Improved detectability of small-bowel lesions via capsule endoscopy with computed virtual chromoendoscopy: A pilot study

Abstract

Objective. Real-time video capsule endoscopy (CE) with flexible spectral imaging color enhancement (FICE) improves visibility of small-bowel lesions. This article aims to clarify whether CE-FICE also improves detectability of small-bowel lesions. Patients and methods. A total of 55 patients who underwent CE at Hiroshima University Hospital during the period November 2009 through March 2010 were enrolled in the study. Five patients were excluded from the study because residues and transit delays prevented sufficient evaluation. Thus, 50 patients participated. Two experienced endoscopists (each having interpreted more than 50 capsule videos) analyzed the images. One interpreted conventional capsule videos; the other, blinded to interpretation of the conventional images, interpreted CE-FICE images obtained at settings 1-3 (setting 1: red 595 nm, green 540 nm, blue 535 nm; setting 2: red 420 nm, green 520 nm, blue 530 nm; setting 3: red 595 nm, green 570 nm, blue 415 nm). Lesions were classified as angioectasia, erosion, ulceration, or tumor. Detectability was compared between the two modalities. Time taken to interpret the capsule videos was also determined. Results. Seventeen angioectasias were identified by conventional CE; 48 were detected by CE-FICE at setting 1, 45 at setting 2, and 24 at setting 3, with significant differences at settings 1 and 2 (p = 0.0003, p < 0.0001, respectively). Detection of erosion, ulceration, and tumor did not differ statistically between conventional CE and CE-FICE, nor did interpretation time (conventional CE 36 ± 6.9 min; CE-FICE setting 1, 36 ± 6.4 min; setting 2, 38 ± 5.8 min; setting 3, 35 ± 6.7 min). Conclusions. CE-FICE is superior in the lesion detection in comparison with conventional CE and improves detection of angioectasia.

Blue mode does not offer any benefit over white light when calculating Lewis score in small-bowel capsule endoscopy

“…Imagawa et al [18] have reported that FICE application provided improved image quality of angioectasias, erosion/ulcerations, and various tumours, when FICE wavelength settings 1 and 2 were used. In a more recent pilot study though [19] , the same group found that the detection rate of ulceration/erosion did not differ statistically between conventional i.e., WL-SBCE and FICE-SBCE review.…”

“…In the remainder (n = 20), the stool specimen for calprotectin was obtained in period of ± 30 d from the SBCE [12] . Interestingly, Imagawa et al [19] also showed that the difference in erosive/ulcerative lesion detection between conventional SBCE and SBCE-FICE (at the various settings) was not statistically significant. This simply means that although chromoendoscopy works well in improving the image quality of captured lesions, it does not lead to improved lesion detection.…”

“…Virtual chromoendoscopy has been already widely used in conventional endoscopy, aiming to improve diagnostic yield by enhancing the contrast between background and surface mucosal abnormalities, through narrowing the bandwidth of WL to that of blue-green light. To date, the published experience of its use in SBCE is only limited [7,[18][19][20][21] . Furthermore, the ability of chromoendscopy to improve detection rate of clinically significant lesions during SBCE is still questionable [21] .…”

Virtual chromoendoscopy can be a useful software tool in capsule endoscopy

“…Prospective studies aiming to determine the potential utility of FICE virtual chromoendoscopy in small-bowel capsule enteroscopy are even fewer. Imagawa et al (8), in a prospective study, again identified settings 1 and 2 as allowing better identification, mainly of angioectasias. In our case, setting 2 was chose and applied.…”

Stochastic Capsule Endoscopy Image Enhancement

“…[40]. Contrast enhancement techniques such as flexible spectral imaging color enhancement (FICE) have been reported to improves detection of angioectasia [41]. Moreover, the new contrast image capsule endoscope (CICE) developed by Olympus medical systems has been shown to improved the visibility of minute structures of adenomatous polyps [42].…”