Evaluation and Validation of a New Score to Measure the Severity of Small Bowel Angiodysplasia on Video Capsule Endoscopy

Abstract

Introduction: Angiodysplasias are responsible of 50 % of small bowel bleeding. An endoscopic method that allows measuring its severity is not available Aims: to validate a new endoscopic score with VCE to measure the severity of small bowel angiodysplasias (SBAD). Methods: Four endoscopists independently reviewed VCE videos of 22 patients with SBAD. The score graded three variables: A. Extent of lesions: E1: located in one half of the intestine and E2:in both halves. B. Number of lesions: N1 <5; N2: 5-10 and N3: >10 lesions. C. Probability of bleeding: P1: pale red spots; P2: bright red spots; P3: bleeding stigmata and P4: active bleeding. CESBAI was calculated as follows: E x 1 + N x 2 + P x 3. Interobserver variability was analyzed by the Spearman's correlation and agreement Kappa statistic tests. Results. The mean CESBAI scores by observers (O) were: O1= 11.6 ± 4.1; O2 =: 11.3 ± 4.8; O3 = 11.1 ± 4.9 and O 4 = 11.8 ± 4.2 (p>0.05). Spearman’s correlation values of CESBAI between every two observers were from 0.61 to 0.94 ( p <0.001) with a global correlation of 0.73 among all observers. Kappa values of CESBAI between every two observers ranged from 0.42 to 0.87 (p<0.001) with global agreement of 0.57 among all observers. All evaluators stated that the method was easy to use. Conclusions: CESBAI is a reliable and reproducible score. Nevertheless, these results must be validated in other studies with larger population before assessing its power for predicting bleeding recurrence.

Gastrointestinal angiodysplasias diagnosed using video capsule endoscopy in 15 dogs

“…For each dog, the presence of a AGD lesion was recorded along with the location (stomach, SI or colon) as well as the probability of bleeding based on a previously reported score. 25 The location of lesions within the small intestine observed by VCE was defined by percentage % of total small bowel transit time (first third, second third and last third). The following data were recorded for each dog: signalment (age, breed, sex, weight), geographical location, clinical signs (type and duration), the reason for the VCE exam (unexplained anemia, overt GIB or a combination of both), complete blood count and biochemistry results, resting/post‐ACTH stimulation cortisol concentrations, TLI, folate, cobalamin concentrations, iron panel, abdominal ultrasound, conventional endoscopy (upper ± lower), GI biopsies histopathology, exploratory laparotomy, historical and concurrent diseases, and medications.…”

“…If only 1 reader observed a lesion of AGD on ≥2 frames, it was considered suspicious. For each dog, the presence of a AGD lesion was recorded along with the location (stomach, SI or colon) as well as the probability of bleeding based on a previously reported score 25 . The location of lesions within the small intestine observed by VCE was defined by percentage % of total small bowel transit time (first third, second third and last third).…”

Evaluation and Validation of a New Score to Measure the Severity of Small Bowel Angiodysplasia on Video Capsule Endoscopy

“…We read with great interest the original article from Diego García-Compeán et al [1], recently published in this journal. To the best of our knowledge, this is the first article providing an objective method that could fill the gap in the evaluation of the severity of small bowel angiodysplasia (SBAD) based on small bowel capsule endoscopy findings.…”