Capsule endoscopy with flexible spectral imaging color enhancement reduces the bile pigment effect and improves the detectability of small bowel lesions

Abstract

BackgroundCapsule 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.MethodsFour 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.ResultsOf 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.ConclusionsCE-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.

Present and future status of flexible spectral imaging color enhancement and blue laser imaging technology

“…Capsule endoscopy (CE) with FICE detects angiodysplastic/vascular lesions in the small intestine with a higher frequency than without FICE . FICE may reduce the bile‐pigment effect and improve the detectability of small bowel lesions by trainees . FICE modes 1 and 2 equipped in CE improve the characterization of these lesions as well as erosions or ulcer .…”

Efficacy of video capsule endoscopy with flexible spectral imaging color enhancement at setting 3 for differential diagnosis of red spots in the small bowel

“…There are three settings: FICE1 for red (wavelength settings: R595, G540, B535) reduces the bile pigment effect and highlights the pigment changes in the mucosa; FICE2 for blue (wavelength settings: R420, G520, B530) stains the bile cyan and highlights blood, blood vessels, and red lesions; and FICE3 for yellow‐green (wavelength settings: R595, G570, B415) increases the differentiation between blood and bile. FICE is useful in the detection of lesions, and studies have shown that FICE1 and FICE2 are particularly useful for the detection of angioectasia, ulcerations, and ulcers, although FICE3 has not previously been shown to be an effective tool for detection …”

Evaluation of the Usefulness of Virtual Chromoendoscopy with Different Color Modes in the MiroCam® System for Characterization of Small Bowel Lesions

“…Sakai et al [24] also showed that FICE 1 and 2 contribute to a significant improvement in the detection of angioectasias, erosions, and ulcers.…”