A multicenter randomized comparison of the Endocapsule and the Pillcam SB.
BACKGROUND
Video capsule endoscopy has been shown to be the single most effective endoscopic procedure for identifying the source of obscure GI bleeding (OGIB).


OBJECTIVE
Our purpose was to report on the Food and Drug Administration pivotal trial in which the Endocapsule (EC) (Olympus America, Allentown, Pa) was compared with the Pillcam SB (PSB) (Given Imaging, Yoqneam, Israel) in patients with OGIB.


METHODS
A novel trial design was used in which the EC and the PSB were swallowed by the same patient 40 minutes apart, in randomized order.


METHODS
Four academic medical centers.


METHODS
Patients with OGIB aged 18 to 85 years who had either been transfused or who had a hematocrit of <31% in males or <28% in females.


METHODS
Both video capsules were swallowed in random order. Videos from the PSB were read locally for patient management. All videos were then read by at least 2 independent readers for normal versus abnormal categorization, a diagnosis, capsule transit time, reading time, and a subjective assessment of image quality.


METHODS
Categorization of videos as either normal or abnormal.


RESULTS
Data from 51 of 63 enrolled patients were analyzed. Nine patients were excluded for technical reasons and 3 for protocol violations. Twenty-four videos were read as normal and 14 as abnormal from both capsules. Disagreement occurred in 13. No adverse events were reported for either capsule. Overall agreement was 38 of 51 (74.5%) with a kappa of 0.48, P = .008.


CONCLUSIONS
Although ingestion order was randomized, the videos could not be read blind owing to a different shape of the image margin.


CONCLUSIONS
(1) Both devices were safe and had a comparable diagnostic yield within the range previously reported. (2) There was a subjective difference in image quality favoring the EC. (3) This study design provided unique information about capsule movement in the small intestine and the lack of electromechanical interference between 2 different capsules.
Cave
David R
DR
University of Massachusetts Memorial Medical Center, Worcester, Massachusetts, USA.
Fleischer
David E
DE
Leighton
Jonathan A
JA
Faigel
Douglas O
DO
Heigh
Russell I
RI
Sharma
Virender K
VK
Gostout
Christopher J
CJ
Rajan
Elizabeth
E
Mergener
Klaus
K
Foley
Anne
A
Lee
Michael
M
Bhattacharya
Kanishka
K
D000046:Academic Medical Centers; D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D053705:Capsule Endoscopes; D053704:Capsule Endoscopy; D020776:Endoscopes, Gastrointestinal; D004867:Equipment Design; D004869:Equipment Safety; D005260:Female; D006471:Gastrointestinal Hemorrhage / Q000175:diagnosis*; D006801:Humans; D007410:Intestinal Diseases / Q000175:diagnosis; D007421:Intestine, Small / Q000473:pathology*; D008297:Male; D008875:Middle Aged; D011336:Probability; D012016:Reference Values; D018570:Risk Assessment; D012680:Sensitivity and Specificity; D012720:Severity of Illness Index; D055815:Young Adult