Original Article
Clinical Endoscopy
Blinded comparison of esophageal capsule endoscopy versus conventional endoscopy for a diagnosis of Barrett's esophagus in patients with chronic gastroesophageal reflux

https://doi.org/10.1016/j.gie.2006.06.035Get rights and content

Background

Esophageal capsule endoscopy (ECE) is an alternative to EGD for Barrett's esophagus screening. A multicenter study found ECE to be safe, well tolerated, and accurate; however, a post hoc adjudication process was used that may have biased results.

Objective

To assess the accuracy of ECE for the diagnosis of Barrett's esophagus.

Design

Prospective and blinded, with no adjudication.

Patients

Screening patients with chronic gastroesophageal reflux and surveillance patients with known Barrett's esophagus.

Interventions

ECE followed by EGD in each subject.

Main Outcome Measurements

Sensitivity, specificity, and positive and negative predictive values of ECE for Barrett's esophagus by using EGD results, with histologic confirmation as the criterion standard.

Results

Ninety-six subjects were enrolled, of whom 90 (94%) completed the study, including 66 screening and 24 surveillance patients. ECE was 67% sensitive and 84% specific for identifying Barrett's esophagus, diagnosing 14 of 21 cases of biopsy-confirmed Barrett's esophagus. Positive and negative predictive values were 22% and 98%, respectively (calculated for screening patients only). Sensitivity for short- and long-segment Barrett's esophagus was similar.

Conclusions

Our blinded, unadjudicated study shows that ECE had only moderate sensitivity and specificity for identifying Barrett's esophagus. ECE in its present form is not suitable as a primary screening tool for Barrett's esophagus but may be used in patients unwilling to undergo EGD. Inadequate visualization of the gastroesophageal junction may be the cause of suboptimal ECE accuracy; this may be improved by advances in ingestion protocol and capsule calibration.

Section snippets

Patients and methods

This study protocol was approved by the institutional review board of Virginia Mason Medical Center, Seattle, Washington. All subjects signed a written informed consent.

Results

We attempted to contact 195 potentially eligible patients: 43 were found to fulfill exclusion criteria and 56 refused or did not respond to our telephone call (Fig. 1). A total of 96 eligible subjects were eventually enrolled. Six subjects had uninterpretable results for the following reasons. One elderly patient was unable to swallow the capsule, despite the absence of any history of stroke or other condition that might impair his swallowing ability. Two patients had the capsule retained in

Discussion

Standard, single-headed, small-bowel video capsules, which capture only 2 frames per second, are not suitable for esophageal imaging. A pilot study showed that esophageal transit time was only 2 seconds and that the gastroesophageal junction was visualized in only 24% of patients.8 Other small studies, published only in abstract form, have demonstrated that small-bowel capsules have low sensitivity or specificity for esophageal abnormalities.9, 10 There have been attempts to attach a string to

References (18)

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    Citation Excerpt :

    In initial studies, the PillCam ESO detected BE with 97% sensitivity and 99% specificity.82 However, further studies showed less than optimal sensitivity (60%–67%) and specificity (84%–100%) in detection of BE.79,83,84 The second-generation ESO2 device, which has a wider viewing angle and can generate 18 images per second, detected BE with 100% sensitivity and 74% specificity.

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