Virtual chromoendoscopy in small bowel capsule endoscopy: New light or a cast of shadow?

Table 1 Summary of results

	Angioectasias (n = 39)	Ulcers/erosions (n = 49)	Villous edema/atrophy (n = 12)	Overall (n = 100)
FICE 1
Improved delineation	38/39 (97.4%)	31/49 (63.3%)	8/12 (66.7%)	77/100 (77.0%)
Percentage of agreement, κ	97.4%, κ = 0.910	81.6%, κ = 0.714	91.7%, κ = 0.815	89.0%, κ = 0.833
FICE 2
Improved delineation	38/39 (97.4%)	28/49 (57.1%)	8/12 (66.7%)	74/100 (74.0%)
Percentage of agreement, κ	89.7%, κ = 0.802	79.6%, κ = 0.703	91.7%, κ = 0.815	85.0%, κ = 0.764
FICE 3
Improved delineation	18/39 (46.2%)	12/49 (24.5%)	0/12 (0.0%)	41/100 (41.0%)
Percentage of agreement, κ	53.8%, κ = NA	75.5%, κ = NA	66.7%, κ = 0.304	66.0%, κ = 0.486
BF
Improved delineation	6/39 (15.4%)	30/49 (61.2%)	3/12 (25.0%)	39/100 (39.0%)
Percentage of agreement, κ	76.9%, κ = 0.558	81.6%, κ = 0.570	25.0%, κ = NA	79.0%, κ = 0.593

FICE: Flexible Spectral Imaging Color Enhancement; BF: Blue Filter; NA: Not available.

Table 2 Summary of publications on small bowel capsule endoscopy-virtual chromoendoscopy

Ref.	Center	Study type	No. of patients	Outcome	Results
Imagawa et al[7]	Single center	Retrospective	122 patients	Delineation	145 lesions
					FICE 1: improved delineation in 87.0% (20/23) of angioectasias, 53.3% (26/47) of ulcers/erosions and 25.3% (19/75) of tumors
					FICE 2: improved delineation in 87.0% (20/23) of angioectasias, 25.5% (12/47) of ulcers/erosions and 20.0% (15/75) of tumors
					FICE 3: no improvement
Imagawa et al[6]	Single center	Prospective	50 patients	Detection rate	FICE 1: increased detection rate of angioectasias (48 vs 17, P = 0.0003)
					FICE 2: increased detection rate of angioectasias (45 vs 17, P < 0.0001)
					FICE 3: increased detection rate of angioectasias (24 vs 17, P = ns)
					Detection of ulcers, erosions and tumors did not differ significantly between conventional SBCE-WL and SBCE-FICE
Gupta et al[22]	Single center	Retrospective	60 patients	Detection rate	157 lesions detected with SBCE-FICE vs 114 with SBCE-WL (P = 0.15)
					5/55 angioectasias were better characterized with SBCE-FICE
					More P0 diagnosed with SBCE-FICE (39 vs 8, P < 0.001)
					Intra-class κ correlations with SBCE-FICE: 0.88 (P2 lesions); 0.61 (P1 lesions)
					Intra-class κ correlations with SBCE-WL: 0.92 (P2 lesions); 0.79 (P1 lesions)
					For P2 lesions, the sensitivity was 94% vs 97% and specificity was 95% vs 96% for SBCE-FICE and SBCE-WL, respectively
Krystallis et al[19]	Single center	Retrospective	200 patients	Delineation	167 lesions including angioectasias (n = 18), erosions/ulcers (n = 60), villi oedema (n = 17), cobblestone (n = 11), blood lumen (n = 15), lesions of unknown clinical significance (n = 46)
					FICE 1: improved delineation in 34%; κ = 0.646
					FICE 2: improved delineation in 8.6%; κ = 0.617
					FICE 3: improved delineation in 7.7%; κ = 0.669
					Blue mode: improved delineation in 83%; κ = 0.786
Duque et al[8]	Single center	Prospective	20 patients	Detection rate	150 lesions
					SBCE-FICE: increased detection rate (95 vs 75), κ = 0.650
					SBCE-FICE did not miss any lesion identified by CE-WL and allowed the identification of a higher number of angioectasias (35 vs 32, P = 0.25) and erosions (41 vs 24, P < 0.001)
Nakamura et al[25]	Single center	Prospective	50 patients	Detection rate (QuickView)	SBCE-WL: sensitivity 80%, specificity 100%
					SBCE-FICE: sensitivity 91% specificity 86%
					SBCE-FICE resulted in more false positive findings and lower specificity
Sakai et al[26]	Single center	Prospective	12 patients	Detection rate	142 lesions including angioectasias (n = 60) and ulcers/erosions (n = 82)
					Angioectasias were detected with CE-WL (26/60), SBCE-FICE 1 (40/60), SBCE-FICE 2 (38/60), SBCE-FICE 3 (31/60)
					Ulcers/erosions were detected with SBCE-WL (38/82), SBCE-FICE 1 (62/82), SBCE-FICE 2 (60/82), SBCE-FICE 3 (20/82)
					SBCE-FICE 1and 2 significantly increased the detection rate of angioectasias (P = 0.0017 and P = 0.014, respectively) and ulcers/erosions (P = 0.0012 and P = 0.0094, respectively)
					In poor bowel visibility conditions, SBCE-FICE yielded a high rate of false-positive findings
Cotter et al	Single center	Retrospective	49 patients	Delineation	100 lesions including angioectasias (n = 39), ulcers/erosions (n = 49), villous edema/atrophy (n = 12)
					FICE 1: image improvement in 77% (κ = 0.833)
					FICE 2: image improvement in 74% (κ = 0.764)
					FICE 3: image improvement in 66% (κ = 0.486)
					BF: image improvement in 79% (κ = 0.593)
					FICE 1 improved the delineation of 97.4% of angioectasias, 63.3% of ulcers/erosions and 66.7% of villous edema/atrophy
					FICE 2 improved the delineation of 97.4% of angioectasias, 57.1% of ulcers/erosions and 66.7% of villous edema/atrophy
					FICE 3 improved the delineation of 46.2% of angioectasias, 24.5% of ulcers/erosions and none of the cases of villous edema/atrophy
					BF improved the delineation of 15.4% of angioectasias, 61.2% of ulcers/erosions and 25.0% of villous edema/atrophy

FICE: Flexible Spectral Imaging Color Enhancement; BF: Blue Filter; SBCE-WL: White light small bowel capsule endoscopy.