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Endosc Int Open 2016; 04(05): E508-E514
DOI: 10.1055/s-0042-106206
Original article
© Georg Thieme Verlag KG Stuttgart · New York

Usefulness of virtual chromoendoscopy in the evaluation of subtle small bowel ulcerative lesions by endoscopists with no experience in videocapsule

Mihai Rimbaş
1   Gastroenterology Department, Colentina Clinical Hospital, Bucharest, Romania
2   Internal Medicine Department, Carol Davila University of Medicine, Bucharest, Romania
,
Denise Carmen Mihaela Zahiu
1   Gastroenterology Department, Colentina Clinical Hospital, Bucharest, Romania
,
Andrei Mihai Voiosu
1   Gastroenterology Department, Colentina Clinical Hospital, Bucharest, Romania
2   Internal Medicine Department, Carol Davila University of Medicine, Bucharest, Romania
,
Theodor Alexandru Voiosu
1   Gastroenterology Department, Colentina Clinical Hospital, Bucharest, Romania
2   Internal Medicine Department, Carol Davila University of Medicine, Bucharest, Romania
,
Alina Ana-Maria Zlate
1   Gastroenterology Department, Colentina Clinical Hospital, Bucharest, Romania
,
Roxana Dinu
1   Gastroenterology Department, Colentina Clinical Hospital, Bucharest, Romania
,
Domenico Galasso
3   Digestive Endoscopy Unit, Catholic University, Rome, Italy
,
Leonardo Minelli Grazioli
3   Digestive Endoscopy Unit, Catholic University, Rome, Italy
,
Mariachiara Campanale
3   Digestive Endoscopy Unit, Catholic University, Rome, Italy
,
Federico Barbaro
3   Digestive Endoscopy Unit, Catholic University, Rome, Italy
,
Bogdan Radu Mateescu
1   Gastroenterology Department, Colentina Clinical Hospital, Bucharest, Romania
2   Internal Medicine Department, Carol Davila University of Medicine, Bucharest, Romania
,
Bogdan Busuioc
1   Gastroenterology Department, Colentina Clinical Hospital, Bucharest, Romania
,
Tiberiu Iordache
1   Gastroenterology Department, Colentina Clinical Hospital, Bucharest, Romania
,
Oana Dolofan
1   Gastroenterology Department, Colentina Clinical Hospital, Bucharest, Romania
,
Adelina Maria Popescu
4   Gastroenterology Department, University Emergency Hospital, Bucharest, Romania
,
Vasile Daniel Balaban
5   Gastroenterology Department, Emergency Military Hospital, Bucharest, Romania
,
Mircea Mihai Raducan
2   Internal Medicine Department, Carol Davila University of Medicine, Bucharest, Romania
,
Cristiano Spada
3   Digestive Endoscopy Unit, Catholic University, Rome, Italy
,
Cristian Răsvan Băicuş
2   Internal Medicine Department, Carol Davila University of Medicine, Bucharest, Romania
,
Guido Costamagna
3   Digestive Endoscopy Unit, Catholic University, Rome, Italy
› Author Affiliations
Further Information

Publication History

submitted 02 December 2015

accepted after revision 29 March 2016

Publication Date:
12 May 2016 (online)

Also available at
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Background and study aims: In videocapsule endoscopy examination (VCE), subtle variations in mucosal hue or pattern such as those seen in ulcerations can be difficult to detect, depending on the experience of the reader. Our aim was to test whether virtual chromoendoscopy (VC) techniques, designed to enhance the contrast between the lesion and the normal mucosa, could improve the characterization of ulcerative mucosal lesions.

Patients and methods: Fifteen trainees or young gastroenterologists with no experience in VCE were randomly assigned to evaluate 250 true ulcerative and 100 false ulcerative, difficult-to-interpret small bowel lesions, initially as white light images (WLI) and then, in a second round, with the addition of one VC setting or again as WLI, labeling them as real lesions or artifacts.

Results: On the overall image evaluation, an improvement in lesion characterization was observed by adding any chromoendoscopy setting, especially Blue mode and FICE 1, with increases in accuracy of 13 % [95 %CI 0.8, 25.3] and 7.1 % [95 %CI – 17.0, 31.3], respectively. However, when only false ulcerative images were considered, with the same presets (Blue mode and FICE 1), there was a loss in accuracy of 10.7 % [95 %CI – 10.9, 32.3] and 7.3 % [95 %CI – 1.3, 16.0], respectively. The interobserver agreement was poor for both readings.

Conclusions: VC helps beginner VCE readers correctly categorize difficult-to-interpret small bowel mucosal ulcerative lesions. However, false lesions tend to be misinterpreted as true ulcerative with the same presets. Therefore care is advised in using VC especially under poor bowel preparation.

 

  • References

  • 1 Rastogi A, Schoen RE, Slivka A. Diagnostic yield and clinical outcomes of capsule endoscopy. Gastrointest Endosc 2004; 60: 959-964
    CrossrefPubMedSearch in Google Scholar
  • 2 Solem CA, Loftus EV, Fletcher JG et al. Small-bowel imaging in Crohn’s disease: a prospective, blinded, 4-way comparison trial. Gastrointest Endosc 2008; 68: 255-266
    CrossrefPubMedSearch in Google Scholar
  • 3 Jensen MD, Nathan T, Rafaelsen SR et al. Diagnostic accuracy of capsule endoscopy for small bowel Crohn’s disease is superior to that of MR enterography or CT enterography. Clin Gastroenterol Hepatol 2011; 9: 124-129
    CrossrefPubMedSearch in Google Scholar
  • 4 Pennazio M, Spada C, Eliakim R et al. Small-bowel capsule endoscopy and device-assisted enteroscopy for diagnosis and treatment of smallbowel disorders: European Society of Gastrointestinal Endoscopy (ESGE) Clinical Guideline. Endoscopy 2015; 47: 352-376
    Thieme ConnectPubMedSearch in Google Scholar
  • 5 Trivedi PJ, Braden B. Indications, stains and techniques in chromoendoscopy. QJM 2013; 106: 117-131
    CrossrefPubMedSearch in Google Scholar
  • 6 Pohl J, Aschmoneit I, Schumann S et al. Computed image modification for enhancement of small-bowel surface structures at video capsule endoscopy. Endoscopy 2010; 42: 490-492
    Thieme ConnectPubMedSearch in Google Scholar
  • 7 Osawa H, Yamamoto H. Present and future status of flexible spectral imaging color enhancement and blue laser imaging technology. Dig Endosc 2014; 26: 105-115
    CrossrefPubMedSearch in Google Scholar
  • 8 Konishi M, Shibuya T, Mori H et al. Usefulness of flexible spectral imaging color enhancement for the detection and diagnosis of small intestinal lesions found by capsule endoscopy. Scand J Gastroenterol 2014; 49: 501-505
    CrossrefPubMedSearch in Google Scholar
  • 9 Kobayashi Y, Watabe H, Yamada A et al. Efficacy of flexible spectral imaging color enhancement on the detection of small intestinal diseases by capsule endoscopy. J Dig Dis 2012; 13: 614-620
    CrossrefPubMedSearch in Google Scholar
  • 10 Duque G, Almeida N, Figueiredo P et al. Virtual chromoendoscopy can be a useful software tool in capsule endoscopy. Rev Esp Enferm Dig 2012; 104: 231-236
    CrossrefPubMedSearch in Google Scholar
  • 11 Krystallis C, Koulaouzidis A, Douglas S et al. Chromoendoscopy in small bowel capsule endoscopy: Blue mode or Fuji Intelligent Colour Enhancement?. Dig Liver Dis 2011; 43: 953-957
    CrossrefPubMedSearch in Google Scholar
  • 12 Imagawa H, Oka S, Tanaka S et al. Improved detectability of small-bowel lesions via capsule endoscopy with computed virtual chromoendoscopy: a pilot study. Scand J Gastroenterol 2011; 46: 1133-1137
    CrossrefPubMedSearch in Google Scholar
  • 13 Cotter J, Magalhães J, Castro FD et al. Virtual chromoendoscopy in small bowel capsule endoscopy: new light or a cast of shadow?. World J Gastrointest Endosc 2014; 6: 359-365
    CrossrefPubMedSearch in Google Scholar
  • 14 Rimbaş M, Marinescu M, Voiosu MR et al. NSAID-induced deleterious effects on the proximal and mid small bowel in seronegative spondyloarthropathy patients. World J Gastroenterol 2011; 17: 1030-1035
    CrossrefPubMedSearch in Google Scholar
  • 15 Rimbaș M, Negreanu L, Ciobanu L et al. Is virtual chromoendoscopy useful in the evaluation of subtle ulcerative small bowel lesions detected by videocapsule endoscopy?. Endoscopy International Open 2015; 3: E615-E620
    Thieme ConnectPubMedSearch in Google Scholar
  • 16 Gralnek IM, Defranchis R, Seidman E et al. Development of a capsule endoscopy scoring index for small bowel mucosal inflammatory change. Aliment Pharmacol Ther 2008; 27: 146-154
    CrossrefPubMedSearch in Google Scholar
  • 17 Goldstein JL, Eisen GM, Lewis B et al. Small bowel mucosal injury is reduced in healthy subjects treated with celecoxib compared with ibuprofen plus omeprazole, as assessed by video capsule endoscopy. Aliment Pharmacol Ther 2007; 25: 1211-1222
    CrossrefPubMedSearch in Google Scholar
  • 18 Pohl J, Aschmoneit I, Schumann S et al. Computed image modification for enhancement of small-bowel surface structures at video capsule endoscopy. Endoscopy 2010; 42: 490-492
    Thieme ConnectPubMedSearch in Google Scholar
  • 19 Gupta T, Ibrahim M, Deviere J et al. Evaluation of Fujinon intelligent chromo endoscopy-assisted capsule endoscopy in patients with obscure gastroenterology bleeding. World J Gastroenterol 2011; 17: 4590-4595
    CrossrefPubMedSearch in Google Scholar
  • 20 Imagawa H, Oka S, Tanaka S et al. Improved visibility of lesions of the small intestine via capsule endoscopy with computed virtual chromoendoscopy. Gastrointestinal Endoscopy 2011; 73: 299-306
    CrossrefPubMedSearch in Google Scholar
  • 21 Koulaouzidis A, Douglas S, Plevris JN. Blue mode does not offer any benefit over white light when calculating Lewis score in small-bowel capsule endoscopy. World J Gastrointest Endosc 2012; 4: 33-37
    CrossrefPubMedSearch in Google Scholar
  • 22 DeLeusse A, Landi B, Edery J et al. Video capsule endoscopy for investigation of obscure gastrointestinal bleeding: feasibility, results, and interobserver agreement. Endoscopy 2005; 37: 617-621
    Thieme ConnectPubMedSearch in Google Scholar
  • 23 Sakai E, Endo H, Kato S et al. Capsule endoscopy with flexible spectral imaging color enhancement reduces the bile pigment effect and improves the detectability of small bowel lesions. BMC Gastroenterol 2012; 12: 83
    CrossrefPubMedSearch in Google Scholar