title: Capsule endoscopy with flexible spectral imaging color enhancement reduces the bile pigment effect and improves the detectability of small bowel lesions.
abstract: BACKGROUND
  Capsule endoscopy with flexible spectral imaging color enhancement (CE-FICE) has been reported to improve the visualization and detection of small-bowel lesions, however, its clinical usefulness is still not established. Therefore, we conducted a study to evaluate whether CE-FICE contributes to improve the detectability of small-bowel lesions by CE trainees.
  
  
  METHODS
  Four gastroenterology trainees without prior CE experience were asked to read and interpret 12 CE videos. Each of the videos was read by conventional visualization method and under three different FICE settings. To evaluate whether the lesion recognition ability of the CE trainees could be improved by the FICE technology, the lesion detection rate under each of the three FICE settings was compared with that by conventional CE. CE trainees tend to miss small-bowel lesions in bile-pigment-positive condition, therefore we evaluated whether CE-FICE contributes to reducing the bile-pigment effect. The bile-pigment condition was determined by the color values around the small-bowel lesions according to the results of the receiver-operating-characteristic analysis. Moreover, we also evaluated whether poor bowel preparion might affect the accuracy of lesion recognition by CE-FICE.
  
  
  RESULTS
  Of a total of 60 angioectasias, CE trainees identified 26 by conventional CE, 40 under FICE setting 1, 38 under FICE setting 2, and 31 under FICE setting 3. Of a total of 82 erosions/ulcerations, CE trainees identified 38 by conventional CE, 62 under FICE setting 1, 60 under FICE setting 2, and 20 under FICE setting 3. Compared with conventional CE, FICE settings 1 and 2 significantly improved the detectability of angioectasia (P = 0.0017 and P = 0.014, respectively) and erosions/ulcerations (P = 0.0012 and P = 0.0094, respectively). Although the detectability of small-bowel lesions by conventional CE (P = 0.020) and under FICE setting 2 (P = 0.0023) was reduced by the presence of bile-pigments, that under FICE setting 1 was not affected (P = 0.59). Our results also revealed that in poor bowel visibility conditions, CE-FICE yielded a high rate of false-positive findings.
  
  
  CONCLUSIONS
  CE-FICE may reduce the bile-pigment effect and improve the detectability of small-bowel lesions by CE trainees; the reliability of CE-FICE may be improved by good bowel preparation.
authors: Gastroenterology Division, Yokohama City University School of Medicine, 3-9 Fuku-ura, Kanazawa-ku, Yokohama 236-0004, Japan.
authors: Eiji
authors: E
authors: Sakai
authors: Hiroki
authors: H
authors: Endo
authors: Shingo
authors: S
authors: Kato
authors: Tetsuya
authors: T
authors: Matsuura
authors: Wataru
authors: W
authors: Tomeno
authors: Leo
authors: L
authors: Taniguchi
authors: Takashi
authors: T
authors: Uchiyama
authors: Yasuo
authors: Y
authors: Hata
authors: Eiji
authors: E
authors: Yamada
authors: Hidenori
authors: H
authors: Ohkubo
authors: Takuma
authors: T
authors: Higrashi
authors: Kunihiro
authors: K
authors: Hosono
authors: Hirokazu
authors: H
authors: Takahashi
authors: Atsushi
authors: A
authors: Nakajima
mesh_terms: D001654:Bile Pigments / Q000009:adverse effects*; D053704:Capsule Endoscopy / Q000379:methods*; D003108:Colonic Diseases / Q000175:diagnosis* / Q000473:pathology; D003113:Colonoscopy / Q000379:methods*; D004108:Dilatation, Pathologic / Q000175:diagnosis / Q000473:pathology; D006801:Humans; D007089:Image Enhancement / Q000379:methods*; D007421:Intestine, Small / Q000473:pathology*; D012372:ROC Curve; D015203:Reproducibility of Results; D012680:Sensitivity and Specificity; D014456:Ulcer / Q000175:diagnosis / Q000473:pathology
chemical_list: D001654:Bile Pigments