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 a...
Main Authors: | , , , , , , , , , , , , , , |
---|---|
Format: | Article |
Language: | English |
Published: |
Georg Thieme Verlag KG
2021-05-01
|
Series: | Endoscopy International Open |
Online Access: | http://www.thieme-connect.de/DOI/DOI?10.1055/a-1372-4051 |
id |
doaj-f8cac6feab28403faf2e292f694cdb99 |
---|---|
record_format |
Article |
collection |
DOAJ |
language |
English |
format |
Article |
sources |
DOAJ |
author |
Bruno Rosa Reuma Margalit-Yehuda Kelly Gatt Martina Sciberras Carlo Girelli Jean-Christophe Saurin Pablo Cortegoso Valdivia Jose Cotter Rami Eliakim Flavio Caprioli Gunnar Baatrup Martin Keuchel Pierre Ellul Ervin Toth Anastasios Koulaouzidis |
spellingShingle |
Bruno Rosa Reuma Margalit-Yehuda Kelly Gatt Martina Sciberras Carlo Girelli Jean-Christophe Saurin Pablo Cortegoso Valdivia Jose Cotter Rami Eliakim Flavio Caprioli Gunnar Baatrup Martin Keuchel Pierre Ellul Ervin Toth Anastasios Koulaouzidis Scoring systems in clinical small-bowel capsule endoscopy: all you need to know! Endoscopy International Open |
author_facet |
Bruno Rosa Reuma Margalit-Yehuda Kelly Gatt Martina Sciberras Carlo Girelli Jean-Christophe Saurin Pablo Cortegoso Valdivia Jose Cotter Rami Eliakim Flavio Caprioli Gunnar Baatrup Martin Keuchel Pierre Ellul Ervin Toth Anastasios Koulaouzidis |
author_sort |
Bruno Rosa |
title |
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_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_sort |
scoring systems in clinical small-bowel capsule endoscopy: all you need to know! |
publisher |
Georg Thieme Verlag KG |
series |
Endoscopy International Open |
issn |
2364-3722 2196-9736 |
publishDate |
2021-05-01 |
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. |
url |
http://www.thieme-connect.de/DOI/DOI?10.1055/a-1372-4051 |
work_keys_str_mv |
AT brunorosa scoringsystemsinclinicalsmallbowelcapsuleendoscopyallyouneedtoknow AT reumamargalityehuda scoringsystemsinclinicalsmallbowelcapsuleendoscopyallyouneedtoknow AT kellygatt scoringsystemsinclinicalsmallbowelcapsuleendoscopyallyouneedtoknow AT martinasciberras scoringsystemsinclinicalsmallbowelcapsuleendoscopyallyouneedtoknow AT carlogirelli scoringsystemsinclinicalsmallbowelcapsuleendoscopyallyouneedtoknow AT jeanchristophesaurin scoringsystemsinclinicalsmallbowelcapsuleendoscopyallyouneedtoknow AT pablocortegosovaldivia scoringsystemsinclinicalsmallbowelcapsuleendoscopyallyouneedtoknow AT josecotter scoringsystemsinclinicalsmallbowelcapsuleendoscopyallyouneedtoknow AT ramieliakim scoringsystemsinclinicalsmallbowelcapsuleendoscopyallyouneedtoknow AT flaviocaprioli scoringsystemsinclinicalsmallbowelcapsuleendoscopyallyouneedtoknow AT gunnarbaatrup scoringsystemsinclinicalsmallbowelcapsuleendoscopyallyouneedtoknow AT martinkeuchel scoringsystemsinclinicalsmallbowelcapsuleendoscopyallyouneedtoknow AT pierreellul scoringsystemsinclinicalsmallbowelcapsuleendoscopyallyouneedtoknow AT ervintoth scoringsystemsinclinicalsmallbowelcapsuleendoscopyallyouneedtoknow AT anastasioskoulaouzidis scoringsystemsinclinicalsmallbowelcapsuleendoscopyallyouneedtoknow |
_version_ |
1721377870375288832 |
spelling |
doaj-f8cac6feab28403faf2e292f694cdb992021-06-14T23:03:37ZengGeorg Thieme Verlag KGEndoscopy International Open2364-37222196-97362021-05-010906E802E82310.1055/a-1372-4051Scoring systems in clinical small-bowel capsule endoscopy: all you need to know!Bruno Rosa0Reuma Margalit-Yehuda1Kelly Gatt2Martina Sciberras3Carlo Girelli4Jean-Christophe Saurin5Pablo Cortegoso Valdivia6Jose Cotter7Rami Eliakim8Flavio Caprioli9Gunnar Baatrup10Martin Keuchel11Pierre Ellul12Ervin Toth13Anastasios Koulaouzidis14Gastroenterology Department, Hospital da Senhora da Oliveira, Guimarães, PortugalDepartment of Gastroenterology, Sheba Medical Center, Sackler School of Medicine, Tel-Aviv, IsraelDivision of Gastroenterology, Mater Dei Hospital, Msida, MaltaDivision of Gastroenterology, Mater Dei Hospital, Msida, MaltaDepartment of Internal Medicine, Gastroenterology & Digestive Endoscopy, Hospital of Busto Arsizio, ItalyHospices Civils de Lyon, Hôpital Edouard Herriot, Service d'Hépato-Gastro-Entérologie et d'Endoscopie Digestive, Lyon, FranceGastroenterology & Endoscopy Unit, University Hospital of Parma, University of Parma, Parma, ItalyGastroenterology Department, Hospital da Senhora da Oliveira, Guimarães, PortugalDepartment of Gastroenterology, Sheba Medical Center, Sackler School of Medicine, Tel-Aviv, IsraelUnit of Gastroenterology and Endoscopy, Fondazione IRCCS Cà Granda, Ospedale Policlinico di Milano, Milan, ItalyDepartment of Clinical Research, University of Southern Denmark, Odense, DenmarkClinic for Internal Medicine, Bethesda Krankenhaus Bergedorf, Hamburg, GermanyDivision of Gastroenterology, Mater Dei Hospital, Msida, MaltaSkåne University Hospital, Lund University, Malmö, SwedenEndoscopy Unit, The Royal Infirmary of Edinburgh, Scotland, UKCapsule 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.http://www.thieme-connect.de/DOI/DOI?10.1055/a-1372-4051 |