Blanco-Velasco Gerardo, Pinho Rolando, Solórzano-Pineda Omar Michel, Martínez-Camacho Claudia, García-Contreras Luis Fernando, Murcio-Pérez Enrique, Hernández-Mondragón Oscar Victor
Endoscopy Service, Hospital de Especialidades, Centro Médico Nacional Siglo XXI, Instituto Mexicano del Seguro Social, Ciudad de México, Mexico.
Department of Gastroenterology, Centro Hospitalar Vila Nova de Gaia/Espinho, Vila Nova de Gaia, Portugal.
GE Port J Gastroenterol. 2021 Jun 17;29(2):106-110. doi: 10.1159/000516947. eCollection 2022 Mar.
The diagnostic yield (DY) of small-bowel capsule endoscopy (SBCE) varies considerably according to its indication. Some strategies have been used to increase DY with varying results. The intention of this study was to identify whether evaluation of the SBCE recordings by a second reviewer can increase DY and change patient management.
One hundred SBCEs with different indications, already read by an endoscopist were read by a second blinded endoscopist. When the results of the 2 readings were different, the images were discussed by the endoscopists; if no consensus was reached, they took the opinion of a third endoscopist into account. All the participating endoscopists had experience in reading SBCEs (i.e., >50 per year). The SBCE findings were divided into positive (vascular lesions, ulcers, and tumors), equivocal (erosions or red spots), and negative. The interobserver agreement and the increase in DY were assessed as well as the percentage of false-negatives (FNs) in the first evaluation.
The indications for SBCE were small-bowel bleeding (SBB) in 48 cases, Crohn's disease (CD) in 30, and other causes (iron-deficiency anemia, small-bowel tumors, and diarrhea) in 22. There was substantial interobserver agreement between evaluations (κ = 0.79). The findings in the first evaluation were positive in 60%, equivocal in 20% and, negative in 20%. In the second evaluation, 66% were positive, 18% were equivocal, and 16% were negative. The increase in DY with the second reading was 6% ( = 0.380), i.e., 6.3% for SBB, 4.4% for CD and 9.2% for other indications, resulting in a change in management of 4% of the patients. FNs in the first SBCE reading were found in 4% of the SBCEs.
A second evaluation of the SBCE recordings identified significant pathology that the first evaluation had missed, resulting in a nonsignificant 6% increase in DY and a change in the management of 4% of the patients.
小肠胶囊内镜检查（SBCE）的诊断率（DY）因其适应证的不同而有很大差异。人们已经采用了一些策略来提高诊断率，但结果各不相同。本研究的目的是确定由第二位阅片者对SBCE记录进行评估是否能提高诊断率并改变患者的治疗方案。
100例具有不同适应证的SBCE检查，已由一名内镜医师阅片，再由另一名不知情的内镜医师进行阅片。当两次阅片结果不同时，内镜医师会对图像进行讨论；若未达成共识，则参考第三位内镜医师的意见。所有参与的内镜医师均有阅读SBCE检查结果的经验（即每年>50例）。SBCE检查结果分为阳性（血管病变、溃疡和肿瘤）、可疑（糜烂或红点）和阴性。评估了观察者间的一致性以及诊断率的提高情况，以及首次评估中的假阴性（FN）百分比。
SBCE的适应证为小肠出血（SBB）48例、克罗恩病（CD）30例、其他原因（缺铁性贫血、小肠肿瘤和腹泻）22例。两次评估之间观察者间有高度一致性（κ=0.79）。首次评估结果中，阳性占60%，可疑占20%，阴性占20%。第二次评估中，阳性占66%，可疑占18%，阴性占16%。第二次阅片诊断率提高了6%（P=0.380），即SBB提高了6.3%，CD提高了4.4%，其他适应证提高了9.2%，4%的患者治疗方案发生了改变。首次SBCE阅片中4%的检查存在假阴性。
对SBCE记录进行第二次评估发现了首次评估遗漏的重要病变，导致诊断率有6%的非显著性提高，4%的患者治疗方案发生改变。
