[Capsule endoscopy interpretation: the role of physician extenders].
OBJECTIVE
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.


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.
Fernández-Urién
I
I
Servicio de Aparato Digestivo, Clínica Universitaria de Navarra, Pamplona, Navarra. ifurien@unav.es
Espinet
E
E
Pérez
N
N
Betés
M
M
Herráiz
M
M
Carretero
C
C
Muñoz-Navas
M
M
D000704:Analysis of Variance; D053704:Capsule Endoscopy; D002983:Clinical Competence; D032921:Consensus; D003951:Diagnostic Errors; D005762:Gastroenterology / Q000592:standards*; D005767:Gastrointestinal Diseases / Q000175:diagnosis*; D005772:Gastrointestinal Transit; D006801:Humans; D007396:Internship and Residency / Q000592:standards; D009726:Nurses / Q000592:standards; D010823:Physician Assistants / Q000592:standards*; D012680:Sensitivity and Specificity; D013997:Time Factors