A randomized trial comparing wireless capsule endoscopy with push enteroscopy for the detection of small-bowel lesions

Appleyard, Mark; Fireman, Zvi; Glukhovsky, Arkady; Jacob, Harold; Shreiver, Reuven; Kadirkamanathan, Srinathan; Lavy, Alexandra; Lewkowicz, Schlomo; Scapa, Eytan; Shofti, Rona; Swain, Paul; Zaretsky, Asaph

doi:10.1053/gast.2000.20844

Cited by 388 publications

(179 citation statements)

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“…The sensitivity of CE was estimated to be 75% for all small bowel mucosal lesions. 10,13,18,19 It was assumed that PE and DBE were able to detect 90% of lesions within the reach of the scope. 18 However, the diagnostic yield of DBE and PE was dependent on the extent of small bowel evaluated.…”

Section: Test Characteristics Of Strategies Modeled and Prevalence Ofmentioning

confidence: 99%

Management of Obscure Occult Gastrointestinal Bleeding: A Cost-Minimization Analysis

Somsouk

Gralnek

Inadomi

2008

Clinical Gastroenterology and Hepatology

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Section: Test Characteristics Of Strategies Modeled and Prevalence Ofmentioning

confidence: 99%

Management of Obscure Occult Gastrointestinal Bleeding: A Cost-Minimization Analysis

Somsouk

Gralnek

Inadomi

2008

Clinical Gastroenterology and Hepatology

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“…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)(2)(3)(4). At present, however, the extensive use of CE is limited by its high cost.…”

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confidence: 99%

Capsule Endoscopy Examination—Preliminary Review by a Nurse

Niv

2005

Dig Dis Sci

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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...

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“…The reported time range typically needed for a complete review of a single capsule endoscopy recording case is anywhere from 50 [6,7] to 120 min [8] . Numerous studies have now demonstrated that the sensitivity and specificity of capsule endoscopy are advantageous over the traditional diagnostic methods of small bowel lesions [5][6][7][9][10][11] . Capsule endoscopy may also reduce total medical utilization and costs as well as improve patient's quality of life in certain circumstances [12] .…”

Section: Introductionmentioning

confidence: 99%

Sensitivity and inter-observer variability for capsule endoscopy image analysis in a cohort of novice readers

Chen

Enayati²,

Tran³

et al. 2006

WJG

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sensitivity in detecting lesions on capsule endoscopy. A group of novice readers can pre-screen recordings to thumbnail potential areas of small bowel lesions for further review. These thumbnails must be reviewed to determine the clinical relevance. Further studies are ongoing to assess other cohorts. INTRODUCTIONCapsule endoscopy is a new diagnostic procedure developed for the complete examination of the small intestine through video images transmitted from an ingestible camera [1][2][3] . Briefly, the PillCam TM capsule endoscopy and diagnostic imaging system (GIVEN Imaging, Yoqneam, Israel) is a commercially available system consisting of three major components: PillCam TM capsule which captures images and transmits digital pictures (at 2 frames/s) over an 8-h period, sensor array and data recorder, which receives and records the data transmitted from the PillCam TM capsule and RAPID TM Workstation, which is used to initialize the data recorder and to download and process the raw data from the data recorder [4,5] . The processed information, composed of approximately 50 000 still images collected over an 8-h period, can be reviewed as a continuous video stream. The reported time range typically needed for a complete review of a single capsule endoscopy recording case is anywhere from 50 [6,7] to 120 min [8] . Numerous studies have now demonstrated that the sensitivity and specificity of capsule endoscopy are advantageous over the traditional diagnostic methods of small bowel lesions [5][6][7][9][10][11] . Capsule endoscopy may also reduce total medical utilization and costs as well as improve patient's quality of life in certain circumstances [12] . RAPID COMMUNICATION Sensitivity and inter METHODS:Ten capsule endoscopy cases of small bowel lesions were administered to the readers. Gold standard findings were pre-defined by gastroenterologists. Ten gold standard "targets" were identified among the 10 cases. Readers were given a 30-min overview of Rapid Reader software and instructed to mark any potential areas of abnormalities. A software program was developed using SAS to analyze the thumbnailed findings. RESULTS:The overall sensitivity for detecting the gold standard findings was 80%. As a group, at least 5 out of 10 readers detected each gold standard finding per recording. All the gold standard targets were identified when the readers' results were combined. Incidental finding/false positive rate ranged between 8.2-59.8 per reader. CONCLUSION:A panel of medical students with minimal endoscopic experience can achieve high

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A randomized trial comparing wireless capsule endoscopy with push enteroscopy for the detection of small-bowel lesions

Cited by 388 publications

References 16 publications

Management of Obscure Occult Gastrointestinal Bleeding: A Cost-Minimization Analysis

Management of Obscure Occult Gastrointestinal Bleeding: A Cost-Minimization Analysis

Capsule Endoscopy Examination—Preliminary Review by a Nurse

Sensitivity and inter-observer variability for capsule endoscopy image analysis in a cohort of novice readers

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