Adler DG, Gostout C. Video Capsule Endoscopy Interpretation: Expert Verses Novice. Gastrointestinal Endoscopy. 2003;57(5)


Abstract

Video capsule endoscopy represents tile newest imaging modality available to gastroenterologists. No studies to date have addressed the learning curve of trainee endoscopists vs. experienced staff endoscopists with this new technology. Methods: A senior GI fellow and a senior staff therapeutic endoscopist :u the Mayo Clinic reviewed in the same order. 20 capsule endoscopy videos performed over a period of 1 year in patient, with obscure GI bleeding. The senior stall' endoscopist had knowledge of the patient's medical history while the senior GI fellow was blinded to the medical history. Both the G1 fellow and staff member were given as much time as needed to review the video. and could view the images at any frame speed. Prior to reviewing the first capsule endoscopy study. the GI fellow had performed 30 small bowel enteroscopies. Results: When comparing small bowel findings alone (the primary indication for the study), the GI fellow and the staff endoscopist had identical findings in 18/20 patients (90%). In one case the staff saw SB erosions and blood while the fellow saw only SB blood, and in 1 patient the staff saw blood in the SB, and the fellow did not record this finding. Viewing times for both physicians raged from 20-9; minutes, with a mean of 60 minutes. Viewing for the GI fellow were, on average, 10-15 minutes longer than for the GI staff. The GI fellow routinely watched the capsule videos at 18-20 frames per second, while the staff watched at 18-25 frames per second. Conclusions: Trainee endoscopists and experienced staff endoscopists had similar results when independently viewing capsule endoscopy videos. Differences between the two observers did not translate into changes in clinical management of patients undergoing capsule endoscopy. Overtly negative studies and ones with florid findings tended to have the highest degree of correlation whereas studies containing lesions of unclear or no clinical significance (nonspecifed "red spots," luminal blood) were more likely to be sources of' disagreement. Overall, trainee proficiency and accuracy in the interpretation of capsule endoscopy in patients with obscure bleeding can be achieved with a relatively small number of patients and can rival that of senior staff endoscopists.