Quality Indicators for Capsule Endoscopy and Deep Enteroscopy

Abstract

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.

A Randomized, Controlled Trial Comparing the Total Enteroscopy Rate and Diagnostic Efficacy of Novel Motorized Spiral Enteroscopy and Single-Balloon Enteroscopy in Patients With Small-Bowel Disorders: The Motor Trial (NCT 05548140)

“…after screening for inclusion and exclusion criteria. Each of these investigators received a block randomization sequence in the form of 6-sealed opaque envelopes labeled block identifiers (1-6) and sequences within blocks (1)(2)(3)(4)(5)(6)(7)(8)(9)(10)(11)(12). These envelopes were prepared by S.F.M.…”

“…Capsule endoscopy and cross-sectional imaging form the first evaluation steps (1) in the management of small-bowel disorders (SBD). Enteroscopy allows direct access to the small intestine for tissue sampling and performing therapeutic procedures.…”

The Saudi Gastroenterology Association guidelines for quality indicators in gastrointestinal endoscopic procedures

“…In patients with swallowing disorders or for patients at risk of gastric retention, endoscopic placement of the CE into the small intestine can overcome the risks associated with these conditions. [ 48 ]…”

A ramble through the small bowel

“…However, both society recommendations were focussed on procedural aspects rather than patient outcomes such as/analogous to adenoma detection for the colon. The other criticism was that many of the recommendations from all the above societal guidance were based on low-quality evidence [5,6] due to limited real world data pertaining to small bowel endoscopy outcomes. The authors also highlight that there are inherent differences in the provision of small bowel endoscopy services in many regions worldwide.…”

“…The European Society of Gastrointestinal Endoscopy (ESGE) begin addressing this issue by setting standards focussed on procedural aspects in 2019 [5]. This milestone was mirrored by the American College of Gastroenterology (ACG) and the American Society of Gastrointestinal Endoscopy (ASGE) [6]. However, both society recommendations were focussed on procedural aspects rather than patient outcomes such as/analogous to adenoma detection for the colon.…”