ASGE Endoscopy Course at ACG: Everyday Endoscopy: Expertise Meets Evidence | October 2024-16_Leighton

16_Leighton_Quality Indicators for CE and DE QUI

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The document outlines the quality indicators (QIs) for enhancing the effectiveness of capsule endoscopy (CE) and deep enteroscopy (DE) procedures in clinical practice. Quality indicators help ensure that healthcare is not only effectively administered but also consistently meets a set standard. These are divided into structural, process, and outcome indicators, and further subdivided into preprocedure, intraprocedure, and postprocedure criteria.<br /><br />For capsule endoscopy, key preprocedure QIs include demonstrating competency, ensuring proper indication for the procedure, and obtaining informed consent while being aware of contraindications such as known stenosis or pregnancy. In identifying risk factors for retention, conditions like Crohn's disease or past bowel obstructions are notable considerations. Diagnostic yield is optimized when CE is conducted close to a bleeding episode, with evidence showing greater yield when done within 48 hours.<br /><br />Intra and post-procedure guidelines emphasize correct placement, proper reading methodologies, and adequate documentation of visualization, landmarks, and potential complications. The recent findings suggest that purgative bowel preparation does not significantly enhance diagnostic yield, advocating for clear fluid preparation over more aggressive methods.<br /><br />For deep enteroscopy, the importance of training is highlighted, with different guidelines suggesting a minimum number of procedures to achieve competency. Like CE, DE should be performed for appropriate indications, informed by videos or cross-sectional imagery, to decide the insertion route and manage anticoagulation appropriately.<br /><br />Postprocedure indicators for both CE and DE emphasize complete reporting, tracking complications, and developing a robust follow-up plan based on findings. Emphasizing competency, proper use of carbon dioxide insufflation, and standardized lesion characterization during DE are essential components of best practices.<br /><br />Overall, these comprehensive QIs are seen as pathways to standardize practices, optimize diagnostic yields, and improve clinical outcomes in managing small bowel diseases.

Keywords

quality indicators

capsule endoscopy

deep enteroscopy

clinical practice

diagnostic yield

preprocedure

informed consent

bowel preparation

competency

small bowel diseases