Division of Gastroenterology and Hepatology, Department of Medicine, University of Alabama at Birmingham, Birmingham, Alabama, USA.
Tinsley Harrison Internal Medicine Residency, Department of Medicine, University of Alabama at Birmingham, Birmingham, Alabama, USA.
Dig Dis. 2023;41(3):500-505. doi: 10.1159/000526744. Epub 2022 Sep 13.
Capsule endoscopy (CE) is an emerging tool in the diagnosis and management of occult bleeding and overt obscure gastrointestinal bleeding (OOGIB). Maximizing the efficiency of CE can lead to rapid bleeding localization and shorter time to therapy. We investigated whether a trained registered nurse (RN) can accurately interpret bleeding by observing the CE findings in real time by measuring inter-observer agreement between RN and physician interpretation.
We conducted a prospective study of patients admitted for OOGIB who underwent live-view capsule endoscopy (LVCE) between December 2016 and November 2017. A matched control group who underwent standard CE was obtained through retrospective review. An RN received a 2-day training program for CE interpretation. RN bedside interpretation for bleeding was followed by interpretation by 2 gastrointestinal physicians blinded to LVCE findings. Outcomes were compared between groups using t-tests and χ2 tests. Cohen's kappa measured the agreement between the physicians and the RN.
Ten subjects were in the LVCE group, and 12 subjects were in the standard-of-care group. The agreement between the physicians and the RN was 9/10 (90%), with a kappa of 0.73 (95% CI: 0.26-1.00; p = 0.016). Patients in the LVCE group had shorter duration to physician interpretation (0.6 vs. 0.7 days [p = 0.50]), shorter duration to endoscopy (1.8 days vs. 3 days [p = 0.240]), and shorter length of stay (8.1 vs. 11.4 days [p = 0.26]) compared to the standard-of-care group.
This study utilizing an RN for LVCE interpretation found inter-observer agreement between RN and physician findings. Larger studies are needed to assess whether this RN-physician team approach can translate to improved outcomes.
胶囊内镜（CE）是诊断和治疗隐匿性出血和显性胃肠道不明原因出血（OOGIB）的新兴工具。提高 CE 的效率可以快速定位出血并缩短治疗时间。我们通过测量护士（RN）和医生对出血的解释之间的观察者间一致性，来调查经过培训的注册护士（RN）是否可以通过实时观察 CE 结果来准确解释出血。
我们对 2016 年 12 月至 2017 年 11 月期间因 OOGIB 入院并接受实时胶囊内镜（LVCE）的患者进行了前瞻性研究。通过回顾性复查获得了接受标准 CE 的匹配对照组。一名 RN 接受了为期 2 天的 CE 解释培训计划。在进行了 LVCE 检查后，RN 床边对出血进行了解释，然后由 2 名对 LVCE 结果不知情的胃肠病医生进行了解释。使用 t 检验和 χ2 检验比较了两组之间的结果。Cohen's kappa 测量了医生和 RN 之间的一致性。
LVCE 组有 10 例患者，标准护理组有 12 例患者。医生和 RN 之间的一致性为 9/10（90%），kappa 值为 0.73（95%CI：0.26-1.00；p=0.016）。LVCE 组患者的医生解释时间更短（0.6 天与 0.7 天 [p=0.50]），内镜检查时间更短（1.8 天与 3 天 [p=0.240]），住院时间更短（8.1 天与 11.4 天 [p=0.26]）。
这项利用 RN 进行 LVCE 解释的研究发现，RN 和医生的发现之间存在观察者间一致性。需要更大的研究来评估这种 RN-医生团队方法是否可以转化为改善结果。
