Digestive Endoscopy
Is formal training necessary for capsule endoscopy?: The largest gastroenterology trainee study with controls

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Abstract

Background

Little is known about the infrastructure to train gastroenterologists in capsule endoscopy. The level of capsule endoscopy exposure among trainees in the United Kingdom or Europe has also not been quantified.

Aims and methods

To assess the ability of 10 gastroenterology trainees with endoscopy experience to interpret 10 capsule endoscopy videos against five medical students, with an expert in capsule endoscopy as the gold standard. Parameters assessed included gastric emptying time, small bowel transit and the diagnosis made. A questionnaire survey assessed the level of capsule endoscopy exposure among United Kingdom trainees.

Results

Trainees were better at determining the gastric emptying time (p = 0.013) and more likely to record true positives compared to the students (p = 0.037). They were also less likely to record false positives (p = 0.005) and more likely to reach the correct diagnosis (p = 0.001, OR 3.6, CI 1.8–7.4). Our survey found that, 65% of trainees had prior exposure to capsule endoscopy but only 13% had done capsule endoscopy reporting. Sixty seven percent felt capsule endoscopy should be incorporated into their training.

Conclusion

This study has shown that prior endoscopic experience enables trainees to interpret capsule endoscopy more accurately than medical students. However, there is a demand for focussed training which would enable trainees to reliably interpret pathology on capsule endoscopy.

Introduction

Capsule endoscopy (CE) is a novel modality to investigate the small bowel [1]. Since its approval by the United States Food and Drug Administration (FDA) in 2001, its use has rapidly expanded to encompass various indications and it is fast emerging as a first line of investigation of the small bowel. It has an established role for investigation of obscure gastrointestinal bleeding (OGB) [2] and is increasingly being used for the investigation of small bowel Crohn's disease when conventional investigations have been negative [3].

Each patient video produces more than 50 000 images. Reading and analysis of a video can take between 30 and 120 min depending on the experience of the reader [4]. There have only been a limited number of studies in the published literature on inter-observer variability between different readers [5], [6], [7], [8], [9], [10], [11], [12]. Assessments of CE reading and interpreting abilities have been made for nurse readers, endoscopy fellows/gastroenterology residents and fourth year medical students by comparison to experienced CE physicians. However, none of these studies has provided an alternative control group. Table 1 details these studies with their corresponding results [5], [6], [7], [8], [9], [10], [11], [12]. The number of trainees involved has never been more than two.

The number of centres in Europe using CE is on the rise. Currently in the United Kingdom (UK), CE is only being performed in selected university and district general hospitals where there is a consultant with an interest in small bowel pathology. However, the working party for small bowel endoscopy of the British Society of Gastroenterology (BSG), UK, anticipates a substantial increase in demand for this service. Despite this, the number of gastroenterology trainees in the UK/Europe, exposed to CE is unknown.

Our aim was to make a comparison of reading of CE videos between gastroenterology trainees and medical students, using an expert on CE as the ‘gold standard’. This was to ascertain if prior endoscopic experience improved the diagnostic ability of the readers. In addition, a survey was also carried out on all gastroenterology trainees in the UK to identify the current level of interest and exposure that, trainees had to CE.

Section snippets

Capsule reading and interpreting

Ten gastroenterology trainees and five medical students were asked to read and interpret 10 CE videos. The gold standard was taken as the CE findings reported by a gastroenterology consultant with experience of reporting more than 700 CE videos (Dr Mark E McAlindon). UK gastroenterology training is currently a 5-year programme. The gastroenterology trainees participating in this study were between second and fourth year of their training programme. The trainees had performed between 200–3500

Results

When comparing the 10 trainees and 5 medical students, the average time taken for the gastroenterology trainees to read the videos was 61 min (range 51–81 min) as compared to 63 min (range 51–87 min) for the students (p = 0.51).

Trainees did better at determining the GET (mean trainees 3.6 min, range 0–18 min, mean students 15 min, range 2–45 min, p = 0.013). However, there was no significant difference on the estimation of the SBT for either group (mean trainee 29, range 15–53 min, mean students 70, range

Discussion

Capsule endoscopy is a modality that is increasingly being used to investigate the small bowel. Current trainees in gastroenterology represent the future service providers for CE in the UK/Europe. This is the first study to make a direct comparison between gastroenterology trainees and a true control group (CE naive) using an expert as a gold standard. Previous studies on trainees or nurses have been with small numbers and have made comparisons to a CE expert with no additional controls. In

Conclusion

This study has shown that prior endoscopic experience enables trainees to interpret CE more accurately than controls. In addition, there is a demand for focussed training which would enable trainees to reliably identify and interpret pathology on CE. This would particularly serve trainees who wish to take on the service as a sub-speciality interest.

Practice points

  • Prior endoscopic experience enables gastroenterology trainees to interpret CE more accurately than medical students.

  • UK gastroenterology trainees

Conflict of interest statement

M.E. McAlindon attended the 3rd International Conference for Capsule Endoscopy in Miami 2004 courtesy of Given Imaging.

References (12)

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