Digestive Diseases and Sciences
A Deeper Look at the Small Bowel: Training Pathways in Video Capsule
Endoscopy and Device‑Assisted Enteroscopy
Andrew J. Read
· Michael D. Rice
· Hari S. Conjeevaram
· Sameer D. Saini
Received: 6 February 2018 / Accepted: 18 May 2018
© Springer Science+Business Media, LLC, part of Springer Nature 2018
Background Although there are guidelines for video capsule endoscopy (VCE) and device-assisted enteroscopy (DAE),
little is known about fellowship training in these technologies.
Aims The aims were to better characterize current small bowel endoscopy training in 3-year GI fellowship programs and
4th-year advanced endoscopy programs in the U.S.
Methods We developed an online multiple-choice survey to assess current GI fellowship program training in small bowel
endoscopy. The survey was distributed via email to GI fellowship program directors in the U.S.
Results Of the 168 program directors contacted, 59 responded (response rate = 35.1%). There was no statistically signiﬁcant
diﬀerence in the availability of VCE or DAE between respondents and non-respondents. VCE training was universally avail-
able in 3-year training programs, with 84.8% (50/59) requiring it for fellows. The majority of 3-year GI fellows graduated
with independence in VCE: 83.1% (49/59) of programs reported “most” or “all” graduates were able to read independently.
DAE techniques were available in 86.4% of training programs (51/59). Training in DAE was more limited and shared between
3-year and 4th-year programs: 12.1% (7/58) of 3-year programs required training in DAE and 22.9% (8/35) of 4th-year
programs required training in DAE.
Conclusions Training in VCE is widely available in U.S. GI fellowship programs, although programs have diﬀerent ways of
incorporating this training into the curriculum and of measuring competency. While DAE technology was available in the
majority of programs, training was less frequently available, and training is shared between 3-year fellowship programs and
4th-year advanced endoscopy programs .
Keywords Capsule endoscopy · Capsule endoscopes · Balloon enteroscopy · Single-balloon enteroscopy · Double-balloon
enteroscopy · Education · Medical · Graduate
The introduction of video capsule endoscopy (VCE) and
device-assisted enteroscopy (DAE) has transformed our
approach to small bowel disorders, allowing for improved
diagnostic tools and therapeutic interventions in areas that
were previously out of reach of traditional endoscopy [1–3].
VCE has become widely available in the U.S., but the diﬀu-
sion of DAE techniques has been primarily limited to refer-
ral centers, given the additional training, time and resources
required to perform these procedures. Data on the availa-
bility and usage of DAE techniques (including single- and
double-balloon enteroscopy, spiral enteroscopy, and through
the scope balloon-assisted deep enteroscopy) in the U.S. are
limited due to the lack of speciﬁcity of Current Procedural
Terminology (CPT) billing codes . While CPT codes for
* Andrew J. Read
Michael D. Rice
Hari S. Conjeevaram
Sameer D. Saini
Division of Gastroenterology and Hepatology, University
of Michigan, University of Michigan Health System, 3912 E
Taubman Center, 1500 E Medical Center Drive, SPC 5362,
Ann Arbor, MI 48109-5362, USA
Institute for Healthcare Policy and Innovation, University
of Michigan, Ann Arbor, MI, USA
VA HSR&D Center for Clinical Management Research,
Ann Arbor, MI, USA