Upper gastrointestinal tract capsule endoscopy using a nurse-led protocol: First reported experience

Abstract

AIMTo test the feasibility and performance of a novel upper gastrointestinal (GI) capsule endoscope using a nurse-led protocol.METHODSWe conducted a prospective cohort analysis of patients who declined gastroscopy (oesophagogastroduodenoscopy, OGD) but who consented to upper GI capsule endoscopy. Patients swallowed the upper GI capsule following ingestion of 1 liter of water (containing simethicone). A series of positional changes were used to exploit the effects of water flow and move the upper GI capsule from one gravity-dependent area to another using a nurse-led protocol. Capsule transit time, video reading time, mucosal visualisation, pathology detection and patient tolerance was evaluated.RESULTSFifty patients were included in the study. The mean capsule transit times in the oesophagus and stomach were 28 s and 68 min respectively. Visualisation of the following major anatomical landmarks was achieved (graded 1-5: Poor to excellent): Oesophagus, 4.8 (± 0.5); gastro-oesophageal junction (GOJ), 4.8 (± 0.8); cardia, 4.8 (± 0.8); fundus, 3.8 (± 1.2); body, 4.5 (± 1); antrum, 4.5 (± 1); pylorus, 4.7 (± 0.8); duodenal bulb, 4.7 (± 0.7); second part of the duodenum (D2), 4.7 (± 1). The upper GI capsule reached D2 in 64% of patients. The mean video reading time was 48 min with standard playback mode and 20 min using Quickview (P = 0.0001). No pathology was missed using Quickview. Procedural tolerance was excellent. No complications were seen with the upper GI capsule.CONCLUSIONThe upper GI capsule achieved excellent views of the upper GI tract. Future studies should compare the diagnostic accuracy between upper GI capsule and OGD.

Magnetically controlled capsule endoscopy in one-time gastro-small intestinal joint examination: a two-centre experience

“…By using simethicone and repetitive position change, the gastric cleanliness in this study was considered good to excellent, which was similar to previous studies [ 20 , 21 ]. Compared to the results of Ching HL et al [ 30 ], our study showed that only 1.95% and 3.91% of patients had insufficient cardia and fundus examinations, respectively. The relevant poor visibility of MCE in the upper stomach was probably due to the mucus and bubbles being retained by the deep mucosal folds of the greater curvature [ 6 , 20 , 21 ].…”

Performance measures for small‐bowel endoscopy: A European Society of Gastrointestinal Endoscopy (ESGE) Quality Improvement Initiative

“…RCTs demonstrate that antifoaming agents improve the quality of mucosal visualization, 10,14 and meta-analyses have concluded that simethicone has a positive impact on the quality of preparation as it significantly decreases the presence of luminal bubbles/foam. 14,17,18,24,26,34–55 The combination of purgatives and antifoaming agents does not increase diagnostic yield; however, it may play a role in improving the quality of small-bowel mucosal visualization.…”

Advances in optical gastrointestinal endoscopy: a technical review

“…The average capsule transit time through the esophagus can be as low as about 30 s [59], mandating a fast frame rate to capture highquality images; once it enters the stomach, the uncontrolled capsule movement further complicates image acquisition. Using the Pillcam UGI capsule that captures 35 frames per second, capsule endoscopy has been shown to visualize important clinical landmarks of the esophagus; in addition, feasibility to view the entire stomach was demonstrated with patients positioned at different planes and angles on an examination bed in a nurse-led protocol [59]. Owing to its moderate accuracy (sensitivity 78% and specificity 73% for BE detection in a meta-analysis of nine studies involving 618 patients by Bhardwaj et al), however, it is not recommended for BE screening [7,60].…”