23 January 2012

Docs can miss abnormalities captured by camera-pill

Capsule endoscopy (using a 'camera-pill') can capture views deep within the small intestine, but the doctors who read the results may fail to spot abnormalities, a study suggests.


Capsule endoscopy (using a 'camera-pill') can capture views deep within the small intestine, but the doctors who read the results may often fail to spot abnormalities, a small study suggests.

Seventeen doctors who viewed images obtained during capsule endoscopy caught fewer than half of the small intestine abnormalities on display.

The researchers say the findings send a message to doctors reading images from the capsule cameras: slow down.

Capsule endoscopy is most often used to find the source of bleeding in the digestive tract that could not be diagnosed after a standard colonoscopy or an upper endoscopy.

But surprisingly little has been known about how well doctors interpret the images from capsule endoscopy, according to Dr Eric Goldberg, the senior researcher on the new study.

Read results much slowly

That's important because a single capsule endoscopy produces about 50 000 images, which makes the chances of missing something high.

"We're looking at 50 000 images in about 30 minutes to an hour-and-a-half," said Dr Goldberg, a gastroenterologist at the University Of Maryland School Of Medicine in Baltimore. "So the question is, are we looking at them too quickly?"

As reported in the American Journal of Gastroenterology, Dr Goldberg's team had 17 clinicians read 24 "clips", 18 of which showed small intestine lesions that could be a source of bleeding.

The endoscopists looked at images in the four most commonly used reading modes. In three modes, Dr Goldberg's team found, the doctors detected between 43% and 47% of abnormalities. With the fourth, the detection rate was only 26%.

"This was a real eye-opener," Dr Goldberg told Reuters Health.

"I think the big message here," he added, "is that we need to be reading much more slowly."

Capsule endoscopy is safe and non-invasive

The advantage of capsule endoscopy, Dr Goldberg said, is that "it's a non-invasive, safe test" with a better diagnostic yield than enteroscopes or X-rays.

If the results of capsule endoscopy are normal but the patient remains symptomatic, Dr Goldberg's advice is to have a second doctor read the stored images.

At his centre it's standard now for a second doctor to look at capsule endoscopy images, to help avoid misses.

The current study included only 17 doctors, all from the Baltimore area. But Dr Goldberg said he thinks the findings could apply more broadly; the endoscopists had a range of experience, and included doctors from university medical centres and community practices.

It's likely, Dr Goldberg said, that doctors elsewhere would perform similarly.

(Amy Norton, Reuters Health, January 2012) 

Read more:

Camera-pill takes pics inside body


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