Esophageal capsule endoscopy for evaluation of patients with chronic gastroesophageal reflux symptoms: findings and its image quality

Abstract

Esophageal capsule endoscopy (ECE) may offer an alternative approach to visualize esophageal lesions associated with gastroesophageal reflux (GER) disease. The objective of this study was to report the ECE findings in patients with GER symptoms and validate a new scoring system to assess ECE video quality. Five hundred two ECE were performed in patients with GER symptoms. We devised a new grading scale called ECE Utility score to assess the quality of images using five different parameters: anatomic landmarks visualized, esophageal transit time, image quality, illumination, and artifacts. The ECE cases were independently scored by two interpreters in a randomized, blinded fashion. Reflux esophagitis was diagnosed via ECE in 254 patients (50.5%). We identified 12 cases (2.4%) with suspected Barrett's esophagus and all of them had endoscopic evidence of Barrett's esophagus on esophagogastroduodenoscopy. Histologic confirmation Barrett's esophagus was found in six patients and dysplasia was found in one patient. From the 502 cases, mean ± standard deviation total ECE Utility score was 8.89 ± 0.96 for interpreter 1 and 8.96 ± 0.93 for interpreter 2. The concordance rate between the two interpreters for the ECE Utility score ranged from 75.9-96.8% across the parameters and the Pearson correlation rate of the total score was 0.81. ECE is shown to be a simple noninvasive valuable technique for evaluating esophageal mucosa and producing high quality images in patients with GER symptoms. ECE can help as an alternative screening tool for diagnosing Barrett's esophagus.

The global prevalence of Barrett’s esophagus: A systematic review of the published literature

“…Characteristics of studies are depicted in Table 1. 10–112 Of the 80 studies in the general population, 12 studies performed a subgroup analysis in GERD patients: 11 studies were included in the GERD analysis, 10 , 15 , 19 , 23 , 27 , 30 , 32 , 42 , 43 , 56 , 79 but one was not included due to the small sample ( n = 26). There was considerable heterogeneity among studies.…”

Alternatives to Traditional Per-Oral Endoscopy for Screening

“…These two studies of 77 and 100 GERD patients reported sensitivities of 60% and 78% and specificities of 100% and 89% respectively43,44. Chavalitdhamrong and colleagues carried out a retrospective review of 502 ECE Pillcam™ ESO (Given Imaging) video files for patients with GERD to assessing ECE video imaging45. They identified 12 BE patients, which we used to estimate the sensitivity for BE diagnosis as 83% and 50% compared to visual inspection by EGD and histological confirmation with IM respectively.…”