Use Of Virtual Chromoendoscopy Research Articles

An unconventional use of virtual chromoendoscopy for targeted biopsies in challenging scenarios

An unconventional use of virtual chromoendoscopy for targeted biopsies in challenging scenarios

P206 Comparison of dye-spraying chromoendoscopy and virtual chromoendoscopy for colonic dysplasia detection in longstanding Inflammatory Bowel Disease

Abstract Background Dye-spraying chromoendoscopy (DCE) is the technique of choice for colonic surveillance in patients with long-standing extensive Inflammatory Bowel Disease (IBD). Conversely, the use of virtual chromoendoscopy (VCE) is still controversial. This study aimed to compare lesion and dysplasia detection and accuracy of margins delineation between VCE and DCE. Methods Eleven gastroenterologists were given a survey with 20 pairs of pictures of IBD surveillance colonoscopies (10 with nondysplastic lesions, 5 with dysplastic lesions and 5 with no lesions). Each pair contained the same image captured during colonoscopy using VCE and DCE. The 40 pictures were randomly ordered to avoid any classification bias. For each picture, the gastroenterologist assessed the presence/absence of lesion and, when a lesion was identified, assessed the presence/absence of dysplasia and delineated its margins. To compare lesion and dysplasia detections between techniques, the sensitivity, specificity and inter-observer agreement (using fleiss’ kappa (K) test) were calculated. The chi-square test was used to assess the accuracy of margins delineation. Results When assessing lesion detection using VCE, sensitivity (S) and specificity (E) were 0.93 and 0.49 and in, DCE, 0.97 and 0.38, respectively. When assessing dysplasia detection using VCE, S and E were 0.74 and 0.60 and, in DCE, 0.67 and 0.62, respectively. Interobserver agreement analysis revealed that VCE and DCE had a moderate agreement in lesion detection - 0.57 and 0.58, respectively; however, for dysplasia detection, VCE had a fair agreement (k=0.30) and DCE a slight agreement (k=0.11). The rate of accurately defined margins was similar for both techniques (p=0.22). Conclusion Similar lesion and dysplasia detection and margins delineation were achieved with both techniques. However, concerning dysplasia detection, interobserver agreement was slightly better using VCE. Therefore, VCE may constitute a valid alternative to DCE for dysplasia screening in IBD. Further studies are needed to validate these findings.

Gastroenterologists' attitudes on the detection and management of gastric premalignant conditions: results of a nationwide survey in Spain.

Gastric premalignant conditions (GPC) surveillance has been proposed to improve the prognosis of gastric cancer (GC), but the early GC detection rate remaining low, and missing GC during an esophago-gastro-duodenoscopy is still a problem. We aimed to explore the gastroenterologists' attitudes on the detection and management of GPC. A cross-sectional study was designed based on a survey among gastroenterologists from Asociación Española de Gastroenterología. The participation rate was 12% (146/1243). Eighty-one percent worked at secondary or tertiary-care hospitals with the capability to perform mucosectomy (80%), but with a lesser availability of endoscopic submucosal dissection (35%). Most respondents had high-definition endoscopes (88%), and virtual chromoendoscopy (86%), but during performing an upper endoscopy, 34% never or rarely use chromoendoscopy, and 73% apply a biopsy protocol often/very often when atrophy or intestinal metaplasia (IM) is suspected. Half of the respondents self-reported their ability to recognize atrophy or IM ≤7 (on a scale from 0 to 10), whereas ≤6 for dysplasia or early GC. Helicobacter pylori infection is eradicated and verified by ≥90%. Endoscopic surveillance of atrophy/IM is performed by 62%. An immediate endoscopy for dysplasia is not always performed. For low-grade dysplasia, 97.6% consider endoscopic management, but for high-grade dysplasia, 23% regard gastric surgery. There is a wide variability in the detection and management of GPC among Spanish gastroenterologists, and compliance with guidelines and biopsy protocols could be improved. Performance of high-quality gastroscopies including use of virtual chromoendoscopy, that might allow an improvement in the GPC detection, needs also to be generalized.

A guide to multimodal endoscopy imaging for gastrointestinal malignancy - an early indicator.

Multimodality imaging is an essential aspect of endoscopic surveillance for the detection of neoplastic lesions, such as dysplasia or intramucosal cancer, because it improves the efficacy of endoscopic surveillance and therapeutic procedures in the gastrointestinal tract. This approach reveals mucosal abnormalities that cannot be detected by standard endoscopy. Currently, these imaging techniques are divided into those for primary detection and those for targeted imaging and characterization, the latter being used to visualize areas of interest in detail and permit histological evaluation. This Review outlines the use of virtual chromoendoscopy, narrow-band imaging, autofluorescence imaging, optical coherence tomography, confocal endomicroscopy and volumetric laser endomicroscopy as new imaging techniques for diagnostic investigation of the gastrointestinal tract. Insights into use of multimodal endoscopic imaging for early disease detection, in particular for pre-malignant lesions, in the oesophagus, stomach and colon are described.

Virtual chromoendoscopy can be a useful software tool in capsule endoscopy

capsule endoscopy (CE) has revolutionized the study of small bowel. One major drawback of this technique is that we cannot interfere with image acquisition process. Therefore, the development of new software tools that could modify the images and increase both detection and diagnosis of small-bowel lesions would be very useful. The Flexible Spectral Imaging Color Enhancement (FICE) that allows for virtual chromoendoscopy is one of these software tools. to evaluate the reproducibility and diagnostic accuracy of the FICE system in CE. this prospective study involved 20 patients. First, four physicians interpreted 150 static FICE images and the overall agreement between them was determined using the Fleiss Kappa Test. Second, two experienced gastroenterologists, blinded to each other results, analyzed the complete 20 video streams. One interpreted conventional capsule videos and the other, the CE-FICE videos at setting 2. All findings were reported, regardless of their clinical value. Non-concordant findings between both interpretations were analyzed by a consensus panel of four gastroenterologists who reached a final result (positive or negative finding). in the first arm of the study the overall concordance between the four gastroenterologists was substantial (0.650). In the second arm, the conventional mode identified 75 findings and the CE-FICE mode 95. The CE-FICE mode did not miss any lesions identified by the conventional mode and allowed the identification of a higher number of angiodysplasias (35 vs 32), and erosions (41 vs. 24). there is reproducibility for the interpretation of CE-FICE images between different observers experienced in conventional CE. The use of virtual chromoendoscopy in CE seems to increase its diagnostic accuracy by highlighting small bowel erosions and angiodysplasias that weren´t identified by the conventional mode.