<p>Poor Quality of Small Bowel Capsule Endoscopy Images Has a Significant Negative Effect in the Diagnosis of Small Bowel Malignancy</p>

Abstract

Background and Aims: Capsule endoscopy (CE) is a visual modality; hence, diagnosis relies on image quality. We studied the contribution of image parameters to visualization quality and their effect on diagnostic certainty of small bowel (SB) lesions. Methods: Five clear CE images of common SB pathology-two vascular lesions, two inflammatory, one polyp-were processed for three image parameters to simulate poor SB conditions: opacity (color-matched to luminal content; 10-90%, 10% increments); blurriness (radius 1-10 pixels; one pixel increments); and contrast (−50-50%; 10% increments). Nine expert readers evaluated whether images were adequate for diagnosis. Points where perception of image quality changed significantly were determined for each parameter. Three further sets of SBCE images (vascular, inflammatory, and neoplastic lesions; nine images/set) were processed for four points/parameters. Twenty experienced/expert CE readers reviewed these images. Results: The negative effects of opacity in diagnostic certainty were mostly evident in images of neoplasia; images of vascular and inflammatory lesions were less affected. Similar results were observed with increasing blur radius, simulating movement, and poor focus. The proportions of readers finding vascular and inflammatory images adequate for diagnosis did not drop significantly at wider blur radii, while images of neoplasia were quickly deemed inadequate. Low contrast had a greater negative effect than high, most consistently in neoplastic lesions. Conclusion: Poor visualization quality in all parameters affected mostly neoplastic lesions. Software to increase contrast and sharpen images can improve visualization quality; smart frame rate adaptation could improve the number of high-quality frames obtained. Thoroughness in SB cleansing is most important when there is a suspicion of neoplasia.

Diving method or simply…water-immersion small-bowel capsule endoscopy

“…The polyethylene glycol regimen is performed routinely in our center, which was clarified in the methods section of our article. 2 As Koulaouzidis et al 3 have said, "continuous luminal volume expansion is associated with enhanced imaging," and we obtained beneficial results by instructing patients to drink water intermittently during the examination. 2 Our prospective randomized controlled trial was performed 5 years ago, so a previous version of CE was used in our study.…”

“…We appreciate the interest of Koulaouzidis et al 1 in our recently published study on small-bowel capsule endoscopy (CE). 2 Bowel preparation before CE is an essential part. The polyethylene glycol regimen is performed routinely in our center, which was clarified in the methods section of our article.…”

“…Recently, we analyzed the visualization quality to CE image parameters (opacity, blur radius, and focus), demonstrating the significance and potential impact of poor visualization in detecting neoplastic lesions in SB CE. 2 Tensions are high in discussions of bowel preparation for SB CE, and the jury is still out. However, a series of meta-analyses, including 1 from our group, 3 support the use of laxatives to reduce the risk of missing subtle findings, although none has ever proved a higher diagnostic yield.…”

Small Bowel Cleanliness in Capsule Endoscopy: A Case-control Study Using Validated Artificial Intelligence Algorithm

“…Adequate bowel cleanliness is one of the important factors for the performance and diagnostic capacity of SBCE. 4,13 However, since small bowel cleanliness is subjective and takes a long time to be measured by clinicians, intra-observer variation is inevitable. 14 For this reason, several studies have been conducted to objectively identify the cleanliness of SBCE using an AI algorithm.…”

Lavage, Simethicone, and Prokinetics—What to Swallow with a Video Capsule

“…Optimal cleanliness is crucial for reliable diagnosis with SBCE. For instance, poor visual quality was associated with lower diagnostic yield in small bowel malignancy [ 8 ]. ESGE has defined a target of >95% SBCE procedures with adequate small bowel visualization as key performance parameter [ 1 ].…”