Capsule endoscopy (CE) is a valid alternative to conventional gastrointestinal (GI) endoscopy tools. In CE, annotation tools are crucial in developing large and annotated medical image databases for training deep neural networks (DNN). We provide an overview of the described and in-use various annotation systems available, focusing on the annotation of adenomatous polyp pathology in the GI tract. Some studies present promising results regarding time efficiency by implementing automated labelling features in annotation systems. Thus, data are inadequate regarding the general overview for users, and may also be more specific on which features provided are necessary for polyp annotation.

The gastrointestinal (GI) tract, particularly the small bowel (SB), can be challenging for novel investigation tools

Summary: Abdominal aortic aneurysm (AAA) is an extremely rare condition in paediatric patients but can occur more frequently in patients with congenital connective tissue diseases such as Marfan syndrome or Loeys-Dietz syndrome (LDS). We report a case of an adolescent with known LDS presenting in the emergency department with spontaneous, acute lumbar back pain. Initially, the pain was managed as acute lumbago but later found to be caused by a ruptured AAA. Following urgent surgical intervention with a bifurcated prosthetic vascular graft, the patient recovered successfully. This case highlights the necessity of maintaining awareness of severe complications in LDS patients, even when alternative diagnoses appear more likely.

Colon capsule endoscopy (CCE) is a noninvasive technique for colon evaluation. Although previous research has demonstrated high accuracy of CCE in detecting polyps, the impact of colonic transit time (CTT) on polyp detection remains unclear. We aimed to identify the lowest acceptable CTT for an optimal polyp detection rate (PDR). This study analyzed data from colorectal cancer screening participants with complete CCE examinations, as part of the CareForColon2015 trial. A multivariate logistic regression model was employed to investigate the relationship between CTT and PDR. Among the 2,031 participants who underwent CCE, 1,266 (62.3%) were eligible for analysis. CTTs ≤ 20 minutes were significantly associated with lower PDR for polyps of any size (OR 0.36, 95% CI 0.22; 0.59, P < .001) and polyps > 5 mm (OR 0.54, 95% CI 0.34; 0.85, P = .007) compared to a CTT of > 60 minutes. A nonsignificant trend was observed for CTTs 21-40 minutes and PDR for polyps > 5 mm (OR 0.68, 95% CI 0.46; 1.01, P = .053). No significant differences in PDR for polyps > 9 mm was found across the CTT categories. A sensitivity analysis with size-adjusted polyps revealed no significant differences in PDR for polyps > 5 mm across CTT categories. CTTs of ≤ 20 min are correlated with lower PDR for polyps of any size and those exceeding > 5 mm, but not for polyps > 9 mm. After size-adjustments of polyps, detection rates of clinically significant polyps were deemed CTT independent.

Background/Objectives: Colonoscopy is the standard examination for many symptomatic patients referred for lower-gastrointestinal investigation, but it is resource-intensive and may be a burdensome experience. Colon capsule endoscopy (CCE) offers a minimally invasive, sedation-free first-line examination, although clinically important findings, inadequate cleansing or incomplete transit can generate downstream colonoscopy. DanCap aims to compare the costs and clinical consequences of a CCE-first pathway with routine conventional colonoscopy (CC). Methods: DanCap is a single-centre, cluster-allocated crossover trial at Odense University Hospital, Denmark. General practice clinics follow CCE or CC according to the parity of their pre-existing provider number, with pathways crossing after 200 consecutive CCE participants; no trial-generated random allocation sequence is used. Eight hundred symptomatic adults aged >18 years referred for expedited lower-gastrointestinal investigation are planned. CCE participants with suspected cancer, any polyp ≥6 mm, inadequate cleansing or an incomplete examination are referred for colonoscopy. The primary outcome is pathway cost. Registered secondary outcomes and prespecified process measures include polyp and colorectalcancer detection, examination quality, reinvestigation and patient-reported consequences. FIT and microbiome are registered secondary outcomes; participation in the substudy is optional and the analyses are exploratory within the CCEpathway. Primary analyses will follow the assigned pathway and account for GP clinic clustering, period and allocation sequence. Expected Results: The trial will quantify the resource use and clinical consequences of implementing CCE in routine symptomatic practice. Conclusions: DanCap is intended to inform decisions about CCE pathway implementation rather than to establish unbiased whole-cohort test sensitivity or specificity. Trial registration: ClinicalTrials.gov NCT06475560; first submitted 20 June 2024 and first posted 26 June 2024. Recruitment began on 27 November 2024; the registry listed the study as recruiting when last updated on 19 March 2026.

Aims Capsule endoscopy (CE) is safe and accepted as the first-line mode of small bowel investigation. As the capsule is orally ingested, aspiration is always possible. We compiled the available data on capsule aspiration to provide an update on this complication of CE. Methods We performed a systematic literature search on PubMed with the search terms ‘capsule endoscopy’ AND ‘aspiration’, searched as keywords and MeSH. We included all observational cohort studies that reported aspiration among their complications, as well as case reports and series. Manual cross-checking of references was also performed. Two extractors performed abstract and full-text reviews and data extraction [1]. Results We found 120 relevant hits (25 were duplicates), and cross-checking references led to additional 14 articles. We removed 58 and ended with 51 references – with 56 cases of aspirated capsules. One death was reported. The median age was 80, with male preponderance. The most common indication for CE was ongoing anemia, and only aspiration of small bowel capsule endoscopes was reported. 82% of the aspirations were symptomatic; most common symptom was coughing. 71% of capsules ended in the bronchus, but only 3 cases experienced desaturation. 29 patients needed intervention for retrieval; the aspiration was self-resolved in the remaining. Conclusions With only 56 cases of aspirated capsules reported in the literature, aspiration remains a rare adverse event that is safely managed and should not deter patients from the procedure. In certain patient groups, aspiration should be anticipated, and in these, the capsule administration should be approached with precautions. Article published online: 14 April 2023 © 2023. European Society of Gastrointestinal Endoscopy. All rights reserved. Georg Thieme Verlag KG Rüdigerstraße 14, 70469 Stuttgart, Germany