Optimizing lesion detection in small-bowel capsule endoscopy: from present problems to future solutions

Abstract

This review presents issues pertaining to lesion detection in small-bowel capsule endoscopy (SBCE). The use of prokinetics, chromoendoscopy, diagnostic yield indicators, localization issues and the use of 3D reconstruction are presented. The authors also review the current status (and future expectations) in automatic lesion detection software development. Automatic lesion detection and reporting, and development of an accurate lesion localization system are the main software challenges of our time. The ‘smart’, selective and judicious use (before as well as during SBCE) of prokinetics in combination with other modalities (such as real time and/or purge) improves the completion rate of SBCE. The tracking of the capsule within the body is important for the localization of abnormal findings and planning of further therapeutic interventions. Currently, localization is based on transit time. Recently proposed software and hardware solutions are proposed herein. Moreover, the feasibility of software-based 3D representation (attempt for 3D reconstruction) is examined.

Keywords:

• 3D reconstruction
• capsule endoscopy
• diagnostic yield
• FICE
• innovation
• lesion detection
• small bowel
• software

Financial & competing interests disclosure

The authors have no relevant affiliations or financial involvement with any organization or entity with a financial interest in or financial conflict with the subject matter or materials discussed in the manuscript. This includes employment, consultancies, honoraria, stock ownership or options, expert testimony, grants or patents received or pending or royalties.

No writing assistance was utilized in the production of this manuscript.

Key issues

• Automatic lesion detection and reporting and development of an accurate lesion localization system are the main software challenges of our days.

• The ‘smart’, selective and judicious use (before as well as during small-bowel capsule endoscopy) of prokinetics, in combination with other modalities, such as real-time and/or purge, is crucial in improving the completion rate of small bowel capsule endoscopy. Caution is advised in unnecessary use of domperidone or metoclopramide for the elderly and those on multiple medications to avoid drug interactions, although such risk is most likely to be present with chronic rather than acute use.

• Further studies are needed to test the feasibility of 3D reconstruction in clinical practice and to evaluate the impact on the reviewing process in terms of both time and diagnostic yield.

• The construction of open-access data repositories will provide capsule endoscopy images and videos along with gold standard information for reproducible experimentation by all researchers.