title: Influence of operator experience and reporting time on the accuracy of esophageal capsule endoscopy screening for varices.
abstract: Conflicting data exist concerning the accuracy of esophageal capsule endoscopy (ECE) for the screening of varices. No study has examined the influence of operator factors on the accuracy of ECE reporting. The primary aims of this study were, therefore, to examine how operator experience with esophagogastroduodenoscopy (EGD) and operator reporting times of capsule videos influenced test accuracy. Twelve cirrhotic patients presenting for EGD had same-day ECE performed. The gold standard for variceal grade was determined using a panel of experienced endoscopists. Six novice capsule endoscopists, blinded to results of EGD, subsequently reported capsule videos for each of the 12 patients.Novice capsule endoscopists accurately identified high-risk varices. The mean area under the receiver operating characteristic curve for identifying high-risk varices for the six operators was 0.88 ±/-0.14. The mean sensitivity, specificity, positive, and negative predictive values for identifying high-risk varices for the six operators were 83%, 93%, 82%, and 97%, respectively. Years of prior EGD experience were not associated with accuracy of capsule reporting (OR = 0.9, 95% CI [0.74, 1.08]; p = .26). Time spent reporting capsule videos was associated with accuracy of capsule reporting for high-risk varices using British Society of Gastroenterology criteria (OR = 1.33, 95% CI [1.05, 1.08]; p = .018). Novice capsule endoscopists are able to accurately identify high-risk esophageal varices. Time taken to report capsule videos, but not amount of prior EGD experience, influenced capsule report accuracy. These findings may have implications for the design of further trials and the cost-effectiveness of ECE screening of varices.
authors.affiliation: Flinders Medical Centre, Adelaide, South Australia. alan.wigg@health.sa.gov.au
authors.forename: Alan J
authors.initials: AJ
authors.lastname: Wigg
authors.forename: Jeff
authors.initials: J
authors.lastname: Bull
authors.forename: Mahinda
authors.initials: M
authors.lastname: de Silva
authors.forename: Melissa
authors.initials: M
authors.lastname: Jusaitis
authors.forename: Jeyamani
authors.initials: J
authors.lastname: Ramachandran
authors.forename: Sam
authors.initials: S
authors.lastname: Edwards
authors.forename: Alexander
authors.initials: A
authors.lastname: Rodgers
authors.forename: Peter
authors.initials: P
authors.lastname: Bampton
authors.forename: Jonathan
authors.initials: J
authors.lastname: Martin
authors.forename: Richard J
authors.initials: RJ
authors.lastname: Woodman
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D053704:Capsule Endoscopy; D002983:Clinical Competence; D016145:Endoscopy, Digestive System; D004932:Esophageal and Gastric Varices / Q000175:diagnosis* / Q000209:etiology; D005260:Female; D006801:Humans; D008103:Liver Cirrhosis / Q000150:complications* / Q000473:pathology; D008297:Male; D008875:Middle Aged; D011237:Predictive Value of Tests; D015203:Reproducibility of Results; D013997:Time Factors