Fernández-Urién I, Espinet E, Pérez N, Betés M, Herráiz M, Carretero C, Muñoz-Navas M
Servicio de Aparato Digestivo, Clínica Universitaria de Navarra, Pamplona, Navarra.
Rev Esp Enferm Dig. 2008 Apr;100(4):219-24. doi: 10.4321/s1130-01082008000400005.
capsule endoscopy (CE) allows for a new era in small-bowel examination. Nevertheless, physicians time for CE-interpretation remains longer than desirable. Alternative strategies to physicians have not been widely investigated. The aim of this study was to evaluate the accuracy of physician extenders in CE-interpretation.
one CE-experienced gastroenterologist and two physician extenders reviewed independently 20 CE-procedures. 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 CE-exams and their relationship with indications were recorded. Gastric emptying time (GEt), small-bowel transit time (SBTt) and time spent by readers were also noted.
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 considered by consensus were found by the readers. Agreement between consensus and readers for images classification and procedures interpretation was good to excellent (? 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, respectively; p < 0.05).
physician extenders could be the perfect complement to gastroenterologists for CE-interpretation but gastroenterologists should supervise their findings. Future cost-efficacy analyses are required to assess the benefits of this alternative.
胶囊内镜检查（CE）开启了小肠检查的新时代。然而，医生解读CE的时间仍比预期的要长。针对医生的替代策略尚未得到广泛研究。本研究的目的是评估医生助理解读CE的准确性。
一名有CE经验的胃肠病学家和两名医生助理独立回顾了20例CE检查过程。每位读者对其同事的检查结果均不知情。由读者和另一位有CE经验的胃肠病学家达成的共识被用作金标准。记录所选图像的数量、类型和位置、CE检查的特征及其与适应症的关系。还记录了胃排空时间（GEt）、小肠传输时间（SBTt）以及读者花费的时间。
对于“整体”病变，胃肠病学家的敏感性和特异性分别为79%和99%；护士为86%和43%；住院医师为80%和57%。读者们发现了所有经共识认定的34处“主要”病变。在图像分类和检查过程解读方面，共识与读者之间的一致性良好至极佳（κ值从0.55至1）。在通过共识和读者获得的GEt和SBTt方面未发现显著差异。胃肠病学家比医生助理速度更快（平均花费时间分别为51.9±13.5分钟，而护士和住院医师分别为62.2±19分钟和60.9±17.1分钟；p<0.05）。
医生助理可能是胃肠病学家解读CE的理想补充，但胃肠病学家应监督他们的检查结果。未来需要进行成本效益分析以评估这种替代方案的益处。
