Poor Quality of Small Bowel Capsule Endoscopy Images Has a Significant Negative Effect in the Diagnosis of Small Bowel Malignancy

Abstract

Background and Aims

Capsule endoscopy (CE) is a visual modality; hence, diagnosis relies on image quality. We studied the contribution of image parameters to visualization quality and their effect on diagnostic certainty of small bowel (SB) lesions.

Methods

Five clear CE images of common SB pathology – two vascular lesions, two inflammatory, one polyp – were processed for three image parameters to simulate poor SB conditions: opacity (color-matched to luminal content; 10–90%, 10% increments); blurriness (radius 1–10 pixels; one pixel increments); and contrast (−50-50%; 10% increments). Nine expert readers evaluated whether images were adequate for diagnosis. Points where perception of image quality changed significantly were determined for each parameter. Three further sets of SBCE images (vascular, inflammatory, and neoplastic lesions; nine images/set) were processed for four points/parameters. Twenty experienced/expert CE readers reviewed these images.

Results

The negative effects of opacity in diagnostic certainty were mostly evident in images of neoplasia; images of vascular and inflammatory lesions were less affected. Similar results were observed with increasing blur radius, simulating movement, and poor focus. The proportions of readers finding vascular and inflammatory images adequate for diagnosis did not drop significantly at wider blur radii, while images of neoplasia were quickly deemed inadequate. Low contrast had a greater negative effect than high, most consistently in neoplastic lesions.

Conclusion

Poor visualization quality in all parameters affected mostly neoplastic lesions. Software to increase contrast and sharpen images can improve visualization quality; smart frame rate adaptation could improve the number of high-quality frames obtained. Thoroughness in SB cleansing is most important when there is a suspicion of neoplasia.

Keywords:

• capsule endoscopy
• small bowel
• image quality
• diagnosis
• neoplasia
• software

Acknowledgments

On behalf of the ESGE Small Bowel Research Working Group (in alphabetical order): Hanneke Beaumont, Rami Eliakim, Pierre Ellul, Ignacio Fernandez-Urien, Gabriele Wurm Johanssen, Martin Keuchel, Uri Kopylov, Richard Makins, Bruno Mauro, Mark McAlindon, Diedre McNamara, Artur Nemeth, Simon Panter, Marco Pennazio, Enrique Perez Cuadrado R, Emanuele Rondonotti, Bruno Rosa, Jean-Christophe Saurin, Reena Sidhu, Christiano Spada, Ervin Toth, Konstatinos Triantafyllou, and Stefania Zammit. Work completed prior to August 2019.

Author Contributions

This study was designed, carried out and written up by DY with guidance from JP and AK. XD and RL contributed images from their separate study which has been alluded to in this one; and contributed to the discussion of this study. JP and AK supervised the process overall. All main (co)authors made a significant contribution to the work reported; have drafted or written, or substantially revised or critically reviewed the article; have agreed on the journal to which the article will be submitted; reviewed & agreed on all versions of the article before submission, during revision, the final version accepted for publication, and any significant changes introduced at the proofing stage and agreed to take responsibility and be accountable for the contents of the article.

The members of the ESGE Small Bowel Working Group have participated in the review and assessment of images.

Disclosure

The abstract of this paper was presented at the ESGE Days 2019 as an oral presentation. The abstract was published in Endoscopy Journal as supplement/ESGE Days2019 – abstract issue. Endoscopy 2019; 51: S1–S273. Dr Romain Leenhardt reports personal fees from Abbvie, Co founder and share Holder of Augmented Endoscopy, outside the submitted work.

Prof. Dr. Xavier Dray reports personal fees from Boston Scientific, personal fees from Fujifilm, personal fees from Alfasigma, personal fees from Norgine, personal fees from Pentax, personal fees from Medtronic, Founder and share-holder for Augmented Endoscopy, outside the submitted work. In addition, Prof. Dr. Xavier Dray has a patent Automatic Quality Classification of WCE images from Small Bowel according a computer-based score pending to EP18305275.2.

Dr Anastasios Koulaouzidis reports travel support from Jinshan and Aquilant, non-financial support from IntroMedic, outside the submitted work. The authors report no other potential conflicts of interest for this work.