Year 2017 / Volume 109 / Number 2
Original
Validation of SPICE, a method to differentiate small bowel submucosal lesions from innocent bulges on capsule endoscopy

106-113

DOI: 10.17235/reed.2017.4629/2016

Jaime P. Rodrigues, Rolando Pinho, Adélia Rodrigues, Joana Silva, Ana Ponte, Mafalda Sousa, João Carvalho,

Abstract
Background and aims: Small bowel submucosal lesions (SBSL) and innocent bulges may have an identical appearance and be difficult to distinguish on small bowel capsule endoscopy (SBCE). Recently, Girelli et al. proposed a score, smooth, protruding lesion index on capsule endoscopy (SPICE), in order to differentiate between the two. We aimed to evaluate and validate SPICE as a differentiation method between innocent bulges and SBSLs. Methods: We evaluated all SBCEs performed in our department between January 2005 and September 2015, and selected the ones with a smooth, round, protruding lesion in the small bowel. Lesions with suspicious characteristics were excluded. A video clip of the region of interest was created and SPICE was assigned blindly and independently by two endoscopists. We determined the discriminative ability of SPICE using the definitive diagnosis of each patient as the standard criteria. Results: We included 30 SBCEs corresponding to 12 SBSLs (four gastrointestinal stromal tumors, two neuroendocrine tumors, four lipomas and two polypoid lymphangiectasias) and 18 innocent bulges. SPICE scores ranged from 0 to 4, allowing the distinction between SBSLs and innocent bulges (p < 0.001). SPICE > 2 had a 66.7% sensitivity, 100.0% specificity, 100.0% positive predictive value and 78.3% negative predictive value, and the area under the curve was 0.88 (95% CI, 0.73-1.00; p < 0.001) for the diagnosis of SBSL. Conclusions: Our data support SPICE, namely a score > 2, as a predictive method of SBSLs. Taking into account its simplicity, it may be very useful in the distinction between SBSLs and innocent bulges on SBCE.
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References
1. O'Riordan BG, Vilor M, Herrera L. Small bowel tumors: an overview. Dig Dis 1996; 14: 245-257
2. Neugut AI, Jacobson JS, Suh S et al. The epidemiology of cancer of the small bowel. Cancer Epidemiol Biomarkers Prev 1998; 7: 243-251
3. Pan SY, Morrison H. Epidemiology of cancer of the small intestine. World J Gastrointest Oncol 2011; 3: 33-42
4. Goodman MT, Matsuno RK, Shvetsov YB. Racial and ethnic variation in the incidence of small-bowel cancer subtypes in the United States, 1995-2008. Dis Colon Rectum 2013; 56: 441-448
5. Haselkorn T, Whittemore AS, Lilienfeld DE. Incidence of small bowel cancer in the United States and worldwide: geographic, temporal, and racial differences. Cancer Causes Control 2005; 16: 781-787
6. Bilimoria KY, Bentrem DJ, Wayne JD et al. Small bowel cancer in the United States: changes in epidemiology, treatment, and survival over the last 20 years. Ann Surg 2009; 249: 63-71
7. Lu Y, Frobom R, Lagergren J. Incidence patterns of small bowel cancer in a population-based study in Sweden: increase in duodenal adenocarcinoma. Cancer Epidemiol 2012; 36: e158-163
8. Bojesen RD, Andersson M, Riis LB et al. Incidence of, phenotypes of and survival from small bowel cancer in Denmark, 1994–2010: a population-based study. Journal of Gastroenterology 2016, DOI: 10.1007/s00535-016-1171-7: 1-9
9. Reynolds I, Healy P, McNamara DA. Malignant tumours of the small intestine. Surgeon 2014; 12: 263-270
10. Sailer J, Zacherl J, Schima W. MDCT of small bowel tumours. Cancer Imaging 2007; 7: 224-233
11. Aparicio T, Zaanan A, Svrcek M et al. Small bowel adenocarcinoma: epidemiology, risk factors, diagnosis and treatment. Dig Liver Dis 2014; 46: 97-104
12. Landerholm K, Falkmer S, Jarhult J. Epidemiology of small bowel carcinoids in a defined population. World J Surg 2010; 34: 1500-1505
13. Pennazio M, Rondonotti E, de Franchis R. Capsule endoscopy in neoplastic diseases. World Journal of Gastroenterology : WJG 2008; 14: 5245-5253
14. Honda W, Ohmiya N, Hirooka Y et al. Enteroscopic and radiologic diagnoses, treatment, and prognoses of small-bowel tumors. Gastrointest Endosc 2012; 76: 344-354
15. Han JW, Hong SN, Jang HJ et al. Clinical Efficacy of Various Diagnostic Tests for Small Bowel Tumors and Clinical Features of Tumors Missed by Capsule Endoscopy. Gastroenterology Research and Practice 2015; 2015: 6
16. Triester SL, Leighton JA, Leontiadis GI et al. A meta-analysis of the yield of capsule endoscopy compared to other diagnostic modalities in patients with obscure gastrointestinal bleeding. Am J Gastroenterol 2005; 100: 2407-2418
17. de Mascarenhas-Saraiva MN, da Silva Araujo Lopes LM. Small-bowel tumors diagnosed by wireless capsule endoscopy: report of five cases. Endoscopy 2003; 35: 865-868
18. Rondonotti E, Pennazio M, Toth E et al. Small-bowel neoplasms in patients undergoing video capsule endoscopy: a multicenter European study. Endoscopy 2008; 40: 488-495
19. Cobrin GM, Pittman RH, Lewis BS. Increased diagnostic yield of small bowel tumors with capsule endoscopy. Cancer 2006; 107: 22-27
20. Bailey AA, Debinski HS, Appleyard MN et al. Diagnosis and outcome of small bowel tumors found by capsule endoscopy: a three-center Australian experience. Am J Gastroenterol 2006; 101: 2237-2243
21. Urbain D, De Looze D, Demedts I et al. Video capsule endoscopy in small-bowel malignancy: a multicenter Belgian study. Endoscopy 2006; 38: 408-411
22. Cheung DY, Lee IS, Chang DK et al. Capsule endoscopy in small bowel tumors: a multicenter Korean study. J Gastroenterol Hepatol 2010; 25: 1079-1086
23. Cardoso H, Rodrigues JT, Marques M et al. Malignant Small Bowel Tumors: Diagnosis, Management and Prognosis. Acta Med Port 2015; 28: 448-456
24. Pennazio M, Santucci R, Rondonotti E et al. Outcome of patients with obscure gastrointestinal bleeding after capsule endoscopy: report of 100 consecutive cases. Gastroenterology 2004; 126: 643-653
25. Hartmann D, Schmidt H, Bolz G et al. A prospective two-center study comparing wireless capsule endoscopy with intraoperative enteroscopy in patients with obscure GI bleeding. Gastrointest Endosc 2005; 61: 826-832
26. Shyung LR, Lin Sc Fau - Shih S-C, Shih Sc Fau - Chang W-H et al. Proposed scoring system to determine small bowel mass lesions using capsule endoscopy. DOI:
27. Ross A, Mehdizadeh S, Tokar J et al. Double balloon enteroscopy detects small bowel mass lesions missed by capsule endoscopy. Dig Dis Sci 2008; 53: 2140-2143
28. Zagorowicz ES, Pietrzak AM, Wronska E et al. Small bowel tumors detected and missed during capsule endoscopy: single center experience. World J Gastroenterol 2013; 19: 9043-9048
29. Chong AK, Chin BW, Meredith CG. Clinically significant small-bowel pathology identified by double-balloon enteroscopy but missed by capsule endoscopy. Gastrointest Endosc 2006; 64: 445-449
30. Baichi M, Arifuddin RM, Mantry PS. Small Bowel Masses Found and Missed On Capsule Endoscopy for Obscure Bleeding. Gastrointestinal Endoscopy; 63: AB176
31. Sato Y, Sagawa T, Hirakawa M et al. Clinical utility of capsule endoscopy with flexible spectral imaging color enhancement for diagnosis of small bowel lesions. Endosc Int Open 2014; 2: E80-87
32. Girelli CM, Porta P. Bulge or mass? A diagnostic dilemma of capsule endoscopy. Endoscopy 2008; 40: 703-704
33. Girelli CM, Porta P, Colombo E et al. Development of a novel index to discriminate bulge from mass on small-bowel capsule endoscopy. Gastrointest Endosc 2011; 74: 1067-1074; quiz 1115 e1061-1065
34. Pennazio M, Spada C, Eliakim R et al. Small-bowel capsule endoscopy and device-assisted enteroscopy for diagnosis and treatment of small-bowel disorders: European Society of Gastrointestinal Endoscopy (ESGE) Clinical Guideline. Endoscopy 2015; 47: 352-376
35. Mergener K, Ponchon T, Gralnek I et al. Literature review and recommendations for clinical application of small-bowel capsule endoscopy, based on a panel discussion by international experts. Consensus statements for small-bowel capsule endoscopy, 2006/2007. Endoscopy 2007; 39: 895-909
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Rodrigues J, Pinho R, Rodrigues A, Silva J, Ponte A, Sousa M, et all. Validation of SPICE, a method to differentiate small bowel submucosal lesions from innocent bulges on capsule endoscopy. 4629/2016


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Publication history

Received: 20/09/2016

Accepted: 29/10/2016

Online First: 10/01/2017

Published: 31/01/2017

Article revision time: 26 days

Article Online First time: 112 days

Article editing time: 133 days


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