Capsule Endoscopy and Small Intestine Ulceration: What Exactly Does It Mean?
Bibliographic record
Abstract
Purpose: Small bowel capsule endoscopy (CE) is the gold standard for non invasively assessing the small intestinal mucosa. Not infrequently, however, findings such as ulceration is noted where the differential diagnosis may be wide and the findings non-specific. In this study we review our experience in patients with small bowel ulceration on their CE in an effort to better determine the etiology and management strategies. Methods: Of 1050 total capsules performed between 10/01-04/11, 111 patients (mean follow up 39 months) were deteremined to have single or multiple small bowel ulceration. Only those patients with the specific finding of small bowel ulceration were selected for further analysis. Their history, findings and outcomes in regards to these ‘ulcerations' were then assessed. Results: 111 patients (61 male, 52 +/- 19 years old) subsequently found to have small bowel ulceration on CE were determined to have been referred for the following indications: obscure gastrointestinal bleeding (58%), abdominal pain (12%), iron deficiency anemia (11%), abnormal radiological findings (4.5%), diarrhea (4.5%), inflammatory bowel disease (IBD) (1%), and “other” indications (9%). Of the 111 patients with ulcerative disease noted on capsule study, 66 (59%) were thought to be related to IBD, 10 (9 %) related to NSAIDs, 3 (3%) celiac disease, 5 (4%) ischemic, 4 (4%) vascular lesions and 3 (3%) were related to malignant lesions. Peptic ulcer disease in distal duodenum was found in 3 (3%) of cases. In 17 (15%) of the cases there was no specific diagnosis made based on the capsule findings and follow up. Ancillary findings included active bleeding (14%), angiodysplasias (9%), strictures (5%) and diverticula (2%). Capsule retention occurred in 2 cases and was managed by surgery. Follow up (mean 39 months) was performed to ensure long term accuracy of diagnosis. Conclusion: In our patient population undergoing CE the most common cause of small bowel ulceration was IBD followed by NSAIDs use. When small bowel ulceration is seen and the etiology is unclear, a careful history can elucidate the most likely etiology and subsequently guide further management. A significant portion of these patients (15%) seem to do well despite these ulcerations and have no specific diagnosis. Disclosure: Dr. Robert Enns: Speaker/Consultant- AstraZeneca, Merck, Nycomed, Abbott, Olympus.
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How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.003 | 0.020 |
| Meta-epidemiology (narrow) | 0.001 | 0.000 |
| Meta-epidemiology (broad) | 0.002 | 0.000 |
| Bibliometrics | 0.002 | 0.003 |
| Science and technology studies | 0.001 | 0.004 |
| Scholarly communication | 0.003 | 0.005 |
| Open science | 0.001 | 0.001 |
| Research integrity | 0.004 | 0.003 |
| Insufficient payload (model declined to judge) | 0.003 | 0.001 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".