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High Concordance between Trained Nurses and Gastroenterologists in Evaluating Recordings of Small Bowel Video Capsule Endoscopy (VCE)

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Alessandra Guarini1, Francesca De Marinis1, Cesare Hassan1, Raffaele Manta2, Vincenzo De Francesco3, Bruno Annibale4, Angelo Zullo1

1) Gastroenterology and Digestive Endoscopy, “Nuovo Regina Margherita” Hospital, Rome,
2) Digestive Endoscopy Unit, “Civile S. Agostino-Estense” Hospital, Baggiovara, Modena,
3) Gastroenterology Unit, “Riuniti” Hospital, Foggia,
4) Department of Digestive and Liver Disease, Sant’Andrea Hospital, “Sapienza” University, Rome, Italy

DOI: http://dx.doi.org/10.15403/jgld.2014.1121.272.vce

Background & Aims: The video capsule endoscopy (VCE) is an accurate and validated tool to investigate the entire small bowel mucosa, but VCE recordings interpretation by the gastroenterologist is time-consuming.
A pre-reading of VCE recordings by an expert nurse could be accurate and cost saving. We assessed the concordance between nurses and gastroenterologists in detecting lesions on VCE examinations.
Methods: This was a prospective study enrolling consecutive patients who had undergone VCE in clinical practice. Two trained nurses and two expert gastroenterologists participated in the study. At VCE pre-reading the nurses selected any abnormalities, saved them as “thumbnails” and classified the detected lesions as a vascular abnormality, ulcerative lesion, polyp, tumor mass, and unclassified lesion. Then, the gastroenterologist evaluated and interpreted the selected lesions and, successively, reviewed the entire video for potential missed lesions. The time for VCE evaluation was recorded.
Results: A total of 95 VCE procedures performed on consecutive patients (M/F: 47/48; mean age: 63 ± 12
years, range: 27−86 years) were evaluated. Overall, the nurses detected at least one lesion in 54 (56.8%) patients.
There was total agreement between nurses and gastroenterologists, no missing lesions being discovered at a second look of the entire VCE recording by the physician. The pre-reading procedure by nurse allowed a time reduction of medical evaluation from 49 (33-69) to 10 (8-16) minutes (difference: -79.6%).
Conclusions: Our data suggest that trained nurses can accurately identify and select relevant lesions in thumbnails that subsequently were faster reviewed by the gastroenterologist for a final diagnosis. This could significantly reduce the cost of VCE procedure.
Key words: video capsule endoscopy − nurse − concordance − cost.
Abbreviations: GI: gastrointestinal; OGIB: obscure gastrointestinal bleeding; VCE: video capsule endoscopy.