Improved visibility of lesions of the small intestine via capsule endoscopy with computed virtual chromoendoscopy

Background: We can now enhance video capsule endoscopy (CE) images in real time by means of a flexible spectral imaging color enhancement (FICE) digital processing system. Reports on the clinical usefulness of this system are few. Objective: To clarify whether visualization of lesions of the small intestine is improved by FICE image analysis. Design: A retrospective study. Setting: Academic medical center. Methods: Five physicians compared FICE images with corresponding conventional images of 145 lesions obtained from 122 patients who underwent video CE at our hospital. The lesions were classified as angioectasia (n = 23), erosion/ulceration (n = 45), or tumor (n = 75), and 3 different sets of FICE images were viewed (ie, at 3 different wavelength settings). Physicians rated the visibility of the lesions on FICE images as follows: +2 (improved visibility), +1 (somewhat improved visibility), 0 (visibility equivalent to that of conventional video CE visibility), I (somewhat decreased visibility), and 2 (decreased visibility). Scores for each lesion were totaled (per FICE setting) and evaluated. Intraobserver agreement was also examined. Results: With FICE setting 1 (red 595 nm, green 540 nm, blue 535 nm), improvement was achieved for 87% (20/23) of angioectasia images, 53.3% (26/47) of erosion/ulceration images, and 25.3% (19/75) of tumor images. With setting 2 (red 420 rim, green, 520 nm, blue 530 nm), improvement was achieved for 87% (20/23), 25.5% (12/47), and 20.0% (15/75), respectively. With setting 3, only equivalence was achieved. Intraobserver agreement was good to satisfactory at 5.4 or higher. Limitations: Single-center study. Conclusions: CE-FICE improves visibility of small-bowel angioectasia, erosion/ulceration, and tumor. (Gastrointest Endosc 2011;73:299-306.)