Background: Chronic gastroenteropathies, including gluten sensitivity and marmoset wasting syndrome, frequently occur in captive colonies of common marmosets (Callithrix jacchus). Early identification and diagnosis of affected animals are desirable. Endoscopic examination of the colon in marmosets is described, but the small intestine can harbor significant mucosal lesions not representing those in the colon. Evaluating the small intestine currently requires invasive surgical biopsies due to the small patient size, carrying a risk of severe complications. Methods: Endoscopic intubation and multisite biopsy of the duodenum/proximal jejunum are demonstrated in 10 marmosets under general anesthesia. Results: Esophagogastroduodenoscopy with colonoscopy efficiently aid in examining the gastrointestinal tract and obtaining an antemortem histologic diagnosis in marmosets with chronic gastrointestinal signs. Conclusions: This minimally invasive technique is feasible in marmosets. Future investigations into the pathogenesis of chronic gastroenteropathies will benefit from these data, leading to improved animal welfare and better individual and colony health management.

Oral iron replacement therapy is often used as a first-line modality for the treatment of iron deficiency anemia (IDA). Oral iron replacement options include tablets, capsules, and liquid formulations. Esophagitis due to iron tablet administration is a well-documented phenomenon, yet peptic ulcer disease secondary to iron tablet administration is less well-known. An 83-year-old female with a past medical history of chronic kidney disease stage V, anemia of inflammatory disease, heart failure with preserved ejection fraction, and gastroesophageal reflux disease presented to the hospital with diffuse abdominal pain and dark red emesis. She was started on ferrous sulfate supplementation two weeks ago and described progressive abdominal pain and nausea since beginning the medication. She was not taking nonsteroidal anti-inflammatories (NSAIDs), antiplatelets, or anticoagulants. Six months ago, she had an unremarkable upper endoscopy performed for new-onset gastroesophageal reflux disease. Laboratory studies revealed a hemoglobin of 7.3 mg/dL and due to a concern for rapid blood loss, she was given one unit of packed red blood cells. A non-contrast computed tomography was performed showing wall thickening of the stomach and the first two portions of the duodenum. A possible ulcer was seen in the distal posterior stomach. The patient was made NPO, and twice daily intravenous pantoprazole was started. An upper endoscopy was performed which revealed a 2.5 cm clean-based ulcer in the duodenal bulb. Biopsies showed acute inflammation and positivity for iron debris but were negative for Helicobacter pylori. Once daily pantoprazole was continued, and her ferrous sulfate tablets were discontinued. Her symptoms did not return. Ferrous sulfate may erode and ulcerate the gastric and duodenal mucosa like that of a chemical burn. Iron deposits may be seen on biopsies performed with Prussian blue staining. Brown crystalline deposits may be seen on hematoxylin and eosin staining. Iron injury may be seen in pill or capsule formulations due to a concentration effect, but this is typically not seen with solution forms. Treatment includes discontinuation of tablet or capsule formulations and substitution with liquid forms.

BACKGROUND: Capsule endoscopy (CE) allows for a non-invasive small bowel evaluation for a wide range of gastrointestinal (GI) symptoms and diseases. Capsule technology has been rapidly advancing over recent years, often improving image frequency and quality. The Pillcam SB3 (SB3) capsule is one such technology that offers an adaptive frame rate advantage over the previous versions of the capsule the Pillcam SB2 (SB2). Some have proposed that this improvement in capsule technology may lead to increased diagnostic yields; however, real world clinical data is currently lacking. AIM: To evaluate the clinically relevant findings of SB3 and SB2 capsules in a population of United States veterans. METHODS: A retrospective analysis of 260 consecutive CE studies was performed including 130 SB3 and 130 SB2 capsule studies. Recorded variables included: age, gender, type of capsule, body mass index, exam completion, inpatient status, opioid use, diabetes, quality of preparation, gastric transit time, small bowel transit time, indication, finding, and if the exam resulted in a change in clinical management. The primary outcome measured was the detection of clinically relevant findings between SB3 and SB2 capsules. RESULTS: Mean age of the study population was 67.1 ± 10.4 years and 94.2% of patients were male. Of these 28.1% were on opioid users. The most common indications for capsule procedure were occult GI bleeding (74.6%) and overt GI bleeding (14.6%). Rates of incomplete exam were similar between SB3 and SB2 groups (16.9% 9.2%, = 0.066). The overall rate of clinically relevant finding was 48.9% in our study. No significant difference was observed in SB3 SB2 capsules for clinically relevant findings (46.2% 51.5%, = 0.385) or change in clinical management (40.8% 50.0%, = 0.135). CONCLUSION: Our study found no significant difference in clinically relevant findings between SB3 and SB2 capsules.

Background: Chronic gastroenteropathies, including gluten sensitivity and marmoset wasting syndrome, frequently occur in captive colonies of common marmosets (Callithrix jacchus). Early identification and diagnosis of affected animals are desirable. Endoscopic examination of the colon in marmosets is described, but the small intestine can harbor significant mucosal lesions not representing those in the colon. Evaluating the small intestine currently requires invasive surgical biopsies due to the small patient size, carrying a risk of severe complications. Methods: Endoscopic intubation and multisite biopsy of the duodenum/proximal jejunum are demonstrated in 10 marmosets under general anesthesia. Results: Esophagogastroduodenoscopy with colonoscopy efficiently aid in examining the gastrointestinal tract and obtaining an antemortem histologic diagnosis in marmosets with chronic gastrointestinal signs. Conclusions: This minimally invasive technique is feasible in marmosets. Future investigations into the pathogenesis of chronic gastroenteropathies will benefit from these data, leading to improved animal welfare and better individual and colony health management

Yes / Video capsule endoscopy (VCE) is a revolutionary technology for the early diagnosis of gastric disorders. However, owing to the high redundancy and subtle manifestation of anomalies among thousands of frames, the manual construal of VCE videos requires considerable patience, focus, and time. The automatic analysis of these videos using computational methods is a challenge as the capsule is untamed in motion and captures frames inaptly. Several machine learning (ML) methods, including recent deep convolutional neural networks approaches, have been adopted after evaluating their potential of improving the VCE analysis. However, the clinical impact of these methods is yet to be investigated. This survey aimed to highlight the gaps between existing ML-based research methodologies and clinically significant rules recently established by gastroenterologists based on VCE. A framework for interpreting raw frames into contextually relevant frame-level findings and subsequently merging these findings with meta-data to obtain a disease-level diagnosis was formulated. Frame-level findings can be more intelligible for discriminative learning when organized in a taxonomical hierarchy. The proposed taxonomical hierarchy, which is formulated based on pathological and visual similarities, may yield better classification metrics by setting inference classes at a higher level than training classes. Mapping from the frame level to the disease level was structured in the form of a graph based on clinical relevance inspired by the recent international consensus developed by domain experts. Furthermore, existing methods for VCE summarization, classification, segmentation, detection, and localization were critically evaluated and compared based on aspects deemed significant by clinicians. Numerous studies pertain to single anomaly detection instead of a pragmatic approach in a clinical setting. The challenges and opportunities associated with VCE analysis were delineated. A focus on maximizing the discriminative power of features corresponding to various subtle lesions and anomalies may help cope with the diverse and mimicking nature of different VCE frames. Large multicenter datasets must be created to cope with data sparsity, bias, and class imbalance. Explainability, reliability, traceability, and transparency are important for an ML-based diagnostics system in a VCE. Existing ethical and legal bindings narrow the scope of possibilities where ML can potentially be leveraged in healthcare. Despite these limitations, ML based video capsule endoscopy will revolutionize clinical practice, aiding clinicians in rapid and accurate diagnosis.

Yes / Surgical smoke removal algorithms can improve the quality of intra-operative imaging and reduce hazards in image-guided surgery, a highly desirable post-process for many clinical applications. These algorithms also enable effective computer vision tasks for future robotic surgery. In this paper, we present a new unsupervised learning framework for high-quality pixel-wise smoke detection and removal. One of the well recognized grand challenges in using convolutional neural networks (CNNs) for medical image processing is to obtain intra-operative medical imaging datasets for network training and validation, but availability and quality of these datasets are scarce. Our novel training framework does not require ground-truth image pairs. Instead, it learns purely from computer-generated simulation images. This approach opens up new avenues and bridges a substantial gap between conventional non-learning based methods and which requiring prior knowledge gained from extensive training datasets. Inspired by the Generative Adversarial Network (GAN), we have developed a novel generative-collaborative learning scheme that decomposes the de-smoke process into two separate tasks: smoke detection and smoke removal. The detection network is used as prior knowledge, and also as a loss function to maximize its support for training of the smoke removal network. Quantitative and qualitative studies show that the proposed training framework outperforms the state-of-the-art de-smoking approaches including the latest GAN framework (such as PIX2PIX). Although trained on synthetic images, experimental results on clinical images have proved the effectiveness of the proposed network for detecting and removing surgical smoke on both simulated and real-world laparoscopic images. / Research Development Fund Publication Prize Award winner, November 2019.

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The objective of this prospective pilot study is to assess the feasibility of a minimally invasive, integrated endoscopic hemilaminectomy in chondrodystrophic dogs with clinically relevant Hansen type 1 intervertebral disc extrusion (IVDE). Study subjects included five client-owned chondrodystrophic dogs under 15kg with an acute, single site IVDE between T10 and L5 of less than 90 days duration and no loss of deep pain perception. The extent of the extrusion could not exceed 2/3 the diameter of the cannula to be used as defined by magnetic resonance imaging (MRI). A postoperative MRI was performed to assess remaining spinal cord compression. If significant compression remained, patients returned to surgery for a standard, open hemilaminectomy. Only the first dog required conversion to an open approach which resulted in adequate decompression. The same dog had a significant surgical complication of iatrogenic damage to the spinal cord during the minimally invasive approach. The other 4 dogs had no complications and achieved adequate spinal cord decompression. Three dogs eventually returned to normal neurologic status and another was improved compared to presentation. One dog was euthanized for reasons unrelated to IVDE. The authors conclude that a minimally invasive, integrated endoscopic hemilaminectomy is a feasible approach and can allow for adequate decompression of the spinal cord secondary to acute, single-site extrusion. Endoscopic approaches have a steep learning curve and extra care is required in the learning phase to avoid complications. Further studies are warranted to compare the safety and efficacy of this technique to a standard approach. / Master of Science / Acute intervertebral disc extrusion, or "slipped disc", is a common spinal emergency in dogs, particularly in small, chondrodystrophic breeds like dachshunds. Surgery is aimed at removing the disc material causing spinal cord compression. The traditional approach, known as a hemilaminectomy, involves elevating the muscles along the spine over multiple vertebrae, followed by creating a window in the bone with a surgical burr. Minimally invasive spinal surgery that minimizes the elevation of muscles, has the potential to decrease postoperative pain, surgical time, hospital stay, intraoperative blood loss and recovery time. This study was designed to assess the use of a minimally invasive, integrated endoscopic approach to a hemilaminectomy in clinical patients. Five dogs were enrolled with an acute, single site intervertebral disc extrusion between T10 and L5 that was no more than 2/3 the diameter of the cannula to be used in surgery. Study subjects were chondrodystrophic breeds under 15kg. All dogs had intact deep pain perception. Spinal cord compression was assessed by magnetic resonance imaging (MRI) both before and after a minimally invasive approach. If significant acute compression remained, a standard, open approach was immediately performed. Spinal cord decompression was adequate in all but one dog which required a second procedure to remove the remaining material. This same dog had accidental damage to the spinal cord during the minimally invasive approach. Three dogs eventually returned to normal neurologic status and the dog that required a second, traditional approach surgery eventually improved compared to his preoperative status. One dog was improving but euthanized eight days later due to chronic disease unrelated to IVDE. This approach is feasible for decompressing the spinal cord after a single site, acute intervertebral disc extrusion in a chondrodystrophic dog. However, like any endoscopic surgery, previous experience is of great benefit and errors are more likely to happen during the learning phase.