Validated computed cleansing score for video capsule endoscopy

Abstract

Background and Aim: Diagnostic yield of video capsule endoscopy may be hampered by intestinal content or air bubbles. A major limitation in video capsule-related study is the lack of a validated objective score for bowel preparation quality. We aimed to design and validate a computed small bowel preparation score for research and clinical use. Methods: Two experienced physicians reached a consensusregarding bowel preparation quality based on known criteria used in previous studies and their confidence of an accurate medical interpretation of the procedure. A computed algorithm based on the pixels in the color bar was created and validated. Concordance between the gastroenterologists' agreement (gold standard) and the computed analysis was assessed.Results: Of 85 videos studied, 44 (52%), 13 (15%) and 28 (33%) had adequate, borderline and inadequate bowel preparation, respectively, according to the gastroenterologists' agreement. Computer analysis restricted to adequate and inadequate cases yielded accurate classification of bowel preparation in 65/72 cases (90% agreement, sensitivity 95%, specificity 82%, total accuracy 90%, Kappa 0.79). When adding the borderline definition, the computer analysis correctly classified 71/85 of the cases, yielding an overall agreement of 84% (Kappa 0.72). Minute-by-minute analysis of 10 cases also yielded an agreement of 91.4%. Conclusion:The present study introduces a user-friendly computer analysis-based small bowel preparation score, which demonstrated excellent concordance with the physician's assessment. This score holds promise as a standardization tool in research and clinical practice of video capsule endoscopy. Further validation is warranted.

The Efficacy of 4 Liters of Clear Liquids for Small Bowel Preparation Prior to Video Capsule Endoscopy

“…However, when validating this scoring method, Brotz et al found that its intra-observer reliability outperformed its inter-observer reliability and that reliability improved when comparing a score of adequate preparation (defined as a score of good or excellent) versus inadequate preparation (a score of poor or fair), which corroborates our decision to also compare these two groups. 24 Development of objective methods to evaluate image quality in VCE has shown promise, such as computed cleansing scores, 26,27 though they are not widely in use at this time. Future studies may benefit from using an objective tool to compare image quality between different SB preparations.…”

Development and validation of an automated algorithm to evaluate the abundance of bubbles in small bowel capsule endoscopy

“…Based on the figures from these articles and on our clinical experience, we determined that a cutoff of 10 % in terms of bubble abundance on a still frame was adequate. Similarly, the only validated score used to determine the quality of visualization of the mucosa in SB-CE also considers that a visibility over 90 % is optimal 16 17 . Moreover, the chosen threshold was unchanged between the development and the validation steps of the study, for both expert analysis and algorithmic assessment.…”

“…Each still frame was categorized based on the estimated percentage of bubbles covering the image (whether these bubbles were large or small and numerous or few), with a 10 % threshold. 16 17 . Still frames presenting with fewer than 10 % bubbles were classified as “scarce in bubbles”.…”

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

“…Currently, existing attempts to develop computer-based automated bowel preparation grading systems have been based mainly on the overall color of frames 5 or on the percentage of the lumen which has been obscured by debris and bubbles. [11][12][13] These approaches can work well for approximating bowel segments or detecting gross abnormalities such as blood in the lumen, 14 but do not take into account the effect of image sharpness and motion blur. Furthermore, the results of this study suggest that the quality of bowel preparation which can be tolerated differs according to clinical indication for the CE examination.…”