Prospective study of diagnostic yields of flexible spectral imaging color enhancement installed in colon capsule endoscopy for colorectal polyps and tumors

Abstract

Background and AimsWe prospectively aimed to determine the efficacy of flexible spectral imaging color enhancement (FICE) at second-generation colon capsule endoscopy (CCE) for colorectal polyps and tumors (CRTs). MethodsThis study included optical colonoscopy within four months after CCE. Two colonoscopists independently reviewed white light images (CCE-WL) and FICE images (CCE-FICE), respectively. Based on colonoscopic findings as the gold standard, the diagnostic accuracy for CRTs was compared between CCE-WL and CCE-FICE. ResultsOf 89 enrolled patients (65 men and 24 women; 75 with CRTs including 36 with serrated lesions, 63 with adenomas, and 9 with adenocarcinomas), the per-patient detectability of CCE-FICE for the representative CRT was significantly higher than that of CCE-WL: overall CRTs (CCE-WL,79%; CCE-FICE,88%, P=0.0001), 6-9 mm CRTs (63%; 94%, P=0.0055), ≥6mm CRTs (78%; 93%, P=0.0159), respectively. The per-lesion sensitivity of CCE-FICE was significantly higher than that of CCE-WL for CRTs: overall (61%; 79%, P<0.0001), <6 mm (53%; 69%, P<0.0001) and 6-9 mm CRTs (65%; 93%, P=0.0007), slightly elevated CRTs (53%; 75 %, P<0.0001), tubular adenomas (61%; 79%, P<0.0001), and serrated polyps (57%; 74%, P=0.0022), respectively. Both modes detected all adenocarcinomas. There were no significant differences of the per-lesion sensitivity for ≥10 mm or protruding CRTs between CCE-WL and CCE-FICE (81%; 94%, P=0.1138, 77%; 86%, P=0.0614, respectively). Kappa coefficients for overall CRTs at CCE-WL and CCE-FICE were 0.66 and 0.64, respectively, which indicated substantial agreement. ConclusionsCCE-FICE improved the detection rates for all CRTs except adenocarcinomas, ≥10 mm and protruding polyps, when compared to CCE-WL (UMIN 000021125).