BACKGROUND AND AIMS:Guidelines recommend EGD and colonoscopy to investigate iron deficiency anemia (IDA), but not small-bowel examination. The aim of the study was to determine the diagnostic yield and location of lesions causing IDA by performing a pan-enteric examination. METHODS:In a prospective, multicenter clinical trial involving 2 public hospitals (United Kingdom and Hong Kong) and a private health center (Hungary), patients underwent small-bowel capsule endoscopy, EGD, and colonoscopy. All lesions identified were described by a blinded consensus panel using a diagnostic register and the Saurin classification (P1 and P2: possible and likely causes of bleeding, respectively). RESULTS:In 170 patients (median, 60.0 years; 47.6% female), small-bowel capsule endoscopy identified P1 or P2 lesions in 85 patients (50.0%; 95% CI, 42.2-57.7), EGD identified in 48 patients (28.2%; 95% CI, 21.6-35.6), and colonoscopy identified in 34 patients (20.0%; 95% CI, 14.2-26.8). The yield of capsule endoscopy for P1 or P2 lesions was higher than EGD (P < .001) and colonoscopy (P < .0001). P2 lesions alone were identified in 17 (10.0%; 95% CI, 6.0-15.5), 11 (6.5%; 95% CI, 3.3-11.3), and 16 (9.4%; 95% CI, 5.4-14.8) patients, respectively. Pan-GI endoscopy identified potential bleeding lesions in 121 patients (71.1%; 95% CI, 64.4-77.9), which changed management in 89 patients (52.3%; 95% CI, 44.5-60.0). CONCLUSIONS:Over two-thirds of patients with IDA had lesions with bleeding potential and they were more common in the small bowel than the upper GI tract and colon.

Background/Objectives: Capsule endoscopy (CE) is a non-invasive tool for evaluating small bowel pathology, but prolonged reading times can lead to reader fatigue. Artificial intelligence-integrated reading software has shown promise to overcome this. This study assesses the diagnostic performance of TOP100 against standard human reading (SR) across different clinical indications. Methods: A retrospective single-centre cohort study was conducted at a tertiary referral centre, including patients who underwent PillCam™SB3 CE between January 2023 to August 2025. Initial reading was performed by expert CE readers (>1000 CE experience) considered as SR. Second blinded reading was performed with TOP100. CE findings from SR were compared with those from TOP100. Results: A total of 1382 CE were identified, of which 1374 had complete examinations and TOP100 data for analysis. The most common indications were inflammatory bowel disease (IBD) (51.5%) and iron-deficiency anaemia (IDA) (25.0%). Diagnostic yield was significantly higher with SR than TOP100 (36.0% vs. 27.5%, p < 0.001). TOP100 demonstrated moderate sensitivity but high specificity; 64.0% and 99.0% for active bleeding, 58.2% and 97.5% for angiodysplasia. In overt bleeding and IDA, sensitivity, and specificity for P2 lesions were 61.0% and 94.3%, respectively. Overall sensitivity and specificity were 55.3% and 95.9% for ulcers, 43.1% and 89.0% for erosions. In IBD, ulcer detection was similar, while TOP100 sensitivity for erosions improved by 9.4%. Conclusions: SR remains the reference standard for reading and reporting capsule endoscopies. However, TOP100 may be a useful adjunct to support interpretation and case prioritisation, especially in high-volume centres.

Background/Objectives: Non-steroidal anti-inflammatory drug (NSAID)-induced small bowel (SB) injuries have a variable clinical and endoscopic presentation. Limited data exists regarding their long-term outcomes, natural course, and discerning factors and differentiation from Crohn’s disease (CD). This study aims to evaluate the spectrum of presentation at capsule endoscopy (CE) and outcome in patients with documented NSAID use. Methods: We retrospectively evaluated all CEs performed at our hospital from 2014 to July 2023 in patients with documented NSAID use and with SB injury on CE. Patients’ demographics, clinical and endoscopic data, CE findings and outcome were recorded. Results: A total of 52 patients (33 females; median age 54 years, IQR 41–65) with documented NSAID use who underwent CE were included. The most prominent findings were erosions (56%) and superficial (46%) and deep ulcers (21%). Median follow-up time was 16 months (IQR 4–57). A total of 26 (50%) patients underwent repeat CE after a median interval of 12 months (IQR 10–15). In 77% (n = 20) of patients, SB injury was still present, with the majority (80%) having a Lewis score of < 790. Overall, compared to the previous CE, there were no changes in 35% of cases, worse appearance in 35%, and an improvement in 30%. SB CD was diagnosed in 7 out of 26 patients on follow-up. There were no statistically significant clinical or endoscopic differences between those with NSAID enteropathy and those diagnosed with CD. Conclusions: NSAID enteropathy presents with a wide spectrum of SB injuries, which cannot be differentiated on CE images alone. This highlights the importance of the clinical picture in the diagnostic process of these patients. Furthermore, our study demonstrated that a percentage of patients still exhibit some degree of SB damage despite cessation of NSAIDs for several months.

Objectives Rapid transit risks inadequate oesophageal capsule endoscopy. Success rate, completion of examination, time taken to read the video and impact on management of a novel dual camera capsule capable of 35 frames per second were determined.Methods Patients referred for screening or surveillance of oesophagogastric varices who declined gastroscopy and throughout the COVID-19 pandemic were examined by capsule endoscopy using the PillCam UGI capsule.Results Capsule endoscopy was performed on 207 patients (median (IQR) age 62 (+/- 18), 53% men). The median reading time was 4 (+/- 2) min. Oesophageal views were complete in 205 (99%); no views were obtained in 2 (1%) patients. Cardiac views were complete in 197 (86.5%), partial in 11 (5.3%) and not seen in 17 (8.21%). Fundal views were complete in 108 (52.2%), partial in 27 (13%) and not seen in 72 (34.8%). Oesophagogastric varices were detected in 58 (28%) patients, mostly (55 (94.2%)) oesophageal varices (38 (66%) grade 1). Overall, 23 (11.1%) patients required further management on the basis of capsule endoscopy findings, and gastroscopy was avoided in 194 (94%) of patients. During a median follow-up period of 24 months (+/- 19), two patients were successfully treated for variceal bleeding. Capsule retention required endoscopic retrieval in one patient (0.5%).Conclusions A dual camera capsule endoscope capturing 35 frames per second provided excellent oesophageal views, avoided gastroscopy in the majority of patients and effectively and safely guided management.

Background and study aims:Colon capsule endoscopy (CCE) is becoming increasingly popular in Europe. However, development of quality assurance and standardized terminology has not kept pace with clinical integration of this technology. As a result, there are significant variations in reporting standards, highlighting the need for a standardized terminology and framework. We used the RAND process to achieve a consensus of experts to determine the terminology in CCE, bowel cleansing assessment, and quality assurance reporting and future research priorities. Methods:A panel comprising 14 European CCE experts evaluated 45 statements during the international REFLECT symposium (Nyborg, Denmark) through three survey rounds and face-to-face and virtual discussions in the initial two rounds. Participants anonymously rated statement appropriateness. Results:Twenty-eight consensus statements were developed. Eight statements focus on consistent terminology for confirming CCE-detected polypoid and inflammatory colonic lesions with colonoscopy. To ensure standardization and quality assurance, 13 mandatory fields were recommended for inclusion in a CCE report. Three endorsed reporting methodologies were suggested, emphasizing prompt notification for suspected malignant findings, recommending a generic disclaimer regarding stomach and small bowel visualization intentions, and establishing reporting timelines at an interdepartmental level based on urgency. Four bowel preparation scale-related statements led to the recommendation to adoptithe Colon Capsule CLEansing Assessment and Reporting (CC-CLEAR) scale as the preferred scale. Conclusions:This study established a framework for terminology, reporting, and assessment of bowel cleansing for CCE. Future research should focus on optimizing bowel preparation regimens and exploring artificial intelligence applications in CCE.

Background The updated Shape of Training curriculum has shortened the duration of specialty training. We present the potential role of out of programme clinical fellowships.Method An electronic online survey was sent to all current fellows to understand their experiences, training opportunities and motivations.Data were collected on fellows’ endoscopic experiences and publications using PubMed for all previous doctors who have completed the Sheffield Fellowship Programme.Results Since 2004, 39 doctors have completed the Sheffield Fellowship.Endoscopic experience: current fellows completed a median average of 350 (IQR 150–500) gastroscopies and 150 (IQR 106–251) colonoscopies per year. Fellows with special interests completed either 428 hepato-pancreato-biliary procedures or 70 endoscopic mucosal resections per year.Medline publications: Median average 9 publications(IQR 4–17). They have also received multiple national or international awards and 91% achieved a doctoral degree.The seven current fellows in the new Shape of Training era (57% male, 29% Caucasian, aged 31–40 years) report high levels of enjoyment due to their research projects, supervisory teams and social aspects. The most cited reasons for undertaking the fellowship were to develop a subspecialty interest, take time off the on-call rota and develop endoscopic skills. The most reported drawback was a reduced income.All current fellows feel that the fellowship has enhanced their clinical confidence and prepared them to become consultants.Conclusion Out of programme clinical fellowships offer the opportunity to develop the required training competencies, subspecialty expertise and research skills in a supportive environment.

Purpose of review Isolated terminal ileitis is an increasing phenomenon identified during colonoscopy. Idiopathic terminal ileitis (IDTI) is a diagnosis of exclusion, representing a significant challenge from a diagnostic and management point of view. This review provides an overview of the most recent and relevant evidence on idiopathic IDTI, focusing on its evolution, the natural history and the management strategies proposed in the literature. Recent findings IDTI is uncommon, with a reported prevalence between 0.5 and 7%. The main differential is with Crohn's disease and intestinal tuberculosis in endemic countries. A proportion of patients (0-50%) can progress and develop Crohn's disease; however, there are no reliable predictive factors to stratify IDTI patients. Summary IDTI is a challenging entity, with a small proportion of patients progressing to Crohn's disease over time thus requiring follow-up. Noninvasive modalities such as capsule endoscopy are useful for follow-up, but further research is required to better understand this entity.

Robotic capsules provide an alternative route of entry to the gastrointestinal tract with minimal discomfort to patients. As capabilities of milli to micro robots progress, the potential of using robotic capsules not just for inspection, but for surgical procedures increase. To aid operations in the intestine, the capsule could be used to expand the site of surgery and anchoring to the intestinal walls to keep itself in place. This paper presents an untethered robotic capsule that can provide volumetric expansion using a chemical reaction without on-board electronic components. The expansion is based on the reaction between chemicals that are safe for ingestion, operated with magnetic fields and temperatures that are within safe limits. The capsule was able to expand greater than the diameter of the small intestine for 44 minutes and provided 0.27N of anchoring force. A theoretical model of the reaction process was built and simulated to predict the behavior of the capsule expansion and validated through the experiments. The design and the simulation presented in this paper can be used for fabricating capsules to specific clinical needs. The work also opens up the possibility of untethered technologies that are remotely and chemically programmed for in-vivo surgical applications.

Aims Non-steroidal anti-inflammatory drugs (NSAIDs)-induced small bowel (SB) injuries constitute a well-established entity, presenting a highly variable spectrum of clinical symptoms and endoscopic presentations. The main differential diagnosis in these patients is Crohn's disease (CD). Limited data exist regarding the long-term outcomes, the natural course of NSAIDs-related SB injuries, and discerning factors for differentiation from CD. This study aims to evaluate the spectrum of presentation at capsule endoscopy (CE) and outcome in patients with documented NSAIDs use.

Background: When commencing enteral feeding, patients and families will want to know the likelihood of returning to an oral diet. There is a paucity of data on the prognosis of patients with gastrostomies. We describe a large dataset of patients, which identifies factors influencing gastrostomy removal and assesses the likelihood of the patient having at home enteral nutrition. Methods: Retrospective data was collected on patients from Sheffield Teaching Hospitals who had received a gastrostomy and had outpatient enteral feeding between January 2016 and December 2019. Demographic data, indication and outcomes were analysed. Results: A total of 451 patients were assessed, median age: 67.7. 183/451(40.6%) gastrostomies were for head and neck cancer, 88/451 (19.5%) for stroke, 28/451 (6.2%) for Motor Neuron Disease, 32/451 (7.1%) for other neurodegenerative causes, 120/451 (26.6%) other. Of the 31.2% who had their gastrostomy removed within 3 years, head and neck cancer was the most common indication (58.3%) followed by stroke (10.2%), Motor Neuron Disease (7.1%) and other neurodegenerative diseases (3.1%). Gastrostomy removal was significantly influenced by age, place of residence, and having head and neck cancer (p < 0.05). There was the greatest likelihood of removal within the first year (24%). 70.5% had enteral feeding at home. Conclusion: This large cohort study demonstrates 31.2% of patients had their gastrostomy removed within 3 years. Head and neck cancer patients, younger age and residing at home can help positively predict removal. Most patients manage their feeding at home rather than a nursing home. This study provides new information on gastrostomy outcomes when counselling patients to provide realistic expectations.