ANALYSIS OF PERFORMANCE MEASURES IN SMALL BOWEL CAPSULE ENDOSCOPY (SBCE)

Aims The European society of gastrointestinal endoscopy (ESGE) small-bowel working group identified a list of performance measures for small-bowel endoscopy with the final goal of quality improvement. The aim of this study is to analyze the performance measures for small bowel capsule endoscopy (SBCE) at a service level.

Methods A cross-sectional analysis of SBCE performed between 01/2018-07/2019 was performed in our center. The authors evaluated the 10 performance measures (6 key and 4 minor) associated to the 5 quality domains that were proposed.

Results The authors analyzed 241 SBCE, 55.6% female, with a mean age of 58.4 ± 18 years-old. Key performance measures: appropriate indication for SBCE according to ESGE clinical guideline in 92.5% (223/241); complete small bowel visualization in 95.9% (231/241); diagnostic yield of 47.3% (114/241); SBCEs performed within 14 days of overt bleeding episode in 78.9% (15/19); post-SBCE referral for DAE according to ESGE technical review in 24.2% (22/91); and capsule retention in 0.4% (1/241). Taking into account the minor performance measures, the following results were identified: adequate bowel preparation according to a validated cleansing scale (Brotz) in in 49.6% (114/230, excluding 11 patients with active bleeding); use of a patency capsule in patients with high risk of capsule retention in 2.6% (1/39); adequacy of SBCE reporting in 35.7% (86/241); and no SBCE reports described the reading speed.

Conclusions In our center, only 2 key performance measures were accomplished: complete small bowel visualization (≥ 80%) and capsule retention (< 2%). Although some standards will be difficult to achieve (i.e. use of standard terminology ≥ 90% and adequate bowel preparation ≥ 95%), feedback to the staff involved in the procedure should be given to increase performance indexes and achieve the proposed standards.