Moderne medizinische Versorgungsstrukturen am Beispiel der Videokapselendoskopie: Erfahrungen aus über 1000 Untersuchungen in einem überregionalen Netzwerk

Zusammenfassung

Hintergrund: Die Kapselendoskopie (KE) ist im diagnostischen Algorithmus der mittleren gastrointestinalen Blutung fest etabliert. Trotz des hohen diagnostischen Wertes limitieren fehlende Erfahrung bei der zeitintensiven Auswertung und hohe Investitionskosten eine flächendeckende Verfügbarkeit. Ein Anwendernetzwerk sollte diese Nachteile kompensieren.

Methode: Ein zentral lokalisiertes Krankenhaus (ZK) stellt die KE peripheren Netzwerkpartnern (NP) zur Verfügung. Auf Anfrage wird das Equipment zugestellt. Die KE erfolgt beim NP unter Verantwortung des örtlichen Personals, die Auswertung nur im ZK.

Ergebnisse: Von Januar 2002 bis Juli 2013 wurden netzwerkweit 1026 KE (548 M., 478 F.; 64 ± 16, 13 – 93 J.) durchgeführt. 744/1026 (73 %) KE fanden bei 17 NP, 282/1026 (27 %) im ZK statt. Zwischen 2002 (n = 39) und 2012 (n = 136) stiegen die jährlichen Untersuchungszahlen um das Dreifache. Hauptindikation zur KE war die mittlere GI-Blutung (80 %). Die Wartezeit zwischen Wunschdatum und Untersuchung lag unter 24 h, zwischen KE und Befundung 2 Tage. Durch die Gerätegemeinschaft wurden 95 % der Primärinvestition bei den NP vermieden.

Schlussfolgerung: Die Erfahrungen aus über 1000 KE belegen, dass der mobile Einsatz eines zentral vorgehaltenen KE-Equipments dauerhaft realisierbar ist und die Prozessqualität im Netzwerk die einer abteilungseigenen Bereitstellung erreicht. Die Netzwerkbildung ermöglicht somit eine hochqualifizierte, flächendeckende und ökonomische Versorgung.

Abstract

Introduction: Capsule endoscopy (CE) is firmly established as a standard procedure in the diagnostic algorithm of mid gastrointestinal (GI) bleeding. Despite its excellent diagnostic yield, missing expertise, reading time and financial expenditure limit an area-wide availability. A multicentric cooperation might compensate these disadvantages.

Methods: The CE device was bought by a centrally located hospital (CH). CE-equipment is transported to the network partner (NP) on request and the procedure performed at the spot. Video reading is exclusively done in the CH.

Results: Between January 2002 and July 2013, 1026 CE (548 m, 478f; 64 ± 16, 13 – 93 yrs.) were performed within the network. 744/1026 (73 %) CE were done at 17 NP, 282/1026 (27 %) in the CH. Between 2002 (n = 39) and 2012 (n = 136) the annual number of CE increased threefold. Leading indication for CE was suspected mid GI-bleeding (80 %). Mean latencies between requested date and actual examination were less than 24 h and 2 days between CE performance and report. 95 % of the capital investment in each cooperating hospital could be avoided by sharing one workstation within the network.

Conclusion: The experience from more than 1000 CE show that long-term multicentric utilization of CE equipment is feasible. Such a network runs at stable procedural quality levels similar to an in-house supply, allows an economic as well as area-wide availability of CE and improves reading expertise by centralized video evaluation.

Schlüsselwörter

gastrointestinale Blutung - Dünndarmblutung - chronisch entzündliche Darmerkrankung

Key words

gastrointestinal bleeding - small intestine bleeding - chronic inflammatory disesase

• Literatur

• 1 Rösch T, Ell C. Position paper on capsule endoscopy for the diagnosis of small bowel disorders. Z Gastroenterol 2004; 42: 247-259
• 2 Mergener K, Ponchon T, Gralnek I et al. Literature review and recommendations for clinical application of small-bowel capsule endoscopy, based on a panel discussion by international experts. Endoscopy 2007; 39: 895-909
• 3 Leighton JA, Goldstein J, Hirota W et al. Obscure gastrointestinal bleeding. Gastrointest Endosc 2003; 58: 650-655
• 4 Ell C, May A. Mid-gastrointestinal bleeding: capsule endoscopy and push-and-pull enteroscopy give rise to a new medical term. Endoscopy 2006; 38: 73-75
• 5 Triester Sl, Leighton JA, Leontiadis GI et al. A meta-analysis of the yield of capsule endoscopy compared to other diagnostic modalities in patients with obscure GI bleeding. Am J Gastroenterol 2005; 100: 2407-2418
• 6 Marmo R, Rotondano G, Piscopo R et al. Metaanalysis: capsule enteroscopy vs. conventional modalities in diagnosis of small bowel diseases. Aliment Pharmacol Ther 2005; 22: 595-604
• 7 Gerson LB. Small bowel endoscopy: cost-effectiveness of the different approaches. Best Pract Res Clin Gastroenterol 2012; 26: 325-335
• 8 May A, Albert J, Keuchel M et al. Capsule endoscopy for the diagnosis of small bowel disease. An updated statement by the endoscopy section of DGVS. Z Gastroenterol 2010; 48: 1384-1404
• 9 Saurin JC, Lapalus MG, Cholet F et al. French Society of Digestive Endoscopy (SFED). Can we shorten the small-bowel capsule reading time with the "Quick-view" image detection system?. Dig Liver Dis 2012; 44: 477-481
• 10 Ben Soussan E, Antonietti M, Hervé S et al. Diagnostic yield and therapeutic implications of capsule endoscopy in obscure gastrointestinal bleeding. Gastroenterol Clin Biol 2004; 28: 1068-1073
• 11 Park SC, Chun HJ, Kim ES et al. Sensitivity of the suspected blood indicator: An experimental study. World J Gastroenterol 2012; 18: 4169-4174
• 12 Korman LY, Delvaux M, Gay G et al. Capsule endoscopy structured terminology (CEST): proposal of an standardized and structured terminology für reporting capsule endoscopy procedures. Endoscopy 2005; 37: 951-959
• 13 Franke A, Hummel F, Knebel P et al. Prospective evaluation of small bowel preparation with bisacodyl and sodium phosphate for capsule endoscopy. World J Gast 2008; 14: 2061-2064
• 14 Pennazio M, Santucci R, Rodonotti E et al. Outcome of patients with obscure gastrointestinal bleeding after capsule endoscopy: report of 100 consecutive cases. Gastroenterology 2004; 126: 643-653
• 15 Estévez E, González-Conde B, Vázquez-Iglesias JL et al. Incidence of tumoral pathology according to study using capsule endoscopy for patients with obscure gastrointestinal bleeding. Surg Endosc 2007; 21: 1776-1780
• 16 Schwartz GD, Barkin JS. Small-bowel tumors detected by wireless capsule endoscopy. Dig Dis Sci 2007; 52: 1026-1030
• 17 Urbain D, BeLooze D, Demets I et al. Multicentric Belgian experience in detection of small bowel malignancies by using capsule video endoscopy. Endoscopy 2006; 38: 408-411
• 18 Liao Z, Gao R, Xu C et al. Indications and detection, completion, and retention rates of small-bowel capsule endoscopy: a systematic review. Gastrointest Endosc 2010; 71: 280-286
• 19 Bandorski D, Irnich W, Bruck M et al. Capsule endoscopy and cardiac pacemakers: investigation for possible interference. Endoscopy 2008; 40: 36-39