White light-emitting contrast image capsule endoscopy for visualization of small intestine lesions: a pilot study

Abstract

Background and study aims Capsule endoscopy (CE) has become a routine means of diagnosing obscure gastrointestinal bleeding (OGIB) in the small intestine. Capsules using novel blue-enhanced white light-emitting diodes are expected to acquire clearer contrast images (CIs) of the small bowel vasculature. We conducted a pilot study to examine whether CIs facilitate visualization of small bowel erosions, ulcers, and areas of angioectasia compared with standard white light images (WLIs).

Patients and methods A total of 24 patients with OGIB were recruited in this study. The main outcome measure was visibility of lesions on CIs compared with WLIs. We also examined the color difference between lesions and normal mucosa (ΔE) with each imaging modality.

Results Three experienced physicians retrospectively evaluated 138 images of small bowel lesions (107 erosions, or ulcers, and 31 areas of angioectasia) obtained from 24 CE examinations. The endoscopists judged that compared with WLIs, CIs afforded easier identification of erosions or ulcers in 29 of 107 cases (27.1 %), were non-inferior in 68 of 107 cases (63.6 %), and were inferior in 10 of 107 cases (9.3 %). Identification of angioectasia was judged to be easier with CIs in 15 of 31 cases (48.4 %), non-inferior in 13 of 31 cases (41.9 %), and inferior in 3 of 31 cases (9.7 %). ΔE was significantly higher for CIs than WLIs, especially for angioectasia, potentially explaining why lesions were easier to visualize.

Conclusions CIs obtained by CE appear to facilitate identification of small bowel erosions, ulcers, and areas of angioectasia compared with WLIs.

• References

• 1 Pohl J, May A, Rabenstein T. et al. Computed virtual chromoendoscopy: a new tool for enhancing tissue surface structures. Endoscopy 2007; 39: 80-83
• 2 Pohl J, May A, Rabenstein T. et al. Comparison of computed virtual chromoendoscopy and conventional chromoendoscopy with acetic acid for detection of neoplasia in Barrett's esophagus. Endoscopy 2007; 39: 594-598
• 3 Iddan G, Meron G, Glukhovsky A. et al. Wireless capsule endoscopy. Nature 2000; 405: 417
• 4 Apostolopoulos P, Liatsos C, Gralnek IM. et al. Evaluation of capsule endoscopy in active, mild-to-moderate, overt, obscure GI bleeding. Gastrointest Endosc 2007; 66: 1174-1181
• 5 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
• 6 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
• 7 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
• 8 Pohl J, Aschmoneit I, Schuhmann S. et al. Computed image modification for enhancement of small-bowel surface structures at video capsule endoscopy. Endoscopy 2010; 42: 490-492
• 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 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
• 11 Tajiri H, Niwa H. Proposal for a consensus terminology in endoscopy: how should different endoscopic imaging techniques be grouped and defined?. Endoscopy 2008; 40: 775-778
• 12 Ogata H, Kumai K, Imaeda H. et al. Clinical impact of a newly developed capsule endoscope: usefulness of a real-time image viewer for gastric transit abnormality. J Gastroenterol 2008; 43: 186-192
• 13 Endo H, Kondo Y, Inamori M. et al. Ingesting 500 ml of Polyethylene Glycol Solution During Capsule Endoscopy Improves the Image Quality and Completion Rate to the Cecum. Dig Dis Sci 2008; 53: 3201-3205
• 14 Hosono K, Endo H, Sakai E. et al. Optimal Approach for Small Bowel Capsule Endoscopy Using Polyethylene Glycol and Metoclopramide with the Assistance of a Real-Time Viewer. Digestion 2011; 84: 119-125
• 15 Kuehni RG. Color-tolerance data and the tentative CIE 1976 L a b formula. J Opt Soc Am 1976; 66: 497-500
• 16 Aihara H, Ikeda K, Tajiri H. Image-enhanced capsule endoscopy based on the diagnosis of vascularity when using a new type of capsule. Gastrointest Endosc 2011; 73: 1274-1279
• 17 Hatogai K, Hosoe N, Imaeda H. et al. Role of enhanced visibility in evaluating polyposis syndromes using a newly developed contrast image capsule endoscope. Gut Liver 2012; 6: 218-222
• 18 Sato Y, Sagawa T, Hirakawa M. et al. Clinical utility of capsule endoscopy with flexible spectral imaging color enhancement for diagnosis of small bowel lesions. Endosc Int Open 2014; 2: E80-87
• 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
• 20 Kaltenbach T, Sano Y, Friedland S. et al. American Gastroenterological Association (AGA) Institute technology assessment on image-enhanced endoscopy. Gastroenterology 2008; 134: 327-340
• 21 Kaltenbach T, Soetikno R. Image-enhanced endoscopy is critical in the detection, diagnosis, and treatment of non-polypoid colorectal neoplasms. Gastrointest Endosc Clin N Am 2010; 20: 471-485
• 22 Gono K, Obi T, Yamaguchi M. et al. Appearance of enhanced tissue features in narrow-band endoscopic imaging. J Biomed Opt 2004; 9: 568-577
• 23 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
• 24 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