Prevalence of Hiatal Hernia and Hernial Size Detected by Esophageal Capsule Endoscopy (ECE) in Patients with Gastroesophageal Reflux Symptoms

Abstract

Purpose: To report the prevalence of hiatal hernia and hernia size detected by esophageal capsule endoscopy (ECE) (Given imaging's PillCam® ESO) in patients referred for evaluation of chronic gastroesophageal reflux disease (GERD) symptoms and/or Barrett's esophagus screening. Methods: We retrospectively reviewed 502 de-identified ECE studies performed from January 2007 to November 2009 for evaluation of reflux symptoms and/or Barrett's esophagus screening. All ECE recordings were independently interpreted by two experienced gastroenterologists (>500 ECE). The diagnosis of hiatal hernia was based on ECE findings of a gastric sac below the gastroesophageal junction and above the diaphragmatic pinch. The hernia size was graded as small to moderate size if it was visualized on only the antegrade or retrograde view (less than 26 mm in length), or large size if the hernia sac could be seen simultaneously on both antegrade and retrograde views (26 mm or larger). The concordance rate between the two gastroenterologists was calculated to assess the inter-observer variability for ECE interpretation for hiatal hernia and hernia size. Results: ECE detected hiatal hernia in 201 of 502 patients (40%). Of the 201 patients with hiatal hernia, 40 patients (19.9%) had large hiatal hernia and 161 patients (79.1%) had small to moderate-size hiatal hernia. The concordance rate for hiatal hernia diagnosis and hernial size evaluation between the two gastroenterologists was 95% and 98%, respectively. Conclusion: Esophageal capsule endoscopy is a useful diagnostic tool to diagnose hiatal hernia and hernia size in patients with GERD symptoms.Figure