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

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.

Publication History

Received: 01 September 2020

Accepted: 26 November 2020

Article published online:
27 May 2021

• References

• 1 Iddan G, Meron G, Glukhovsky A. et al. Wireless capsule endoscopy. Nature 2000; 405: 417
• 2 MacLeod C, Wilson P, Watson AJM. Colon capsule endoscopy: an innovative method for detecting colorectal pathology during the COVID-19 pandemic?. Colorectal Dis 2020; 22: 621-624
• 3 Koulaouzidis A, Marlicz W, Wenzek H. et al. Returning to digestive endoscopy normality will be slow and must include novelty and telemedicine. Dig Liver Dis 2020; 52: 1099-1101
• 4 Vasilakakis MD, Koulaouzidis A, Marlicz W. et al. The future of capsule endoscopy in clinical practice: from diagnostic to therapeutic experimental prototype capsules. Prz Gastroenterol 2020; 15: 179-193
• 5 Steiger C, Abramson A, Nadeau P. et al. Ingestible electronics for diagnostics and therapy. Nat Rev Mater 2019; 5: 83-98
• 6 Ding Z, Shi H, Zhang H. et al. Gastroenterologist-level identification of small-bowel diseases and normal variants by capsule endoscopy using a deep-learning model. Gastroenterology 2019; 157: 1044-1054 e1045
• 7 Min JK, Kwak MS, Cha JM. Overview of deep learning in gastrointestinal endoscopy. Gut Liver 2019; 13: 388-393
• 8 Fernandez-Urien I, Panter S, Carretero C. et al. International core curriculum for capsule endoscopy training courses. Endosc Int Open 2017; 5: E526-E538
• 9 Sidhu R, Chetcuti Zammit S, Baltes P. et al. Curriculum for small-bowel capsule endoscopy and device-assisted enteroscopy training in Europe: European Society of Gastrointestinal Endoscopy (ESGE) Position Statement. Endoscopy 2020; 52: 669-686
• 10 Pioche M, Filoche B, Jacob P. et al. Randomized Prospective Comparison of the Diagnostic yield of PillCam SB2 and Mirocam videocapsules in patients with obscure digestive bleeding. Gastrointest Endosc 2011; 73: 1181-1188
• 11 Saurin JC, Ben Soussan E, Gaudric M. et al. Can we shorten the small-bowel capsule reading time? validation of the “quick-view” image detection system. Gastrointest Endosc 2009; 69: AB189 (abstr.)
• 12 Leenhardt R, Li C, Koulaouzidis A. et al. Nomenclature and semantic description of vascular lesions in small bowel capsule endoscopy: an international Delphi consensus statement. Endosc Int Open 2019; 7: E372-E379
• 13 Leenhardt R, Buisson A, Bourreille A. et al. Nomenclature and semantic descriptions of ulcerative and inflammatory lesions seen in Crohnʼs disease in small bowel capsule endoscopy: An international Delphi consensus statement. United European Gastroenterol J 2020; 8: 99-107
• 14 Gerson LB, Fidler JL, Cave DR. et al. ACG Clinical Guideline: Diagnosis and Management of Small Bowel Bleeding. Am J Gastroenterol 2015; 110: 1265-87 quiz 1288
• 15 Pennazio M, Spada C, Eliakim R. et al. Small-bowel capsule endoscopy and device-assisted enteroscopy for diagnosis and treatment of small-bowel disorders: European Society of Gastrointestinal Endoscopy (ESGE) Clinical Guideline. Endoscopy 2015; 47: 352-376
• 16 Liao Z, Gao R, Xu C. et al. Indications and detection, completion, and retention rates of small-bowel capsule endoscopy: a systematic review. Gastrointest Endosc 2010; 71: 280-286
• 17 Islam RS, Leighton JA, Pasha SF. Evaluation and management of small-bowel tumors in the era of deep enteroscopy. Gastrointest Endosc 2014; 79: 732-740
• 18 Song JH, Hong SN, Kyung ChangD. et al. The etiology of potential small-bowel bleeding depending on patientʼs age and gender. United European Gastroenterol J 2018; 6: 1169-1178
• 19 Saurin JC, Delvaux M, Gaudin JL. et al. Diagnostic value of endoscopic capsule in patients with obscure digestive bleeding: blinded comparison with video push-enteroscopy. Endoscopy 2003; 35: 576-584
• 20 Saurin JC, Delvaux M, Vahedi K. et al. Clinical impact of capsule endoscopy compared to push enteroscopy: 1-year follow-up study. Endoscopy 2005; 37: 318-323
• 21 Rahmi G, Samaha E, Vahedi K. et al. Long-term follow-up of patients undergoing capsule and double-balloon enteroscopy for identification and treatment of small-bowel vascular lesions: a prospective, multicenter study. Endoscopy 2014; 46: 591-597
• 22 Spada C, McNamara D, Despott EJ. et al. Performance measures for small-bowel endoscopy: A European Society of Gastrointestinal Endoscopy (ESGE) Quality Improvement Initiative. United Europ Gastroenterol J 2019; 7: 614-641
• 23 Saurin JC, Pilleul F, Soussan EB. et al. Small-bowel capsule endoscopy diagnoses early and advanced neoplasms in asymptomatic patients with Lynch syndrome. Endoscopy 2010; 42: 1057-1062
• 24 Rondonotti E, Pennazio M, Toth E. et al. How to read small bowel capsule endoscopy: a practical guide for everyday use. Endosc Int Open 2020; 8: E1-E5
• 25 Yano T, Yamamoto H, Sunada K. et al. Endoscopic classification of vascular lesions of the small intestine (with videos). Gastrointest Endosc 2008; 67: 169-172
• 26 Arieira C, Magalhães R, Dias de Castro F. et al. Small bowel angioectasias rebleeding and the identification of higher risk patients [published online ahead of print, 2020 Feb 18]. Dig Dis Sci 2021; 66: 175-180
• 27 Shinozaki S, Yamamoto H, Yano T. et al. Favorable long-term outcomes of repeat endotherapy for small-intestine vascular lesions by double-balloon endoscopy. Gastrointest Endosc 2014; 80: 112-117
• 28 Lepileur L, Dray X, Antonietti M. et al. Factors associated with diagnosis of obscure gastrointestinal bleeding by video capsule enteroscopy. Clin Gastroenterol Hepatol 2012; 10: 1376-1380
• 29 Pennazio M, Santucci R, Rondonotti E. et al. Outcome of patients with obscure gastrointestinal bleeding after capsule endoscopy: report of 100 consecutive cases. Gastroenterology 2004; 126: 643-653
• 30 Nennstiel S, Machanek A, von Delius S. et al. Predictors and characteristics of angioectasias in patients with obscure gastrointestinal bleeding identified by video capsule endoscopy. United Europ Gastroenterol J 2017; 5: 1129-1135
• 31 Shahidi NC, Ou G, Svarta S. et al. Factors associated with positive findings from capsule endoscopy in patients with obscure gastrointestinal bleeding. Clin Gastroenterol Hepatol 2012; 10: 1381-1385
• 32 Pate GE, Mulligan A. An epidemiological study of Heydeʼs syndrome: an association between aortic stenosis and gastrointestinal bleeding. J Heart Valve Dis 2004; 13: 713-716
• 33 Tabibian JH, Rhoades DP, Forde KA. et al. Timing of gastrointestinal bleeding after implantation of left ventricular assist devices associates with anatomic location, presentation, and management. Clin Gastroenterol Hepatol 2019; 17: 448-454
• 34 Igawa A, Oka S, Tanaka S. et al. Major predictors and management of small-bowel angioectasia. BMC Gastroenterol 2015; 15: 108
• 35 Holleran G, Hall B, Hussey M. et al. Small bowel angiodysplasia and novel disease associations: a cohort study. Scand J Gastroenterol 2013; 48: 433-438
• 36 Veyradier A, Balian A, Wolf M. et al. Abnormal von Willebrand factor in bleeding angiodysplasias of the digestive tract. Gastroenterology 2001; 120: 346-353
• 37 Sidhu R, Sanders DS, Kapur K. et al. Factors predicting the diagnostic yield and intervention in obscure gastrointestinal bleeding investigated using capsule endoscopy. J Gastrointestin Liver Dis 2009; 18: 273-278
• 38 Garcia-Compean D, Del Cueto-Aguilera AN, Jimenez-Rodriguez AR. et al. Diagnostic and therapeutic challenges of gastrointestinal angiodysplasias: A critical review and view points. World J Gastroenterol 2019; 25: 2549-2564
• 39 Tziatzios G, Gkolfakis P, Papanikolaou IS. et al. antithrombotic treatment is associated with small-bowel video capsule endoscopy positive findings in obscure gastrointestinal bleeding: a systematic review and meta-analysis. Dig Dis Sci 2019; 64: 15-24
• 40 Boal Carvalho P, Rosa B, Moreira MJ. et al. New evidence on the impact of antithrombotics in patients submitted to small bowel capsule endoscopy for the evaluation of obscure gastrointestinal bleeding. Gastroenterol Res Pract 2014; 2014: 709217
• 41 Marya N, Wang L, Dasharathy S. et al. Development of a scoring system to predict a positive diagnosis on video capsule endoscopy for suspected small bowel bleeding. Tech Innov Gastrointest Endosc 2020; 22: 178-184
• 42 Ohmiya N, Nakamura M, Osaki H. et al. Development of a comorbidity index to identify patients with small bowel bleeding at risk for rebleeding and small bowel vascular diseases. Clin Gastroenterol Hepatol 2019; 17: 896-904 e4
• 43 Wetwittayakhlang P, Wonglhow J, Netinatsunton N. et al. Re-bleeding and its predictors after capsule endoscopy in patients with obscure gastrointestinal bleeding in long-term follow-up. BMC Gastroenterol 2019; 19: 216
• 44 Ponte A, Perez-Cuadrado Robles E, Pinho R. et al. High short-term rebleeding rate in patients undergoing a second endoscopic therapy for small-bowel angioectasias after recurrent bleeding. Rev Esp Enferm Dig 2018; 110: 88-93
• 45 Matsumura T, Arai M, Saito K. et al. Predictive factor of re-bleeding after negative capsule endoscopy for obscure gastrointestinal bleeding: over 1-year follow-up study. Dig Endosc 2014; 26: 650-658
• 46 Fan GW, Chen TH, Lin WP. et al. Angiodysplasia and bleeding in the small intestine treated by balloon-assisted enteroscopy. J Dig Dis 2013; 14: 113-116
• 47 Tan W, Ge ZZ, Gao YJ. et al. Long-term outcome in patients with obscure gastrointestinal bleeding after capsule endoscopy. J Dig Dis 2015; 16: 125-134
• 48 Koh SJ, Im JP, Kim JW. et al. Long-term outcome in patients with obscure gastrointestinal bleeding after negative capsule endoscopy. World J Gastroenterol 2013; 19: 1632-1638
• 49 Sakai E, Endo H, Taguri M. et al. Frequency and risk factors for rebleeding events in patients with small bowel angioectasia. BMC Gastroenterol 2014; 14: 200
• 50 Romagnuolo J, Brock AS, Ranney N. Is endoscopic therapy effective for angioectasia in obscure gastrointestinal bleeding? A systematic review of the literature. J Clin Gastroenterol 2015; 49: 823-830
• 51 Jackson CS, Gerson LB. Management of gastrointestinal angiodysplastic lesions (gastrointestinalADs): a systematic review and meta-analysis. Am J Gastroenterol 2014; 109: 474-83 quiz 484
• 52 Gerson LB, Batenic MA, Newsom SL. et al. Long-term outcomes after double-balloon enteroscopy for obscure gastrointestinal bleeding. Clin Gastroenterol Hepatol 2009; 7: 664-669
• 53 Ribeiro I, Pinho R, Rodrigues A. et al. What is the long-term outcome of a negative capsule endoscopy in patients with obscure gastrointestinal bleeding?. Rev Esp Enferm Dig 2015; 107: 753-758
• 54 May A, Friesing-Sosnik T, Manner H. et al. Long-term outcome after argon plasma coagulation of small-bowel lesions using double-balloon enteroscopy in patients with mid-gastrointestinal bleeding. Endoscopy 2011; 43: 759-765
• 55 Esaki M, Matsumoto T, Yada S. et al. Factors associated with the clinical impact of capsule endoscopy in patients with overt obscure gastrointestinal bleeding. Dig Dis Sci 2010; 55: 2294-2301
• 56 Neu B, Ell C, May A. et al. Capsule endoscopy versus standard tests in influencing management of obscure digestive bleeding: results from a German multicenter trial. Am J Gastroenterol 2005; 100: 1736-1742
• 57 Canas-Ventura A, Marquez L, Bessa X. et al. Outcome in obscure gastrointestinal bleeding after capsule endoscopy. World J Gastrointest Endosc 2013; 5: 551-558
• 58 Yung DE, Koulaouzidis A, Avni T. et al. Clinical outcomes of negative small-bowel capsule endoscopy for small-bowel bleeding: a systematic review and meta-analysis. Gastrointest Endosc 2017; 85: 305-317 e2
• 59 Lai LH, Wong GL, Chow DK. et al. Long-term follow-up of patients with obscure gastrointestinal bleeding after negative capsule endoscopy. Am J Gastroenterol 2006; 101: 1224-1228
• 60 Samaha E, Rahmi G, Landi B. et al. Long-term outcome of patients treated with double balloon enteroscopy for small bowel vascular lesions. Am J Gastroenterol 2012; 107: 240-246
• 61 Grooteman KV, Holleran G, Matheeuwsen M. et al. A risk assessment of factors for the presence of angiodysplasias during endoscopy and factors contributing to symptomatic bleeding and rebleeds. Dig Dis Sci 2019; 64: 2923-2932
• 62 Redondo-Cerezo E, Gomez-Ruiz CJ, Sanchez-Manjavacas N. et al. Long-term follow-up of patients with small-bowel angiodysplasia on capsule endoscopy. Determinants of a higher clinical impact and rebleeding rate. Rev Esp Enferm Dig 2008; 100: 202-207
• 63 Davie M, Yung DE, Douglas S. et al. Mapping the distribution of small bowel angioectasias. Scand J Gastroenterol 2019; 54: 597-602
• 64 Jackson CS, Strong R. Gastrointestinal Angiodysplasia: Diagnosis and Management. Gastrointest Endosc Clin N Am 2017; 27: 51-62
• 65 Baba Y, Kawano S, Kono Y. et al. Clinical characteristics and risk factors for rebleeding in patients with obscure gastrointestinal bleeding. Intern Med 2020; 59: 1345-1350
• 66 Karagiannis S, Goulas S, Kosmadakis G. et al. Wireless capsule endoscopy in the investigation of patients with chronic renal failure and obscure gastrointestinal bleeding (preliminary data). World J Gastroenterol 2006; 12: 5182-5185
• 67 de Sousa Magalhaes R, Curdia Goncalves T, Rosa B. et al. RHEMITT score: predicting the risk of rebleeding for patients with mid-gastrointestinal bleeding submitted to small bowel capsule endoscopy. Dig Dis 2020; 38: 299-309
• 68 Silva JC, Pinho R, Ponte A. et al. Predicting the risk of rebleeding after capsule endoscopy in obscure gastrointestinal bleeding – External validation of the RHEMITT Score. Dig Dis 2020;
• 69 Uchida G, Hirooka Y, Nakamura M. et al. Nomogram-based prediction of rebleeding in small bowel bleeding patients: the ‛PRSBBʼ score. Sci Rep 2018; 8: 6378
• 70 Uchida G, Nakamura M, Watanabe O. et al. Development and validation of a new scoring system to determine the necessity of small-bowel endoscopy in obscure gastrointestinal bleeding. Dig Liver Dis 2017; 49: 1218-1224
• 71 Niikura R, Yamada A, Nagata N. et al. New predictive model of rebleeding during follow-up of patents with obscure gastrointestinal bleeding: A multicenter cohort study. J Gastroenterol Hepatol 2016; 31: 752-760
• 72 OʼBrien EC, Simon DN, Thomas LE. et al. The ORBIT bleeding score: a simple bedside score to assess bleeding risk in atrial fibrillation. Eur Heart J 2015; 36: 3258-3264
• 73 Curdia GoncalvesT, Arieira C, Monteiro S. et al. ORBIT score: an useful predictor of small bowel rebleeding in patients under chronic anticoagulation. Scand J Gastroenterol 2018; 53: 179-184
• 74 Rondonotti E, Spada C, Adler S. et al. Small-bowel capsule endoscopy and device-assisted enteroscopy for diagnosis and treatment of small-bowel disorders: European Society of Gastrointestinal Endoscopy (ESGE) Technical Review. Endoscopy 2018; 50: 423-446
• 75 Pérez-Cuadrado Robles E, Pinho R, González-Suárez B. et al. Small bowel enteroscopy – A joint clinical guideline by the Spanish and Portuguese small-bowel study groups. Rev Esp Enferm Dig 2020; 112: 309-318
• 76 Gay G, Delvaux M, Fassler I. Outcome of capsule endoscopy in determining indication and route for push-and-pull enteroscopy. Endoscopy 2006; 38: 49-58
• 77 Nakamura M, Ohmiya N, Shirai O. et al. Route selection for double-balloon endoscopy, based on capsule transit time, in obscure gastrointestinal bleeding. J Gastroenterol 2010; 45: 592-599
• 78 Maeda Y, Moribata K, Deguchi H. et al. Video capsule endoscopy as the initial examination for overt obscure gastrointestinal bleeding can efficiently identify patients who require double-balloon enteroscopy. BMC Gastroenterol 2015; 15: 132
• 79 Li X, Chen H, Dai J. et al. Predictive role of capsule endoscopy on the insertion route of double-balloon enteroscopy. Endoscopy 2009; 41: 762-766
• 80 Lin T-N, Su M-Y, Hsu C-M. et al. Combined use of capsule endoscopy and double-balloon enteroscopy in patients with obscure gastrointestinal bleeding. Chang Gung Med J 2008; 31: 450-456
• 81 Chalazan B, Gostout CJ, Song LM. et al. Use of capsule small bowel transit time to determine the optimal enteroscopy approach. Gastroenterology Res 2012; 5: 39-44
• 82 Tsuboi A, Oka S, Tanaka S. et al. The Clinical usefulness of the pillcam progress indicator for route selection in double balloon endoscopy. Intern Med 2019; 58: 1375-1381
• 83 Mandaliya R, Korenblit J, OʼHare B. et al. Spiral enteroscopy utilizing capsule location index for achieving high diagnostic and therapeutic yield. Diagn Ther Endosc 2015; 2015: 1-7
• 84 Jensen MD, Nathan T, Rafaelsen SR. et al. Diagnostic accuracy of capsule endoscopy for small bowel Crohnʼs disease is superior to that of MR enterography or CT enterography. Clin Gastroenterol Hepatol 2011; 9: 124-129
• 85 Bar-Meir S. Review article: capsule endoscopy – are all small intestinal lesions Crohnʼs disease?. Aliment Pharmacol Ther 2006; 24: 19-21
• 86 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
• 87 Cotter J, Dias de Castro F, Magalhaes J. et al. Validation of the Lewis score for the evaluation of small-bowel Crohnʼs disease activity. Endoscopy 2015; 47: 330-335
• 88 Rosa B, Moreira MJ, Rebelo A. et al. Lewis Score: a useful clinical tool for patients with suspected Crohnʼs Disease submitted to capsule endoscopy. J Crohnʼs Colitis 2012; 6: 692-697
• 89 Santos A, Silva MA, Cardoso H. et al. Lewis score: a useful tool for diagnosis and prognosis in Crohnʼs disease. Rev Esp Enferm Dig 2020; 112: 121-126
• 90 Ben-Horin S, Lahat A, Amitai MM. et al. Assessment of small bowel mucosal healing by video capsule endoscopy for the prediction of short-term and long-term risk of Crohnʼs disease flare: A prospective cohort study. Lancet Gastroenterol Hepatol 2019; 4: 519-528
• 91 Gal E, Geller A, Fraser G. et al. Assessment and Validation of the New Capsule Endoscopy Crohnʼs Disease Activity Index (CECDAI). Dig Dis Sci 2008; 53: 1933-1937
• 92 Niv Y, Ilani S, Levi Z. et al. Validation of the Capsule Endoscopy Crohnʼs Disease Activity Index (CECDAI or Niv score): a multicenter prospective study. Endoscopy 2012; 44: 21-26
• 93 Koulaouzidis A, Douglas S, Plevris JN. Lewis score correlates more closely with fecal calprotectin than capsule endoscopy Crohnʼs disease activity index. Dig Dis Sci 2012; 57: 987-993
• 94 Ponte A, Pinho R, Rodrigues A. et al. Evaluation and comparison of capsule endoscopy scores for assessment of inflammatory activity of small-bowel in Crohnʼs disease. Gastroenterol Hepatol 2018; 41: 245-250
• 95 Yablecovitch D, Lahat A, Neuman S. et al. The Lewis score or the capsule endoscopy Crohnʼs disease activity index: which one is better for the assessment of small bowel inflammation in established Crohnʼs disease?. Therap Adv Gastroenterol 2018; 11: 1756283X17747780
• 96 Kopylov U, Nemeth A, Koulaouzidis A. et al. Small bowel capsule endoscopy in the management of established Crohnʼs disease: clinical impact, safety, and correlation with inflammatory biomarkers. Inflamm Bowel Dis 2015; 21: 93-100
• 97 Buchman AL, Miller FH, Wallin A. et al. Video capsule endoscopy versus barium contrast studies for the diagnosis of Crohnʼs disease recurrence involving the small intestine. Am J Gastroenterol 2004; 99: 2171-2177
• 98 Graham DY, Opekun AR, Willingham FF. et al. Visible small-intestinal mucosal injury in chronic NSAID users. Clin Gastroenterol Hepatol 2005; 3: 55-59
• 99 Niv Y, Gal E, Gabovitz V. et al. Capsule endoscopy Crohnʼs disease activity index (CECDAIic or Niv Score) for the small bowel and colon. J Clin Gastroenterol 2018; 52: 45-49
• 100 Arieira C, Magalhães R, Dias de Castro F. et al. CECDAIic – a new useful tool in pan-intestinal evaluation of Crohnʼs disease patients in the era of mucosal healing. Scand J Gastroenterol 2019; 54: 1326-1330
• 101 Eliakim R, Spada C, Lapidus A. et al. Evaluation of a new pan-enteric video capsule endoscopy system in patients with suspected or established inflammatory bowel disease – feasibility study. Endosc Int Open 2018; 6: E1235-E1246
• 102 Eliakim R, Yablecovitch D, Lahat A. et al. A novel PillCam Crohnʼs capsule score (Eliakim score) for Quantification of mucosal inflammation in Crohnʼs disease. United European Gastroenterol J 2020; 8: 544-551
• 103 Zagorowicz ES, Pietrzak AM, Wronska E. et al. Small bowel tumors detected and missed during capsule endoscopy: single center experience. World J Gastroenterol 2013; 19: 9043-9048
• 104 Postgate A, Despott E, Burling D. et al. Significant small-bowel lesions detected by alternative diagnostic modalities after negative capsule endoscopy. Gastrointest Endosc 2008; 68: 1209-1214
• 105 Girelli CM, Porta P, Colombo E. et al. Development of a novel index to discriminate bulge from mass on small-bowel capsule endoscopy. Gastrointest Endosc 2011; 74: 1067-1074
• 106 Hatem G, Buda A, Caccaro A. et al. Bulges on small-bowel capsule endoscopy: innocent lesions we should take with a pinch of SPICE. UEG; 2014
• 107 Rodrigues JP, Pinho R, Rodrigues A. et al. Validation of SPICE, a method to differentiate small-bowel submucosal lesions from innocent bulges on capsule endoscopy. Rev Esp Enferm Dig 2017; 109: 106-113
• 108 Min M, Noujaim MG, Green J. et al. Role of mucosal protrusion angle in discriminating between true and false masses of the small-bowel on video capsule endoscopy. J Clin Med 2019; 8: 418
• 109 Shying LR, Lin SC, Shih SC. et al. Proposed scoring system to determine small bowel mass lesions using capsule endoscopy. J Formos Med Assoc 2009; 108: 533-538
• 110 Calderwood AH, Schroy PC, Lieberman DA. et al. Boston Bowel Preparation Scale scores provide a standardized definition of adequate for describing bowel cleanliness. Gastrointest Endosc 2014; 80: 269-276
• 111 Van Weyenberg SJ, De Leest HT, Mulder CJ. Description of a novel grading system to assess the quality of bowel preparation in video capsule endoscopy. Endoscopy 2011; 43: 406-411
• 112 Abou AliE, Histace A, Camus M. et al. Development and validation of a computed assessment of cleansing score for evaluation of quality of small-bowel visualization in capsule endoscopy. Endosc Int Open 2018; 6: E646-E651
• 113 Ponte A, Pinho R, Rodrigues A. et al. Validation of the Computed Assessment of Cleansing score with the Mirocam® system. Rev Esp Enferm Dig 2016; 108: 709-715
• 114 Klein A, Gizbar M, Bourke M. et al. A validated computerized cleansing score for Video Capsule Endoscopy. Dig Endosc 2015; 28: 564-569
• 115 Pietri O, Rezgui G, Histace A. et al. Development and validation of an automated algorithm to evaluate the abundance of bubbles in small bowel capsule endoscopy. Endosc Int Open 2018; 6: E462-E469
• 116 Oumrani S, Histace A, Abou AliE. et al. Multi-criterion, automated, high-performance, rapid tool for assessing mucosal visualization quality of still images in small bowel capsule endoscopy. Endosc Int Open 2019; 7: E944-E948
• 117 Park SC, Keum B, Hyun JJ. et al. A novel cleansing score system for capsule endoscopy. World J Gastroenterol 2010; 16: 875-880
• 118 Brotz C, Nandi N, Conn M. et al. A validation study of 3 grading systems to evaluate small-bowel cleansing for wireless capsule endoscopy: a quantitative index, a qualitative evaluation, and an overall adequacy assessment. Gastrointest Endosc 2009; 69: 262-270.e1
• 119 Ponte A, Pinho R, Rodrigues A. et al. Review of small-bowel cleansing scales in capsule endoscopy: A panoply of choices. World J Gastrointest Endosc 2016; 8: 600-609
• 120 Lai EJ, Calderwood AH, Doros G. et al. The Boston bowel preparation scale: a valid and reliable instrument for colonoscopy-oriented research. Gastrointest Endosc 2009; 69: 620-625