title: Screening for esophagitis and Barrett's esophagus with wireless esophageal capsule endoscopy: a multicenter prospective trial in patients with reflux symptoms.
abstract: OBJECTIVE
  Esophageal capsule endoscopy (ECE) is a new technology that allows noninvasive investigation of the esophagus. Our aim was to evaluate prospectively the diagnostic yield of ECE in patients with chronic reflux symptoms.
  
  
  METHODS
  Eighty-nine patients (40 men, mean age 54 yr) referred to five endoscopic centers for esophagogastroduodenoscopy (EGD) were enrolled. Patients first underwent ECE, then EGD; endoscopists who performed the EGD were blind to the ECE data that were interpreted separately by two independent readers. The Los Angeles, Prague, and Montreal classification systems were used to describe endoscopic findings.
  
  
  RESULTS
  Seventy-seven patients completed the study. Esophagitis and endoscopically suspected esophageal metaplasia (ESEM) were present in 24 and 10 patients, respectively. Columnar lining was histologically confirmed in seven patients (3 with specialized intestinal metaplasia and 4 with gastric metaplasia). The kappa values for interobserver agreement regarding the diagnosis of esophagitis and ESEM were 0.67 (0.49-0.85) and 0.49 (0.17-0.81), respectively. The diagnostic yields of ECE to detect esophagitis and ESEM were as follows: sensitivity 79% and 60%, specificity 94% and 100%, positive predictive value (PPV) 83% and 100%, negative predictive value (NPV) 92% and 95%, respectively.
  
  
  CONCLUSIONS
  As a screening tool in patients with reflux symptoms, ECE has an excellent specificity and NPV for the diagnosis of esophagitis and ESEM. However, its sensitivity for the diagnosis of ESEM is not optimal. Further studies are necessary to improve the procedure, and to compare the cost-effectiveness of strategies using ECE or EGD.
authors.affiliation: CHU Nantes, Nantes, France.
authors.forename: Jean-Paul
authors.initials: JP
authors.lastname: Galmiche
authors.forename: Sylvie
authors.initials: S
authors.lastname: Sacher-Huvelin
authors.forename: Emmanuel
authors.initials: E
authors.lastname: Coron
authors.forename: Franck
authors.initials: F
authors.lastname: Cholet
authors.forename: Emmanuel Ben
authors.initials: EB
authors.lastname: Soussan
authors.forename: Véronique
authors.initials: V
authors.lastname: Sébille
authors.forename: Bernard
authors.initials: B
authors.lastname: Filoche
authors.forename: Gilles
authors.initials: G
authors.lastname: d'Abrigeon
authors.forename: Michel
authors.initials: M
authors.lastname: Antonietti
authors.forename: Michel
authors.initials: M
authors.lastname: Robaszkiewicz
authors.forename: Marc
authors.initials: M
authors.lastname: Le Rhun
authors.forename: Philippe
authors.initials: P
authors.lastname: Ducrotté
mesh_terms: D001471:Barrett Esophagus / Q000150:complications / Q000175:diagnosis*; D053704:Capsule Endoscopy; D004941:Esophagitis / Q000150:complications / Q000175:diagnosis*; D005260:Female; D005764:Gastroesophageal Reflux / Q000150:complications*; D006801:Humans; D008297:Male; D008875:Middle Aged; D015588:Observer Variation; D011237:Predictive Value of Tests; D012680:Sensitivity and Specificity