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Scoring systems in clinical small-bowel capsule endoscopy: all you need to know!
Capsule endoscopy (CE) emerged out of the pressing clinical need to image the small bowel (SB) in cases of midgut bleeding and provide an overall comfortable and reliable gastrointestinal (GI) diagnosis 1 . Since its wider adoption in clinical practice, significant progress has been made in several...
Autores principales: | , , , , , , , , , , , , , , |
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Formato: | Online Artículo Texto |
Lenguaje: | English |
Publicado: |
Georg Thieme Verlag KG
2021
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Acceso en línea: | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8159625/ https://www.ncbi.nlm.nih.gov/pubmed/34079861 http://dx.doi.org/10.1055/a-1372-4051 |
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author | Rosa, Bruno Margalit-Yehuda, Reuma Gatt, Kelly Sciberras, Martina Girelli, Carlo Saurin, Jean-Christophe Cortegoso Valdivia, Pablo Cotter, Jose Eliakim, Rami Caprioli, Flavio Baatrup, Gunnar Keuchel, Martin Ellul, Pierre Toth, Ervin Koulaouzidis, Anastasios |
author_facet | Rosa, Bruno Margalit-Yehuda, Reuma Gatt, Kelly Sciberras, Martina Girelli, Carlo Saurin, Jean-Christophe Cortegoso Valdivia, Pablo Cotter, Jose Eliakim, Rami Caprioli, Flavio Baatrup, Gunnar Keuchel, Martin Ellul, Pierre Toth, Ervin Koulaouzidis, Anastasios |
author_sort | Rosa, Bruno |
collection | PubMed |
description | Capsule endoscopy (CE) emerged out of the pressing clinical need to image the small bowel (SB) in cases of midgut bleeding and provide an overall comfortable and reliable gastrointestinal (GI) diagnosis 1 . Since its wider adoption in clinical practice, significant progress has been made in several areas including software development, hardware features and clinical indications, while innovative applications of CE never cease to appear 2 3 . Currently, several manufacturers provide endoscopic capsules with more or less similar technological features 4 . Although there is engaging and continuous academic and industry-fueled R&D, promising furtherment of CE technology 4 5 , the current status of clinical CE remains that of by and large an imaging modality. Clinical relevance of CE images is cornerstone in the decision-making process for medical management. In one of the larger to date SB CE studies, 4,206 abnormal images were detected in 3,280 patients 6 . Thus, CE leads to the identification of a large amount of potential pathology, some of which are pertinent (or relevant) while some (probably the majority) are not. Soon artificial intelligence (AI) is likely to carry out several roles currently performed by humans; in fact, we are witnessing only the first stages of a transition in the clinical adoption of AI-based solutions in several aspects of gastroenterology including CE 7 . Until then though, human-based decision-making profoundly impacts patient care and – although not suggested in the updated European Society of Gastrointestinal Endoscopy (ESGE) European curriculum 8 9 – it should be an integral part of CE training. Frequently, interpretation of CE images by experts or at least experienced readers differs. In a tandem CE reading study, expert review of discordant cases revealed a 50 % (13/25 discordant results) error rate by experienced readers, corresponding (in 5/13 cases) to ‘over-classification’ of an irrelevant abnormality 10 . Another comparative study showed an ‘over-classification’ of such irrelevant abnormalities in ~10 % of CE readings 11 . One thing which has been for a while on the table – in relation to optimizing and/or standardizing CE reporting and subsequent decision-making – is the need for reproducible scoring systems and for a reliable common language among clinicians responsible for further patient’s management. Over the years, several of these scoring systems were developed while others appear in the wake of software and hardware improvements aiming to replace and/or complement their predecessors. This review presents a comprehensive account of the currently available classification/scoring systems in clinical CE spanning from predicting the bleeding potential of identified SB lesions (with emphasis on vascular lesions), and the individual rebleeding risk; scoring systems for the prediction of SB lesions in patients with obscure gastrointestinal bleeding (OGlB), having the potential to improve patient selection and rationalize the use of enteroscopy, with better allocation of resources, optimized diagnostic workflow and tailored treatment. This review also includes scores for reporting the inflammatory burden, the cleansing level that underscores confidence in CE reporting and the mass or bulge question in CE. Essentially, the aim is to become a main text for reference when scoring is required and facilitate the inclusion of -through readiness of access- one of the other in the final report. |
format | Online Article Text |
id | pubmed-8159625 |
institution | National Center for Biotechnology Information |
language | English |
publishDate | 2021 |
publisher | Georg Thieme Verlag KG |
record_format | MEDLINE/PubMed |
spelling | pubmed-81596252021-06-01 Scoring systems in clinical small-bowel capsule endoscopy: all you need to know! Rosa, Bruno Margalit-Yehuda, Reuma Gatt, Kelly Sciberras, Martina Girelli, Carlo Saurin, Jean-Christophe Cortegoso Valdivia, Pablo Cotter, Jose Eliakim, Rami Caprioli, Flavio Baatrup, Gunnar Keuchel, Martin Ellul, Pierre Toth, Ervin Koulaouzidis, Anastasios Endosc Int Open Capsule endoscopy (CE) emerged out of the pressing clinical need to image the small bowel (SB) in cases of midgut bleeding and provide an overall comfortable and reliable gastrointestinal (GI) diagnosis 1 . Since its wider adoption in clinical practice, significant progress has been made in several areas including software development, hardware features and clinical indications, while innovative applications of CE never cease to appear 2 3 . Currently, several manufacturers provide endoscopic capsules with more or less similar technological features 4 . Although there is engaging and continuous academic and industry-fueled R&D, promising furtherment of CE technology 4 5 , the current status of clinical CE remains that of by and large an imaging modality. Clinical relevance of CE images is cornerstone in the decision-making process for medical management. In one of the larger to date SB CE studies, 4,206 abnormal images were detected in 3,280 patients 6 . Thus, CE leads to the identification of a large amount of potential pathology, some of which are pertinent (or relevant) while some (probably the majority) are not. Soon artificial intelligence (AI) is likely to carry out several roles currently performed by humans; in fact, we are witnessing only the first stages of a transition in the clinical adoption of AI-based solutions in several aspects of gastroenterology including CE 7 . Until then though, human-based decision-making profoundly impacts patient care and – although not suggested in the updated European Society of Gastrointestinal Endoscopy (ESGE) European curriculum 8 9 – it should be an integral part of CE training. Frequently, interpretation of CE images by experts or at least experienced readers differs. In a tandem CE reading study, expert review of discordant cases revealed a 50 % (13/25 discordant results) error rate by experienced readers, corresponding (in 5/13 cases) to ‘over-classification’ of an irrelevant abnormality 10 . Another comparative study showed an ‘over-classification’ of such irrelevant abnormalities in ~10 % of CE readings 11 . One thing which has been for a while on the table – in relation to optimizing and/or standardizing CE reporting and subsequent decision-making – is the need for reproducible scoring systems and for a reliable common language among clinicians responsible for further patient’s management. Over the years, several of these scoring systems were developed while others appear in the wake of software and hardware improvements aiming to replace and/or complement their predecessors. This review presents a comprehensive account of the currently available classification/scoring systems in clinical CE spanning from predicting the bleeding potential of identified SB lesions (with emphasis on vascular lesions), and the individual rebleeding risk; scoring systems for the prediction of SB lesions in patients with obscure gastrointestinal bleeding (OGlB), having the potential to improve patient selection and rationalize the use of enteroscopy, with better allocation of resources, optimized diagnostic workflow and tailored treatment. This review also includes scores for reporting the inflammatory burden, the cleansing level that underscores confidence in CE reporting and the mass or bulge question in CE. Essentially, the aim is to become a main text for reference when scoring is required and facilitate the inclusion of -through readiness of access- one of the other in the final report. Georg Thieme Verlag KG 2021-06 2021-05-27 /pmc/articles/PMC8159625/ /pubmed/34079861 http://dx.doi.org/10.1055/a-1372-4051 Text en The Author(s). This is an open access article published by Thieme under the terms of the Creative Commons Attribution-NonDerivative-NonCommercial License, permitting copying and reproduction so long as the original work is given appropriate credit. Contents may not be used for commercial purposes, or adapted, remixed, transformed or built upon. (https://creativecommons.org/licenses/by-nc-nd/4.0/) https://creativecommons.org/licenses/by-nc-nd/4.0/This is an open-access article distributed under the terms of the Creative Commons Attribution-NonCommercial-NoDerivatives License, which permits unrestricted reproduction and distribution, for non-commercial purposes only; and use and reproduction, but not distribution, of adapted material for non-commercial purposes only, provided the original work is properly cited. |
spellingShingle | Rosa, Bruno Margalit-Yehuda, Reuma Gatt, Kelly Sciberras, Martina Girelli, Carlo Saurin, Jean-Christophe Cortegoso Valdivia, Pablo Cotter, Jose Eliakim, Rami Caprioli, Flavio Baatrup, Gunnar Keuchel, Martin Ellul, Pierre Toth, Ervin Koulaouzidis, Anastasios Scoring systems in clinical small-bowel capsule endoscopy: all you need to know! |
title | Scoring systems in clinical small-bowel capsule endoscopy: all you need to know! |
title_full | Scoring systems in clinical small-bowel capsule endoscopy: all you need to know! |
title_fullStr | Scoring systems in clinical small-bowel capsule endoscopy: all you need to know! |
title_full_unstemmed | Scoring systems in clinical small-bowel capsule endoscopy: all you need to know! |
title_short | Scoring systems in clinical small-bowel capsule endoscopy: all you need to know! |
title_sort | scoring systems in clinical small-bowel capsule endoscopy: all you need to know! |
url | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8159625/ https://www.ncbi.nlm.nih.gov/pubmed/34079861 http://dx.doi.org/10.1055/a-1372-4051 |
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