Protein-losing enteropathy (PLE) is an uncommon and often underrecognized manifestation of lymphoproliferative disorders and may be difficult to diagnose when conventional gastrointestinal investigations are unrevealing. We present an 82-year-old woman with recurrent hospital admissions initially spanning six months for diarrhea, weight loss, peripheral edema, and persistent hypoalbuminemia. Initial upper gastrointestinal endoscopy was normal, and colonoscopy was deferred due to intercurrent infection. Despite extensive laboratory and radiologic evaluation, including routine biochemical testing and imaging, the etiology of PLE remained unclear. Peripheral blood flow cytometry subsequently identified a small kappa-restricted monoclonal B-cell population compatible with marginal zone lymphoma, later confirmed on bone marrow biopsy, raising suspicion for gastrointestinal involvement. Video capsule enteroscopy demonstrated diffuse erosive and ulcerative disease throughout the small intestine, providing an anatomical explanation for the patient’s protein loss. Following lymphoma-directed therapy, repeat capsule enteroscopy showed complete normalization of the small bowel mucosa. This case highlights the diagnostic value of combining peripheral blood flow cytometry and capsule endoscopy in unexplained protein-losing enteropathy, a rare and diagnostically challenging presentation of indolent lymphoma, and illustrates the role of capsule imaging in both disease localization and treatment monitoring. As a single-case report, these findings are not generalizable, and further studies are required to evaluate the broader applicability of this diagnostic approach.

Background and study aims:Second-generation colon capsule endoscopy (CCE) has achieved high diagnostic accuracy for polyp detection. However, its widespread adoption as a filter test is hampered by major cost-effectiveness concerns, due to significant follow-up endoscopy rates (FER), quantified as high as 42%, thus revealing a potential paradox: CCE superior detection of un-characterized lesions may worsen the economic problem. Flexible spectral imaging color enhancement (FICE) is a standard virtual chromoendoscopy tool, but its role in CCE has been considered uncertain. This scoping review aimed to evaluate available evidence on FICE in addressing CCE limitations in lesion detection and characterization. Methods:A systematic literature search identified studies investigating use of FICE in CCE, focusing on studies analyzing FICE performance in improving detection rates and differentiating polyp histology. Results:Two key studies representing complementary evidence were analyzed. Regarding detection, a prospective trial demonstrated that FICE significantly improved overall per-lesion sensitivity compared with white light (WL) (79% vs. 61%). Specifically, FICE outperformed WL for 6-9-mm polyps (93% vs. 65%), flat/non-protruding lesions (75% vs. 53%), and serrated polyps (74% vs. 57%). Regarding characterization, a quantitative colorimetric analysis identified that the color difference between polyps and mucosa in FICE reliably discriminates histology, yielding a 0.928 area-under-the-curve (AUC), with 91.2% sensitivity and 88.2% specificity. Conclusions:FICE may play a complementary role in CCE, significantly improving detection of high-risk flat/serrated lesions and providing objective data for differentiating adenomas from hyperplastic polyps. Integrating FICE into diagnostic workflows could provide a smart solution to address CCE high FER and cost-effectiveness barriers.

Background: Colon capsule endoscopy (CCE) is a minimally invasive alternative to colonoscopy, but its diagnostic performance depends entirely on adequate mucosal cleansing (adequate cleansing rate, ACR) and complete colonic transit (completion rate, CR). These requirements impose stringent preparation demands. Existing systematic reviews (SRs) show substantial heterogeneity in recommendations. Objectives: To identify optimal CCE preparation strategies. Design: Umbrella review (overview of SRs). Methods: A comprehensive literature search was conducted through November 2025 for SRs and meta-analyses (MAs) assessing CCE bowel preparation regimens. Methodological quality was assessed using AMSTAR2, and primary study overlap was quantified using the Corrected Covered Area (CCA). Outcomes included ACR and CR, stratified by preparation components. Results: Fourteen SRs (11 MAs) encompassing 102 primary studies (moderate overlap, CCA 8.59%) were included. Pooled ACR (72.5%–76.8%) and CR (79.8%–83.0%) remained below colonoscopy benchmarks. In inflammatory bowel disease, ACR varied widely (49%–98.5%) with no superior regimen. In the general population, low-volume polyethylene glycol (PEG <4 L) yielded higher ACR (77.5%) than high-volume PEG (72.9%). Sodium phosphate (NaP) boosters outperformed PEG specifically for CR, with NaP + Gastrografin achieving the highest CR (93.1%). Castor oil improved excretion (OR 0.17 of incomplete CCE transit, 95% CI 0.09–0.32), and routine prokinetics improved CR compared with no use (OR 1.86, 95% CI 1.13–3.05). Low-fiber diets provided better cleansing than clear liquids (ACR 78.5% vs 70.0%). Conclusion: Current CCE bowel preparation regimens demonstrate variable performance relative to targets, with no single intervention demonstrating unequivocal superiority over others in pairwise comparisons. Evidence supports optimizing performance via low-volume PEG, NaP or Gastrografin-based boosters, routine prokinetics, and a low-fiber diet. A universal regimen is unlikely to suit all patients, highlighting the need for personalized protocols. Standardized cleansing scores and AI-assisted assessment are critical to improving reproducibility and cost-effectiveness.