Interobserver agreement on landmark and flexure identification in colon capsule endoscopy

Abstract

Purpose When an optical colonoscopy is carried out, Scope Guide can assist the endoscopist in determining the localization. In colon capsule endoscopy (CCE), this support is not available. To our knowledge, the interobserver agreement on landmark identification has never been studied. This study aims to investigate the interobserver agreement on landmark identification in CCE. Methods An interobserver study was carried out comparing the landmark identification (the ileocecal valve, hepatic flexure, splenic flexure, and anus) in CCE investigations between an external private contractor and three in-house CCE readers with different levels of experience. All CCE investigations analyzed in this study were carried out as a part of the Danish screening program for colorectal cancer. Patients were between 50 and 74 years old with a positive fecal immunochemical test (FIT). A random sample of 20 CCE investigations was taken from the total sample of more than 800 videos. Results Overall interobserver agreement on all landmarks was 51%. Interobserver agreement on the first cecal image (ileocecal valve), hepatic flexure, splenic flexure, and last rectal image (anus) was 72%, 29%, 22%, and 83%, respectively. The overall interobserver agreement, including only examinations with adequate bowel preparation (n = 16), was 54%, and for individual landmarks, 73%, 32%, 24%, and 85%. Conclusion Overall interobserver agreement on all four landmarks from CCE was poor. Measures are needed to improve landmark identification in CCE investigations. Artificial intelligence could be a possible solution to this problem.

Rationalizing polyp matching criteria in colon capsule endoscopy: an international expert consensus through RAND (modified DELPHI) process

“…This issue was also examined by Schelde-Olesen et al ., 4 who illustrated only 51% agreement on all landmarks. Remarkably, the interobserver agreement for hepatic flexure and splenic flexure was as low as 29% and 22%, respectively, which is indeed concerning.…”

“…Given this variability and uncertainty associated with these landmarks, relying on them as references for locating polyps might not be a dependable approach. 4 …”

“… 3 These stem from CCE’s limitations, including long reading times, poor localization of anatomical landmarks, inaccurate polyp differentiation, inability to provide therapy, interobserver variability in reporting and decision-making, and long procedural times with a relatively low completion rate. 4 – 6 One of the common observations is the difficulty in detecting CCE-reported polyps in subsequent optical colonoscopy (OC). This issue primarily arises for two reasons: (1) false-negative findings by OC and (2) false-positive findings by CCE.…”