Implementation of European Society of Gastrointestinal Endoscopy (ESGE) recommendations for small-bowel capsule endoscopy into clinical practice: Results of an official ESGE survey

Abstract

Background We aimed to document international practices in small-bowel capsule endoscopy (SBCE), measuring adherence to European Society of Gastrointestinal Endoscopy (ESGE) technical and clinical recommendations. Methods Participants reached through the ESGE contact list completed a 52-item web-based survey. Results 217 responded from 47 countries (176 and 41, respectively, from countries with or without a national society affiliated to ESGE). Of respondents, 45 % had undergone formal SBCE training. Among SBCE procedures, 91 % were performed with an ESGE recommended indication, obscure gastrointestinal bleeding (OGIB), iron-deficiency anemia (IDA), and suspected/established Crohn’s disease being the commonest and with higher rates of positive findings (49.4 %, 38.2 % and 53.5 %, respectively). A watchful waiting strategy after a negative SBCE for OGIB or IDA was preferred by 46.7 % and 70.3 %, respectively. SBCE was a second-line exam for evaluation of extent of new Crohn’s disease for 62.2 % of respondents. Endoscopists adhered to varying extents to ESGE technical recommendations regarding bowel preparation ( > 60 %), use in those with pacemaker holders (62.5 %), patency capsule use (51.2 %), and use of a validated scale for bowel preparation assessment (13.3 %). Of the respondents, 67 % read and interpreted the exams themselves and 84 % classified exams findings as relevant or irrelevant. Two thirds anticipated future increase in SBCE demand. Inability to obtain tissue (78.3 %) and high cost (68.1 %) were regarded as the main limitations, and implementation of artificial intelligence as the top development priority (56.2 %). Conclusions To some extent, endoscopists follow ESGE guidelines on using SBCE in clinical practice. However, variations in practice have been identified, whose implications require further evaluation.

Outcomes in high and low volume hospitals in patients with acute hematochezia in a cohort study

“…Although CT is more commonly performed in high-volume hospitals, the use of colonoscopy is the reverse of CT. Upper gastrointestinal bleeding should be suspected in cases of gastrointestinal bleeding with unstable vitals, even for patients presenting with acute hematochezia. CT was recommended as a first-line diagnostic modality for these patients 10 – 14 . Our finding that CT was performed more frequently in high-volume hospitals might explain the high proportion of patients with unstable vital signs, such as patients with upper gastrointestinal bleeding who presented with acute hematochezia.…”

“…A few recent studies have reported the therapeutic utility of ligation therapy for colonic diverticular bleeding 18 , 19 . Moreover, the guidelines for endoscopic clipping recommend that clips be placed onto the vessels by grasping directly, not in a zipper fashion, to ensure hemostatic effects 10 – 14 . However, the reason for the significant difference in the treatment methods between the groups was not clear in the present study.…”

“…Third, we performed path and mediation analyses on a colonoscopy-based strategy. However, because there are different paths, such as interventional radiology for the management of patients with acute hematochezia 10 – 14 , additional path and mediation analyses were required to evaluate the mediation effects between hospital characteristics and outcomes.…”

“…Second, this study is the first to report a comparison of management and clinical outcomes for patients with acute hematochezia according to hospital characteristics and perform path and mediation analyses. Several guidelines for the management of ALGIB have been published 10 – 14 . However, there is little information on the association between hospital characteristics and clinical outcomes, types of hospitals that should receive patients with acute hematochezia, and mediation effects on important outcomes.…”

“…Recently, path analysis and a generalized structural equation model (GSEM) have been used not only in causal pathways but also for the evaluation of complex network and mediation analysis 8 , 9 . As acute hematochezia has many possible causes and the diagnosis of ALGIB requires computed tomography (CT) and colonoscopy, management strategies remain complicated despite the currently available guidelines 10 – 14 . The introduction of path and mediation analyses may be required for the evaluation of these diagnostic and treatment modalities for patients with ALGIB.…”