Rodrigues Jaime P, Pinho Rolando, Rodrigues Adélia, Silva Joana, Ponte Ana, Sousa Mafalda, Carvalho João
Gastrenterologia, Centro Hospitalar Vila Nova Gaia, Portugal.
Gastroenterology and Hepatology department, Centro Hospitalar de Gaia/Espinho, Portugal.
Rev Esp Enferm Dig. 2017 Feb;109(2):106-113. doi: 10.17235/reed.2017.4629/2016.
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.
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.
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.
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.
小肠黏膜下病变（SBSL）与良性隆起可能具有相同的外观，在小肠胶囊内镜检查（SBCE）中难以区分。最近，吉雷利等人提出了一种胶囊内镜下平滑突出病变指数（SPICE）评分，以区分两者。我们旨在评估和验证SPICE作为区分良性隆起和SBSL的方法。
我们评估了2005年1月至2015年9月在我们科室进行的所有SBCE，并选择了小肠内有平滑、圆形、突出病变的病例。排除具有可疑特征的病变。创建感兴趣区域的视频片段，由两名内镜医师独立盲目地分配SPICE评分。我们以每位患者的最终诊断作为标准，确定SPICE的鉴别能力。
我们纳入了30例SBCE，对应12例SBSL（4例胃肠道间质瘤、2例神经内分泌肿瘤、4例脂肪瘤和2例息肉样淋巴管扩张症）和18例良性隆起。SPICE评分范围为0至4，能够区分SBSL和良性隆起（p<0.001）。SPICE>2时，诊断SBSL的敏感性为66.7%，特异性为100.0%，阳性预测值为100.0%，阴性预测值为78.3%，曲线下面积为0.88（95%CI，0.73-1.00；p<0.001）。
我们的数据支持SPICE（即评分>2）作为SBSL的预测方法。考虑到其简单性，它在SBCE区分SBSL和良性隆起方面可能非常有用。
