Scoring systems in clinical small-bowel capsule endoscopy: all you need to know!

Bruno Rosa; Reuma Margalit-Yehuda; Kelly Gatt; Martina Sciberras; Carlo Girelli; Jean-Christophe Saurin; Pablo Cortegoso Valdivia; Jose Cotter; Rami Eliakim; Flavio Caprioli; Gunnar Baatrup; Martin Keuchel; Pierre Ellul; Ervin Toth; Anastasios Koulaouzidis

doi:10.1055/a-1372-4051

Endoscopy International Open, Table of Contents

CC BY-NC-ND 4.0 · Endosc Int Open 2021; 09(06): E802-E823
DOI: 10.1055/a-1372-4051

Review

Scoring systems in clinical small-bowel capsule endoscopy: all you need to know!

Authors

Bruno Rosa

¹Gastroenterology Department, Hospital da Senhora da Oliveira, Guimarães, Portugal

²Life and Health Sciences Research Institute (ICVS), School of Medicine, University of Minho-Braga. Portugal

³ICVS/3B’s, PT Government Associate Laboratory – Braga/Guimarães, Portugal.
Reuma Margalit-Yehuda

⁴Department of Gastroenterology, Sheba Medical Center, Sackler School of Medicine, Tel-Aviv, Israel
Kelly Gatt

⁵Division of Gastroenterology, Mater Dei Hospital, Msida, Malta
Martina Sciberras

⁵Division of Gastroenterology, Mater Dei Hospital, Msida, Malta
Carlo Girelli

⁶Department of Internal Medicine, Gastroenterology & Digestive Endoscopy, Hospital of Busto Arsizio, Italy
Jean-Christophe Saurin

⁷Hospices Civils de Lyon, Hôpital Edouard Herriot, Service d'Hépato-Gastro-Entérologie et d'Endoscopie Digestive, Lyon, France
Pablo Cortegoso Valdivia

⁸Gastroenterology & Endoscopy Unit, University Hospital of Parma, University of Parma, Parma, Italy
Jose Cotter

¹Gastroenterology Department, Hospital da Senhora da Oliveira, Guimarães, Portugal

²Life and Health Sciences Research Institute (ICVS), School of Medicine, University of Minho-Braga. Portugal

³ICVS/3B’s, PT Government Associate Laboratory – Braga/Guimarães, Portugal.
Rami Eliakim

⁴Department of Gastroenterology, Sheba Medical Center, Sackler School of Medicine, Tel-Aviv, Israel
Flavio Caprioli

⁹Unit of Gastroenterology and Endoscopy, Fondazione IRCCS Cà Granda, Ospedale Policlinico di Milano, Milan, Italy
Gunnar Baatrup

¹⁰Department of Clinical Research, University of Southern Denmark, Odense, Denmark
Martin Keuchel

¹¹Clinic for Internal Medicine, Bethesda Krankenhaus Bergedorf, Hamburg, Germany
Pierre Ellul

⁵Division of Gastroenterology, Mater Dei Hospital, Msida, Malta
Ervin Toth

¹²Skåne University Hospital, Lund University, Malmö, Sweden
Anastasios Koulaouzidis

¹³Endoscopy Unit, The Royal Infirmary of Edinburgh, Scotland, UK

¹⁴Department of Social Medicine & Public Health, Pomeranian Medical University, Szczecin, Poland

Abstract

Capsule endoscopy (CE) emerged out of the pressing clinical need to image the small bowel (SB) in cases of midgut bleeding and provide an overall comfortable and reliable gastrointestinal (GI) diagnosis [1]. Since its wider adoption in clinical practice, significant progress has been made in several areas including software development, hardware features and clinical indications, while innovative applications of CE never cease to appear [2] [3]. Currently, several manufacturers provide endoscopic capsules with more or less similar technological features [4]. Although there is engaging and continuous academic and industry-fueled R&D, promising furtherment of CE technology [4] [5], the current status of clinical CE remains that of by and large an imaging modality. Clinical relevance of CE images is cornerstone in the decision-making process for medical management. In one of the larger to date SB CE studies, 4,206 abnormal images were detected in 3,280 patients [6]. Thus, CE leads to the identification of a large amount of potential pathology, some of which are pertinent (or relevant) while some (probably the majority) are not.

Soon artificial intelligence (AI) is likely to carry out several roles currently performed by humans; in fact, we are witnessing only the first stages of a transition in the clinical adoption of AI-based solutions in several aspects of gastroenterology including CE [7]. Until then though, human-based decision-making profoundly impacts patient care and – although not suggested in the updated European Society of Gastrointestinal Endoscopy (ESGE) European curriculum [8] [9] – it should be an integral part of CE training. Frequently, interpretation of CE images by experts or at least experienced readers differs. In a tandem CE reading study, expert review of discordant cases revealed a 50 % (13/25 discordant results) error rate by experienced readers, corresponding (in 5/13 cases) to ‘over-classification’ of an irrelevant abnormality [10]. Another comparative study showed an ‘over-classification’ of such irrelevant abnormalities in ~10 % of CE readings [11]. One thing which has been for a while on the table – in relation to optimizing and/or standardizing CE reporting and subsequent decision-making – is the need for reproducible scoring systems and for a reliable common language among clinicians responsible for further patient’s management.

Over the years, several of these scoring systems were developed while others appear in the wake of software and hardware improvements aiming to replace and/or complement their predecessors. This review presents a comprehensive account of the currently available classification/scoring systems in clinical CE spanning from predicting the bleeding potential of identified SB lesions (with emphasis on vascular lesions), and the individual rebleeding risk; scoring systems for the prediction of SB lesions in patients with obscure gastrointestinal bleeding (OGlB), having the potential to improve patient selection and rationalize the use of enteroscopy, with better allocation of resources, optimized diagnostic workflow and tailored treatment. This review also includes scores for reporting the inflammatory burden, the cleansing level that underscores confidence in CE reporting and the mass or bulge question in CE. Essentially, the aim is to become a main text for reference when scoring is required and facilitate the inclusion of -through readiness of access- one of the other in the final report.

Full Text

References

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