ABSTRACT
Patients with inflammatory bowel disease (IBD) may develop rheumatic diseases, particularly enterophatic spondyloarthritis (ESpA). Similarly, an IBD may develop in patients with SpA. Management of these patients in a dedicated ambulatory could be advantageous. We pioneered an integrated "GastroReumatology" ambulatory where a gastroenterologist and a rheumatologist with a long-lasting expertise in IBD and spondyloarthritis, respectively, simultaneously visit those patients referred for a suspected ESpA. A total of 101 different patients with suspected or known IBD and/or a rheumatic disease were visited. A new diagnosis of ESpA was eventually achieved in 13 (12.9%) patients, and further 12 patients with an already known ESpA were referred for an appropriate management. No cases of IBD in those patients with an established rheumatic disease were observed. Early diagnosis of ESpA is possible in a "GastroReumatology" ambulatory.
Subject(s)
Ambulatory Care/methods , Gastroenterology/methods , Rheumatology/methods , Spondylarthritis/diagnosis , Ambulatory Care Facilities , Delivery of Health Care, Integrated , Early Diagnosis , Humans , Inflammatory Bowel Diseases/complications , Spondylarthritis/etiologyABSTRACT
BACKGROUND AND 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.
Subject(s)
Capsule Endoscopy/standards , Gastroenterologists/standards , Intestinal Diseases/diagnosis , Adult , Aged , Aged, 80 and over , Capsule Endoscopy/economics , Capsule Endoscopy/nursing , Clinical Competence , Cost Savings , Female , Health Care Costs/statistics & numerical data , Humans , Intestinal Diseases/economics , Intestine, Small , Italy , Male , Middle Aged , Observer Variation , Prospective Studies , Reproducibility of ResultsABSTRACT
The video capsule endoscopy is an accurate tool to investigate the entire small bowel. Currently, the nurse actively participates in the procedure from patient preparation to the video download, whereas a gastroenterologist interprets the endoscopic findings. However, few studies recently showed high accuracy of nurses in detecting lesions in the small bowel on video capsule endoscopy recordings. This prospective study aimed to assess the ability of experienced and trained nurses in detecting small bowel lesions as compared with gastroenterologists. Forty-six consecutive video capsule endoscopy procedures were analyzed. Overall, the nurse evaluation was highly (95.6%) accurate in detecting small bowel lesions, with a 100% concordance with the gastroenterologist for the relevant findings. In addition, the absence of lesions was confirmed by the endoscopist in all cases classified as negative by the nurse. Data of this study found that trained nurses, with a large experience in endoscopic features, correctly identified small bowel lesions on video capsule endoscopy recordings. Therefore, a trained nurse may accurately select the thumbnails of all mucosal irregularities that may be faster reviewed by the endoscopist for a final diagnosis.
