Alessandra Guarini, RN Francesca De Marinis, RN Cesare Hassan, MD Cristiano Spada, MD Vincenzo Bruzzese, MD Angelo Zullo, MD
Accuracy of Trained Nurses in Finding Small Bowel Lesions at Video Capsule Endoscopy ABSTRACT The video capsule endoscopy is an accurate tool to investigate the entire small bowel. Currently, the nurse actively participates in the procedure from patient preparation to the video download, whereas a gastroenterologist interprets the endoscopic findings. However, few studies recently showed high accuracy of nurses in detecting lesions in the small bowel on video capsule endoscopy recordings. This prospective study aimed to assess the ability of experienced and trained nurses in detecting small bowel lesions as compared with gastroenterologists. Forty-six consecutive video capsule endoscopy procedures were analyzed. Overall, the nurse evaluation was highly (95.6%) accurate in detecting small bowel lesions, with a 100% concordance with the gastroenterologist for the relevant findings. In addition, the absence of lesions was confirmed by the endoscopist in all cases classified as negative by the nurse. Data of this study found that trained nurses, with a large experience in endoscopic features, correctly identified small bowel lesions on video capsule endoscopy recordings. Therefore, a trained nurse may accurately select the thumbnails of all mucosal irregularities that may be faster reviewed by the endoscopist for a final diagnosis.
Received March 6, 2013; accepted October 29, 2013. About the authors: Alessandra Guarini, RN, is with Gastroenterology and Digestive Endoscopy, Nuovo Regina Margherita Hospital, Roma, Italy. Francesca De Marinis, RN, is with Gastroenterology and Digestive Endoscopy, Nuovo Regina Margherita Hospital, Roma, Italy. Cesare Hassan, MD, is with Gastroenterology and Digestive Endoscopy, Nuovo Regina Margherita Hospital, Roma, Italy. Cristiano Spada, MD, is with Digestive Endoscopy Unit, Catholic University, Rome, Italy. Vincenzo Bruzzese, MD, is with Gastroenterology and Digestive Endoscopy, Nuovo Regina Margherita Hospital, Roma, Italy. Angelo Zullo, MD, is with Gastroenterology and Digestive Endoscopy, Nuovo Regina Margherita Hospital, Roma, Italy. The authors declare no conflicts of interest. Correspondence to: Angelo Zullo, MD, Gastroenterologia ed Endoscopia Digestiva, PTP Nuovo Regina Margherita, Via E. Morosini, 30 00153 Roma, Italia ([email protected]). DOI: 10.1097/SGA.0000000000000096
VOLUME 38 | NUMBER 2 | MARCH/APRIL 2015
V
ideo capsule endoscopy (VCE) is an accurate, wireless technologic method introduced in the last decade for investigating the entire small bowel (Comstock, 2003; Saddler, 2005). The main indications for VCE include obscure gastrointestinal bleeding (OGIB), Crohn disease, hereditary polyposis syndrome, and malabsorptive syndromes (Jungles, 2004; Nutter et al., 2010). Drug-related enteropathy, chronic diarrhea, and follow-up of patients who underwent intestinal transplantation are also potential indications under investigation (Bossa, Cocomazzi, Valvano, Andriulli, & Annese, 2006). Video capsule endoscopy is generally performed when both upper endoscopy and colonoscopy are negative. The swallowable capsule allows up to 54,000 video images to be acquired during the 8 hours of recording. The current role of the nurse in such a procedure includes preparation of the patient with application of 107
Copyright © 2015 Society of Gastroenterology Nurses and Associates. Unauthorized reproduction of this article is prohibited.
GNJ-D-13-00030_LR 107
23/03/15 7:20 PM
Accuracy in Finding Small Bowel Lesions at Video Capsule Endoscopy
sensor arrays, administration of the capsule, and, subsequently, download of images. The major limitation of VCE is the time needed to review the stored images, which is ranging from 60 to 120 minutes (Costamagna et al., 2002), a long-time for a procedure to be performed by a gastroenterologist. Different from traditional endoscopy, the VCE procedure itself is an operator-independent process and, consequently, both quantity and quality of recorded images are not affected by the operator skill. To rationalize the exploitation of medical resources, the longlasting VCE recordings may be effectively read by nurses appropriately trained (Brock, Freeman, Roberts, Dantzler, & Hoffman, 2012; Saddler, 2005; Sidhu, 2007). To date, a few studies assessed the accurateness of nurses in detecting lesions in the small bowel on VCE recordings, showing a good/excellent agreement with the gastroenterologist (Bossa et al., 2006; Levinthal, Burke, & Santisi, 2003). We therefore performed a prospective study to assess the ability of experienced and trained nurses in detecting small bowel lesions using VCE as compared with experienced gastroenterologists.
Methods VCE Procedure All consecutive patients who underwent small bowel examination with VCE in routine clinical practice in a single center were enrolled in the study. The procedure was performed following negative findings at both upper endoscopy and colonoscopy when OGIB was suspected, as well as to search for either small bowel localization of disease or polyps in Crohn disease and hereditary polyposis syndrome, respectively. In all cases, the PillCam Small Bowel (SB) Capsule Endoscope (Given Imaging Ltd., Lorenzatto, Turin, Italy) was used. The patients ingested a polyethylene glycol solution (2 L with two sachets of PEG 1000) between 7 p.m. and 9 p.m. the day before the examination and therefore remained fasting overnight, as per protocol in our unit. Two hours after ingestion of the capsule, patients were allowed to drink clear liquids and then eat a light snack after another 2 hours. The sensor array and recorder pack were disconnected after 8 hours, and images were downloaded to a workstation. Written informed consent was obtained from all the patients.
VCE Findings Evaluation Two nurses (A.G and F.D.M.) with greater than 15 years of experience in upper endoscopy and colonoscopy, but not enteroscopy, participated in the study. These nurses previously attended a specific 2-day course, organized by the local capsule distributor
(Lorenzatto, Turin, Italy), where they were trained in VCE videos to recognize the most common lesions of the small bowel. The nurses independently reviewed the VCE recordings and selected the first image of stomach, duodenum, and colon, as well as all the endoscopic lesions/abnormalities that were saved as “thumbnails.” All the videos were successively reviewed by a gastroenterologist with long-lasting experience in diagnostic and operative endoscopy, also trained on VCE procedure (C.H.), who was unaware of the nurses’ report. Similarly, the physician saved the thumbnails of the first image of stomach, duodenum, and colon, plus the detected endoscopic lesions. The time utilized to review the full VCE registration by either the nurse or the gastroenterologist was recorded. The detected small bowel lesions were categorized as “relevant” (bleeding, tumor, polyp, ulcer/ erosion, angiodysplasia, stenosis) or “irrelevant” (lymphangiectasia, lymphoid follicle, erythema, edema), as suggested in literature (Bossa et al., 2006; Levinthal et al., 2003). When a disagreement emerged, the VCE recording was further reviewed by another gastroenterologist (C.S.) who had a vast experience in small bowel capsule procedure and arbitrated the finding. The overall agreement between the nurse and the gastroenterologist in detecting small bowel lesions was calculated, as well as for either relevant and irrelevant findings.
Results Overall, 46 consecutive patients (M/F: 22/24; mean age: 58 ± 19.9 years, range: 23−93 years) were enrolled into the study. Indications for VCE included iron deficiency anemia (n = 37), suspected Crohn disease (n = 3), hereditary polyposis syndrome (n = 4), and chronic diarrhea (n = 2). The entire small bowel, with an adequate cleansing, was visualized in all cases. The two nurses randomly evaluated 22 and 24 VCEs, respectively, whereas the endoscopist evaluated all 46 videos. The average time to evaluate the videos was significantly longer for the nurses as compared with the gastroenterologist (78 minutes vs. 53 minutes; p < .001). Overall, 174 and 142 thumbnails were selected by nurses and the physician, respectively. The first endoscopic image of stomach, duodenum, and colon selected by the nurses overlapped with that of gastroenterologists in all cases. Overall, at least 1 lesion in the small bowel was detected in 27 (59%) and 25 (54%) patients by nurses and the endoscopist, respectively. As shown in Table 1, a total agreement between nurse and physician evaluation was observed for relevant findings, whereas the presence of two out of five irrelevant lesions reported by nurses (one lesion for each nurse) was not confirmed by the endoscopist. The absence of these irrelevant lesions was finally
108 Copyright © 2015 Society of Gastroenterology Nurses and Associates
Gastroenterology Nursing
Copyright © 2015 Society of Gastroenterology Nurses and Associates. Unauthorized reproduction of this article is prohibited.
GNJ-D-13-00030_LR 108
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Accuracy in Finding Small Bowel Lesions at Video Capsule Endoscopy
TABLE 1. Patients With Lesions Detected by Nurses and the Endoscopist Finding
Nurses
Endoscopist
Disagreement
Accuracy [95% CI]
Relevant lesions
22
22
0
100%
Angiodysplasias
7
7
0
Erosions
6
6
0
Polyps
5
5
0
Crohn disease
2
2
0
Cancer
1
1
0
Active bleeding
1
1
0
Irrelevant lesions
5
3
2a
Erythema
2
1
1
Edema
2
1
1
Lymphangiectasia
1
1
0
Overall lesions
27
25
2
92.6% [83, 100]
No lesions
19
19
0
100%
Overall agreement
60%
44/46; 95.6% [89.7, 100]
Note. CI = confidence interval. a The second endoscopist (arbitrator) confirmed the absence of both irrelevant lesions.
established by the referee endoscopist. Of note, the “no lesions” were found by the gastroenterologist in the VCE recordings also judged negative by the nurses.
Discussion The use of VCE for small bowel investigation is increasing in clinical practice, because no lesions are detected at both upper endoscopy and colonoscopy in different patients with either anemia or OGIB. The VCE is a highly accurate tool for mucosal examination of the entire small bowel (Costamagna et al., 2002). Currently, the nurse actively participates in the procedure from patient preparation to the video download in a dedicated workstation, whereas a gastroenterologist interprets the endoscopic findings. However, the VCE is an automatic registration, so that the operator may not affect the quality of stored images, but he or she may just review and interpret the findings. On the basis of this consideration, it is expected that an expert gastroenterology nurse, specifically trained on VCE images, would be able to accurately search for and classify the main small bowel lesions. Some studies found that the diagnostic yield of trained nurses did not differ from that of experienced gastroenterologists. Indeed, it has been found that the accuracy of nurses in interpreting VCE features, particularly for relevant lesions, is as high as 85%−100% (Bossa et al., 2006; Levinthal et al., 2003). Data of our VOLUME 38 | NUMBER 2 | MARCH/APRIL 2015
study found that trained nurses, with a large experience in endoscopic features, correctly identified the intestinal tract (stomach, small bowel, and colon) and found small bowel lesions on VCE recordings with the same accuracy as an experienced gastroenterologist. In detail, the nurses were able to detect all the relevant lesions that would affect patient management. In addition, the physician failed to find either relevant or irrelevant lesions among those VCE videos classified as “negative” by the nurses. These observations suggest that a trained nurse may accurately evaluate the VCE findings, by selecting the thumbnails of all mucosal irregularities that may then be faster reviewed by the endoscopist for a final diagnosis. This would significantly reduce the relatively high cost of VCE procedure (Rondonotti et al., 2010), as calculated elsewhere (Bossa et al., 2006). On the contrary, the observed propensity of nurses in overcalling some irrelevant findings could be easily marginalized by the successive physician’s interpretation of the selected thumbnails, without increasing the management cost.
Conclusion In conclusion, this study found that an experienced gastroenterology nurse, specifically trained on the procedure, is able to accurately review and interpret the VCE findings, as well as detect all the small bowel lesions as compared with an experienced endoscopist. 109
Copyright © 2015 Society of Gastroenterology Nurses and Associates. Unauthorized reproduction of this article is prohibited.
GNJ-D-13-00030_LR 109
23/03/15 7:20 PM
Accuracy in Finding Small Bowel Lesions at Video Capsule Endoscopy
Therefore, the entire VCE procedure could be safely performed by a trained nurse, leaving to the physician the final interpretation of the accurately selected endoscopic findings.
REFERENCES Bossa, F., Cocomazzi, G., Valvano, M. R., Andriulli, A., & Annese, V. (2006). Detection of abnormal lesions recorded by capsule endoscopy. A prospective study comparing endoscopist’s and nurse’s accuracy. Digestive and Liver Disease, 38, 599–602. Brock, A. S., Freeman, J., Roberts, J., Dantzler, T. E., & Hoffman, B. J. (2012). Resource-efficient tool for training novices in wireless capsule endoscopy. Gastroenterology Nursing, 35, 45–48. Comstock, D. (2003). Performing capsule endoscopy. Gastroenterology Nursing, 26, 178–181. Costamagna, G., Shah, S. K., Riccioni, M. E., Foschia, F., Mutignani, M., Perri, V., … Marano, P. (2002). A prospective trial comparing small bowel radiographs and video capsule endoscopy for suspected small bowel disease. Gastroenterology, 123, 999–1005.
Jungles, S. L. (2004). Video wireless capsule endoscopy. A diagnostic tool for early Crohn’s disease. Gastroenterology Nursing, 27, 170–175. Levinthal, G. N., Burke, C. A., & Santisi, J. M. (2003). The accuracy of an endoscopy nurse in interpreting capsule endoscopy. The American Journal of Gastroenterology, 98, 2669–2671. Nutter, M., Dunston, D., Ieyoub, J., Hart, A., Harper, J., & Burke, M. S. (2010) A retrospective analysis comparing small bowel follow-through with wireless capsule endoscopy in the evaluation of obscure gastrointestinal bleeding. Gastroenterology Nursing, 33, 298–302. Rondonotti, E., Soncini, M., Girelli, C., Villa, F., Russo, A., & de Franchis, R. (2010). Cost estimation of small bowel capsule endoscopy based on “real world” data: inpatient or outpatient procedure? Digestive and Liver Disease, 42, 798–802. Saddler, D. (2005). Wireless capsule endoscopy. Two research methods, one outcome. Gastroenterology Nursing, 28, 516–517. Sidhu, R., Sanders, D. S., Kapur, K., Marshall, L., Hurlstone, D. P., & McAlindon, M. E. (2007). Capsule endoscopy. Is there a role for nurses as physician extenders? Gastroenterology Nursing, 30, 45–48.
110 Copyright © 2015 Society of Gastroenterology Nurses and Associates
Gastroenterology Nursing
Copyright © 2015 Society of Gastroenterology Nurses and Associates. Unauthorized reproduction of this article is prohibited.
GNJ-D-13-00030_LR 110
23/03/15 7:20 PM
Accuracy of Trained Nurses in Finding Small Bowel Lesions at Video Capsule Endoscopy ABSTRACT The video capsule endoscopy is an accurate tool to investigate the entire small bowel. Currently, the nurse actively participates in the procedure from patient preparation to the video download, whereas a gastroenterologist interprets the endoscopic findings. However, few studies recently showed high accuracy of nurses in detecting lesions in the small bowel on video capsule endoscopy recordings. This prospective study aimed to assess the ability of experienced and trained nurses in detecting small bowel lesions as compared with gastroenterologists. Forty-six consecutive video capsule endoscopy procedures were analyzed. Overall, the nurse evaluation was highly (95.6%) accurate in detecting small bowel lesions, with a 100% concordance with the gastroenterologist for the relevant findings. In addition, the absence of lesions was confirmed by the endoscopist in all cases classified as negative by the nurse. Data of this study found that trained nurses, with a large experience in endoscopic features, correctly identified small bowel lesions on video capsule endoscopy recordings. Therefore, a trained nurse may accurately select the thumbnails of all mucosal irregularities that may be faster reviewed by the endoscopist for a final diagnosis.
Received March 6, 2013; accepted October 29, 2013. About the authors: Alessandra Guarini, RN, is with Gastroenterology and Digestive Endoscopy, Nuovo Regina Margherita Hospital, Roma, Italy. Francesca De Marinis, RN, is with Gastroenterology and Digestive Endoscopy, Nuovo Regina Margherita Hospital, Roma, Italy. Cesare Hassan, MD, is with Gastroenterology and Digestive Endoscopy, Nuovo Regina Margherita Hospital, Roma, Italy. Cristiano Spada, MD, is with Digestive Endoscopy Unit, Catholic University, Rome, Italy. Vincenzo Bruzzese, MD, is with Gastroenterology and Digestive Endoscopy, Nuovo Regina Margherita Hospital, Roma, Italy. Angelo Zullo, MD, is with Gastroenterology and Digestive Endoscopy, Nuovo Regina Margherita Hospital, Roma, Italy. The authors declare no conflicts of interest. Correspondence to: Angelo Zullo, MD, Gastroenterologia ed Endoscopia Digestiva, PTP Nuovo Regina Margherita, Via E. Morosini, 30 00153 Roma, Italia ([email protected]). DOI: 10.1097/SGA.0000000000000096
VOLUME 38 | NUMBER 2 | MARCH/APRIL 2015
V
ideo capsule endoscopy (VCE) is an accurate, wireless technologic method introduced in the last decade for investigating the entire small bowel (Comstock, 2003; Saddler, 2005). The main indications for VCE include obscure gastrointestinal bleeding (OGIB), Crohn disease, hereditary polyposis syndrome, and malabsorptive syndromes (Jungles, 2004; Nutter et al., 2010). Drug-related enteropathy, chronic diarrhea, and follow-up of patients who underwent intestinal transplantation are also potential indications under investigation (Bossa, Cocomazzi, Valvano, Andriulli, & Annese, 2006). Video capsule endoscopy is generally performed when both upper endoscopy and colonoscopy are negative. The swallowable capsule allows up to 54,000 video images to be acquired during the 8 hours of recording. The current role of the nurse in such a procedure includes preparation of the patient with application of 107
Copyright © 2015 Society of Gastroenterology Nurses and Associates. Unauthorized reproduction of this article is prohibited.
GNJ-D-13-00030_LR 107
23/03/15 7:20 PM
Accuracy in Finding Small Bowel Lesions at Video Capsule Endoscopy
sensor arrays, administration of the capsule, and, subsequently, download of images. The major limitation of VCE is the time needed to review the stored images, which is ranging from 60 to 120 minutes (Costamagna et al., 2002), a long-time for a procedure to be performed by a gastroenterologist. Different from traditional endoscopy, the VCE procedure itself is an operator-independent process and, consequently, both quantity and quality of recorded images are not affected by the operator skill. To rationalize the exploitation of medical resources, the longlasting VCE recordings may be effectively read by nurses appropriately trained (Brock, Freeman, Roberts, Dantzler, & Hoffman, 2012; Saddler, 2005; Sidhu, 2007). To date, a few studies assessed the accurateness of nurses in detecting lesions in the small bowel on VCE recordings, showing a good/excellent agreement with the gastroenterologist (Bossa et al., 2006; Levinthal, Burke, & Santisi, 2003). We therefore performed a prospective study to assess the ability of experienced and trained nurses in detecting small bowel lesions using VCE as compared with experienced gastroenterologists.
Methods VCE Procedure All consecutive patients who underwent small bowel examination with VCE in routine clinical practice in a single center were enrolled in the study. The procedure was performed following negative findings at both upper endoscopy and colonoscopy when OGIB was suspected, as well as to search for either small bowel localization of disease or polyps in Crohn disease and hereditary polyposis syndrome, respectively. In all cases, the PillCam Small Bowel (SB) Capsule Endoscope (Given Imaging Ltd., Lorenzatto, Turin, Italy) was used. The patients ingested a polyethylene glycol solution (2 L with two sachets of PEG 1000) between 7 p.m. and 9 p.m. the day before the examination and therefore remained fasting overnight, as per protocol in our unit. Two hours after ingestion of the capsule, patients were allowed to drink clear liquids and then eat a light snack after another 2 hours. The sensor array and recorder pack were disconnected after 8 hours, and images were downloaded to a workstation. Written informed consent was obtained from all the patients.
VCE Findings Evaluation Two nurses (A.G and F.D.M.) with greater than 15 years of experience in upper endoscopy and colonoscopy, but not enteroscopy, participated in the study. These nurses previously attended a specific 2-day course, organized by the local capsule distributor
(Lorenzatto, Turin, Italy), where they were trained in VCE videos to recognize the most common lesions of the small bowel. The nurses independently reviewed the VCE recordings and selected the first image of stomach, duodenum, and colon, as well as all the endoscopic lesions/abnormalities that were saved as “thumbnails.” All the videos were successively reviewed by a gastroenterologist with long-lasting experience in diagnostic and operative endoscopy, also trained on VCE procedure (C.H.), who was unaware of the nurses’ report. Similarly, the physician saved the thumbnails of the first image of stomach, duodenum, and colon, plus the detected endoscopic lesions. The time utilized to review the full VCE registration by either the nurse or the gastroenterologist was recorded. The detected small bowel lesions were categorized as “relevant” (bleeding, tumor, polyp, ulcer/ erosion, angiodysplasia, stenosis) or “irrelevant” (lymphangiectasia, lymphoid follicle, erythema, edema), as suggested in literature (Bossa et al., 2006; Levinthal et al., 2003). When a disagreement emerged, the VCE recording was further reviewed by another gastroenterologist (C.S.) who had a vast experience in small bowel capsule procedure and arbitrated the finding. The overall agreement between the nurse and the gastroenterologist in detecting small bowel lesions was calculated, as well as for either relevant and irrelevant findings.
Results Overall, 46 consecutive patients (M/F: 22/24; mean age: 58 ± 19.9 years, range: 23−93 years) were enrolled into the study. Indications for VCE included iron deficiency anemia (n = 37), suspected Crohn disease (n = 3), hereditary polyposis syndrome (n = 4), and chronic diarrhea (n = 2). The entire small bowel, with an adequate cleansing, was visualized in all cases. The two nurses randomly evaluated 22 and 24 VCEs, respectively, whereas the endoscopist evaluated all 46 videos. The average time to evaluate the videos was significantly longer for the nurses as compared with the gastroenterologist (78 minutes vs. 53 minutes; p < .001). Overall, 174 and 142 thumbnails were selected by nurses and the physician, respectively. The first endoscopic image of stomach, duodenum, and colon selected by the nurses overlapped with that of gastroenterologists in all cases. Overall, at least 1 lesion in the small bowel was detected in 27 (59%) and 25 (54%) patients by nurses and the endoscopist, respectively. As shown in Table 1, a total agreement between nurse and physician evaluation was observed for relevant findings, whereas the presence of two out of five irrelevant lesions reported by nurses (one lesion for each nurse) was not confirmed by the endoscopist. The absence of these irrelevant lesions was finally
108 Copyright © 2015 Society of Gastroenterology Nurses and Associates
Gastroenterology Nursing
Copyright © 2015 Society of Gastroenterology Nurses and Associates. Unauthorized reproduction of this article is prohibited.
GNJ-D-13-00030_LR 108
23/03/15 7:20 PM
Accuracy in Finding Small Bowel Lesions at Video Capsule Endoscopy
TABLE 1. Patients With Lesions Detected by Nurses and the Endoscopist Finding
Nurses
Endoscopist
Disagreement
Accuracy [95% CI]
Relevant lesions
22
22
0
100%
Angiodysplasias
7
7
0
Erosions
6
6
0
Polyps
5
5
0
Crohn disease
2
2
0
Cancer
1
1
0
Active bleeding
1
1
0
Irrelevant lesions
5
3
2a
Erythema
2
1
1
Edema
2
1
1
Lymphangiectasia
1
1
0
Overall lesions
27
25
2
92.6% [83, 100]
No lesions
19
19
0
100%
Overall agreement
60%
44/46; 95.6% [89.7, 100]
Note. CI = confidence interval. a The second endoscopist (arbitrator) confirmed the absence of both irrelevant lesions.
established by the referee endoscopist. Of note, the “no lesions” were found by the gastroenterologist in the VCE recordings also judged negative by the nurses.
Discussion The use of VCE for small bowel investigation is increasing in clinical practice, because no lesions are detected at both upper endoscopy and colonoscopy in different patients with either anemia or OGIB. The VCE is a highly accurate tool for mucosal examination of the entire small bowel (Costamagna et al., 2002). Currently, the nurse actively participates in the procedure from patient preparation to the video download in a dedicated workstation, whereas a gastroenterologist interprets the endoscopic findings. However, the VCE is an automatic registration, so that the operator may not affect the quality of stored images, but he or she may just review and interpret the findings. On the basis of this consideration, it is expected that an expert gastroenterology nurse, specifically trained on VCE images, would be able to accurately search for and classify the main small bowel lesions. Some studies found that the diagnostic yield of trained nurses did not differ from that of experienced gastroenterologists. Indeed, it has been found that the accuracy of nurses in interpreting VCE features, particularly for relevant lesions, is as high as 85%−100% (Bossa et al., 2006; Levinthal et al., 2003). Data of our VOLUME 38 | NUMBER 2 | MARCH/APRIL 2015
study found that trained nurses, with a large experience in endoscopic features, correctly identified the intestinal tract (stomach, small bowel, and colon) and found small bowel lesions on VCE recordings with the same accuracy as an experienced gastroenterologist. In detail, the nurses were able to detect all the relevant lesions that would affect patient management. In addition, the physician failed to find either relevant or irrelevant lesions among those VCE videos classified as “negative” by the nurses. These observations suggest that a trained nurse may accurately evaluate the VCE findings, by selecting the thumbnails of all mucosal irregularities that may then be faster reviewed by the endoscopist for a final diagnosis. This would significantly reduce the relatively high cost of VCE procedure (Rondonotti et al., 2010), as calculated elsewhere (Bossa et al., 2006). On the contrary, the observed propensity of nurses in overcalling some irrelevant findings could be easily marginalized by the successive physician’s interpretation of the selected thumbnails, without increasing the management cost.
Conclusion In conclusion, this study found that an experienced gastroenterology nurse, specifically trained on the procedure, is able to accurately review and interpret the VCE findings, as well as detect all the small bowel lesions as compared with an experienced endoscopist. 109
Copyright © 2015 Society of Gastroenterology Nurses and Associates. Unauthorized reproduction of this article is prohibited.
GNJ-D-13-00030_LR 109
23/03/15 7:20 PM
Accuracy in Finding Small Bowel Lesions at Video Capsule Endoscopy
Therefore, the entire VCE procedure could be safely performed by a trained nurse, leaving to the physician the final interpretation of the accurately selected endoscopic findings.
REFERENCES Bossa, F., Cocomazzi, G., Valvano, M. R., Andriulli, A., & Annese, V. (2006). Detection of abnormal lesions recorded by capsule endoscopy. A prospective study comparing endoscopist’s and nurse’s accuracy. Digestive and Liver Disease, 38, 599–602. Brock, A. S., Freeman, J., Roberts, J., Dantzler, T. E., & Hoffman, B. J. (2012). Resource-efficient tool for training novices in wireless capsule endoscopy. Gastroenterology Nursing, 35, 45–48. Comstock, D. (2003). Performing capsule endoscopy. Gastroenterology Nursing, 26, 178–181. Costamagna, G., Shah, S. K., Riccioni, M. E., Foschia, F., Mutignani, M., Perri, V., … Marano, P. (2002). A prospective trial comparing small bowel radiographs and video capsule endoscopy for suspected small bowel disease. Gastroenterology, 123, 999–1005.
Jungles, S. L. (2004). Video wireless capsule endoscopy. A diagnostic tool for early Crohn’s disease. Gastroenterology Nursing, 27, 170–175. Levinthal, G. N., Burke, C. A., & Santisi, J. M. (2003). The accuracy of an endoscopy nurse in interpreting capsule endoscopy. The American Journal of Gastroenterology, 98, 2669–2671. Nutter, M., Dunston, D., Ieyoub, J., Hart, A., Harper, J., & Burke, M. S. (2010) A retrospective analysis comparing small bowel follow-through with wireless capsule endoscopy in the evaluation of obscure gastrointestinal bleeding. Gastroenterology Nursing, 33, 298–302. Rondonotti, E., Soncini, M., Girelli, C., Villa, F., Russo, A., & de Franchis, R. (2010). Cost estimation of small bowel capsule endoscopy based on “real world” data: inpatient or outpatient procedure? Digestive and Liver Disease, 42, 798–802. Saddler, D. (2005). Wireless capsule endoscopy. Two research methods, one outcome. Gastroenterology Nursing, 28, 516–517. Sidhu, R., Sanders, D. S., Kapur, K., Marshall, L., Hurlstone, D. P., & McAlindon, M. E. (2007). Capsule endoscopy. Is there a role for nurses as physician extenders? Gastroenterology Nursing, 30, 45–48.
110 Copyright © 2015 Society of Gastroenterology Nurses and Associates
Gastroenterology Nursing
Copyright © 2015 Society of Gastroenterology Nurses and Associates. Unauthorized reproduction of this article is prohibited.
GNJ-D-13-00030_LR 110
23/03/15 7:20 PM
