A prospective study of the diagnostic accuracy of PillCam ESO esophageal capsule endoscopy versus conventional upper endoscopy in patients with chronic gastroesophageal reflux diseases.
BACKGROUND
Endoscopy is commonly performed to evaluate for suspected or established esophageal diseases including gastroesophageal reflux disease (GERD) and its complications. The newly developed PillCam ESO Esophageal Capsule offers an alternative approach to visualize the esophagus and to evaluate patients with suspected esophageal disease.


OBJECTIVE
Compare the accuracy (specificity, sensitivity, positive predictive value [PPV], and negative predictive value [NPV]) of esophageal capsule endoscopy (ECE) compared with esophagogastroduodenoscopy (EGD) in evaluating patients with GERD.


METHODS
A multicenter pivotal trial was conducted at seven sites. The PillCam ESO esophageal capsule is similar to the standard capsule endoscope used for the small bowel but acquires video images from both ends of the device at 2 frames/second/end. A total of 106 patients (93 GERD; 13 Barrett) underwent ECE followed by EGD. ECE videos were evaluated by an investigator blinded to EGD findings. A blinded adjudication committee reviewed all discrepant findings between ECE and EGD.


RESULTS
Sixty-six of 106 patients had positive esophageal findings, ECE identified esophageal abnormalities in 61 (sensitivity, 92%; specificity, 95%). The per-protocol sensitivity, specificity, PPV, and NPV of ECE for Barrett esophagus were 97%, 99%, 97%, and 99%, respectively, and for esophagitis 89%, 99%, 97%, and 94%, respectively. ECE was preferred over EGD by all patients. There were no adverse events related to ECE.


CONCLUSIONS
ECE is a convenient and sensitive method for visualization of esophageal mucosal pathology and may provide an effective method to evaluate patients for esophageal disease.
Rambam Medical Center, Haifa, Israel.
Rami
R
Eliakim
Virender K
VK
Sharma
Kamel
K
Yassin
Samuel N
SN
Adler
Harold
H
Jacob
David R
DR
Cave
Ritu
R
Sachdev
Roger D
RD
Mitty
Dirk
D
Hartmann
Dieter
D
Schilling
Jurgen F
JF
Riemann
Simon
S
Bar-Meir
Eytan
E
Bardan
Brian
B
Fennerty
Glenn
G
Eisen
Douglas
D
Faigel
Blair S
BS
Lewis
David E
DE
Fleischer
D016099:Endoscopy, Gastrointestinal / Q000379:methods*; D004867:Equipment Design; D020701:Esophagoscopes; D005240:Feasibility Studies; D005260:Female; D005764:Gastroesophageal Reflux / Q000175:diagnosis*; D006801:Humans; D008297:Male; D008875:Middle Aged; D017060:Patient Satisfaction; D011237:Predictive Value of Tests; D011795:Surveys and Questionnaires; D013686:Telemetry / Q000295:instrumentation*; D014741:Video Recording / Q000295:instrumentation