Efficacy of Repeat Review with Flexible Spectral Imaging Color Enhancement in Patients with no Findings by Capsule Endoscopy

Background/Aim:The efficacy of flexible spectral imaging color enhancement (FICE) ch. 1 (F1) for the detection of ulcerative lesions and angioectasias in the small intestine with capsule endoscopy (CE) has been reported. In the present study, we evaluated whether F1 could detect incremental findings in patients with no findings in a standard review mode.Results:F1 detected five significant lesions in three patients with overt OGIB; three erosions, one aphtha, and one angioectasia. For nonsignificant lesions, F1 detected 12 red mucosas and 16 red spots. Moreover, 29 patients with 71 findings were considered false positives.Conclusion:F1 detected incremental significant findings in a small percentage of patients with no findings in the standard review mode. In addition, F1 showed many false-positive findings. The incremental effect of a repeated review by F1 in patients with no findings in the first review is limited.Key Words: Capsule endoscopy, flexible spectral imaging color enhancement, obscure gastrointestinal bleeding, repeat review, small intestinal lesionFlexible spectral imaging color enhancement (FICE), an image-enhanced endoscopy (IEE) technique, has been used widely in gastroscopy and colonoscopy.1,2] FICE depends on optical filters and the use of spectral estimation technology to reconstruct images at different wavelengths based on images from white-light endoscopy. It has been reported that it improves the visualization of both neoplastic and non-neoplastic lesions in gastroscopy and colonoscopy.3,4,5]Capsule endoscopy (CE) has become an important examination of the small intestine.6] The efficacy of CE for small intestinal diseases has been reported.7,8,9,10,11] CE has demonstrated efficacy for patients with obscure gastrointestinal bleeding (OGIB). It can detect various kinds of disease states such as tumors, polyps, angioectasias, ulcers, and erosions.Rapid 6.5 (Given Imaging Ltd., Yoqneam, Israel), a CE reading system, includes FICE.12] Several studies have shown the effects of FICE in CE.13,14,15,16,17,18,19,20] In a previous study, we found that FICE Ch. 1 (F1) detected a larger number of ulcerative lesions and angioectasias in the small intestine compared to a standard review.16] However, little is known about the impact of FICE on CE in patients, with no findings in the standard mode CE. In the present study, we investigated whether F1 could detect incremental findings in patients with no findings in the standard review mode.