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Gastrointestinal Endoscopy

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Prospective multicenter study to evaluate capsule endoscopy competency using a validated assessment tool - 20/04/20

Doi : 10.1016/j.gie.2019.12.024 
Elizabeth Rajan, MD 1, ⁎, Manuel Martinez, MD 2, Emmanuel Gorospe, MD, MPH 5, Badr Al Bawardy, MD 7, Akira Dobashi, MD, PhD 1, Kristin C. Mara, MS 6, Stephanie L. Hansel, MD, MS 1, David H. Bruining, MD 1, Joseph A. Murray, MD 1, Cadman L. Leggett, MD 1, Vandana Nehra, MD 1, Prasad G. Iyer, MD 1, Shabana F. Pasha, MD 4, Jonathan A. Leighton, MD 4, Arthur D. Shiff, MD 4, Suryakanth R. Gurudu, MD 4, Laura E. Raffals, MD 1, Crystal Lavey 1, David A. Katzka, MD 1, Chien-Huan H. Chen, MD, PhD 3
1 Division of Gastroenterology and Hepatology, Mayo Clinic, Rochester, Minnesota, USA 
2 Division of Gastroenterology, New York Harbor VA, SUNY Downstate Medical Center, New York, New York, USA 
3 Division of Gastroenterology, Washington University, St. Louis, Missouri, USA 
4 Division of Gastroenterology and Hepatology, Mayo Clinic, Scottsdale, Arizona, USA 
5 Division of Gastroenterology, Hospitals of Providence Healthcare System, El Paso, Texas, USA 
6 Division of Biomedical Statistics and Informatics, Mayo Clinic, Rochester, Minnesota, USA 
7 Yale School of Medicine, Section of Digestive Diseases, New Haven, Connecticut, USA 

∗Reprint requests: Elizabeth Rajan, MD FASGE, Professor of Medicine, Mayo Clinic College of Medicine, 200 First Street SW, Rochester, MN 55905.Professor of MedicineMayo Clinic College of Medicine200 First Street SWRochesterMN55905

Abstract

Background and Aims

Capsule endoscopy (CE) is an established, noninvasive modality for examining the small bowel. Minimum training requirements are based primarily on guidelines and expert opinion. A validated tool to assess the competence of CE is lacking. In this prospective, multicenter study, we determined the minimum number of CE procedures required to achieve competence during gastroenterology fellowship; validated a capsule competency test (CapCT); and evaluated any correlation between CE competence and endoscopy experience.

Methods

We included second- and third-year gastroenterology fellows from 3 institutions between 2013 and 2018 in a structured CE training program with supervised CE interpretation. Fellows completed the CapCT with a maximal score of 100. For comparison, expert faculty completed the same CapCT. Trainee competence was defined as a score ≥90% compared with the mean expert score. Fellows were tested after 15, 25, and 35 supervised CE interpretations. CapCT was validated using expert consensus and item analysis. Data were collected on the number of previous endoscopies.

Results

A total of 68 trainees completed 102 CapCTs. Fourteen CE experts completed the CapCT with a mean score of 94. Mean scores for fellows after 15, 25, and 35 cases were 83, 86, and 87, respectively. Fellows with at least 25 interpretations achieved a mean score ≥84 in all 3 institutions. CapCT item analysis showed high interobserver agreement among expert faculty (k = 0.85). There was no correlation between the scores and the number of endoscopies performed.

Conclusion

After a structured CE training program, gastroenterology fellows should complete a minimum of 25 supervised CE interpretations before assessing competence using the validated CapCT, regardless of endoscopy experience.

Il testo completo di questo articolo è disponibile in PDF.

Abbreviations : ASGE, CapCT, CE


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 DISCLOSURE: Dr Rajan has undertaken research for Medtronic and CheckCap, has intellectual property with Medtronic, and has consulted for Olympus. Dr Gorospe has been a speaker for Boston Scientific and Allergan Pharmacy. Dr Dobashi has intellectual property with Medtronic. Dr Bruining has undertaken research and has intellectual property with Medtronic. Dr Murray has received grant support from Nexpep/ImmusanT, National Institutes of Health, Immunogenix, Takeda Pharmaceutical, Allakos, Oberkotter Foundation, Cour, has been a consultant for Bionix, Lilly Research Laboratory, Johnson & Johnson, Dr. Schar USA, UCB Biopharma, Innovate Biopharmaceuticals, Glenmark Pharmaceuticals, Celimmune, Amgen Intrexon Corporation, Kanyos, and Boehringer Ingelheim, Chugai Pharmaceuticals, and has received royalties and has intellectual property with Evelo Biosciences and Torax Medical. Dr Leggett has undertaken research with NinePoint Medical. Dr Iyer has undertaken research for Exact Sciences, PENTAX Medical, Medtronic, and Nine Point Medical and has been a consultant for Medtronic, CSA Medical, PENTAX Medical, and Symple Surgical. Dr Pasha has undertaken research for Medtronic and Xyken and has been a consultant for Medtronic and Olympus. Dr Leighton has undertaken research for Medtronic, Pfizer, and Shire and has been a consultant for Medtronic, Olympus, and CheckCap. Dr Gurudu has undertaken research for Gilead Pharmaceuticals. Dr Raffals has been a consultant for Pfizer. Dr Katzka has been a speaker for Celegene. All other authors disclosed no financial relationships.
 If you would like to chat with an author of this article, you may contact Dr Rajan at rajan.elizabeth16@mayo.edu.


© 2020  American Society for Gastrointestinal Endoscopy. Pubblicato da Elsevier Masson SAS. Tutti i diritti riservati.
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Vol 91 - N° 5

P. 1140-1145 - maggio 2020 Ritorno al numero
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