Retrospective Study
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World J Gastrointest Endosc. Aug 16, 2014; 6(8): 359-365
Published online Aug 16, 2014. doi: 10.4253/wjge.v6.i8.359
Virtual chromoendoscopy in small bowel capsule endoscopy: New light or a cast of shadow?
José Cotter, Joana Magalhães, Francisca Dias de Castro, Mara Barbosa, Pedro Boal Carvalho, Sílvia Leite, Maria João Moreira, Bruno Rosa
José Cotter, Joana Magalhães, Francisca Dias de Castro, Mara Barbosa, Pedro Boal Carvalho, Sílvia Leite, Maria João Moreira, Bruno Rosa, Gastroenterology Department, Centro Hospitalar do Alto Ave, 4835-044 Guimarães, Portugal
José Cotter, Life and Health Sciences Research Institute (ICVS), School of Health Sciences, University of Minho, 4710-057 Braga, Portugal
José Cotter, ICVS/3B’s, PT Government Associate Laboratory, 4710-057 Braga/Guimarães, Portugal
Author contributions: Cotter J carried out the study, critically revised the manuscript and approved the final version to be submitted; Magalhães J and Leite S participated in the design of the study and statistical analysis; Dias de Castro F, Barbosa M and Boal Carvalho P reviewed the capsule endoscopy videos, performed data analysis and literature research and drafted the manuscript; Moreira MJ and Rosa B revised the manuscript and reviewed the capsule endoscopy videos; all the authors read and approved the final manuscript.
Correspondence to: José Cotter, MD, Gastroenterology Department, Centro Hospitalar do Alto Ave, Rua dos Cutileiros, Creixomil, 4835-044 Guimarães, Portugal. jcotter@chaa.min-saude.pt
Telephone: +351-253-540330 Fax: +351-253-421308
Received: April 24, 2014
Revised: May 26, 2014
Accepted: June 27, 2014
Published online: August 16, 2014
Processing time: 112 Days and 9 Hours
Abstract

AIM: To evaluate whether virtual chromoendoscopy can improve the delineation of small bowel lesions previously detected by conventional white light small bowel capsule endoscopy (SBCE).

METHODS: Retrospective single center study. One hundred lesions selected from forty-nine consecutive conventional white light SBCE (SBCE-WL) examinations were included. Lesions were reviewed at three Flexible Spectral Imaging Color Enhancement (FICE) settings and Blue Filter (BF) by two gastroenterologists with experience in SBCE, blinded to each other’s findings, who ranked the quality of delineation as better, equivalent or worse than conventional SBCE-WL. Inter-observer percentage of agreement was determined and analyzed with Fleiss Kappa (κ) coefficient. Lesions selected for the study included angioectasias (n = 39), ulcers/erosions (n = 49) and villous edema/atrophy (n = 12).

RESULTS: Overall, the delineation of lesions was improved in 77% of cases with FICE 1, 74% with FICE 2, 41% with FICE 3 and 39% with the BF, with a percentage of agreement between investigators of 89% (κ = 0.833), 85% (κ = 0.764), 66% (κ = 0.486) and 79% (κ = 0.593), respectively. FICE 1 improved the delineation of 97.4% of angioectasias, 63.3% of ulcers/erosions and 66.7% of villous edema/atrophy with a percentage of agreement of 97.4% (κ = 0.910), 81.6% (κ = 0.714) and 91.7% (κ = 0.815), respectively. FICE 2 improved the delineation of 97.4% of angioectasias, 57.1% of ulcers/erosions and 66.7% of villous edema/atrophy, with a percentage of agreement of 89.7% (κ = 0.802), 79,6% (κ = 0.703) and 91.7% (κ = 0.815), respectively. FICE 3 improved the delineation of 46.2% of angioectasias, 24.5% of ulcers/erosions and none of the cases of villous edema/atrophy, with a percentage of agreement of 53.8% [κ = not available (NA)], 75.5% (κ = NA) and 66.7% (κ = 0.304), respectively. The BF improved the delineation of 15.4% of angioectasias, 61.2% of ulcers/erosions and 25% of villous edema/atrophy, with a percentage of agreement of 76.9% (κ = 0.558), 81.6% (κ = 0.570) and 25.0% (κ = NA), respectively.

CONCLUSION: Virtual chromoendoscopy can improve the delineation of angioectasias, ulcers/erosions and villous edema/atrophy detected by SBCE, with almost perfect interobserver agreement for FICE 1.

Keywords: Capsule endoscopy; Virtual chromoendoscopy; Small bowel enteroscopy; Flexible Spectral Imaging Color Enhancement Endoscopy; Imaging review

Core tip: One of the recent technical advances of small bowel capsule endoscopy (SBCE) technology is the possibility to enhance endoscopic imaging with computed virtual chromoendoscopy, using the Flexible Spectral Imaging Color Enhancement (FICE) or the Blue Filter modes. In our study, virtual chromoendoscopy, particularly FICE 1, improved the delineation of three main types of small bowel mucosal lesions: vascular (angioectasias), mucosal breaks (ulcers and erosions) and villous pattern (edema and atrophy), with substantial inter-observer agreement. Thus, we support the use of virtual chromoendoscopy as a complement to conventional white light SBCE for the evaluation of difficult to interpret endoscopic images.