title: Is virtual chromoendoscopy useful in the evaluation of subtle ulcerative small-bowel lesions detected by video capsule endoscopy?
abstract: BACKGROUND
  The identification of subtle small-bowel mucosal lesions by video capsule endoscopy (VCE) can be challenging. Virtual chromoendoscopy techniques, based on narrowing the bandwidth of conventional white light endoscopic imaging (WLI), were developed to improve the analysis of mucosal patterns. However, data on the already-implemented Flexible spectral Imaging (or Fujinon Intelligent) Color Enhancement (FICE) software application in VCE are limited.
  
  
  METHODS
  An evaluation of 250 difficult-to-interpret small-bowel ulcerative and 50 artifact lesions selected from 64 VCE recordings was conducted by four experienced VCE readers in two steps: initially as WLI, then with the addition of all available virtual chromoendoscopy pre-sets (FICE 1, 2, and 3 and Blue mode). The readers labeled them as real or false ulcerative lesions and rated the usefulness of each of the pre-sets.
  
  
  RESULTS
  Between the first (WLI-only) and second (virtual chromoendoscopy-aided) readings, in terms of accuracy there was a global 16.5 % (95 % confidence interval [95 %CI] 13.6 - 19.4 %) improvement (P < 0.001), derived from a 22 % [95 %CI 18.9 - 25.1 %] improvement in the evaluation of true ulcerative images (P < 0.001) and an 11 % (95 %CI 4.1 - 17.7 %) decrease in the evaluation of false ulcerative ones (P = 0.003). The FICE 1 and 2 pre-sets were rated as most useful.
  
  
  CONCLUSIONS
  The application of virtual chromoendoscopy for VCE is useful to better categorize difficult-to-interpret small-bowel mucosal ulcerative lesions. However, care must be taken, and individual images should be evaluated only as part of a sequence in a recording because the technology can also mistakenly guide to the incorrect interpretation of artifacts as ulcerative lesions.
authors.affiliation: Gastroenterology Department, Colentina Clinical Hospital, Bucharest, Romania ; Internal Medicine Department, Carol Davila University of Medicine and Pharmacy, Bucharest, Romania.
authors.forename: Mihai
authors.initials: M
authors.lastname: Rimbaş
authors.affiliation: Internal Medicine Department, Carol Davila University of Medicine and Pharmacy, Bucharest, Romania ; Internal Medicine and Gastroenterology Department, University Emergency Hospital, Bucharest, Romania.
authors.forename: Lucian
authors.initials: L
authors.lastname: Negreanu
authors.affiliation: Regional Institute of Gastroenterology and Hepatology, Iuliu Hatieganu University of Medicine and Pharmacy, Cluj-Napoca, Romania.
authors.forename: Lidia
authors.initials: L
authors.lastname: Ciobanu
authors.affiliation: Internal Medicine Department, Carol Davila University of Medicine and Pharmacy, Bucharest, Romania.
authors.forename: Andreea
authors.initials: A
authors.lastname: Benguş
authors.affiliation: Digestive Endoscopy Unit, Università Cattolica del Sacro Cuore, Rome, Italy.
authors.forename: Cristiano
authors.initials: C
authors.lastname: Spada
authors.affiliation: Internal Medicine Department, Carol Davila University of Medicine and Pharmacy, Bucharest, Romania ; Clinical Research Unit RECIF (Réseau d'Epidémiologie Clinique International Francophone), Bucharest, Romania.
authors.forename: Cristian Răsvan
authors.initials: CR
authors.lastname: Băicuş
authors.affiliation: Digestive Endoscopy Unit, Università Cattolica del Sacro Cuore, Rome, Italy.
authors.forename: Guido
authors.initials: G
authors.lastname: Costamagna