[Capsule endoscopy interpretation: the role of physician extenders]. / Interpretación de la cápsula endoscópica: el papel del personal no especializado.

BACKGROUND AND AIMS: capsule endoscopy (CE) allows for a new era in small-bowel examination. Nevertheless, physicians time for CE-interpretation remains longer than desirable. Alternative strategies to physicians have not been widely investigated. The aim of this study was to evaluate the accuracy of physician extenders in CE-interpretation. MATERIAL AND METHODS: one CE-experienced gastroenterologist and two physician extenders reviewed independently 20 CE-procedures. Each reader was blinded to the findings of their colleagues. A consensus formed by the readers and a second CE-experienced gastroenterologist was used as gold standard. Number, type and location of images selected, character of CE-exams and their relationship with indications were recorded. Gastric emptying time (GEt), small-bowel transit time (SBTt) and time spent by readers were also noted. RESULTS: sensitivity and specificity for "overall" lesions was 79 and 99% for the gastroenterologist; 86 and 43% for the nurse; and 80 and 57% for the resident. All 34 "major" lesions considered by consensus were found by the readers. Agreement between consensus and readers for images classification and procedures interpretation was good to excellent (? from 0.55 to 1). No significant differences were found in the GEt and SBTt obtained by consensus and readers. The gastroenterologist was faster than physician extenders (mean time spent was 51.9 +/- 13.5 minutes versus 62.2 +/- 19 and 60.9 +/- 17.1 for nurse and resident, respectively; p < 0.05). CONCLUSIONS: physician extenders could be the perfect complement to gastroenterologists for CE-interpretation but gastroenterologists should supervise their findings. Future cost-efficacy analyses are required to assess the benefits of this alternative.

Interpretación de la cápsula endoscópica: el papel del personal no especializado / No disponible

Introducción y objetivos: la cápsula endoscópica (CE) hasupuesto una nueva era en el estudio del intestino delgado. Noobstante, el tiempo empleado por el gastroenterólogo en esteprocedimiento es mayor del deseable y no se han evaluado completamentealternativas al personal especializado. El objetivo deeste estudio es evaluar la precisión de personal no especializadoen la interpretación de la CE.Material y métodos: un gastroenterólogo con experienciaen CE y personal no especializado revisaron independientemente20 procedimientos. Los hallazgos de cada participante eran desconocidospor el resto. Un consenso formado por los participantesy un segundo gastroenterólogo fue empleado como gold standard.Se analizaron número, tipo y localización de las imágenesseleccionadas y tiempo de evacuación gástrica (tEG), tiempo detránsito en intestino delgado (tTID) y tiempo empleado por losparticipantes.Resultados: la sensibilidad y la especificidad global fueron del79 y 99% para el gastroenterólogo; del 86 y 43% para la enfermera;y del 80 y 57% para el residente. Las 34 lesiones “mayores”consideradas por consenso fueron detectadas por los tresparticipantes. El acuerdo entre consenso y participantes para clasificare interpretar las imágenes fue de buena a excelente (k de0,55 a 1). No se encontraron diferencias estadísticamente significativasen el tEG y tTID obtenido por consenso y participantes. Elgastroenterólogo fue el más rápido en revisar los procedimientos(51,9 ± 13,5 minutos versus 62,2 ± 19 y 60,9 ± 17,1 para enfermeray residente, respectivamente; p < 0,05).Conclusiones: el personal no especializado podría ser elcomplemento perfecto al gastroenterólogo en la interpretación dela CE, aunque este debería supervisar sus hallazgos. Los beneficiosde esta alternativa deberían ser contrastados en el futuro poranálisis coste-efectividad

Background and aims: capsule endoscopy (CE) allows for anew era in small-bowel examination. Nevertheless, physicians’time for CE-interpretation remains longer than desirable. Alternativestrategies to physicians have not been widely investigated.The aim of this study was to evaluate the accuracy of physicianextenders in CE-interpretation.Material and methods: one CE-experienced gastroenterologistand two physician extenders reviewed independently 20 CEprocedures.Each reader was blinded to the findings of their colleagues.A consensus formed by the readers and a secondCE-experienced gastroenterologist was used as gold standard.Number, type and location of images selected, character of CEexamsand their relationship with indications were recorded. Gastricemptying time (GEt), small-bowel transit time (SBTt) and timespent by readers were also noted.Results: sensitivity and specificity for “overall” lesions was 79and 99% for the gastroenterologist; 86 and 43% for the nurse;and 80 and 57% for the resident. All 34 “major” lesions consideredby consensus were found by the readers. Agreement betweenconsensus and readers for images classification and proceduresinterpretation was good to excellent (k from 0.55 to 1). Nosignificant differences were found in the GEt and SBTt obtainedby consensus and readers. The gastroenterologist was faster thanphysician extenders (mean time spent was 51.9 ± 13.5 minutesversus 62.2 ± 19 and 60.9 ± 17.1 for nurse and resident, respectively;p < 0.05).Conclusions: physician extenders could be the perfect complementto gastroenterologists for CE-interpretation but gastroenterologistsshould supervise their findings. Future cost-efficacyanalyses are required to assess the benefits of this alternative

[Utility of endoscopy in digestive hemorrhage due to vasculitis]. / Utilidad de la endoscopia en la hemorragia digestiva por vasculitis.

Vasculitides constitute a heterogeneous group of diseases characterized by inflammation of blood vessels. The skin is mainly affected, although the gastrointestinal tract mucosa can also be involved. The contribution of endoscopy in these cases has not been clearly determined. We report three cases of systemic vasculitis (polyarteritis nodosa, Schonlein-Henoch purpura and Behcet's disease) presenting with acute digestive bleeding. Endoscopy was an effective technique for completing the diagnosis and in establishing an effective nonsurgical therapeutic approach in these potentially lethal cases of gastrointestinal hemorrhage.