Detection of abnormal lesions recorded by capsule endoscopy. A prospective study comparing endoscopist's and nurse's accuracy.
OBJECTIVE
Capsule endoscopy is a non-invasive technique for small bowel examination but its evaluation is time consuming. The aim of this study was to assess whether, following adequate training, an endoscopy nurse is capable of picking up all significant images without reducing the diagnostic accuracy of the procedure.


METHODS
Between April 2003 and December 2004, a total of 41 consecutive capsule endoscopy studies were blindly reviewed by both an endoscopy nurse and an endoscopist. The two operators had to select all significant images independently and to complete a structured questionnaire. Thirty-nine capsule endoscopy examinations (two studies discharged for premature battery failure) were evaluated. The agreement between the two operators was calculated by kappa statistics (coefficient of agreement).


RESULTS
Agreement was excellent for all kind of selected lesions (mean kappa>0.85); the agreement was complete (kappa=1) for site identification, active bleeding, stenosis and negative studies. The greater disagreement (kappa=0.77) was found in cases of subtle mucosal abnormalities (i.e. reduction of villi), which were over-estimated by the nurse.


CONCLUSIONS
The preview recordings made by the nurse may increase the cost/effectiveness of the study, by considerably reducing the time needed for the endoscopist to make the final report (about 5-10 min), without compromising final diagnosis.
Bossa
F
F
Department of General Medicine, Unit of Gastroenterology and Endoscopy, Casa Sollievo della Sofferenza Hospital, Institute for Health Care and Medical Research, Viale Cappuccini, 1, 71013 San Giovanni Rotondo (FG), Italy.
Cocomazzi
G
G
Valvano
M R
MR
Andriulli
A
A
Annese
V
V
D053704:Capsule Endoscopy / Q000191:economics; D003362:Cost-Benefit Analysis; D006801:Humans; D007410:Intestinal Diseases / Q000175:diagnosis*; D007413:Intestinal Mucosa / Q000473:pathology; D007421:Intestine, Small / Q000473:pathology*; D007558:Italy; D009726:Nurses / Q000191:economics; D015588:Observer Variation; D010820:Physicians / Q000191:economics; D011446:Prospective Studies