Implementation of ESGE quality performance indicators for small bowel capsule endoscopy-first service audit

Aims Key performance indicators (KPIs) ensure quality service provision. ESGE introduced KPIs in small bowel capsule endoscopy(SBCE) in 2019. The KPIs look at major and minor domains. Assess the quality of service provision for SBCE service in Letterkenny University Hospital since its implementation in 2022.

Methods SBCE data was collected retrospectively from the initiation of service to July 2024. This was compared against the key main domains and target standards as recommended by ESGE, which are as follows: 1. Pre-procedure, 2. Completeness of procedure, 3. Identification of pathology, 4. Management of pathology, and 5. Complications.SBCE data was collected retrospectively from the initiation of service to July 2024. This was compared against the key main domains and target standards as recommended by ESGE, which are as follows: 1. Pre-procedure, 2. Completeness of procedure, 3. Identification of pathology, 4. Management of pathology, and 5. Complications.

Results 182 small bowel capsule studies were performed, with iron deficiency anaemia being the most common indication (24.2%). Appropriate indications included 80.8%. If undifferentiated anaemia was also included, the appropriate indication would be 84.6%. Adequate Bowel preparation was seen in 94.5% (Target≥95%). Patency capsules were offered to 55.1% (Target≥95%) of patients at high retention risk. However, the retention rate met target standards with no cases of capsule retention since service initiation (Target<2%). The completeness of the procedure is determined by caecal or stomal visualisation, and the targets are met at 97.8% (Target≥95%). The lesion detection rate in our cohort was 54.9% (Target≥50%). However, the timing of SBCE for overt GI bleeding did not meet targets at 36.8% (Target≥90%). Appropriate referral to device-associated enteroscopy was low at 1.1% (Min≥75%, Target≥90%)

Conclusions The SBCE service in Letterkenny has successfully met procedure completeness and lesion detection rate targets. However, there are areas for improvement that we can focus on to enhance our service. We can further improve our performance by avoiding indications such as diarrhoea, abdominal pain, and malabsorption. The issue of undifferentiated anaemia needs to be clarified to determine if it is a suitable indication for SBCE. The timing for overt bleeding for SBCE did not meet the target, and an acute bleed service may be considered to triage and expedite urgent small bowel capsules. Referral to DAE was also suboptimal. However, it's worth noting that most patients did not require endotherapy. Furthermore, LUH is committed to continuous improvement and is expected to initiate a DBE service in 2025. Offering patency capsules did not meet the ESGE target, but reassuringly, there has been no capsule retention since the service induction. These domains will be reaudited in one year, demonstrating our ongoing commitment to quality improvement [1].

Conflicts of Interest

Authors do not have any conflict of interest to disclose.

• References

• 1 Spada C, McNamara D, Despott EJ, Adler S, Cash BD, Fernández-Urién I, Ivekovic H, Keuchel M, McAlindon M, Saurin JC, Panter S.. Performance measures for small-bowel endoscopy: a European Society of Gastrointestinal Endoscopy (ESGE) quality improvement initiative. Endoscopy 2019; 51 (06): 574-98

Publication History

Article published online:
27 March 2025