Improving Diagnostic Yield of Capsule Endoscopy in Coeliac Disease: Can Flexible Spectral Imaging Colour Enhancement Play a Role?

• Published in: Digestion Vol. 101; no. 4; p. 347
• Main Authors: Chetcuti Zammit, Stefania, McAlindon, Mark E, Ellul, Pierre, Rondonotti, Emanuele, Carretero, Cristina, Sanders, David S, Sidhu, Reena
• Format: Journal Article
• Language: English
• Published: Switzerland 01-07-2020
• Subjects: Adult; Capsule Endoscopy - methods; Capsule Endoscopy - statistics & numerical data; Celiac Disease - diagnosis; Color; Diagnosis, Differential; Europe; Female; Humans; Image Enhancement - methods; Intestine, Small - diagnostic imaging; Male; Sensitivity and Specificity; Spectrum Analysis - methods; Spectrum Analysis - statistics & numerical data; Europe; Small bowel capsule endoscopy; Coeliac disease; Flexible spectral imaging colour enhancement
• ISSN: 1421-9867
• DOI: 10.1159/000500906

Flexible spectral imaging colour enhancement (FICE) is a form of virtual chromoendoscopy that is incorporated in the capsule reading software and that can be used by reviewers to enhance the delineation of lesions in the small bowel. This has been shown to be useful in the detection of pigmented (ulcers, angioectasias) lesions. However, its application to coeliac disease (CD) images from small bowel capsule endoscopies (SBCEs) has rarely been studied.
This was a European, multicentre study that included 5 expert capsule reviewers who were asked to evaluate a number of normal and abnormal de-identified images from SBCEs of patients with CD to determine whether the use of FICE and blue light can improve the detection of CD-related changes.
Sensitivity and specificity of conventional white light in the delineation of CD-related changes were 100%. The next best image modification was FICE 1 with a sensitivity of 80% and a specificity of 100%. There was no difference between conventional white light, FICE and blue light for the identification of CD-related changes. There was a low agreement (Fleiss kappa 0.107; p = 0.147) between expert reviewers in selecting the best image modification that detected CD-related changes.
FICE and blue light were not found to be superior to conventional white light in the delineation of macroscopic changes related to CD on SBCEs.