title: Usefulness of virtual chromoendoscopy in the evaluation of subtle small bowel ulcerative lesions by endoscopists with no experience in videocapsule.
abstract: OBJECTIVE
  In videocapsule endoscopy examination (VCE), subtle variations in mucosal hue or pattern such as those seen in ulcerations can be difficult to detect, depending on the experience of the reader. Our aim was to test whether virtual chromoendoscopy (VC) techniques, designed to enhance the contrast between the lesion and the normal mucosa, could improve the characterization of ulcerative mucosal lesions.
  
  
  METHODS
  Fifteen trainees or young gastroenterologists with no experience in VCE were randomly assigned to evaluate 250 true ulcerative and 100 false ulcerative, difficult-to-interpret small bowel lesions, initially as white light images (WLI) and then, in a second round, with the addition of one VC setting or again as WLI, labeling them as real lesions or artifacts.
  
  
  RESULTS
  On the overall image evaluation, an improvement in lesion characterization was observed by adding any chromoendoscopy setting, especially Blue mode and FICE 1, with increases in accuracy of 13 % [95 %CI 0.8, 25.3] and 7.1 % [95 %CI - 17.0, 31.3], respectively. However, when only false ulcerative images were considered, with the same presets (Blue mode and FICE 1), there was a loss in accuracy of 10.7 % [95 %CI - 10.9, 32.3] and 7.3 % [95 %CI - 1.3, 16.0], respectively. The interobserver agreement was poor for both readings.
  
  
  CONCLUSIONS
  VC helps beginner VCE readers correctly categorize difficult-to-interpret small bowel mucosal ulcerative lesions. However, false lesions tend to be misinterpreted as true ulcerative with the same presets. Therefore care is advised in using VC especially under poor bowel preparation.
authors.affiliation: Gastroenterology Department, Colentina Clinical Hospital, Bucharest, Romania; Internal Medicine Department, Carol Davila University of Medicine, Bucharest, Romania.
authors.forename: Mihai
authors.initials: M
authors.lastname: Rimbaş
authors.affiliation: Gastroenterology Department, Colentina Clinical Hospital, Bucharest, Romania.
authors.forename: Denise Carmen Mihaela
authors.initials: DC
authors.lastname: Zahiu
authors.affiliation: Gastroenterology Department, Colentina Clinical Hospital, Bucharest, Romania; Internal Medicine Department, Carol Davila University of Medicine, Bucharest, Romania.
authors.forename: Andrei Mihai
authors.initials: AM
authors.lastname: Voiosu
authors.affiliation: Gastroenterology Department, Colentina Clinical Hospital, Bucharest, Romania; Internal Medicine Department, Carol Davila University of Medicine, Bucharest, Romania.
authors.forename: Theodor Alexandru
authors.initials: TA
authors.lastname: Voiosu
authors.affiliation: Gastroenterology Department, Colentina Clinical Hospital, Bucharest, Romania.
authors.forename: Alina Ana-Maria
authors.initials: AA
authors.lastname: Zlate
authors.affiliation: Gastroenterology Department, Colentina Clinical Hospital, Bucharest, Romania.
authors.forename: Roxana
authors.initials: R
authors.lastname: Dinu
authors.affiliation: Digestive Endoscopy Unit, Catholic University, Rome, Italy.
authors.forename: Domenico
authors.initials: D
authors.lastname: Galasso
authors.affiliation: Digestive Endoscopy Unit, Catholic University, Rome, Italy.
authors.forename: Leonardo
authors.initials: L
authors.lastname: Minelli Grazioli
authors.affiliation: Digestive Endoscopy Unit, Catholic University, Rome, Italy.
authors.forename: Mariachiara
authors.initials: M
authors.lastname: Campanale
authors.affiliation: Digestive Endoscopy Unit, Catholic University, Rome, Italy.
authors.forename: Federico
authors.initials: F
authors.lastname: Barbaro
authors.affiliation: Gastroenterology Department, Colentina Clinical Hospital, Bucharest, Romania; Internal Medicine Department, Carol Davila University of Medicine, Bucharest, Romania.
authors.forename: Bogdan Radu
authors.initials: BR
authors.lastname: Mateescu
authors.affiliation: Gastroenterology Department, Colentina Clinical Hospital, Bucharest, Romania.
authors.forename: Bogdan
authors.initials: B
authors.lastname: Busuioc
authors.affiliation: Gastroenterology Department, Colentina Clinical Hospital, Bucharest, Romania.
authors.forename: Tiberiu
authors.initials: T
authors.lastname: Iordache
authors.affiliation: Gastroenterology Department, Colentina Clinical Hospital, Bucharest, Romania.
authors.forename: Oana
authors.initials: O
authors.lastname: Dolofan
authors.affiliation: Gastroenterology Department, University Emergency Hospital, Bucharest, Romania.
authors.forename: Adelina Maria
authors.initials: AM
authors.lastname: Popescu
authors.affiliation: Gastroenterology Department, Emergency Military Hospital, Bucharest, Romania.
authors.forename: Vasile Daniel
authors.initials: VD
authors.lastname: Balaban
authors.affiliation: Internal Medicine Department, Carol Davila University of Medicine, Bucharest, Romania.
authors.forename: Mircea Mihai
authors.initials: MM
authors.lastname: Raducan
authors.affiliation: Digestive Endoscopy Unit, Catholic University, Rome, Italy.
authors.forename: Cristiano
authors.initials: C
authors.lastname: Spada
authors.affiliation: Internal Medicine Department, Carol Davila University of Medicine, Bucharest, Romania.
authors.forename: Cristian Răsvan
authors.initials: CR
authors.lastname: Băicuş
authors.affiliation: Digestive Endoscopy Unit, Catholic University, Rome, Italy.
authors.forename: Guido
authors.initials: G
authors.lastname: Costamagna