Virtual chromoendoscopy in small bowel capsule endoscopy: New light or a cast of shadow?

AIM: To evaluate whether virtual chromoendoscopy can improve the delineation of small bowel lesions previously detected by conventional white light small bowel capsule endoscopy (SBCE).

METHODS: Retrospective single center study. One hundred lesions selected from forty-nine consecutive conventional white light SBCE (SBCE-WL) examinations were included. Lesions were reviewed at three Flexible Spectral Imaging Color Enhancement (FICE) settings and Blue Filter (BF) by two gastroenterologists with experience in SBCE, blinded to each other’s findings, who ranked the quality of delineation as better, equivalent or worse than conventional SBCE-WL. Inter-observer percentage of agreement was determined and analyzed with Fleiss Kappa (κ) coefficient. Lesions selected for the study included angioectasias (n = 39), ulcers/erosions (n = 49) and villous edema/atrophy (n = 12).

RESULTS: Overall, the delineation of lesions was improved in 77% of cases with FICE 1, 74% with FICE 2, 41% with FICE 3 and 39% with the BF, with a percentage of agreement between investigators of 89% (κ = 0.833), 85% (κ = 0.764), 66% (κ = 0.486) and 79% (κ = 0.593), respectively. FICE 1 improved the delineation of 97.4% of angioectasias, 63.3% of ulcers/erosions and 66.7% of villous edema/atrophy with a percentage of agreement of 97.4% (κ = 0.910), 81.6% (κ = 0.714) and 91.7% (κ = 0.815), respectively. FICE 2 improved the delineation of 97.4% of angioectasias, 57.1% of ulcers/erosions and 66.7% of villous edema/atrophy, with a percentage of agreement of 89.7% (κ = 0.802), 79,6% (κ = 0.703) and 91.7% (κ = 0.815), respectively. FICE 3 improved the delineation of 46.2% of angioectasias, 24.5% of ulcers/erosions and none of the cases of villous edema/atrophy, with a percentage of agreement of 53.8% [κ = not available (NA)], 75.5% (κ = NA) and 66.7% (κ = 0.304), respectively. The BF improved the delineation of 15.4% of angioectasias, 61.2% of ulcers/erosions and 25% of villous edema/atrophy, with a percentage of agreement of 76.9% (κ = 0.558), 81.6% (κ = 0.570) and 25.0% (κ = NA), respectively.

CONCLUSION: Virtual chromoendoscopy can improve the delineation of angioectasias, ulcers/erosions and villous edema/atrophy detected by SBCE, with almost perfect interobserver agreement for FICE 1.

Anesthetic management for small bowel enteroscopy in a World Gastroenterology Organization Endoscopy Training Center

AIM

To study the anesthetic management of patients undergoing small bowel enteroscopy in the World Gastroenterology Organization (WGO) Endoscopy Training Center in Thailand.

METHODS

Patients who underwent small bowel enteroscopy during the period of March 2005 to March 2011 in Siriraj Gastrointestinal Endoscopy Center were retrospectively analyzed. The patients' characteristics, pre-anesthetic problems, anesthetic techniques, anesthetic agents, anesthetic time, type and route of procedure and anesthesia-related complications were assessed.

RESULTS

One hundred and forty-four patients underwent this procedure during the study period. The mean age of the patients was 57.6 ± 17.2 years, and most were American Society of Anesthesiologists (ASA) class II (53.2%). Indications for this procedure were gastrointestinal bleeding (59.7%), chronic diarrhea (14.3%), protein losing enteropathy (2.6%) and others (23.4%). Hematologic disease, hypertension, heart disease and electrolyte imbalance were the most common pre-anesthetic problems. General anesthesia with endotracheal tube was the anesthetic technique mainly employed (50.6%). The main anesthetic agents administered were fentanyl, propofol and midazolam. The mean anesthetic time was 94.0 ± 50.5 min. Single balloon and oral (antegrade) intubation was the most common type and route of enteroscopy. The anesthesia-related complication rate was relatively high. The overall and cardiovascular-related complication rates including hypotension in the older patient group (aged ≥ 60 years old) were significantly higher than those in the younger group.

CONCLUSION

During anesthetic management for small bowel enteroscopy, special techniques and drugs are not routinely required. However, for safety reasons anesthetic personnel need to optimize the patient's condition.