Capsule endoscopy interpretation: The role of physician extenders

Background and aims: capsule endoscopy (CE) allows for a new era in small-bowel examination. Nevertheless, physicians’ time for CE-interpretation remains longer than desirable. Alterna tive strategies to physicians have not been widely investigated. The aim of this study was to evaluate the accuracy of physician extenders in CE-interpretation. Material and methods: oneCE-experiencedgastroenterolo gist and two physician extenders reviewed independently 20 CEprocedures. Each reader was blinded to the findings of their colleagues. A consensus formed by the readers and a second CE-experienced gastroenterologist was used as gold standard. Number, type and location of images selected, character of CEexams and their relationship with indications were recorded. Gas tric emptying time (GEt), small-bowel transit time (SBTt) and time spent by readers were also noted. Results: sensitivity and specificity for “overall” lesions was 79 and 99% for the gastroenterologist; 86 and 43% for the nurse; and 80 and 57% for the resident. All 34 “major” lesions consid ered by consensus were found by the readers. Agreement be tween consensus and readers for images classification and proce dures interpretation was good to excellent ( κ from 0.55 to 1). No significant differences were found in the GEt and SBTt obtained by consensus and readers. The gastroenterologist was faster than physician extenders (mean time spent was 51.9 ± 13.5 minutes versus 62.2 ± 19 and 60.9 ± 17.1 for nurse and resident, re spectively; p < 0.05). Conclusions: physician extenders could be the perfect com plement to gastroenterologists for CE-interpretation but gastroen terologists should supervise their findings. Future cost-efficacy analyses are required to assess the benefits of this alternative.