Background and study aims: Inadequate bowel preparation negatively influences the reliability of examinations by video capsule endoscopy (VCE). Currently, only subjective scales are available to describe mucosal visibility. We aimed to design a score that was derived directly from the VCE images.
Patients and methods: A computed assessment of cleansing score was developed based on color intensities of the tissue color bar. The feasibility of this score was retrospectively tested in 24 VCE studies. A prospective study was conducted using 40 VCE segments from 10 consecutive VCE studies. The computed scores were compared with three existing methods of assessing small-intestinal cleansing. Correlations between the existing scoring systems and the computed score were evaluated using the intraclass correlation coefficient and Spearman's rho correlation.
Results: All computed measurements were obtained twice and resulted in exactly the same results. Both overall and segmental mucosal visibility could be assessed. The computed score and the 10-point quantitative index were significantly associated for both readers (Spearman's rho: 0.68 and 0.75, respectively; P < 0.001). The intraclass correlation coefficient for the 4-point qualitative evaluation and the computed score was 0.67 for reader 1 and 0.64 for reader 2. For reader 1, the mean computed score for segments assessed as either inadequately or adequately cleansed was 5.0 and 6.4 (P = 0.001). For reader 2 these values were 4.0 and 6.3, respectively (P = 0.005).
Conclusions: A computed assessment of small-bowel mucosal visibility based on the ratio of color intensities of the red and green channel of the tissue color bar is feasible and more reproducible than existing subjective scales. Such a computed scale could be integrated into VCE reading software. For this novel scoring system we propose the term Computed Assessment of Cleansing (CAC) score.
References
-
1
Iddan G, Meron G, Glukhovsky A, Swain P.
Wireless capsule endoscopy.
Nature.
2000;
405
417
-
2
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
-
3
Jones B H, Fleischer D E, Sharma V K et al.
Yield of repeat wireless video capsule endoscopy in patients with obscure gastrointestinal bleeding.
Am J Gastroenterol.
2005;
100
1058-1064
-
4
Viazis N, Sgouros S, Papaxoinis K et al.
Bowel preparation increases the diagnostic yield of capsule endoscopy: a prospective, randomized, controlled study.
Gastrointest Endosc.
2004;
60
534-538
-
5
Villa F, Signorelli C, Rondonotti E, de Franchis R.
Preparations and prokinetics.
Gastrointest Endosc Clin N Am.
2006;
16
211-220
-
6
Fireman Z.
What is the optimal bowel preparation for capsule endoscopy?.
Nat Clin Pract Gastroenterol Hepatol.
2008;
5
418-419
-
7
Ge Z Z, Chen H Y, Gao Y J et al.
The role of simeticone in small-bowel preparation for capsule endoscopy.
Endoscopy.
2006;
38
836-840
-
8
Kantianis A, Karagiannis S, Liatsos C et al.
Comparison of two schemes of small bowel preparation for capsule endoscopy with polyethylene glycol: a prospective, randomized single-blind study.
Eur J Gastroenterol Hepatol.
2009;
21
1140-1144
-
9
Koornstra J J.
Bowel preparation before small bowel capsule endoscopy: what is the optimal approach?.
Eur J Gastroenterol Hepatol.
2009;
21
1107-1109
-
10
Lapalus M G, Ben Soussan E, Saurin J C et al.
Capsule endoscopy and bowel preparation with oral sodium phosphate: a prospective randomized controlled trial.
Gastrointest Endosc.
2008;
67
1091-1096
-
11
Niv Y, Niv G.
Capsule endoscopy: role of bowel preparation in successful visualization.
Scand J Gastroenterol.
2004;
39
1005-1009
-
12
Pons Beltran V, Carretero C, Gonzalez-Suarez B et al.
Intestinal preparation prior to capsule endoscopy administration.
World J Gastroenterol.
2008;
14
5773-5775
-
13
Rey J F, Repici A, Kuznetsov K et al.
Optimal preparation for small bowel examinations with video capsule endoscopy.
Dig Liver Dis.
2009;
41
486-493
-
14
Rokkas T, Papaxoinis K, Triantafyllou K et al.
Does purgative preparation influence the diagnostic yield of small bowel video capsule endoscopy? A meta-analysis.
Am J Gastroenterol.
2009;
104
219-227
-
15
Spada C, Riccioni M E, Familiari P et al.
Polyethylene glycol plus simethicone in small-bowel preparation for capsule endoscopy.
Dig Liver Dis.
2010;
42
365-370
-
16
van Tuyl S A, den Ouden H, Stolk M F, Kuipers E J.
Optimal preparation for video capsule endoscopy: a prospective, randomized, single-blind study.
Endoscopy.
2007;
39
1037-1040
-
17
Rex D K, Petrini J L, Baron T H et al.
Quality indicators for colonoscopy.
Gastrointest Endosc.
2006;
63
S16-S28
-
18
Eliakim R, Fireman Z, Gralnek I M et al.
Evaluation of the PillCam Colon capsule in the detection of colonic pathology: results of the first multicenter, prospective, comparative study.
Endoscopy.
2006;
38
963-970
-
19
Schoofs N, Deviere J, Van Gossum A.
PillCam colon capsule endoscopy compared with colonoscopy for colorectal tumor diagnosis: a prospective pilot study.
Endoscopy.
2006;
38
971-977
-
20 Horn E, Krupnik H. System and method for presentation of data streams.. United States (Yoqneam, IL): Given Imaging Ltd; 2009
-
21
Van Weyenberg S J, Van Turenhout S T, Bouma G et al.
Double-balloon endoscopy as the primary method for small-bowel video capsule endoscope retrieval.
Gastrointest Endosc.
2010;
71
535-541
S. J. B. Van WeyenbergMD
Department of Gastroenterology and Hepatology
VU University Medical Center
De Boelelaan 1118
1081 HV Amsterdam
The Netherlands
Fax: +31-20-4440554
Email: sjb.vanweyenberg@vumc.nl
