Virtual chromoendoscopy can be a useful software tool in capsule endoscopy.
BACKGROUND
capsule endoscopy (CE) has revolutionized the study of small bowel. One major drawback of this technique is that we cannot interfere with image acquisition process. Therefore, the development of new software tools that could modify the images and increase both detection and diagnosis of small-bowel lesions would be very useful. The Flexible Spectral Imaging Color Enhancement (FICE) that allows for virtual chromoendoscopy is one of these software tools.


OBJECTIVE
to evaluate the reproducibility and diagnostic accuracy of the FICE system in CE.


METHODS
this prospective study involved 20 patients. First, four physicians interpreted 150 static FICE images and the overall agreement between them was determined using the Fleiss Kappa Test. Second, two experienced gastroenterologists, blinded to each other results, analyzed the complete 20 video streams. One interpreted conventional capsule videos and the other, the CE-FICE videos at setting 2. All findings were reported, regardless of their clinical value. Non-concordant findings between both interpretations were analyzed by a consensus panel of four gastroenterologists who reached a final result (positive or negative finding).


RESULTS
in the first arm of the study the overall concordance between the four gastroenterologists was substantial (0.650). In the second arm, the conventional mode identified 75 findings and the CE-FICE mode 95. The CE-FICE mode did not miss any lesions identified by the conventional mode and allowed the identification of a higher number of angiodysplasias (35 vs 32), and erosions (41 vs. 24).


CONCLUSIONS
there is reproducibility for the interpretation of CE-FICE images between different observers experienced in conventional CE. The use of virtual chromoendoscopy in CE seems to increase its diagnostic accuracy by highlighting small bowel erosions and angiodysplasias that weren´t identified by the conventional mode.
Department of Gastroenterology, Faculty of Medicine University of Coimbra, Coimbra University Hospital, Coimbra, Portugal. gabrieladuquepena@gmail.com
Gabriela
G
Duque
Nuno
N
Almeida
Pedro
P
Figueiredo
Pedro
P
Monsanto
Sandra
S
Lopes
Paulo
P
Freire
Manuela
M
Ferreira
Rita
R
Carvalho
Hermano
H
Gouveia
Carlos
C
Sofia
D000368:Aged; D000369:Aged, 80 and over; D016888:Angiodysplasia / Q000150:complications / Q000175:diagnosis*; D053705:Capsule Endoscopes; D053704:Capsule Endoscopy / Q000295:instrumentation* / Q000379:methods; D005260:Female; D006471:Gastrointestinal Hemorrhage / Q000209:etiology*; D006801:Humans; D007089:Image Enhancement / Q000295:instrumentation*; D007410:Intestinal Diseases / Q000150:complications / Q000175:diagnosis*; D007421:Intestine, Small / Q000473:pathology*; D008297:Male; D008875:Middle Aged; D015588:Observer Variation; D011446:Prospective Studies; D015203:Reproducibility of Results; D016037:Single-Blind Method; D012984:Software