title: Validation of SPICE, a method to differentiate small bowel submucosal lesions from innocent bulges on capsule endoscopy.
abstract: OBJECTIVE
  Small bowel submucosal lesions (SBSL) and innocent bulges may have an identical appearance and be difficult to distinguish on small bowel capsule endoscopy (SBCE). Recently, Girelli et al. proposed a score, smooth, protruding lesion index on capsule endoscopy (SPICE), in order to differentiate between the two. We aimed to evaluate and validate SPICE as a differentiation method between innocent bulges and SBSLs.
  
  
  METHODS
  We evaluated all SBCEs performed in our department between January 2005 and September 2015, and selected the ones with a smooth, round, protruding lesion in the small bowel. Lesions with suspicious characteristics were excluded. A video clip of the region of interest was created and SPICE was assigned blindly and independently by two endoscopists. We determined the discriminative ability of SPICE using the definitive diagnosis of each patient as the standard criteria.
  
  
  RESULTS
  We included 30 SBCEs corresponding to 12 SBSLs (four gastrointestinal stromal tumors, two neuroendocrine tumors, four lipomas and two polypoid lymphangiectasias) and 18 innocent bulges. SPICE scores ranged from 0 to 4, allowing the distinction between SBSLs and innocent bulges (p < 0.001). SPICE > 2 had a 66.7% sensitivity, 100.0% specificity, 100.0% positive predictive value and 78.3% negative predictive value, and the area under the curve was 0.88 (95% CI, 0.73-1.00; p < 0.001) for the diagnosis of SBSL.
  
  
  CONCLUSIONS
  Our data support SPICE, namely a score > 2, as a predictive method of SBSLs. Taking into account its simplicity, it may be very useful in the distinction between SBSLs and innocent bulges on SBCE.
authors.affiliation: Gastrenterologia, Centro Hospitalar Vila Nova Gaia, Portugal.
authors.forename: Jaime P
authors.initials: JP
authors.lastname: Rodrigues
authors.affiliation: Gastroenterology and Hepatology department, Centro Hospitalar de Gaia/Espinho, Portugal.
authors.forename: Rolando
authors.initials: R
authors.lastname: Pinho
authors.affiliation: Gastroenterology and Hepatology department, Centro Hospitalar de Gaia/Espinho, Portugal.
authors.forename: Adélia
authors.initials: A
authors.lastname: Rodrigues
authors.affiliation: Gastroenterology and Hepatology department, Centro Hospitalar de Gaia/Espinho.
authors.forename: Joana
authors.initials: J
authors.lastname: Silva
authors.affiliation: Gastroenterology and Hepatology department, Centro Hospitalar Vila Nova de Gaia/Espinho, Portugal.
authors.forename: Ana
authors.initials: A
authors.lastname: Ponte
authors.affiliation: Gastroenterology and Hepatology department, Centro Hospitalar de Gaia/Espinho.
authors.forename: Mafalda
authors.initials: M
authors.lastname: Sousa
authors.affiliation: Gastroenterology and Hepatology department, Centro Hospitalar de Gaia/Espinho.
authors.forename: João
authors.initials: J
authors.lastname: Carvalho
mesh_terms: D000465:Algorithms; D053704:Capsule Endoscopy / Q000379:methods*; D003937:Diagnosis, Differential; D006801:Humans; D007410:Intestinal Diseases / Q000000981:diagnostic imaging*; D007413:Intestinal Mucosa / Q000000981:diagnostic imaging*; D007414:Intestinal Neoplasms / Q000000981:diagnostic imaging; D007421:Intestine, Small / Q000000981:diagnostic imaging*; D011237:Predictive Value of Tests; D012189:Retrospective Studies