Bowel preparation with sodium phosphate before capsule endoscopy offers better visualization than overnight fasting alone and induces fewer disturbances by intraluminal turbid fluid.

SUMMARYBackground: Capsule endoscopy can identify lesions of the small bowel that cannot be detected by other techniques. In addition to patient safety, quality of care and cost-efficiency, good preparation is an important factor for good visualization. Aim: To evaluate the efficacy of oral sodium phosphate preparation. Methods: Forty-six consecutive patients scheduled for capsule endoscopy in two medical centres. The patients treated in Dallas were prepared by 12 h fasting (group A), and those treated in Israel were also asked to drink 45 mL of sodium phosphate with

Capsule endoscopy (CE) has been recommended as the method of choice for diagnostic endoscopy of the small bowel. An experienced nurse, after proper training, may contribute to the endoscopy procedures as previously described for sigmoidoscopy. The aim of this study was to evaluate the ability of an experienced gastroenterology nurse to prepare CE records for physician interpretation, by detecting abnormal thumbnails. A prospective, observational design was used. Fifty CE videos were preread by a specially trained gastroenterology nurse who thumbnailed the abnormalities detected for interpretation by the gastroenterologist. The nurse's description of the lesions and the calculated gastric and bowel transit times were compared to the interpretation of the videos made directly by the gastroenterologist (gold standard). The primary end point of the study was the quality of the nurse's pathology findings; the secondary end point was the cost effectiveness of this practice. There was complete agreement between the nurse and gastroenterologist for all 12 cases interpreted as normal by the gastroenterologist. In the remaining 38 cases, the nurse created 130 thumbnail selections and the physician, 99. Complete interobserver agreement was achieved for 93 of the 96 lesions categorized as "significant" by the physician (96.9%). After all relevant variables were taken into account, this approach saved $324 per CE examination. The use of nurse practitioner to preread CE videos and prepare thumbnail selections for further assessment by the gastroenterologist appears to be safe, reliable, and cost effective.KEY WORDS: M2A; capsule endoscopy; endoscopy; enteroscopy; small bowel.Recent studies recommending video capsule endoscopy (CE) as the method of choice for small bowel diagnostic endoscopy have led to its growing application in medical practice (1-4). At present, however, the extensive use of CE is limited by its high cost. Furthermore, as with any new technique, its proper implementation involves experience and a learning curve to minimize errors in interpretation. Previous studies of conventional endoscopy demonstrated variability in findings and interpretations among gastroenterologists (5-9), as well as between gastroenterologists and nurses (10-13). Most of the differences were associated with level of experience and borderline results (8, 9). There was a high level of agreement for clear and well-known findings, such as polyps and ulcers, and a low level for indeterminate lesions such as irregular "Z-lines." Levinthal et al. (12) in a small study of 20 capsule videos, found that goal results were achieved when the capsule results were first read by a trained gastroenterology nurse who demarcated the areas of suspected pathology for further assessment by the physician. This strategy saved time and money without compromising the quality of the examination. It is supported by a wealth of evidence in the literature that gastroenterology nurses can efficiently interpret other types of endoscopic data (10-12).The aim of the...