Clinical utility of capsule endoscopy with flexible spectral imaging color enhancement for diagnosis of small bowel lesions

Yasushi Sato; Tamotsu Sagawa; Masahiro Hirakawa; Hiroyuki Ohnuma; Takahiro Osuga; Yutaka Okagawa; Fumito Tamura; Hiroto Horiguchi; Kohichi Takada; Tsuyoshi Hayashi; Tsutomu Sato; Koji Miyanishi; Rishu Takimoto; Masayoshi Kobune; Junji Kato

doi:10.1055/s-0034-1365526

Endoscopy International Open, Table of Contents

Endosc Int Open 2014; 02(02): E80-E87
DOI: 10.1055/s-0034-1365526

Original article

Clinical utility of capsule endoscopy with flexible spectral imaging color enhancement for diagnosis of small bowel lesions

Yasushi Sato

¹Department of Medical Oncology and Hematology, School of Medicine, Sapporo Medical University, Sapporo, Japan

,

Tamotsu Sagawa

²Division of Gastroenterology, Hokkaido Cancer Center, Sapporo, Japan

,

Masahiro Hirakawa

¹Department of Medical Oncology and Hematology, School of Medicine, Sapporo Medical University, Sapporo, Japan

,

Hiroyuki Ohnuma

¹Department of Medical Oncology and Hematology, School of Medicine, Sapporo Medical University, Sapporo, Japan

,

Takahiro Osuga

¹Department of Medical Oncology and Hematology, School of Medicine, Sapporo Medical University, Sapporo, Japan

,

Yutaka Okagawa

¹Department of Medical Oncology and Hematology, School of Medicine, Sapporo Medical University, Sapporo, Japan

,

Fumito Tamura

¹Department of Medical Oncology and Hematology, School of Medicine, Sapporo Medical University, Sapporo, Japan

,

Hiroto Horiguchi

¹Department of Medical Oncology and Hematology, School of Medicine, Sapporo Medical University, Sapporo, Japan

,

Kohichi Takada

¹Department of Medical Oncology and Hematology, School of Medicine, Sapporo Medical University, Sapporo, Japan

,

Tsuyoshi Hayashi

¹Department of Medical Oncology and Hematology, School of Medicine, Sapporo Medical University, Sapporo, Japan

,

Tsutomu Sato

¹Department of Medical Oncology and Hematology, School of Medicine, Sapporo Medical University, Sapporo, Japan

,

Koji Miyanishi

¹Department of Medical Oncology and Hematology, School of Medicine, Sapporo Medical University, Sapporo, Japan

,

Rishu Takimoto

¹Department of Medical Oncology and Hematology, School of Medicine, Sapporo Medical University, Sapporo, Japan

,

Masayoshi Kobune

¹Department of Medical Oncology and Hematology, School of Medicine, Sapporo Medical University, Sapporo, Japan

,

Junji Kato

¹Department of Medical Oncology and Hematology, School of Medicine, Sapporo Medical University, Sapporo, Japan

› Author Affiliations

Abstract

Background and study aims: The clinical utility of computed virtual chromoendoscopy with flexible spectral imaging color enhancement (FICE) in capsule endoscopy (CE) remains controversial. To clarify the clinical utility of FICE-enhanced CE in evaluating small bowel lesions, we quantitatively assessed white light (WL), FICE, and blue mode (BM) images and examined the sensitivity of these 3 imaging modes of small-bowel lesions from patients who underwent CE.

Methods: The CIELAB color difference (∆E) and visual analogue scales (VAS) were measured in 261 CE images (3 different lesion categories) using WL and FICE set 1, 2, and 3, and BM images, respectively. Three endoscopists reviewed CE videos with WL, 3 FICE mode settings, and BM, and compared the sensitivity and detectability for small intestinal diseases from 50 patients who underwent CE.

Results: In the assessment of visibility in the 152 vascular lesion images, the ∆E and VAS of FICE set 1, 2, and BM images were significantly higher than that of WL images. In 88 erosion/ulceration images, the ∆E and VAS of FICE set 1 and 2 images were significantly higher than that of WL images. In 21 tumor images, there were no significant differences in ∆E among these modalities. When analyzed on a per-patient basis, FICE settings 1 and 2 had the highest sensitivity (100 %) and specificity (97.3 – 100 %) for vascular lesions. As for erosive/ulcerative lesions, FICE setting 2 had the highest sensitivity (100 %) and specificity (97.2 %). For tumors or polyps, WL had the highest sensitivity (90.9 %) and specificity (87.1 %). In per-lesion analysis, FICE settings 1 and 2 showed significantly superior detection ability over WL for vascular lesions. In the detection of erosive/ulcerative lesions, FICE setting 2 was significantly superior to WL. In tumor images, there was no significant improvement with any of the settings relative to WL images.

Conclusions: FICE is most useful for improving CE image quality and detection in cases of angioectasia and erosion/ulceration of the small intestine.

Full Text

References

References
1 Triester SL, Leighton JA, Leontiadis GI et al. A meta-analysis of the yield of capsule endoscopy compared to other diagnostic modalities in patients with obscure gastrointestinal bleeding. Am J Gastroenterol 2005; 100: 2407-2418
2 Wong RF, Tuteja AK, Haslem DS et al. Video capsule endoscopy compared with standard endoscopy for the evaluation of small-bowel polyps in persons with familial adenomatous polyposis (with video). Gastrointest Endosc 2006; 64: 530-537
3 Chong AK, Taylor A, Miller A et al. Capsule endoscopy vs. push enteroscopy and enteroclysis in suspected small-bowel Crohn’s disease. Gastrointest Endosc 2005; 61: 255-261
4 Ell C, Remke S, May A et al. The first prospective controlled trial comparing wireless capsule endoscopy with push enteroscopy in chronic gastrointestinal bleeding. Endoscopy 2002; 34: 685-689
5 Pohl J, May A, Rabenstein T et al. Computed virtual chromoendoscopy: a new tool for enhancing tissue surface structures. Endoscopy 2007; 39: 80-83
6 Miyake Y, Takeuchi S, Yamataka S. Proceedings of the Thirteenth Color Imaging Conference: Color Science and Engineering Systems, Technologies, and Applications. Arizona: Scottsdale; 2005: 261-263 (ISBN/ISSN: 0-89208-259-3)
7 Fedeli P, Gasbarrini A, Cammarota G. Spectral endoscopic imaging: the multiband system for enhancing the endoscopic surfacts visualization. J Clin Gastroenterol 2011; 45: 6-15
8 Togashi K, Osawa H, Koinuma K et al. A comparison of conventional endoscopy, chromoendoscopy, and the optimal-band imaging system for the differentiation of neoplastic and non-neoplastic colonic polyps. Gastrointest Endosc 2009; 69: 734-741
9 Imagawa H, Oka S, Tanaka S et al. Improved visibility of lesions of the small intestine via capsule endoscopy with computed virtual chromoendoscopy. Gastrointest Endosc 2011; 73: 299-306
10 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
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
12 Kuehni RG. Color-tolerance data and the tentative CIE 1976 L a b formula. J Opt Soc Am 1976; 66: 497-500
13 Ghanaati H, Rokni-Yazdi H, Jalali AH et al. Improvement of MR cholangiopancreatography (MRCP) images after black tea consumption. Eur Radiol 2011; 21: 2551-2557
14 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
15 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
16 Nakamura M, Ohmiya N, Miyahara R et al. Usefulness of flexible spectral imaging color enhancement (FICE) for the detection of angiodysplasia in the preview of capsule endoscopy. Hepatogastroenterology 2012; 59: 1474-1477
17 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
18 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
19 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
20 Matsumura T, Arai M, Sato T et al. Efficacy of computed image modification of capsule endoscopy in patients with obscure gastrointestinal bleeding. World J Gastrointest Endosc 2012; 4: 421-428
21 Raju GS, Gerson L, Das A et al. American Gastroenterological Association (AGA) Institute medical position statement on obscure gastrointestinal bleeding. Gastroenterology 2007; 133: 1694-1696