiopancreatography (DAE-ERCP) as a first-line endoscopic approach to treat pancreaticobiliary diseases in patients with surgically altered anatomy (except for Billroth II patients).Strong recommendation, moderate quality evidence.
- MeSH
- anemie z nedostatku železa * diagnóza etiologie terapie MeSH
- Crohnova nemoc * MeSH
- gastrointestinální endoskopie metody MeSH
- gastrointestinální krvácení diagnóza etiologie terapie MeSH
- kapslová endoskopie * MeSH
- lidé MeSH
- nemoci střev * diagnóza terapie MeSH
- Check Tag
- lidé MeSH
- Publikační typ
- časopisecké články MeSH
Nespecifické střevní záněty (IBD) jsou skupinou zánětlivých onemocnění postihujících zažívací trakt. Incidence a prevalence IBD v dětství jsou na vzestupu. IBD se klasifikují na Crohnovu chorobu (CD) a ulcerózní kolitidu (UC). Speciální jednotky tvoří IBD u dětí mladších 6 let (VEO-IBD) a IBD s nediferencovaným postižením tlustého střeva (IBD-U). Etiologie IBD je multifaktoriální a není dosud plně objasněna. Genetické predispozice, alterace střevní mikrobioty, dieta a faktory životního prostředí v ní zcela jistě hrají roli. Klinické projevy CD se odvíjí od lokalizace postižení a obvykle se skládají z bolestí břicha, nauzey, zvracení, průjmů s/bez příměsi krve a hubnutí. U UC jsou typicky bolesti břicha s imperativními defekacemi průjmovitých stolic s makroskopickou příměsí krve. Stanovení diagnózy IBD je postaveno na anamnéze, fyzikálním vyšetření, laboratorních nálezech a zobrazovacích metodách, zejména endoskopiích.
Inflammatory bowel disease (IBD) is a group of inflammatory illnesses affecting the gastrointestinal tract. The incidence and prevalence of paediatric IBD is on the rise. IBD is classified into Crohn's disease (CD) and Ulcerative colitis (UC). Special subunits consist of IBD affecting children younger than 6 years of age (VEO-IBD) and undifferentiated affection of the colon (IBD-U). IBD aetiology is multifactorial and still not fully understood. Genetic predisposition, alterations of gut microbiota, diet and environmental factors play a role in its development. Clinical manifestations of CD depend on disease location, and they usually consist of abdominal pain, nausea, vomiting, diarrhoea with/out blood and weight loss. UC presents with abdominal pain and imperative defecations of bloody diarrheal stools. Establishing IBD diagnosis is based on careful history, thorough physical examination, laboratory work and imaging methods, mainly endoscopies.
- MeSH
- Crohnova nemoc diagnóza epidemiologie etiologie MeSH
- diagnostické zobrazování metody MeSH
- dítě MeSH
- endoskopie trávicího systému metody MeSH
- idiopatické střevní záněty * diagnóza epidemiologie etiologie MeSH
- kapslová endoskopie metody MeSH
- lidé MeSH
- magnetická rezonanční tomografie metody MeSH
- ulcerózní kolitida diagnóza epidemiologie etiologie MeSH
- ultrasonografie metody MeSH
- Check Tag
- dítě MeSH
- lidé MeSH
- Publikační typ
- přehledy MeSH
Závěrečná zpráva o řešení grantu Agentury pro zdravotnický výzkum MZ ČR
Nestr.
Multicentre, multidisciplinary (3 gastroenterology units; biostatistics department; cooperation with general practitioners), prospective study is focused on examination of individuals with average colorectal cancer (CRC) risk (asymptomatic, age 50-75 years). In years 2016 – 2019, there will be 230 persons with positive semi-quantitative immunochemical fecal occult blood tests (FIT; QuikRead, Orion Diagnostica Oy, Finland) with cut-off level 75 ng/ml involved. Every person will be examined by second generation colon capsule endoscopy (CCE2) and optical colonoscopy afterwards. Main objective is to show that the negative predictive value (NPV) of the CCE2 applied in patients with positive FIT result is sufficient to include this method in the National CRC screening as the “filter” test with aim to reduce the necessity of subsequent optical colonoscopy.
Multicentrická, multioborová (3 pracoviště z oboru gastroenterologie, pracoviště biostatistiky, spolupráce s praktickými lékaři) prospektivní studie je zaměřena na vyšetření osob s běžným rizikem kolorektálního karcinomu (KRK), tedy o asymptomatické jedince ve věku 50-75 let. V letech 2016 – 2019 bude do studie zařazeno 230 jedinců s pozitivním semikvantitativním imunochemickým testem na okultní krvácení do stolice (QuikRead, Orion Diagnostica Oy, Finland) s hranicí pozitivity (cut-off hodnota) 75 ng/ml. Každý vyšetřovaný absolvuje kolonickou kapslovou endoskopii druhé generace a následně optickou kolonoskopii. Primárním cílem je určit zda negativní prediktivní hodnota kolonické kapslové endoskopie je dostatečná, aby tato metoda mohla být realizována v rámci Národního screeningu KRK jako „filtrační“ test s cílem snížit nutnost následné optické kolonoskopie.
- MeSH
- imunochemie metody MeSH
- kapslová endoskopie metody MeSH
- kolonoskopie metody MeSH
- kolorektální nádory chirurgie diagnóza MeSH
- lidé MeSH
- okultní krev MeSH
- prospektivní studie MeSH
- rizikové faktory MeSH
- senzitivita a specificita MeSH
- Check Tag
- lidé MeSH
- mužské pohlaví MeSH
- Publikační typ
- multicentrická studie MeSH
- srovnávací studie MeSH
- Konspekt
- Patologie. Klinická medicína
- NLK Obory
- gastroenterologie
- onkologie
- NLK Publikační typ
- závěrečné zprávy o řešení grantu AZV MZ ČR
- Klíčová slova
- retence endoskopické kapsle,
- MeSH
- bolesti břicha * etiologie MeSH
- chirurgie trávicího traktu metody MeSH
- diagnostické techniky gastrointestinální MeSH
- kapslová endoskopie * metody škodlivé účinky MeSH
- kolonoskopie metody MeSH
- lidé středního věku MeSH
- lidé MeSH
- střevní obstrukce * etiologie MeSH
- výsledek terapie MeSH
- Check Tag
- lidé středního věku MeSH
- lidé MeSH
- ženské pohlaví MeSH
- Publikační typ
- kazuistiky MeSH
Wireless capsule endoscopy (WCE) is one of the most efficient methods for the examination of gastrointestinal tracts. Computer-aided intelligent diagnostic tools alleviate the challenges faced during manual inspection of long WCE videos. Several approaches have been proposed in the literature for the automatic detection and localization of anomalies in WCE images. Some of them focus on specific anomalies such as bleeding, polyp, lesion, etc. However, relatively fewer generic methods have been proposed to detect all those common anomalies simultaneously. In this paper, a deep convolutional neural network (CNN) based model 'WCENet' is proposed for anomaly detection and localization in WCE images. The model works in two phases. In the first phase, a simple and efficient attention-based CNN classifies an image into one of the four categories: polyp, vascular, inflammatory, or normal. If the image is classified in one of the abnormal categories, it is processed in the second phase for the anomaly localization. Fusion of Grad-CAM++ and a custom SegNet is used for anomalous region segmentation in the abnormal image. WCENet classifier attains accuracy and area under receiver operating characteristic of 98% and 99%. The WCENet segmentation model obtains a frequency weighted intersection over union of 81%, and an average dice score of 56% on the KID dataset. WCENet outperforms nine different state-of-the-art conventional machine learning and deep learning models on the KID dataset. The proposed model demonstrates potential for clinical applications.
- Klíčová slova
- retence endoskopické kapsle,
- MeSH
- bolesti břicha * etiologie MeSH
- chirurgie trávicího traktu metody MeSH
- diagnostické techniky gastrointestinální MeSH
- kapslová endoskopie * metody škodlivé účinky MeSH
- kolonoskopie metody MeSH
- lidé středního věku MeSH
- lidé MeSH
- střevní obstrukce * etiologie MeSH
- výsledek terapie MeSH
- Check Tag
- lidé středního věku MeSH
- lidé MeSH
- ženské pohlaví MeSH
- Publikační typ
- kazuistiky MeSH
PURPOSE OF REVIEW: Peutz-Jeghers syndrome is a rare, autosomal dominant, hereditary polyposis syndrome defined by gastrointestinal hamartomas and mucocutaneous pigmentations, caused by a germline mutation in the serine/ threonine kinase 11 or liver kinase B1 (STK11/LKB1) genes. Hamartomatous polyps located throughout the gastrointestinal tract can be complicated by bleeding and small bowel intussusception, potentially leading to the need for emergency surgery. Individuals suffering from Peutz-Jeghers syndrome have an increased lifetime risk of various forms of cancer (gastrointestinal, pancreatic, lung, breast, uterine, ovarian and testicular). Surveillance should lead to the prevention of complications and thus a reduction in mortality and morbidity of patients. RECENT FINDINGS: A combined approach based on wireless capsule endoscopy, magnetic resonance enterography and device-assisted enteroscopy is effective in reduction of the polyp burden and thus decreasing the risk of bleeding and intussusception. Current guidelines for screening and surveillance are mostly based on expert opinion rather than evidence. SUMMARY: Peutz-Jeghers syndrome is an emerging disease that significantly affects the quality of life enjoyed by patients. Despite of all the progress in improved early diagnostics, options for advanced endoscopic therapy and elaborate surveillance, acute and chronic complications decrease the life expectancy of patients suffering from Peutz-Jeghers syndrome.
Gastrointestinal side effects of donepezil, including dyspepsia, nausea, vomiting or diarrhea, occur in 20-30% of patients. The pathogenesis of these dysmotility associated disorders has not been fully clarified yet. Pharmacokinetic parameters of donepezil and its active metabolite 6-O-desmethyldonepezil were investigated in experimental pigs with and without small intestinal injury induced by dextran sodium sulfate (DSS). Morphological features of this injury were evaluated by a video capsule endoscopy. The effect of a single and repeated doses of donepezil on gastric myoelectric activity was assessed. Both DSS-induced small intestinal injury and prolonged small intestinal transit time caused higher plasma concentrations of donepezil in experimental pigs. This has an important implication for clinical practice in humans, with a need to reduce doses of the drug if an underlying gastrointestinal disease is present. Donepezil had an undesirable impact on porcine myoelectric activity. This effect was further aggravated by DSS-induced small intestinal injury. These findings can explain donepezil-associated dyspepsia in humans.
- MeSH
- donepezil chemie farmakokinetika farmakologie MeSH
- gastrointestinální trakt účinky léků patologie patofyziologie MeSH
- indany metabolismus MeSH
- kapslová endoskopie MeSH
- metabolom * účinky léků MeSH
- migrující myoelektrický komplex * účinky léků MeSH
- piperidiny metabolismus MeSH
- prasata MeSH
- síran dextranu MeSH
- žaludek účinky léků patofyziologie MeSH
- zvířata MeSH
- Check Tag
- ženské pohlaví MeSH
- zvířata MeSH
- Publikační typ
- časopisecké články MeSH
One of the most recent non-invasive technologies to examine the gastrointestinal tract is wireless capsule endoscopy (WCE). As there are thousands of endoscopic images in an 8-15 h long video, an evaluator has to pay constant attention for a relatively long time (60-120 min). Therefore the possibility of the presence of pathological findings in a few images (displayed for evaluation for a few seconds only) brings a significant risk of missing the pathology with all negative consequences for the patient. Hence, manually reviewing a video to identify abnormal images is not only a tedious and time consuming task that overwhelms human attention but also is error prone. In this paper, a method is proposed for the automatic detection of abnormal WCE images. The differential box counting method is used for the extraction of fractal dimension (FD) of WCE images and the random forest based ensemble classifier is used for the identification of abnormal frames. The FD is a well-known technique for extraction of features related to texture, smoothness, and roughness. In this paper, FDs are extracted from pixel-blocks of WCE images and are fed to the classifier for identification of images with abnormalities. To determine a suitable pixel block size for FD feature extraction, various sizes of blocks are considered and are fed into six frequently used classifiers separately, and the block size of 7×7 giving the best performance is empirically determined. Further, the selection of the random forest ensemble classifier is also done using the same empirical study. Performance of the proposed method is evaluated on two datasets containing WCE frames. Results demonstrate that the proposed method outperforms some of the state-of-the-art methods with AUC of 85% and 99% on Dataset-I and Dataset-II respectively.
- MeSH
- fraktály MeSH
- gastrointestinální trakt MeSH
- kapslová endoskopie * MeSH
- lidé MeSH
- Check Tag
- lidé MeSH
- Publikační typ
- časopisecké články MeSH
- práce podpořená grantem MeSH
