Abstract
Introduction: Video capsule endoscopy (VCE) is an emerging tool used in the management of GI bleeding. VCE has a crucial role diagnostically and maximizing its efficiency will lead to more rapid localization of bleeding sources and shorter time to therapy. We hypothesized that a trained nurse can accurately interpret acute bleeding by VCE in real time. The primary outcome was inter-observer agreement between nurse and physician interpretation. Secondary outcomes were time to formal physician interpretation, endoscopy, and hospital length of stay (LOS). Methods: Two physicians from our GI division gave a registered nurse a tutorial in VCE. Patients admitted for overt obscure GI bleeding to our center between 12/2016 and 6/2017 were enrolled. A VCE was deployed per protocol. The nurse interpreted the patient's video recorder at the bedside for 2 minutes in 30-minute intervals for the duration of the study. The nurse would document a “blood” or “no blood” interpretation. The VCE interpreting physician was blinded to the nurse's findings. We retrospectively reviewed outcomes for 12 patients admitted to our unit for inpatient VCE who had received the standard of care for comparison to the live-view (LV) group. Means and proportions of demographic and clinical characteristics were compared using two-sided two-group t-test and two-sided two-group chi-square test, respectively. The kappa statistic indicated the level of agreement between the physicians and nurse.Table: Table. Patient CharacteristicsTable: Table. Secondary OutcomesResults: Nine subjects have been enrolled to date. The overall agreement between the 2 physicians and the nurse was 8/9 giving a kappa statistic of 0.73, 95% CI (0.24,1.00), p=0.023. Delay in time to physician interpretation in LV group was 0.5±0.1 days (d) vs standard group 0.7±0.3 d (p=0.059). Time to endoscopy in LV group was 1.7±1.5 d vs standard group 3±1.6 d (p=0.16). LOS in LV group was 8.9±5.7 d vs standard group was 11.4±7.8 d (p=0.46). Conclusion: This first of its kind pilot trial utilized a nurse for live-view VCE found interobserver agreement that was statistically significant. Patients in the live-view group had shorter times to physician interpretation, endoscopy, and shorter LOS. We suggest the positive impact on outcomes relates to the fostering of a team approach integrating nursing more directly into diagnostic evaluation. If nurse real time accurate interpretation of VCE bleeding can be confirmed, it will translate to more efficient and cost-effective care.
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