Training in video capsule endoscopy: Current status and unmet needs

Abstract

Since its introduction to clinical practice nearly 20 years ago, wireless capsule endoscopy has revolutionized the landscape in the diagnosis and management of small bowel diseases. Over the past 10 years, capsule endoscopy has evolved beyond the small intestine and a range of capsules are now available to examine the esophagus, stomach and colon. Because of its ease of use, tolerability, paucity of complications and ability to visualize the entire gastrointestinal tract, capsule endoscopy has entered the mainstream of clinical practice. This review of the literature summarizes the current state of capsule training and highlights the limited data available to assess reader competence and standards expected of an independent practitioner. There are neither standardized teaching strategies nor national or international metrics for accreditation of physicians and non-physicians interested in mastering this examination. Summating the few publications, there appears to be consensus that diagnostic expertise improves with experience, and that trainees should be fully supervised for at least 20 full case studies. Formative and summative assessment is advisable and the number of taught cases should not be the sole determinant of competence. The review also highlights differences in recommendations from major national gastroenterology societies. Finally, the authors discuss areas of unmet needs in teaching and learning for capsule endoscopy.

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

“…Another interesting finding from the survey is that most endoscopists involved in performing SBCE have not undergone any formal training. SBCE training programs are neither available nor a prerequisite for completing specialist gastroenterology training in most countries [24][25][26]. Still, their beneficial effect on lesion recognition and improvement in classification skills is undisputed [9].…”

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

“…Analysis of CapCT showed high interobserver agreement among CE experts with each test item, supporting CapCT as a validated assessment tool for CE competency. A comprehensive review of CE training by Koffas et al 11 identified several studies that showed a high degree of interobserver agreement among experienced readers. Although based on a small sample size of 10 patients, Petroniene et al 19 showed an excellent interobserver agreement in diagnosing celiac disease among experts (kappa Z 1) and poor agreement (kappaZ 0.2) between investigators with limited exposure to CE.…”

“…[1][2][3][4][5][6][7][8][9] However, the minimum training requirements to achieve competence in CE are primarily based on societal guidelines, limited data, and expert opinion. [10][11][12] There is no universally accepted standardized training program or competency assessment tool. Objective measures to assess and define competence are lacking.…”

Untitled

“…Ultimately, we believe that although SBCE is a highly technical tool, the most effective way to shorten reading times while maintaining accuracy and effectiveness is strictly linked to reader competency. Although expertise in upper and lower gastrointestinal endoscopy is necessary prerequisite [9,26,27], SBCE has specific technical features that make it different from other endoscopy techniques (e. g. underwater view, non-distended lumen, tangential non-adjustable view, back-and-forth capsule movements etc.). Therefore, even experienced endoscopists still require dedicated training.…”

“…Therefore, even experienced endoscopists still require dedicated training. However, SBCE training is currently not standardized, differing widely between countries and institutions [26,27] and the definition of competency has not yet been universally established. Several clinical researchers have evaluated the number of SBCE procedures needed to obtain reading privileges.…”