Prospective multicenter study to evaluate capsule endoscopy competency using a validated assessment tool

Rajan, Elizabeth; Martı́nez, Manuel; Gorospe, Emmanuel C.; Bawardy, Badr Al; Dobashi, Akira; Mara, Kristin C.; Hansel, Stephanie L.; Murray, Joseph A.; Leggett, Cadman L.; Nehra, Vandana; Iyer, Prasad G.; Leighton, Jonathan A.; Shiff, Arthur D.; Gurudu, Suryakanth R.; Raffals, Laura E.; Lavey, Crystal; Katzka, David A.; Chen, Chien Huan H.

doi:10.1016/j.gie.2019.12.024

Cited by 8 publications

(4 citation statements)

References 29 publications

(24 reference statements)

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“…The performance of fellows with less than 20 supervised SBCE readings was inferior to the performance of those who had read more than 20 SBCEs after a formalized training program [8]. In a recent American multicenter study, fellows enrolled in a structured SBCE training program achieved a mean score of 84 or better when they had interpreted at least 25 SBCEs [30].…”

Section: Knowledge and Maintaining Competence In Sbcementioning

confidence: 97%

Curriculum for small-bowel capsule endoscopy and device-assisted enteroscopy training in Europe: European Society of Gastrointestinal Endoscopy (ESGE) Position Statement

et al. 2020

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Main RecommendationsThe European Society of Gastrointestinal Endoscopy (ESGE) has recognized the need to formalize training in small-bowel endoscopy across European centers. The following criteria and framework for training in small-bowel capsule endoscopy (SBCE) and device-assisted enteroscopy (DAE), which aim to provide uniform and high quality training to ensure that small-bowel endoscopists are competent to operate independently, are based on the current literature and experience of experts in the field. Three main areas are covered: skills required prior to commencing training in small-bowel endoscopy; structured training for trainees to become independent endoscopists; and ways of ensuring competence is achieved. 1 Centers providing training in SBCE should perform a minimum of 75 – 100 SBCEs/year. 2 Experience in bidirectional endoscopies is desirable for structured training in SBCE. 3 SBCE courses should consist of at least 50 % hands-on training and cover information on technology, indications and contraindications for SBCE, pathologies that can be encountered on SBCE, and standard terminology that should be used during reporting of SBCE. An SBCE course should be completed prior to achieving competence in SBCE reporting. 4 Competence in SBCE can be assessed by considering a minimum of 30 SBCEs. Direct Observation of Procedural Skills, short SBCE videos, and multiple-choice questions can be useful to assess improvement in the skills of trainees. 5 Centers offering training in DAE should aim to carry out at least 75 DAEs/year, should have direct links with an SBCE service, and should allow regular discussion of cases at a radiology small-bowel MDT. Training centers with lower numbers are encouraged to offer training by “buddying-up” with other centers, or using mentoring systems. 6 DAE trainees must be independent in bidirectional endoscopies and have experience in level 1 polypectomy prior to commencement of training. They should also be competent in reviewing SBCEs. 7 Training in DAE should be structured with a minimum of 75 procedures, including 35 retrograde DAEs, with therapeutic procedures undertaken in at least 50 % of the DAEs performed. Training should cover the indications, contraindications, complications including prevention, and technicalities of the DAE procedure; formal evaluation should follow. DAE trainees must acquire skills to independently manage and advise on small-bowel pathology following DAE procedures. 8 It is highly recommended that international societies develop online modules and courses on DAE, which are currently lacking across Europe.

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Section: Knowledge and Maintaining Competence In Sbcementioning

confidence: 97%

Curriculum for small-bowel capsule endoscopy and device-assisted enteroscopy training in Europe: European Society of Gastrointestinal Endoscopy (ESGE) Position Statement

et al. 2020

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“…Similarly, 2018 performance measures were also analyzed according to the 2018 caseload: centers performing ≤ 35 SBCEs in 2018 were defined as low volume centers, whereas those performing ≥ 36 SBCEs were defined as medium-high volume centres. Although we have to acknowledge that this threshold (35 procedures") is fully arbitrary, taking into account the available evidence [13][14][15][16][17] the recently published ESGE Position Statement [18] stated that competence in SBCE can be assessed by considering a minimum of 30 SBCEs. Therefore, we might argue that 35 could represent a reasonable number of procedures to achieve and maintain proficiency in reading SBCE over time.…”

Section: Subanalysesmentioning

confidence: 99%

Quality performance measures for small capsule endoscopy: Are the ESGE quality standards met?

Rondonotti

Spada

Cadoni³

et al. 2021

Endosc Int Open

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Background and study aims The European Society of Gastrointestinal Endoscopy (ESGE) recently issued a quality performance measures document for small bowel capsule endoscopy (SBCE). The aim of this nationwide survey was to explore SBCE practice with ESGE quality measures as a benchmark. Patients and methods A dedicated per-center semi-quantitative questionnaire based on ESGE performance measures for SBCE was created by a group of SBCE experts. One-hundred-eighty-one centers were invited to participate and were asked to calculate performance measures for SBCE performed in 2018. Data were compared with 10 ESGE quality standards for both key and minor performance measures. Results Ninety-one centers (50.3 %) participated in the data collection. Overall in the last 5 years (2014–2018), 26,615 SBCEs were performed, 5917 of which were done in 2018. Eighty percent or more of the participating centers reached the minimum standard established by the ESGE Small Bowel Working Group (ESBWG) for four performance measures (indications for SBCE, complete small bowel evaluation, diagnostic yield and retention rate). Conversely, compliance with six minimum standards established by ESBWG concerning adequate bowel preparation, patient selection, timing of SBCE in overt bleeding, appropriate reporting, reading protocols and referral to device-assisted enteroscopy was met by only 15.5 %, 10.9 %, 31.1 %, 67.7 %, 53.4 %, and 32.2 % of centers, respectively. Conclusions The present survey shows significant variability across SBCE centers; only four (4/10: 40 %) SBCE procedural minimum standards were met by a relevant proportion of the centers ( ≥ 80 %). Our data should help in identifying target areas for quality improvement programs in SBCE.

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“…A small prospective study showed that 20 CE studies were the number at which diagnostic yield was no longer significantly different between gastroenterology trainees and attending physicians (11). A multicenter study using a CE competency test to compare trainees to CE experts showed that trainees who underwent a structured CE training program should complete at least 25 supervised CE study interpretations before assessment of competency because that number was where the learning curve flattened (12). Whether interpretation of a minimum number of studies is regularly required to maintain competency remains unclear (9).…”

Section: Capsule Endoscopymentioning

confidence: 99%

Quality Indicators for Capsule Endoscopy and Deep Enteroscopy

et al. 2022

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INTRODUCTION:Capsule endoscopy (CE) and deep enteroscopy (DE) can be useful for diagnosing and treating suspected small-bowel disease. Guidelines and detailed recommendations exist for the use of CE/DE, but comprehensive quality indicators are lacking. The goal of this task force was to develop quality indicators for appropriate use of CE/DE by using a modified RAND/UCLA Appropriateness Method.METHODS:An expert panel of 7 gastroenterologists with diverse practice experience was assembled to identify quality indicators. A literature review was conducted to develop a list of proposed quality indicators applicable to preprocedure, intraprocedure, and postprocedure periods. The panelists reviewed the literature; identified and modified proposed quality indicators; rated them on the basis of scientific evidence, validity, and necessity; and determined proposed performance targets. Agreement and consensus with the proposed indicators were verified using the RAND/UCLA Appropriateness Method.RESULTS:The voting procedure to prioritize metrics emphasized selecting measures to improve quality and overall patient care. Panelists rated indicators on the perceived appropriateness and necessity for clinical practice. After voting and discussion, 2 quality indicators ranked as inappropriate or uncertain were excluded. Each quality indicator was categorized by measure type, performance target, and summary of evidence. The task force identified 13 quality indicators for CE and DE.DISCUSSION:Comprehensive quality indicators have not existed for CE or DE. The task force identified quality indicators that can be incorporated into clinical practice. The panel also addressed existing knowledge gaps and posed research questions to better inform future research and quality guidelines for these procedures.

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Prospective multicenter study to evaluate capsule endoscopy competency using a validated assessment tool

Cited by 8 publications

References 29 publications

Curriculum for small-bowel capsule endoscopy and device-assisted enteroscopy training in Europe: European Society of Gastrointestinal Endoscopy (ESGE) Position Statement

Curriculum for small-bowel capsule endoscopy and device-assisted enteroscopy training in Europe: European Society of Gastrointestinal Endoscopy (ESGE) Position Statement

Quality performance measures for small capsule endoscopy: Are the ESGE quality standards met?

Quality Indicators for Capsule Endoscopy and Deep Enteroscopy

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