Clinical Practice Guidelines for the Use of Video Capsule Endoscopy

The gastrointestinal (GI) tract offers the opportunity to detect physiological and pathophysiological signals from the human body. Ingestible electronics can gain close proximity to major organs through the GI tract and therefore can serve as clinical tools for diagnostics and therapy. In this Review, we summarize the physiological and anatomical characteristics of the GI tract, which present both challenges and opportunities for the development of ingestible devices. We describe recent breakthroughs in materials science, electrical engineering and data science that have permitted the exploration of technologies for sensing and therapy via the GI tract. Novel sensing opportunities include electrochemical, electromagnetic, optical and acoustic protocols, which have the capacity to sense luminal or extra-luminal analytes in the GI tract. We review therapeutic interventions, such as anatomical targeting for drug delivery, delivery of macromolecules and electrical signals. Finally, we investigate major challenges associated with ingestible electronics, including safety, communication, powering, steering and tissue interactions. Ingestible electronics are an exciting area of scientific innovation and they may pave the way for a new era in medicine, enabling patients to receive remote, electronically assisted health care. Ingestible electronics can be used as clinical tools for diagnosis and therapy. In this Review, the authors discuss clinical applications of ingestible electronic devices and highlight materials and sensor technologies, drug delivery applications and major challenges and opportunities for clinical translation, such as safety, powering and communication.

Ingestible electronics for diagnostics and therapy

Although colorectal cancer (CRC) screening is included in organized programs of many countries worldwide, there is still a place for better screening tools. In this study, 418 breath samples were collected from 65 patients with CRC, 22 with advanced or nonadvanced adenomas, and 122 control cases. All patients, including the controls, had undergone colonoscopy. The samples were analysed with two different techniques. The first technique relied on gas chromatography coupled with mass spectrometry (GC-MS) for identification and quantification of volatile organic compounds (VOCs). The T-test was used to identify significant VOCs (p values < 0.017). The second technique relied on sensor analysis with a pattern recognition method for building a breath pattern to identify different groups. Blind analysis or leave-one-out cross validation was conducted for validation. The GC-MS analysis revealed four significant VOCs that identified the tested groups; these were acetone and ethyl acetate (higher in CRC), ethanol and 4-methyl octane (lower in CRC). The sensor-analysis distinguished CRC from the control group with 85% sensitivity, 94% specificity and 91% accuracy. The performance of the sensors in identifying the advanced adenoma group from the non-advanced adenomas was 88% sensitivity, 100% specificity, and 94% accuracy. The performance of the sensors in identifying the advanced adenoma group was distinguished from the control group was 100% sensitivity, 88% specificity, and 94% accuracy. For summary, volatile marker testing by using sensor analysis is a promising noninvasive approach for CRC screening.

https://www.onlinelibrary.wiley.com/doi/pdf/10.1002/ijc.29701

Breath testing as potential colorectal cancer screening tool

Although colorectal cancer (CRC) screening is included in organized programs of many countries worldwide, there is still a place for better screening tools. In this study, 418 breath samples were collected from 65 patients with CRC, 22 with advanced or nonadvanced adenomas, and 122 control cases. All patients, including the controls, had undergone colonoscopy. The samples were analysed with two different techniques. The first technique relied on gas chromatography coupled with mass spectrometry (GC‐MS) for identification and quantification of volatile organic compounds (VOCs). The T‐test was used to identify significant VOCs (p values < 0.017). The second technique relied on sensor analysis with a pattern recognition method for building a breath pattern to identify different groups. Blind analysis or leave‐one‐out cross validation was conducted for validation. The GC‐MS analysis revealed four significant VOCs that identified the tested groups; these were acetone and ethyl acetate (higher in CRC), ethanol and 4‐methyl octane (lower in CRC). The sensor‐analysis distinguished CRC from the control group with 85% sensitivity, 94% specificity and 91% accuracy. The performance of the sensors in identifying the advanced adenoma group from the non‐advanced adenomas was 88% sensitivity, 100% specificity, and 94% accuracy. The performance of the sensors in identifying the advanced adenoma group was distinguished from the control group was 100% sensitivity, 88% specificity, and 94% accuracy. For summary, volatile marker testing by using sensor analysis is a promising noninvasive approach for CRC screening.

Breath Testing as Potential Colorectal Cancer Screening Tool

Background Colon capsule endoscopy (CCE) is a technology that might contribute to colorectal cancer (CRC) screening programs as a filter test between fecal immunochemical testing and standard colonoscopy. The aim was to systematically review the literature for studies investigating the diagnostic yield of second-generation CCE compared with standard colonoscopy. Methods A systematic literature search was performed in PubMed, Embase, and Web of Science. Study characteristics including quality of bowel preparation and completeness of CCE transits were extracted. Per-patient sensitivity and specificity were extracted for polyps (any size, ≥ 10 mm, ≥ 6 mm) and lesion characteristics. Meta-analyses of diagnostic yield were performed. Results The literature search revealed 1077 unique papers and 12 studies were included. Studies involved a total of 2199 patients, of whom 1898 were included in analyses. The rate of patients with adequate bowel preparation varied from 40 % to 100 %. The rates of complete CCE transit varied from 57 % to 100 %. Our meta-analyses demonstrated that mean (95 % confidence interval) sensitivity, specificity, and diagnostic odds ratio were: 0.85 (0.73–0.92), 0.85 (0.70–0.93), and 30.5 (16.2–57.2), respectively, for polyps of any size; 0.87 (0.82–0.90), 0.95 (0.92–0.97), and 136.0 (70.6–262.1), respectively, for polyps ≥ 10 mm; and 0.87 (0.83–0.90), 0.88 (0.75–0.95), and 51.1 (19.8–131.8), respectively, for polyps ≥ 6 mm. No serious adverse events were reported for CCE. Conclusion CCE had high sensitivity and specificity for per-patient polyps compared with standard colonoscopy However, the relatively high rate of incomplete investigations limits the application of CCE in a CRC screening setting.

/pdf/diagnostic-accuracy-of-capsule-endoscopy-compared-with-hwjf4ksq78.pdf

Diagnostic accuracy of capsule endoscopy compared with colonoscopy for polyp detection: systematic review and meta-analyses

BACKGROUND: Conventional colonoscopy (CC) is the gold standard for diagnostic examination of the colon. However, the overall acceptance of this procedure is low due to patient fears of complications or embarrassment. Colon capsule endoscopy (CCE) represents a minimally invasive, patient-friendly procedure that offers complete visualization of the entire intestine.

/pdf/colon-capsule-endoscopy-detection-of-colonic-polyps-compared-4q1k3vy1du.pdf

Colon capsule endoscopy: detection of colonic polyps compared with conventional colonoscopy and visualization of extracolonic pathologies.

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Colon capsule endoscopy: detection of colonic polyps compared with conventional colonoscopy and visualization of extracolonic pathologies.