Does a Second Reading Of a Capsule Endoscopy Increase Diagnostic Yield?

Aims Diagnostic yield (DY) of capsule endoscopy (CE) has a wide range (44.2 % in occult bleeding to 92.3 % in active bleeding) with a moderate to substantial interobserver agreement among experts (kappa 0.48-0.61). False negatives of CE are around 9 %. The intention of this study is to identify whether a second CE reading by another endoscopist can increase DY.

Methods 100 CE already read with different indications were reread by a second blinded endoscopist. When the results of the readings were different, the images were discussed between both endoscopists, taking into account the opinion of a third endoscopist if there was no agreement between both. All the participating endoscopists have experience in reading CE (> 50 CE/year). The CE findings were divided in 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 in the CE initially read.

Results Indications for CE included were small bowel bleeding (SBB) in 48 cases, Crohn’s disease (CD) in 30, and other causes (iron-deficiency anemia, search for small-bowel tumors, and diarrhea) in 22. The interobserver agreement between both endoscopists was substantial (κ=0.79). The findings in the first reading were 60 % positive, 20 % equivocal and 20 % negative, while in the second they were 66 % positive, 18 % equivocal and 16 % negative. The increase in the DY with the second reading was 6 % (p = 0.429) for the total CE, 6.3 % for SBB, 4.4 % for CD and 9.2 % for other indications. False negatives of the first CE reading were reported in 6 % of cases.

Conclusions A second reading increases the diagnostic yield of the capsule endoscopy by 6 % without a statistically significant difference.

Citation: Blanco-Velasco G, Solórzano-Pineda OM, García-Contreras LF et al. eP98 DOES A SECOND READING OF A CAPSULE ENDOSCOPY INCREASE DIAGNOSTIC YIELD?. Endoscopy 2021; 53: S128.

Publication History

Article published online:
19 March 2021