Elsevier

Gastrointestinal Endoscopy

Volume 96, Issue 5, November 2022, Pages 693-711
Gastrointestinal Endoscopy

Quality indicators
Quality indicators for capsule endoscopy and deep enteroscopy

https://doi.org/10.1016/j.gie.2022.08.039Get rights and content

Background and Aims

Capsule endoscopy (CE) and deep enteroscopy (DE) can be useful for diagnosing and treating suspected small-bowel disease. Guidelines and detailed recommendations exist for the use of CE/DE, but comprehensive quality indicators are lacking. The goal of this task force was to develop quality indicators for appropriate use of CE/DE by using a modified RAND/UCLA Appropriateness Method.

Methods

An expert panel of 7 gastroenterologists with diverse practice experience was assembled to identify quality indicators. A literature review was conducted to develop a list of proposed quality indicators applicable to preprocedure, intraprocedure, and postprocedure periods. The panelists reviewed the literature; identified and modified proposed quality indicators; rated them on the basis of scientific evidence, validity, and necessity; and determined proposed performance targets. Agreement and consensus with the proposed indicators were verified using the RAND/UCLA Appropriateness Method.

Results

The voting procedure to prioritize metrics emphasized selecting measures to improve quality and overall patient care. Panelists rated indicators on the perceived appropriateness and necessity for clinical practice. After voting and discussion, 2 quality indicators ranked as inappropriate or uncertain were excluded. Each quality indicator was categorized by measure type, performance target, and summary of evidence. The task force identified 13 quality indicators for CE and DE.

Conclusions

Comprehensive quality indicators have not existed for CE or DE. The task force identified quality indicators that can be incorporated into clinical practice. The panel also addressed existing knowledge gaps and posed research questions to better inform future research and quality guidelines for these procedures.

Section snippets

Methods

This report describes new data pertaining to quality indicators for CE and DE. Indicators with wide-ranging clinical applications are prioritized as are those associated with practice variations and outcomes. Whenever possible, we focus on quality indicators validated in clinical studies. The RAND/University of California Los Angeles Appropriateness Method (RAM) was used to develop quality indicators for CE and DE to be used for patients with suspected small-bowel disease.6 Based on RAM, an

Preprocedure

  • 1.

    Frequency of demonstrating competency in CE

Type of measure: process

Performance target: 100%

Evidence summary: Formal training in CE can be obtained during fellowship or postgraduate and subspecialty-society–sponsored courses. As for any endoscopic procedure, a minimum standard of performance is required for an endoscopist to be deemed competent, understanding that learners may achieve competency after different numbers of CE studies performed. Multiple society guidelines recommend a minimum

Preprocedure

  • 1.

    Frequency of demonstrating competency in DE

Type of measure: process

Performance target: 100%

Evidence summary: Limited data exist regarding training requirements for DE, which is labor-intensive with a steep learning curve. The procedure requires a unique set-up and instruments and a trained, skilled nurse/technologist or team. Two studies using balloon enteroscopy reported that procedural time and small-bowel extent visualized improves after 10 to 15 procedures.72,73 In a single-center study of

Conclusion

CE and DE have an important positive impact on the diagnosis and management of small-bowel diseases. However, comprehensive quality indicators for CE and DE performance have been lacking, despite previous efforts to create individual quality metrics. The task force hoped to improve the quality performance of these relatively new small-bowel diagnostic techniques by compiling comprehensive recommendations of quality indicators for CE and DE procedures. Incorporating the measures into clinical

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    DISCLOSURE: The following authors disclosed financial relationships: J. A. Leighton: Consultant for Medtronic, Olympus America, and Check-Cap Ltd. D. J. Hass: Consultant and speaker for Medtronic. N. M. Guda: Consultant for Boston Scientific Corporation and Hemostasis LLC, Minneapolis. All other authors disclosed no financial relationships.

    This article is being published jointly in Gastrointestinal Endoscopy and The American Journal of Gastroenterology. The article is identical except for minor stylistic and spelling differences in keeping with each journal's style. Citations from either journal can be used when citing this article.

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