Endoscopy 2019; 51(04): S29
DOI: 10.1055/s-0039-1681255
ESGE Days 2019 oral presentations
Friday, April 5, 2019 11:00 – 13:00: Capsule – enteroscopy Club B
Georg Thieme Verlag KG Stuttgart · New York

FUTURE KEY PERFORMANCE INDICES FOR DEVICE ASSISTED ENTEROSOCPY; WHAT WE CAN LEARN FROM CURRENT PRACTICE

, , Trinity Academic Gastroenterology Group
MS Ismail
1   Department of Gastroenterology, Tallaght University Hospital, Dublin, Ireland
2   Trinity Academic Gastroenterology Group, Trinity College Dublin, Dublin, Ireland
,
A O'Keefe
1   Department of Gastroenterology, Tallaght University Hospital, Dublin, Ireland
,
CJ Aylward
3   Trinity College Dublin, Dublin, Ireland
,
N Hickey
3   Trinity College Dublin, Dublin, Ireland
,
D McNamara
1   Department of Gastroenterology, Tallaght University Hospital, Dublin, Ireland
2   Trinity Academic Gastroenterology Group, Trinity College Dublin, Dublin, Ireland
› Author Affiliations
Further Information

Publication History

Publication Date:
18 March 2019 (online)

Also available at
 
 

    Aims: Introduction:

    ESGE has recommended device-assisted-enteroscopy (DAE) is used to confirm and treat small bowel lesions. DAE is relatively new and lacks Key Performance Indices (KPI). Quality of DAE would have significant impact on patient outcome; assessment of current practice could highlight important future KPIs.

    Aims:

    To identify potential KPIs for DAE through assessment of current practice in a single university-affiliated DAE centre.

    Methods:

    DAE procedures from 2014 – 2017 were included. Electronic records were reviewed including small-bowel capsule-endoscopy (SBCE) reporting system. Demographics, indication, findings, histology, intervention and complication rates were documented. Data was analysed according to potential KPI and compared using a chi2 test, a p < 0.05 was considered significant.

    Results:

    251 DAE cases were reviewed; 146 (58%) male; mean age 59+/-17years. Of DAE-procedures, 186 (74%) were anterograde; average depth of insertion was significantly longer 2.37+/-0.97 vs. 1.06+/-0.66 m for anterograde versus retrograde, p < 0.0001 (95%-CI 1.05 – 1.58). 83%(n = 206) had small bowel imaging. The overall diagnostic yield was 58%(n = 145); 30%(n = 74) involved a therapeutic procedure, and tattooing was undertaken in 36%(n = 99). Complications was low, 2 (0.8%); one post-polypectomy bleed and one mild pancreatitis.

    Diagnostic yield was higher for patients with a prior SBCE (64%, n = 103/162) compared to both those with prior radiology (51%, n = 21/47) or with no prior small bowel imaging (47%, n = 42/89), p = 0.02, OR 1.9 (95%, CI-1.15 – 3.3).

    Therapeutic intent was achieved in 98%(n = 74/75) of cases including APC, polypectomies and tattooing for localisation. Independent trainees, trainees under supervision or a consultant performed 21%, 49% and 30% of procedures respectively. Reporting of positive findings was significantly higher 66% vs. 49%(p = 0.02) by independent trainees.

    Overall reporting quality was good with approach, indication and bowel preparation clearly documented in 99.6%(n = 250), while depth of insertion was reported in 95%(n = 238) and findings in 100%.

    Conclusions:

    DAE in our practice was effective and associated with few complications. Our data suggests that pre-screening with SBCE could be a future KPI, enhancing diagnostic yield and targeting approach.


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