Abstract
Artificial intelligence (AI) is predicted to have profound effects on the future of video capsule endoscopy (VCE) technology. The potential lies in improving anomaly detection while reducing ...manual labour. Existing work demonstrates the promising benefits of AI-based computer-assisted diagnosis systems for VCE. They also show great potential for improvements to achieve even better results. Also, medical data is often sparse and unavailable to the research community, and qualified medical personnel rarely have time for the tedious labelling work. We present
Kvasir-Capsule
, a large VCE dataset collected from examinations at a Norwegian Hospital.
Kvasir-Capsule
consists of 117 videos which can be used to extract a total of 4,741,504 image frames. We have labelled and medically verified 47,238 frames with a bounding box around findings from 14 different classes. In addition to these labelled images, there are 4,694,266 unlabelled frames included in the dataset. The
Kvasir-Capsule
dataset can play a valuable role in developing better algorithms in order to reach true potential of VCE technology.
We recently noticed in nonpolypoid adenomas (NPA) and the adjacent normal mucosa, nondysplastic crypts in symmetric and asymmetric fission (NDCSAF).
All NDCSAF found in 80 small NPA and in the ...adjacent mucosa were registered.
A total of 178 NDCSAF (mean, 2.2) were found: 12 (6.7%) interspersed between adenomatous glands, 36 (20.2%) partially replaced by dysplastic epithelium, and 130 (73%) underneath the adenomatous tissue. Of the 61 cases with normal mucosa adjacent to NPA, 40 (65.6%) disclosed NDCSAF, and the remaining 21 (34.4%) normal crypts, exclusively.
The accruing of NDCSAF within NPA and surrounding mucosa, are outstanding findings. Given that colonic crypts may undergo only one fission every 30-40 years, the accruing of NDCSAF in and about small NPA reveals mucosal hubs with pathological aberrations of cryptogenesis, probably conveyed by somatic mutations. The findings support the existence of field cancerization in the colonic mucosa.
Headache and facial pain are among the most common, disabling and costly diseases in Europe, which demands for high quality health care on all levels within the health system. The role of the Danish ...Headache Society is to educate and advocate for the needs of patients with headache and facial pain. Therefore, the Danish Headache Society has launched a third version of the guideline for the diagnosis, organization and treatment of the most common types of headaches and facial pain in Denmark. The second edition was published in Danish in 2010 and has been a great success, but as new knowledge and treatments have emerged it was timely to revise the guideline. The recommendations for the primary headaches and facial pain are largely in accordance with the European guidelines produced by the European Academy of Neurology. The guideline should be used a practical tool for use in daily clinical practice for primary care physicians, neurologists with a common interest in headache, as well as other health-care professionals treating headache patients. The guideline first describes how to examine and diagnose the headache patient and how headache treatment is organized in Denmark. This description is followed by sections on the characteristics, diagnosis and treatment of each of the most common primary and secondary headache disorders and trigeminal neuralgia. The guideline includes many tables to facilitate a quick overview. Finally, the particular challenges regarding migraine and female hormones as well as headache in children are addressed.
Histologic sections from patients with inflammatory bowel disease (IBD) usually exhibit crypts with architectural distortions and branching crypts. It has been postulated that crypt branching should ...be assessed only in well‐oriented, upright crypts. However, those crypts are mostly found in sections from colectomy specimens and colon mucosectomies. Sections from endoscopic biopsies are fortuitously cut in a horizontal plane, a procedure mostly revealing cross‐cut crypt rings. In endoscopic biopsies from UC patients we previously detected cross‐cut crypts heralding the crest domain of branching crypts. Recently, the scrutiny of biopsies from IBD patients revealed that branching‐crest domains concurred either with crypts in symmetric branching, typified by twin, amalgamating back‐to‐back isometrics crypt‐rings, or with crypts in asymmetric branching, characterized by ≥2 amalgamating anisometric crypt‐rings; both symmetric and asymmetric branching‐crest domains were encased by a thin muscularis mucosae. Quantitative studies in biopsies from Swedish and German patients with IBD showed that crypts in asymmetric branching outnumbered those in symmetric branching. Because crypt‐branching seldom occurs in the normal colon in adults and considering that colon crypts typically divide once or twice during a lifetime, the accruing of asymmetric branching crypts in IBD biopsies emerges as a significant histologic parameter. Although the biological significance of asymmetric crypt‐branching in IBD remains at present elusive, their occurrence deserves to be further investigated. The future policy will be to include in our pathologic reports, the number of crypts in asymmetric branching, in order to monitor their frequency in prospective surveillance biopsies in patients with IBD.
Colonic crypts with normal epithelial lining displaying corrupted shapes (called non-dysplastic crypts with corrupted shapes, NDCs) were earlier recorded underneath the adenomatous glands of ...conventional colon adenomas in rats.
To assess the frequency of NDCs in clinical sporadic conventional (tubular/villous) adenomas.
NDCs found underneath the adenomatous epithelium in 255 sporadic conventional adenomas removed at endoscopy were classified into four groups: i) With fission distortions, ii) with length distortions, iii) with outline distortions, and iv) with axial polarity distortions. In 22 controls, the colonic mucosa proximal or distal to surgically removed colonic adenocarcinomas was scrutinized for NDCs.
Nearly three-quarters of the sporadic conventional adenomas investigated here had three or more NDCs underneath the adenomatous tissue, those with ≥4 NDCs being more frequent (46.3%) than those having 1, 2 or 3 NDCs (p<0.05). Nineteen out of the 22 control colon segments had normal crypts and the remaining three had occasional NDCs (mean=3.7, range=2-5).
NDCs were found underneath the adenomatous glands in all 255 sporadic conventional adenomas. Occasionally, NDCs were present in the mucosa of the stalk of pediculated conventional adenomas. The absence of adenomatous tissue in NDCs of the stalk should rule out the possibility that the adenomatous tissue on top had directly orchestrated the development of NDCs below. Moreover, NDCs rarely occurred in controls. Accordingly, NDCs emerge as a genuine phenomenon of crypt deformation in sporadic conventional adenomas. Considering that human colonic crypts typically divide at most once or twice during a lifetime, with an average crypt cycle length of 36 years, the accumulation of NDCs underneath sporadic conventional adenomas is remarkable. In light of these considerations, it is suggested that these putative mutated NDCs may represent the initial histological recordable event heralding the development of sporadic conventional adenomas in the human colon.
The Swedish National Patient Register (SNPR) is frequently used in studies of colonic diverticular disease (DD). Despite this, the validity of the coding for this specific disease in the register has ...not been studied.
From SNPR, 650 admissions were randomly identified encoded with ICD 10, K572-K579. From the years 2002 and 2010, 323 and 327 patients respectively were included in the validation study. Patients were excluded prior to, or up to 2 years after a diagnosis with IBD, Celiac disease, IBS, all forms of colorectal cancer (primary and secondary), and anal cancer. Medical records were collected and data on clinical findings with assessments, X-ray examinations, endoscopies and laboratory results were reviewed. The basis of coding was compared with internationally accepted definitions for colonic diverticular disease. Positive predictive values (PPV) were calculated.
The overall PPV for all diagnoses and both years was 95% (95% CI: 93-96). The PPV for the year 2010 was slightly higher 98% (95% CI: 95-99) than in the year 2002, 91% (95% CI: (87-94) which may be due to the increasing use of computed tomography (CT).
The validity of DD in SNPR is high, making the SNPR a good source for population-based studies on DD.
AIM To describe the development and implementation of a person-centered endoscopy safety checklist and to evaluate the effects of a “checklist intervention”.METHODS The checklist,based on previously ...published safety checklists,was developed and locally adapted,taking patient safety aspects into consideration and using a person-centered approach. This novel checklist was introduced to the staff of an endoscopy unit at a Stockholm University Hospital during half-day seminars and team training sessions. Structured observations of the endoscopy team’s performance were conducted before and after the introduction of the checklist. In addition,questionnaires focusing on patient participation,collaboration climate,and patient safety issues were collected from patients and staff. RESULTS A person-centered safety checklist was developed and introduced by a multi-professional group in the endoscopy unit. A statistically significant increase in accurate patient identity verification by the physicians was noted(from 0% at baseline to 87% after 10 mo,P < 0.001),and remained high among nurses(93% at baseline vs 96% after 10 mo,P = nonsignificant). Observations indicated that the professional staff made frequent attempts to use the checklist,but compliance was suboptimal: All items in the observed nurse-led “summaries” were included in 56% of these interactions,and physicians participated by directly facing the patient in 50% of the interactions. On the questionnaires administered to the staff,items regarding collaboration and the importance of patient participation were rated more highly after the introduction of the checklist,but this did not result in statistical significance(P = 0.07/P = 0.08). The patients rated almost all items as very high both before and after the introduction of the checklist;hence,no statistical difference was noted.CONCLUSION The intervention led to increased patient identity verification by physicians-a patient safety improvement. Clear evidence of enhanced person-centeredness or team work was not found.
Abstract
Background and Aims
Inflammatory bowel disease may cause long-standing inflammation and fibrosis and may increase the risk of adverse events in colonoscopy. We evaluated whether inflammatory ...bowel disease and other potential risk factors are associated with bleeding or perforation in a nationwide, population-based, Swedish study.
Methods
Data from 969 532 colonoscopies, including 164 012 17% on inflammatory bowel disease patients, between 2003 and 2019, were retrieved from the National Patient Registers. ICD-10 codes for bleeding T810 and perforation T812 within 30 days of the colonoscopy were recorded. Multivariable logistic regression was used to test if inflammatory bowel disease status, inpatient setting, time period, general anaesthesia, age, sex, endoscopic procedures, and antithrombotic treatment were associated with higher odds for bleeding and perforation.
Results
Bleeding and perforation were reported in 0.19% and 0.11% of all colonoscopies, respectively. Bleeding odds ratio 0.66, p <0.001 and perforation odds ratio 0.79, p <0.033 were less likely in colonoscopies in individuals with inflammatory bowel disease status. Bleeding and perforation were more common in inpatient than in outpatient inflammatory bowel disease colonoscopies. The odds for bleeding but not perforation increased between 2003 to 2019. General anaesthesia was associated with double the odds for perforation.
Conclusions
Individuals with inflammatory bowel disease did not have more adverse events compared with individuals without inflammatory bowel disease status. However, the inpatient setting was associated with more adverse events, particularly in inflammatory bowel disease status. General anaesthesia was associated with a greater risk of perforation.
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