Quality performance measures for small capsule endoscopy: Are the ESGE quality standards met?

Abstract

Background and study aims The European Society of Gastrointestinal Endoscopy (ESGE) recently issued a quality performance measures document for small bowel capsule endoscopy (SBCE). The aim of this nationwide survey was to explore SBCE practice with ESGE quality measures as a benchmark.

Patients and methods A dedicated per-center semi-quantitative questionnaire based on ESGE performance measures for SBCE was created by a group of SBCE experts. One-hundred-eighty-one centers were invited to participate and were asked to calculate performance measures for SBCE performed in 2018. Data were compared with 10 ESGE quality standards for both key and minor performance measures.

Results Ninety-one centers (50.3 %) participated in the data collection. Overall in the last 5 years (2014–2018), 26,615 SBCEs were performed, 5917 of which were done in 2018. Eighty percent or more of the participating centers reached the minimum standard established by the ESGE Small Bowel Working Group (ESBWG) for four performance measures (indications for SBCE, complete small bowel evaluation, diagnostic yield and retention rate). Conversely, compliance with six minimum standards established by ESBWG concerning adequate bowel preparation, patient selection, timing of SBCE in overt bleeding, appropriate reporting, reading protocols and referral to device-assisted enteroscopy was met by only 15.5 %, 10.9 %, 31.1 %, 67.7 %, 53.4 %, and 32.2 % of centers, respectively.

Conclusions The present survey shows significant variability across SBCE centers; only four (4/10: 40 %) SBCE procedural minimum standards were met by a relevant proportion of the centers ( ≥ 80 %). Our data should help in identifying target areas for quality improvement programs in SBCE.

Publication History

Received: 16 May 2020

Accepted: 19 October 2020

Article published online:
25 January 2021

• References

• 1 Sapienza PE, Levine GM, Pomerantz S. et al. Impact of a quality assurance program on gastrointestinal endoscopy. Gastroenterology 1992; 102: 387-393
• 2 Corley DA, Jensen CD, Marks AR. et al. Adenoma detection rate and risk of colorectal cancer and death. N Engl J Med 2014; 370: 1298-1306
• 3 Yalamarthi S, Witherspoon P, McCole D. et al. Missed diagnoses in patients with upper gastrointestinal cancers. Endoscopy 2004; 36: 874-879
• 4 Raftopoulos SC, Segarajasingam DS, Burke V. et al. A cohort study of missed and new cancers after esophagogastroduodenoscopy. Am J Gastroenterol 2010; 105: 1292-1297
• 5 Enochsson L, Swahn F, Arnelo U. et al. Nationwide, population-based data from 11,074 ERCP procedures from the Swedish Registry for Gallstone Surgery and ERCP. Gastrointest Endosc 2010; 72: 1175-1184
• 6 Cohen J, Pike IM. Defining and measuring quality in endoscopy. Gastrointest Endosc 2015; 81: 1-2
• 7 Rutter MD, Senore C, Bisschops R. et al. The European Society of Gastrointestinal Endoscopy Quality Improvement Initiative: developing performance measures. Endoscopy 2016; 48: 81-89
• 8 Rees CJ, Thomas Gibson S, Rutter MD. et al. UK key performance indicators and quality assurance standards for colonoscopy. Gut 2016; 65: 1923-1929
• 9 Valori R, Cortas G, de Lange T. et al. Performance measures for endoscopy services: a European Society of Gastrointestinal Endoscopy (ESGE) Quality Improvement Initiative. Endoscopy 2018; 50: 1186-1204
• 10 Bisschops R, Areia M, Coron E. et al. Performance measures for upper gastrointestinal endoscopy: a European Society of Gastrointestinal Endoscopy (ESGE) Quality Improvement Initiative. Endoscopy 2016; 48: 843-864
• 11 Domagk D, Oppong KW, Aabakken L. et al. Performance measures for ERCP and endoscopic ultrasound: a European Society of Gastrointestinal Endoscopy (ESGE) Quality Improvement Initiative. Endoscopy 2018; 50: 1116-1127
• 12 Kaminski MF, Thomas-Gibson S, Bugajski M. et al. Performance measures for lower gastrointestinal endoscopy: a European Society of Gastrointestinal Endoscopy (ESGE) Quality Improvement Initiative. Endoscopy 2017; 49: 378-397
• 13 Spada C, McNamara D, Despott EJ. et al. Performance measures for small-bowel endoscopy: a European Society of Gastrointestinal Endoscopy (ESGE) Quality Improvement Initiative. United European Gastroenterol J 2019; 7: 21-44
• 14 Albert JG, Humbla O, McAlindon ME. et al. A simple evaluation tool (ET-CET) indicates increase of diagnostic skills from small bowel capsule endoscopy training courses: a prospective observational European multicenter study. Medicine (Baltimore) 2015; 94: e1941
• 15 Rajan E, Martinez M, Gorospe E. et al. Prospective multicenter study to evaluate capsule endoscopy competency using a validated as- sessment tool. Gastrointest Endosc 2020; 91: 1140-1145
• 16 The European Section and Board of Gastroenterology and Hepatology. Speciality Training Programme and Curriculum for Gastroenterology and Hepatology. The Blue Book; 2017 Available from (last accessed 09/08/2020): http://www.eubogh.org/blue-book/
• 17 Rajan E, Iyer PG, Oxentenko AS. et al. Training in small-bowel capsule endoscopy: assessing and defining competency. Gastrointest Endosc 2013; 78: 617-622
• 18 Sidhu R, Chetcuti Zammit S, Baltes P. et al. Curriculum for small-bowel capsule endoscopy and device assisted enteroscopy training in Europe: European Society of Gastrointestinal Endoscopy (ESGE) Position statement. Endoscopy 2020; 52: 669-686
• 19 Rondonotti E, Spada C, Pennazio M. et al. Adherence to European Society of Gastrointestinal Endoscopy recommendations of endoscopists performing small bowel capsule endoscopy in Italy. Dig Liver Dis 2019; 51: 818-823
• 20 Rondonotti E, Spada C, Adler S. et al. Small-bowel capsule endoscopy and device-assisted enteroscopy for diagnosis and treatment of small-bowel disorders: European Society of Gastrointestinal Endoscopy (ESGE) Technical Review. Endoscopy 2018; 50: 423-446
• 21 Gkolfakis P, Tziatzios G, Dimitriadis GD. et al. Meta-analysis of randomized controlled trials challenging the usefulness of purgative preparation before small-bowel video capsule endoscopy. Endoscopy 2018; 50: 671-683
• 22 Pennazio M, Spada C, Eliakim R. et al. Small-bowel capsule endoscopy and device-assisted enteroscopy for diagnosis and treatment of small-bowel disorders: European Society of Gastrointestinal Endoscopy (ESGE) Clinical Guideline. Endoscopy 2015; 47: 352-376
• 23 Yung DE, Koulaouzidis A, Douglas S. et al. Earlier use of capsule endoscopy in inpatients with melena or severe iron deficiency anemia reduces need for colonoscopy and shortens hospital stay. Endosc Int Open 2018; 6: E1075-E1084
• 24 Marya NB, Jawaid S, Foley A. et al. A randomized controlled trial comparing efficacy of early video capsule endoscopy with standard of care in the approach to nonhematemesis GI bleeding (with videos). Gastrointest Endosc 2019; 89: 33-43
• 25 Iio S, Oka S, Tanaka S. et al. Clinical utility of emergency capsule endoscopy for diagnosing the source and nature of ongoing overt obscure gastrointestinal bleeding. Gastroenterol Res Pract 2019;
• 26 Schlag C, Menzel C, Nennstiel S. et al. Emergency video capsule endoscopy in patients with acute severe GI bleeding and negative upper endoscopy results. Gastrointest Endosc 2015; 81: 889-895
• 27 Rozendorn N, Klang E, Lahat A. et al. Prediction of patency capsule retention in known Crohnʼs disease patients by using magnetic resonance imaging. Gastrointest Endosc 2016; 83: 182-187
• 28 Rondonotti E, Soncini M, Girelli CM. et al. Short article: Negative small-bowel cross-sectional imaging does not exclude capsule retention in high-risk patients. Eur J Gastroenterol Hepatol 2016; 28: 871-875
• 29 Omori T, Nakamura S, Shiratori K. Localization of the patency capsule by abdominal tomosynthesis. Digestion 2015; 91: 318-325
• 30 Assadsangabi A, Blakeborough A, Drew K. et al. Small bowel patency assessment using the patency device and a novel targeted (limited radiation) computed tomography-based protocol. J Gastroenterol Hepatol 2015; 30: 984-989
• 31 Tennekoon G, Hill LG. Measuring bias in self-reported data. Int J Behav Healthc Res 2011; 2: 320-332