Mucosal protrusion angle measured on capsule endoscopy for the diagnosis of small bowel submucosal tumors: a preliminary exploration of diagnostic accuracy based on a case series
- 1Third Department of Gastroenterology, Heilongjiang Provincial Hospital, Harbin, China
Abstract
INTRODUCTION:: Small bowel submucosal tumors (SBSTs) are rare, often asymptomatic in early stages, and difficult to detect due to the anatomical inaccessibility of the small intestine and limitations of conventional endoscopy.
AIM:: We aimed to evaluate the diagnostic accuracy of the mucosal protrusion angle (MPA) measured on capsule endoscopy for distinguishing SBSTs from benign bulges, and to compare its performance with the established smooth, protruding lesions index on capsule endoscopy (SPICE) scoring system.
MATERIALS AND METHODS:: This case series study retrospectively reviewed 622 patients. Among them, 69 cases with smooth, protruding lesions were initially identified. After excluding lesions with alarm features and those without definitive follow-up confirmation, 31 cases were included in the final analysis.
RESULTS:: Mean MPA was significantly smaller in the SBST group than in the bulge cohort. The area under the receiver operating characteristic curve for MPA in predicting SBSTs was 0.98, significantly higher than that of SPICE scoring. The optimal diagnostic cutoff for MPA was 88°, rounded to 90° for clinical practicality. Using a threshold below 90°, MPA achieved sensitivity of 100%, specificity of 95%, positive predictive value (PPV) of 91.7%, and negative predictive value (NPV) of 100%—all superior to SPICE scoring at a threshold above 2 points (sensitivity, 72.7%; specificity, 85%; PPV, 72.7%; NPV, 85%). A combined criterion (MPA <90° and SPICE >2) yielded 100% specificity and PPV, but lower sensitivity (72.7%).
CONCLUSIONS:: MPA is a simple, highly accurate, and superior metric to SPICE scoring for differentiating SBSTs from innocent bulges on capsule endoscopy.
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BibTeX
@article{xue2026mucosal,
title = {{Mucosal protrusion angle measured on capsule endoscopy for the diagnosis of small bowel submucosal tumors: a preliminary exploration of diagnostic accuracy based on a case series}},
author = {Zhaoguo Xue and Yongming Kang and Xiaomei Sun},
journal = {Videosurgery and other Miniinvasive Techniques},
year = {2026},
month = oct,
doi = {10.20452/wiitm.2026.18051},
url = {https://doi.org/10.20452/wiitm.2026.18051},
note = {CC BY-NC-SA 4.0},
}
RIS
TY - JOUR
TI - Mucosal protrusion angle measured on capsule endoscopy for the diagnosis of small bowel submucosal tumors: a preliminary exploration of diagnostic accuracy based on a case series
AU - Zhaoguo Xue
AU - Yongming Kang
AU - Xiaomei Sun
PY - 2026
DA - 2026/10/27
JO - Videosurgery and other Miniinvasive Techniques
DO - 10.20452/wiitm.2026.18051
UR - https://doi.org/10.20452/wiitm.2026.18051
AB - INTRODUCTION:: Small bowel submucosal tumors (SBSTs) are rare, often asymptomatic in early stages, and difficult to detect due to the anatomical inaccessibility of the small intestine and limitations of conventional endoscopy. AIM:: We aimed to evaluate the diagnostic accuracy of the mucosal protrusion angle (MPA) measured on capsule endoscopy for distinguishing SBSTs from benign bulges, and to compare its performance with the established smooth, protruding lesions index on capsule endoscopy (SPICE) scoring system. MATERIALS AND METHODS:: This case series study retrospectively reviewed 622 patients. Among them, 69 cases with smooth, protruding lesions were initially identified. After excluding lesions with alarm features and those without definitive follow-up confirmation, 31 cases were included in the final analysis. RESULTS:: Mean MPA was significantly smaller in the SBST group than in the bulge cohort. The area under the receiver operating characteristic curve for MPA in predicting SBSTs was 0.98, significantly higher than that of SPICE scoring. The optimal diagnostic cutoff for MPA was 88°, rounded to 90° for clinical practicality. Using a threshold below 90°, MPA achieved sensitivity of 100%, specificity of 95%, positive predictive value (PPV) of 91.7%, and negative predictive value (NPV) of 100%—all superior to SPICE scoring at a threshold above 2 points (sensitivity, 72.7%; specificity, 85%; PPV, 72.7%; NPV, 85%). A combined criterion (MPA <90° and SPICE >2) yielded 100% specificity and PPV, but lower sensitivity (72.7%). CONCLUSIONS:: MPA is a simple, highly accurate, and superior metric to SPICE scoring for differentiating SBSTs from innocent bulges on capsule endoscopy.
SN - 1895-4588
SN - 2299-0054
ER -