Development of a computed cleansing score to assess quality of bowel preparation in colon capsule endoscopy

Aymeric Becq; Aymeric Histace; Marine Camus; Isabelle Nion-Larmurier; Einas Abou Ali; Olivia Pietri; Olivier Romain; Ulriikka Chaput; Cynthia Li; Philippe Marteau; Christian Florent; Xavier Dray

doi:10.1055/a-0577-2897

Endoscopy International Open, Table of Contents

CC BY-NC-ND 4.0 · Endosc Int Open 2018; 06(07): E844-E850
DOI: 10.1055/a-0577-2897

Original article

Development of a computed cleansing score to assess quality of bowel preparation in colon capsule endoscopy

Authors

Aymeric Becq

¹Saint-Antoine Hospital, AP-HP, Department of Hepatogastroenterology, 184 rue du Faubourg Saint Antoine, 75012 Paris, France

²Sorbonne University, Paris, France
Aymeric Histace

³ETIS UMR 8051, University Paris-Seine, University of Cergy-Pontoise, ENSEA, CNRS, Cergy, France
Marine Camus

¹Saint-Antoine Hospital, AP-HP, Department of Hepatogastroenterology, 184 rue du Faubourg Saint Antoine, 75012 Paris, France

²Sorbonne University, Paris, France
Isabelle Nion-Larmurier

¹Saint-Antoine Hospital, AP-HP, Department of Hepatogastroenterology, 184 rue du Faubourg Saint Antoine, 75012 Paris, France
Einas Abou Ali

¹Saint-Antoine Hospital, AP-HP, Department of Hepatogastroenterology, 184 rue du Faubourg Saint Antoine, 75012 Paris, France
Olivia Pietri

¹Saint-Antoine Hospital, AP-HP, Department of Hepatogastroenterology, 184 rue du Faubourg Saint Antoine, 75012 Paris, France

²Sorbonne University, Paris, France
Olivier Romain

³ETIS UMR 8051, University Paris-Seine, University of Cergy-Pontoise, ENSEA, CNRS, Cergy, France
Ulriikka Chaput

¹Saint-Antoine Hospital, AP-HP, Department of Hepatogastroenterology, 184 rue du Faubourg Saint Antoine, 75012 Paris, France
Cynthia Li

¹Saint-Antoine Hospital, AP-HP, Department of Hepatogastroenterology, 184 rue du Faubourg Saint Antoine, 75012 Paris, France

⁴College of Arts and Sciences, Drexel University, Philadelphia, Pennsylvania, United States
Philippe Marteau

¹Saint-Antoine Hospital, AP-HP, Department of Hepatogastroenterology, 184 rue du Faubourg Saint Antoine, 75012 Paris, France

²Sorbonne University, Paris, France
Christian Florent

¹Saint-Antoine Hospital, AP-HP, Department of Hepatogastroenterology, 184 rue du Faubourg Saint Antoine, 75012 Paris, France

²Sorbonne University, Paris, France
Xavier Dray

¹Saint-Antoine Hospital, AP-HP, Department of Hepatogastroenterology, 184 rue du Faubourg Saint Antoine, 75012 Paris, France

²Sorbonne University, Paris, France

³ETIS UMR 8051, University Paris-Seine, University of Cergy-Pontoise, ENSEA, CNRS, Cergy, France

Abstract

Background and study aims Colon capsule endoscopy (CCE) does not possess an objective and reliable scoring system to assess the quality of visualization of the colon mucosa. The aim of this study was to establish a colonic computed assessment of cleansing (CAC) score able to discriminate “adequately cleansed” from “inadequately cleansed” CCE still frames.

Patients and methods Twelve normal and complete CCEs, using the Pillcam Colon 2 system (Medtronic, Minnesota, United States), were prospectively selected amongst a database. A CAC score, defined as the ratio of color intensities red over green (R/G ratio), and red over brown (R/(R + G) ratio) was calculated for each extracted colonic frame. After sorting and random selection, two sets of still frames representative of the range of these ratios were obtained. These images were analyzed twice in random order by two experienced CCE readers who were blinded to the CAC scores. A receiver operating characteristic (ROC) curve was forged for both types of ratios and a threshold established, yielding the highest diagnostic performance in terms of adequate cleansing assessment.

Results Four-hundred-and-eight frames were extracted. Regarding the R/G ratio, a threshold value of 1.55 was calculated, with a sensitivity of 86.5 % and a specificity of 77.7 %. Regarding the R/(R + G) ratio, a threshold value of 0.58 was calculated with a sensitivity of 95.5 % and a specificity of 62.9 %.

Conclusion The two proposed CAC scores based on the ratio of color intensities come with high sensitivities for discriminating between “adequately cleansed” and “inadequately cleansed” CCE still frames, but they lack specificity. Further refinement, with implementation of additional image parameters, is warranted.

Full Text

References

References
1 Koulaouzidis A, Rondonotti E, Karargyris A. Small-bowel capsule endoscopy: a ten-point contemporary review. World J Gastroenterol 2013; 19: 3726-3746
2 Fisher LR, Hasler WL. New vision in video capsule endoscopy: current status and future directions. Nat Rev Gastroenterol Hepatol 2012; 9: 392-405
3 Rondonotti E, Soncini M, Girelli C. et al. Small bowel capsule endoscopy in clinical practice: a multicenter 7-year survey. Eur J Gastroenterol Hepatol 2010; 22: 1380-1386
4 Eliakim R, Yassin K, Niv Y. et al. Prospective multicenter performance evaluation of the second-generation colon capsule compared with colonoscopy. Endoscopy 2009; 41: 1026-1031
5 Adrián-de-Ganzo Z, Alarcón-Fernández O, Ramos L. et al. Uptake of colon capsule endoscopy vs colonoscopy for screening relatives of patients with colorectal cancer. Clin Gastroenterol Hepatol Off Clin Pract J Am Gastroenterol Assoc 2015; 13: 2293-2301.e1
6 Spada C, Hassan C, Barbaro B. et al. Colon capsule versus CT colonography in patients with incomplete colonoscopy: a prospective, comparative trial. Gut 2015; 64: 272-281
7 Spada C, Hassan C, Costamagna G. Colon capsule endoscopy. Gastrointest Endosc Clin N Am 2015; 25: 387-401
8 Pioche M, de Leusse A, Filoche B. et al. Prospective multicenter evaluation of colon capsule examination indicated by colonoscopy failure or anesthesia contraindication. Endoscopy 2012; 44: 911-916
9 Spada C, Pasha SF, Gross SA. et al. Accuracy of first- and second-generation Colon capsules in endoscopic detection of colorectal polyps: a systematic review and meta-analysis. Clin Gastroenterol Hepatol Off Clin Pract J Am Gastroenterol Assoc 2016; 14: 1533-1543
10 Spada C, Hassan C, Galmiche JP. et al. Colon capsule endoscopy: European Society of Gastrointestinal Endoscopy (ESGE) Guideline. Endoscopy 2012; 44: 527-536
11 Van Gossum A, Munoz-Navas M, Navas MM. et al. Capsule endoscopy versus colonoscopy for the detection of polyps and cancer. N Engl J Med 2009; 361: 264-270
12 Spada C, Hassan C, Munoz-Navas M. et al. Second-generation colon capsule endoscopy compared with colonoscopy. Gastrointest Endosc 2011; 74: 581-589.e1
13 Morgan DR, Malik PR, Romeo DP. et al. Initial US evaluation of second-generation capsule colonoscopy for detecting colon polyps. BMJ Open Gastroenterol 2016; 3: e000089
14 Ramos L, Alarcón O, Adrian Z. et al. One-day versus two-day cleansing for colon capsule endoscopy: a prospective randomized pilot study. Gastroenterol Hepatol 2014; 37: 101-106
15 Van Weyenberg SJB, De Leest HTJI, Mulder CJJ. Description of a novel grading system to assess the quality of bowel preparation in video capsule endoscopy. Endoscopy 2011; 43: 406-411
16 Fireman Z. What is the optimal bowel preparation for capsule endoscopy?. Nat Clin Pract Gastroenterol Hepatol 2008; 5: 418-419
17 Spada C, Riccioni ME, Familiari P. et al. Polyethylene glycol plus simethicone in small-bowel preparation for capsule endoscopy. Dig Liver Dis Off J Ital Soc Gastroenterol Ital Assoc Study Liver 2010; 42: 365-370
18 Park SC, Keum B, Hyun JJ. et al. A novel cleansing score system for capsule endoscopy. World J Gastroenterol 2010; 16: 875-880
19 Brotz C, Nandi N, Conn M. et al. A validation study of 3 grading systems to evaluate small-bowel cleansing for wireless capsule endoscopy: a quantitative index, a qualitative evaluation, and an overall adequacy assessment. Gastrointest Endosc 2009; 69: 262-270 , 270.e1
20 Rex DK, Petrini JL, Baron TH. et al. Quality indicators for colonoscopy. Gastrointest Endosc 2006; 63: S16-S28
21 Bouchard S, Ibrahim M, Van Gossum A. Video capsule endoscopy: perspectives of a revolutionary technique. World J Gastroenterol 2014; 20: 17330-17344
22 Abou Ali E, Histace A, Camus M. et al. Development and validation of a highly sensitive and highly specific computed assessment of cleansing score for small bowel capsule. Endosc Int Open 2018; 06: E646-E651