Background Motorized Spiral Enteroscopy (MSE) reduces procedure time and increases insertion depth into the small bowel; however, there is scarce evidence on factors affecting MSE efficacy. Aims To evaluate diagnostic yield and adverse events of MSE including patients with prior major abdominal surgery. Methods A prospective observational study was conducted on patients undergoing MSE from June 2019 to December 2021. Demographic characteristics, procedure time, depth of maximum insertion (DMI), technical success, diagnostic yield, and adverse events were collected. Results Seventy-four anterograde (54.4%) and 62 retrograde (45.6%) enteroscopies were performed in 117 patients (64 males, median age 67 years). Fifty patients (42.7%) had prior major abdominal surgery. Technical success was 91.9% for anterograde and 90.3% for retrograde route. Diagnostic yield was 71.6% and 61.3%, respectively. The median DMI was 415 cm (264–585) for anterograde and 120 cm (37–225) for retrograde enteroscopy. In patients with prior major abdominal surgery, MSE showed significantly longer small bowel insertion time (38 vs 29 min, p = 0.004), with similar diagnostic yield (61 vs 71.4%, p = 0.201) and DMI (315 vs 204 cm, p = 0.226). The overall adverse event rate was 10.3% (SAE 1.5%), with no differences related to prior abdominal surgery (p = 0.598). Patients with prior surgeries directly involving the gastrointestinal tract showed lower DMI (189 vs 374 cm, p = 0.019) with equal exploration time (37.5 vs 38 min, p = 0.642) compared to those with other abdominal surgeries. Conclusions MSE is effective and safe in patients with major abdominal surgery, although longer procedure times were observed. A lower depth of insertion was detected in patients with gastrointestinal surgery.

The integration of artificial intelligence (AI) into capsule endoscopy is transforming gastrointestinal diagnostics by enhancing lesion detection and optimizing reading efficiency. This review focuses on the clinical applications of commercially available AI-powered capsule endoscopy systems, particularly for small bowel evaluation. Recent clinical trials and observational studies are analyzed to assess the diagnostic performance, practical benefits, and limitations of these systems. Additionally, key challenges related to standardization, data quality, and clinical validation are discussed. Currently available AI systems significantly reduce reading times and demonstrate high detection capabilities, depending on the algorithm and device used. However, a substantial number of lesions remain undetected, preventing full reliance on these tools. Future advancements must focus on improving detection rates and validating the clinical relevance of missed lesions. Additionally, standardizing AI algorithms across different capsule systems is essential to ensure consistency, reliability, and broader clinical adoption. Establishing homologation frameworks will be key to achieving uniform performance and seamless integration into routine practice.

INTRODUCTION: Crohn's disease (CD) varies by location, potentially affecting therapy efficacy and surgery risk, although research on this topic is conflicting. This study aims to investigate the independent association between CD location and therapeutic patterns. METHODS: We analyzed patients with CD diagnosed from January 2005 to May 2023 registered in the nationwide ENEIDA registry. A univariate Cox regression analysis assessed the association of disease location with biologic use and persistence (with treatment discontinuation as a failure event), as well as the use of intestinal resections. A multivariate model was constructed to evaluate the independent association of disease location with therapeutic patterns, controlling for potential confounders such as sex, age at inclusion and diagnosis, disease duration and behavior, previous surgery or biological therapy, extraintestinal manifestations, and perianal disease. RESULTS: The study included 17,292 patients with a median follow-up period of 6 years (interquartile range 2–10 years). Ileocolonic location was associated with a higher biologic use than colonic location (hazard ratio [HR] 1.30, 95% confidence interval [CI] 1.22–1.38) and ileal disease (HR 1.21, 95% CI 1.16–1.27), independently predicting biologic use (P < 0.001). Ileal location was associated with a lower biologic persistence than ileocolonic location (HR 1.14, 95% CI 1.07–1.21) and colonic disease (HR 1.10, 95% CI 1.01–1.20), independently predicting biologic persistence (P = 0.019). Ileal disease was associated with a higher likelihood of intestinal resections than colonic (HR 2.82, 95% CI 2.45–3.25) and ileocolonic location (HR 1.13, 95% CI 1.05–1.22), independently predicting the use of surgery (P < 0.001). DISCUSSION: CD location with ileal predominance is associated with a distinct therapeutic pattern, including higher biologic use, lower treatment persistence, and increased rates of intestinal resections.

Background and Aim: Autologous haematopoietic stem cell transplantation [AHSCT] is a therapeutic option for refractory Crohn’s disease [CD]. However, high adverse event rates related to chemotherapy toxicity and immunosuppression limit its applicability. This study aims to evaluate AHSCT’s safety and efficacy using a cyclophosphamide [Cy]-free mobilisation regimen. Methods: A prospective, observational study included 14 refractory CD patients undergoing AHSCT between June 2017 and October 2022. The protocol involved outpatient mobilisation with G-CSF 12–16 μg/kg/daily for 5 days, and optional Plerixafor 240 μg/d [1–2 doses] if the CD34 + cell count target was unmet. Standard conditioning with Cy and anti-thymocyte globulin was administered. Clinical, endoscopic, and radiological assessments were conducted at baseline and during follow-up. Results: All patients achieved successful outpatient mobilisation [seven patients needed Plerixafor] and underwent transplantation. Median follow-up was 106 weeks (interquartile range [IQR] 52–348). No mobilisation-related serious adverse events [SAEs] or CD worsening occurred. Clinical and endoscopic remission rates were 71% and 41.7% at 26 weeks, 64% and 25% at 52 weeks, and 71% and 16.7% at the last follow-up, respectively. The percentage of patients who restarted CD therapy for clinical relapse and/or endoscopic/radiological activity was 14% at 26 weeks, 57% at 52 weeks, and 86% at the last follow-up, respectively. Peripheral blood cell populations and antibody levels post-AHSCT were comparable to Cy-based mobilisation. Conclusions: Cy-free mobilisation is safe and feasible in refractory CD patients undergoing AHSCT. Although relapse occurs in a significant proportion of patients, clinical and endoscopic responses are achieved upon CD-specific therapy reintroduction.

Background: The expanding use of targeted therapies in inflammatory bowel disease has made treatment sequencing increasingly relevant, yet evidence on anti‐TNF effectiveness after prior biologics with different mechanisms of action (MOA) remains limited. Our objective is to evaluate the durability of anti‐TNF treatment in this scenario. Methods: Multicentre study based on data from the ENEIDA registry. Patients who received second‐line anti‐TNF therapy after a first biologic with a different MOA for active luminal disease were identified. Using propensity score matching, each case was matched with three controls from two cohorts: patients treated with second‐line anti‐TNF after another anti‐TNF and patients receiving first‐line anti‐TNF therapy. Treatment durability and short‐ and long‐term clinical effectiveness were assessed. Results: Sixty‐six Crohn's disease patients and 117 UC patients receiving anti‐TNF after other MOA were included. In CD, second‐line anti‐TNF therapy after a different MOA (62% ustekinumab) was associated with a higher risk of treatment discontinuation compared with first‐line anti‐TNF therapy (HR 1.55; 95% CI, 1.05–2.30), without significant differences in short‐ or long‐term clinical effectiveness. In UC, anti‐TNF therapy after a different MOA (90% vedolizumab) was associated with lower treatment durability compared with first‐line anti‐TNF therapy (HR 1.69; 95% CI, 1.31–2.19) and with anti‐TNF after another anti‐TNF agent (HR 1.91; 95% CI, 1.48–2.48), its remission rates significantly lower at both short‐ and long‐term follow‐up ( p < 0.001). Conclusions: Anti‐TNF therapy used after a different MOA is associated with reduced effectiveness and durability compared with its use as first‐line therapy or after another anti‐TNF agent, especially in UC.