New ESGE recommendations match CorporateHealth best practices

The new ESGE recommendations for SB capsule endoscopy picked up what CorporateHealth has been working on since many years:

  • Using qualified nurses as pre-readers
  • Performing capsule endoscopy as an outpatient procedure

CorporateHealth has created a team that achieves highest levels of quality and productivity by combining pre-reading by nurses with a medically sound validation by a doctor. This ensures trust in the results, no matter where the procedure was conducted.

Furthermore, CorporateHealth provides full patient management services: From a referral to transfer of the video, we can make sure that the patient is prepared well and the procedure conducted according to the latest best-practices: At any location, even the home of the patient.

In the newly published ESGE Technical Review, those processes are recognized as new recommendations.

 

Small-bowel capsule endoscopy and device-assisted enteroscopy for diagnosis and treatment of small-bowel disorders: European Society of Gastrointestinal Endoscopy (ESGE) Technical Review

Emanuele Rondonotti, Cristiano Spada, Samuel Adler, Andrea May, Edward J Despott, Anastasios Koulaouzidis, Simon Panter, Dirk Domagk, Ignacio Fernandez-Urien, Gabriel Rahmi, Maria Elena Riccioni, Jeanin E van Hooft, Cesare Hassan, Marco Pennazio

Endoscopy 2018 March 14

SMALL-BOWEL CAPSULE ENDOSCOPY (SBCE): 1: ESGE recommends that prior to SBCE patients ingest a purgative (2 L of polyethylene glycol [PEG]) for better visualization.Strong recommendation, high quality evidence.However, the optimal timing for taking purgatives is yet to be established. 2: ESGE recommends that SBCE should be performed as an outpatient procedure if possible, since completion rates are higher in outpatients than in inpatients.Strong recommendation, moderate quality evidence. 3: ESGE recommends that patients with pacemakers can safely undergo SBCE without special precautions.Strong recommendation, low quality evidence. 4: ESGE suggests that SBCE can also be safely performed in patients with implantable cardioverter defibrillators and left ventricular assist devices.Weak recommendation, low quality evidence. 5: ESGE recommends the acceptance of qualified nurses and trained technicians as prereaders of capsule endoscopy studies as their competency in identifying pathology is similar to that of medically qualified readers. The responsibility of establishing a diagnosis must however remain with the attending physician.Strong recommendation, moderate quality evidence. 6: ESGE recommends observation in cases of asymptomatic capsule retention.Strong recommendation, moderate quality evidence.In cases where capsule retrieval is indicated, ESGE recommends the use of device-assisted enteroscopy as the method of choice.Strong recommendation, moderate quality evidence.

 Link

WEO CRC Screening Committee Meeting Presentations

The World Endoscopy Organization holds regular meetings of their CRC Screening Committee. CorporateHealth was represented by Tanja Nowak at the latest event in Barcelona. Interesting presentations were shown and discussions held, incl. an overview by Prof Gunnar Baatrup of Odense University Hospital of the first clinical trial supported by CorporateHealth.

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Home-Delivered CCE superior to standard colonoscopy

When you compare a standard colonoscopy with CorporateHealth’ home-delivered colon capsule endoscopy, the results speak for themselves: “In participants with complete colon capsule endoscopy and colonoscopy examinations (N=126), per-patient sensitivity of >9 mm polyps in colon capsule endoscopy (97%; 95% CI: 94-100) was superior to colonoscopy (89%; 95% CI: 84-94).”

Kobaek-Larsen, Morten, Rasmus Kroijer, Anne-Kirstine Dyrvig, Maria Magdalena Buijs, Robert J C Steele, Niels Qvist, and Gunnar Baatrup. “Back-to-Back Colon Capsule Endoscopy and Optical Colonoscopy in Colorectal Cancer Screening Individuals.” Colorectal Disease, n.d., n/a-n/a. https://doi.org/10.1111/codi.13965.

Medtronic PillCam SB Indications, Contraindications and Risks

Medtronic describes the indications for use, contra indications, and procedure risks for their PillCam SB:

Indications for Use

  • The PillCam Platform with PillCam SB capsules is intended for visualization of the small bowel mucosa and:
    • May be used in the visualization of lesions that may be a source of obscure bleeding (either overt or occult) not detected by upper and lower endoscopy
    • May be used in the visualization of lesions that may be potential causes of iron deficiency anemia (IDA) not detected by upper and lower endoscopy
    • May be used in the visualization and monitoring of lesions that may indicate Crohn’s disease not detected by upper and lower endoscopy
  • The PillCam Platform with PillCam SB capsules may be used as a tool in the detection of abnormalities of the small bowel and is intended for use in adults and children from two years of age
  • The Suspected Blood Indicator (SBI) feature is intended to mark frames of the video suspected of containing blood or red areas

Contraindications

  • Patients with known or suspected GI obstructions, strictures or fistulas based on the clinical picture or pre-procedure testing and profile
  • Patients with cardiac pacemakers or other implanted electromedical devices
  • Patients with swallowing disorders

Procedure Risk Information

  • The risks of PillCam capsule endoscopy include capsule retention, aspiration and skin irritation
  • Endoscopic placement may present additional risks
  • Medical, endoscopic or surgical intervention may be necessary to address any of these complications, should they occur
  • After ingesting the PillCam SB capsule and until it is excreted, patients should not be near any source of powerful electromagnetic fields, such as one created near an MRI device
  • Please refer to the product user manual for detailed information
 Medtronic / Given Imaging “PillCam Capsule Endoscopy. User Manual RAPID v8.0”, March 2013

Same prep CHI-CCE and Colonoscopy

Khoury et al. find that is it feasible to create a tandem offering, where a colonoscopy could be conducted right after a capsule endoscopy. That way for over 80% of patients that would have required a follow-up, invasive procedure, a second prep might have been avoided.

Khoury, Marwan et al. “Enabling Tandem Procedure of Colonoscopy Following Colon Capsule Endoscopy in Colorectal Cancer Screening.” Accessed November 22, 2016. https://www.ueg.eu/education/document/enabling-tandem-procedure-of-colonoscopy-following-colon-capsule-endoscopy-in-colorectal-cancer-screening/115476
Link.