Can we improve the detection rate and interobserver agreement in capsule endoscopy?

Small bowel capsule endoscopy (SBCE) has become a first line diagnostic tool. Several training courses with a similar format have been established in Europe; however, data on learning curve and training in SBCE remain sparse.Between 2008 and 2011, different basic SBCE training courses were organized internationally in UK (n = 2), Italy (n = 2), Germany (n = 2), Finland (n = 1), and nationally in Germany (n = 10), applying similar 8-hour curricula with 50% lectures and 50% hands-on training. The Given PillCam System was used in 12 courses, the Olympus EndoCapsule system in 5, respectively. A simple evaluation tool for capsule endoscopy training (ET-CET) was developed using 10 short SBCE videos including relevant lesions and normal or irrelevant findings. For each video, delegates were required to record a diagnosis (achievable total score from 0 to 10) and the clinical relevance (achievable total score 0 to 10). ET-CET was performed at baseline before the course and repeated, with videos in altered order, after the course.Two hundred ninety-four delegates (79.3% physicians, 16.3% nurses, 4.4% others) were included for baseline analysis, 268 completed the final evaluation. Forty percent had no previous experience in SBCE, 33% had performed 10 or less procedures. Median scores for correct diagnosis improved from 4.0 (IQR 3) to 7.0 (IQR 3) during the courses (P < 0.001, Wilcoxon), and for correct classification of relevance of the lesions from 5.0 (IQR 3) to 7.0 (IQR 3) (P < 0.001), respectively. Improvement was not dependent on experience, profession, SBCE system, or course setting. Previous experience in SBCE was associated with higher baseline scores for correct diagnosis (P < 0.001; Kruskal–Wallis). Additionally, independent nonparametric partial correlation with experience in gastroscopy (rho 0.33) and colonoscopy (rho 0.27) was observed (P < 0.001).A simple ET-CET demonstrated significant improvement of diagnostic skills on completion of formal basic SBCE courses with hands-on training, regardless of preexisting experience, profession, and course setting. Baseline scores for correct diagnoses show a plateau after interpretation of 25 SBCE before courses, supporting this number as a compromise for credentialing. Experience in flexible endoscopy may be useful before attending an SBCE course.

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“…After participation in a 10-hour expert tutorial there was no improvement of detection rate and agreement with reference standard. 11 …”

Section: Discussionmentioning

confidence: 99%

A Simple Evaluation Tool (ET-CET) Indicates Increase of Diagnostic Skills From Small Bowel Capsule Endoscopy Training Courses

et al. 2015

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“…The requirements for computational efficiency in such software are increased as a result of the real-time constraints posed by the clinical workflows and the reviewers' reaction times. 4,5,8,17 The process of developing clinically viable VCE localization software is challenging. Algorithms for estimating motion that are used for tracking the capsule endoscope should become more robust so that they can withstand the motility and deformability of the gastrointestinal tract.…”

Section: Technical Challengesmentioning

confidence: 99%

“…1,2,6 Furthermore, the accuracy of VCE is heavily dependent on accurate interpretation that is not influenced by the reviewer's experience. 7,8 Historically, the VCE miss rates for vascular lesions, ulcers and neoplasms were 5.9%, 0.5% and 18.9%, respectively. 9 Computational methods, which are integral to the reviewing software of the VCE devices, could contribute to the reduction of both the time required by the reviewers and errors in human interpretation.…”

Section: Introductionmentioning

confidence: 99%

Software for enhanced video capsule endoscopy: challenges for essential progress

Iakovidis

Koulaouzidis

2015

Nat Rev Gastroenterol Hepatol

189

113

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Video capsule endoscopy (VCE) has revolutionized the diagnostic work-up in the field of small bowel diseases. Furthermore, VCE has the potential to become the leading screening technique for the entire gastrointestinal tract. Computational methods that can be implemented in software can enhance the diagnostic yield of VCE both in terms of efficiency and diagnostic accuracy. Since the appearance of the first capsule endoscope in clinical practice in 2001, information technology (IT) research groups have proposed a variety of such methods, including algorithms for detecting haemorrhage and lesions, reducing the reviewing time, localizing the capsule or lesion, assessing intestinal motility, enhancing the video quality and managing the data. Even though research is prolific (as measured by publication activity), the progress made during the past 5 years can only be considered as marginal with respect to clinically significant outcomes. One thing is clear-parallel pathways of medical and IT scientists exist, each publishing in their own area, but where do these research pathways meet? Could the proposed IT plans have any clinical effect and do clinicians really understand the limitations of VCE software? In this Review, we present an in-depth critical analysis that aims to inspire and align the agendas of the two scientific groups.

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“…Video speed can be increased, although it appears that the miss rate may increase with greater viewing speeds (and an optimal viewing speed of no more than 15 frames per second has been recommended) although dual or quadruple view may allow quicker reading times without obvious diminution of pathology detection. The QuickView facility on the Medtronic system (other systems have similar softwares) selects 10% (the proportion selected can be altered by the operator) of the most standout images for viewing, and earlier iterations of this software suggest a sensitivity of lesion detection of 89-100% compared to conventional viewing with a significant reduction in reading time (28,29,(31)(32)(33)(34)(35)(36)(37)(38)(39)(40). Some operators use it as a preliminary screen to look for obvious pathology if information is needed quickly.…”

Section: Ce Reading Softwarementioning

confidence: 99%

“…Some operators use it as a preliminary screen to look for obvious pathology if information is needed quickly. The spontaneous blood indicator selects images containing multiple red pixels, potentially useful in detecting bleeding lesions, but has variable reported sensitivities and specificities for detecting potential bleeding lesions or active bleeding of only 26-81% and 33-76% respectively (28,29,(39)(40)(41)(42)(43).…”

Section: Ce Reading Softwarementioning

confidence: 99%

Capsule endoscopy of the small bowel

McAlindon¹,

Ching²,

Yung³

et al. 2016

Ann. Transl. Med.

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Capsule endoscopy (CE) is a first line small bowel investigative modality which provides more sensitive mucosal imaging than comparators. It is a non-invasive, non-irradiating tool well tolerated by patients. The risk of retention of the capsule can be minimised by ensuring luminal patency using the Agile patency device. Research continues into how to minimise missed pathology and variability in the identification of pathology or interpretation of images. The consensus is that bowel preparation using laxatives improves visibility and diagnostic yield. Research includes the development of image recognition software, both to eliminate sequentially identical images to improve viewing speed and to select or enhance images likely to represent pathology. However, careful reading by experienced capsule endoscopists remains the benchmark. This should be performed at a speed comfortable to the viewer, probably at a maximum of 15 frames per second. Some prior experience of endoscopy appears to be helpful for novice capsule endoscopists and formal training on a hands-on training course seems to improve pathology recognition, for novices and for those with CE experience.

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Can we improve the detection rate and interobserver agreement in capsule endoscopy?

Cited by 40 publications

References 21 publications

A Simple Evaluation Tool (ET-CET) Indicates Increase of Diagnostic Skills From Small Bowel Capsule Endoscopy Training Courses

A Simple Evaluation Tool (ET-CET) Indicates Increase of Diagnostic Skills From Small Bowel Capsule Endoscopy Training Courses

Software for enhanced video capsule endoscopy: challenges for essential progress

Capsule endoscopy of the small bowel

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