String Capsule Endoscopy Research Articles

The inter- and intra-observer variability of wireless string capsule endoscopy for the diagnosis of common esophageal pathology

The inter- and intra-observer variability of wireless string capsule endoscopy for the diagnosis of common esophageal pathology

String capsule endoscopy for screening and surveillance of esophageal varices in patients with cirrhosis

EGD is the gold standard for the screening and surveillance of esophageal varices. A less invasive, safer and sedationless alternative procedure is needed. To assess the sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV) as well as the beyond the chance agreement (kappa index), of string capsule endoscopy (SCE) in the diagnosis of esophageal varices. Cirrhotic patients underwent string capsule endoscopy (SCE) and EGD for screening and surveillance purposes. Varices were graded at EGD and SCE as small, medium and large. Descriptors at SCE were added as follows: PLUS, for the presence of red wale signs or, MINUS for their absence, irrespective of the estimated variceal size. Clinically significant varices were defined by their size (medium/large at either EGD or SCE) and/or, the PLUS descriptor irrespective of the estimated size at SCE. Sensitivity, specificity, PPV, NPV, accuracy and kappa index were calculated. Procedure time, procedure-related discomfort and patient's preference were documented. 100 patients (33 for screening and 67 for surveillance) were enrolled. The sensitivity and specificity of SCE for clinically significant varices when using the PLUS/MINUS descriptors were 82% and 90%, respectively with a PPV of 84% and NPV of 89% and a kappa of 0.73. String capsule endoscopy had an acceptable sensitivity and specificity for the diagnosis of clinically significant esophageal varices but the lack of air insufflation still hampers its correlation with the grading used with EGD.

String capsule endoscopy: a novel application for the preoperative identification of a small-bowel obscure GI bleeding source (with video)

Wireless video capsule endoscopy has revolutionized the field of GI endoscopy for evaluation of small-bowel pathology1,2 and is often beneficial for evaluation of obscure GI bleeding (OGIB).3 There are instances, however, in which the source may not be clearly identified or the precise anatomical location cannot be determined. In these elusive cases, surgery may be needed to provide the definitive diagnosis and therapy. We describe a case with a novel application of string capsule endoscopy (SCE) in which long strings were attached to a small-bowel wireless capsule endoscopy device (Pillcam SB; Given Imaging Limited, Yoqneam, Israel) (Fig.

The Role of a Tethering Device Attached to the PillCam ESO for the Evaluation and Diagnosis of Esophageal Disorders

Major drawbacks of capsule endoscopy in the esophagus include among others: unpredictable transit time, inability to examine any area of interest more than once, and the compromised quality of pictures by secretions/bubbles that cannot be cleared. The attachment of a tethering device to the Pill Cam ESO has not been previously described and may help to circumvent these deficiencies. Aim: To determine the utility of string capsule endoscopy using the Pill Cam Eso device in evaluation and diagnosis of esophageal disorders. Methods: Thirty-six patients: 14 with Barrett's esophagus, 12 with cirrhosis and portal hypertension and 10 with new esophageal symptoms undergoing EGD were enrolled. The tethering device was attached to the Pill Cam ESO. The study was divided in 2 consecutive diagnostic parts: 1) diagnosis by using the Pill Cam ESO following the manufacturer's recommendations of ingestion and progressive elevation of the head of the bed; 2) diagnosis during the maneuvering of the capsule using the tethering device after the first diagnostic part was completed and/or after the device had entered the stomach. An experienced endoscopist blinded to the EGD findings reviewed the pictures and rendered his diagnoses. Diagnoses were compared to the diagnosis by EGD. In addition the following times were recorded: time to swallow, to first visualization of the z line; to first gastric image; time from 1st Z-line to 1st gastric images and total procedure time. All procedures were carried out using the Real time viewer. Each Pill Cam ESO was retrieved, cleaned, disinfected and used 3 times in different patients. Patients were asked about their preference compared to EGD. Results: Of the 36 patients studied, the mean time from the 1st Z-line to the 1st gastric images was 50.1 sec. However, there were 2 patients in whom the capsule never went into the stomach; 3 patients in whom the time from the z-line to the stomach was zero and 8 additional patients in whom the interval time was ≤ 5 sec. There were 14 patients (38.9%) in whom a firm diagnosis could not be made during the first diagnostic part of the study. The use of the tethering device provided a diagnosis that matched the EGD diagnoses in all except 1 patient (EGD: small varices; string capsule short segment Barrett's). Conclusion: 1) The addition of the tethering device may increase the yield in up to 38% patients in whom the diagnosis cannot be firmly established using the conventional Pill Cam ESO method. 2) Eso-string capsule is a safe, well tolerated procedure without any complications. 3) The majority of patients (86.1%) preferred this tool to EGD.

Sleeve string capsule endoscopy for real-time viewing of the esophagus: a pilot study (with video)

Previous studies suggest that string capsule endoscopy is feasible, safe, accurate, highly acceptable, and likely to be proven as a more cost-effective technique than conventional EGD. However, this technique needs proper high-level disinfection, and the string attachment is not easy to perform. We developed a modified esophageal capsule endoscopy, called sleeve string capsule endoscopy (SSCE). To assess the feasibility and safety of SSCE in the evaluation of esophageal diseases. A pilot study. Outpatient setting in a tertiary hospital, Shanghai, China. Two healthy volunteers and 8 patients with suspected esophageal diseases were enrolled. The OMOM capsule endoscope was enclosed in a small, transparent, thin, latex sleeve, with a string attached to the caudal end. Both the sleeve and the string were for single use and were discarded after completion of the procedure. Two healthy volunteers without previous EGD and 8 patients who had undergone EGD swallowed the capsules. Pictures of the esophagus were viewed in real time. Discomfort associated with the procedure, quality, and diagnostic value of the pictures were documented. In addition, patient preference between SSCE and conventional EGD was recorded. SSCE was successfully carried out in the 10 subjects. The procedures were easy and safe to perform. No sleeves and strings were disrupted or broken, and no capsule was lost. The mean overall discomfort score during SSCE in the 8 patients was 2.88 (range 2-5). Pictures generated during SSCE were generally of high quality and produced identical diagnoses to those obtained by EGD in all 8 patients. In addition, all the 8 patients preferred SSCE to EGD. This was a single-center nonrandomized study with a small sample size. SSCE was a feasible, easy-to-operate, and safe method for the diagnosis of esophageal diseases without the need for disinfection. SSCE appears to possess the same diagnostic capacity as that of EGD.

Feasibility of string capsule endoscopy for screening of Barrett's esophagus

Feasibility of string capsule endoscopy for screening of Barrett's esophagus

Screening of Barrett's esophagus with string-capsule endoscopy: a prospective blinded study of 100 consecutive patients using histology as the criterion standard

The yield of wireless capsule endoscopy for Barrett's esophagus (BE) has not been compared with its true criterion standard, histology. To determine the sensitivity, specificity, positive predictive value, and negative predictive value of string capsule endoscopy (SCE) for the screening of BE by using specialized intestinal metaplasia as the criterion standard. Prospective, blinded, comparative study. Endoscopy unit, Veterans Affairs medical center. Patients with chronic reflux symptoms who were undergoing EGD for screening for BE. SCE performed immediately before EGD. The yield of SCE was compared with EGD for the visual and histologic diagnosis. One hundred patients, 86 men and 14 women, with a mean age of 56.5 years. The sensitivity and the specificity of SCE for the visual diagnosis of BE were 78.3% and 82.8%, respectively, when compared with EGD; the kappa index was 0.676. The sensitivity and the specificity of SCE for the histologic diagnosis of BE were 93.5% and 78.7%, respectively, with a kappa index of 0.66. No complications occurred; the procedure was well tolerated, and 80% of the patients indicated that they would prefer SCE to EGD. A total of 4 capsules were used for the study. When compared with EGD, SCE had an acceptable sensitivity and specificity for the visual diagnosis of BE and compared favorably when histology was used as the criterion standard. SCE was safe and well tolerated, with a high patient's preference rate, and it may prove to be cost effective for the screening of this condition.

The yield and safety of string capsule endoscopy in patients with dysphagia

Dysphagia is a contraindication for the use of conventional capsule endoscopy (CE). Because string CE (SCE) allows for the immediate retrieval of the device, it eliminates the risk of capsule retention. To assess the yield and safety of SCE in patients with dysphagia. Comparative study of SCE and EGD. Phoenix Veteran Affairs Medical Center. Patients with dysphagia underwent SCE and EGD. In 40 patients with dysphagia, the EGD findings were normal in 13 (32.5%); Schatzki's ring in 10 (25%); esophageal tumors in 9 (22.5%), with 1 of these having 2 separate and distinct malignancies; erosive esophagitis in 4 (10%); strictures in 2 (5%); and a web and large esophageal varices in 1 patient each (2.5%). The sensitivity of SCE for diagnosing anatomic pathology as the likely cause of dysphagia was 92.9%, with a specificity of 92.3%, a positive predictive value of 96.3%, and negative predictive value of 85.7%. The overall agreement between SCE and EGD was 92.7% and the kappa index was 0.83. There were no complications with either procedure. There was no case of capsule retention. The SCE recording time was 385.8 seconds; 77.5% patients preferred SCE to EGD. (1) SCE was safe, well tolerated, and accurate for the diagnosis of pathology responsible for dysphagia; (2) SCE was preferred to EGD by more than three fourths of patients; (3) SCE can be safely performed in patients with dysphagia.

Cost-Effectiveness of String Capsule Endoscopy for Screening for Barrett's Esophagus

Screening for Barrett's esophagus (BE) is recommended for patients with chronic gastro-esophageal reflux disease (GERD) symptoms. Although EGD is commonly used for screening of BE, we have recently reported on excellent performance characteristics of string capsule endoscopy (SCE) in screening for BE. String capsule endoscopy (SCE) allows multiple uses after high-grade disinfection but its cost-effectiveness has not been tested. Aim: To evaluate the cost-effectiveness of SCE in screening for BE compared to EGD and PillCam Eso(PCE). Methods: A Markov model with a third party payer's perspective was built to compare different competing strategies of screening for BE and subsequent management in a hypothetical cohort of 50 year old patients with chronic GERD. In strategy I, no screening was performed and natural history of BE was modeled. In strategies II, III, and IV, SCE, PCE, and EGD, respectively were used for screening of BE. With SCE and PCE, positive findings were confirmed subsequently by EGD and biopsy. In the last three strategies, management of BE was based on the ACG guidelines. Incidence, Prevalence, and Natural history of BE was obtained from published information. Cost estimates were obtained from Medicare reimbursement data. Only discounted direct costs were considered. Incremental cost-effectiveness ratio (ICER) in terms of quality adjusted life years (QALYs) gained under each strategy was the main outcome compared. Results: Table shows the results of the baseline analysis. The SCE based strategy was more cost-effective compared to strategy of no screening and dominated the PCE based strategy. Although EGD based screening strategy yielded higher QALY, its ICER over SCE was prohibitively high. The results of the baseline analysis were robust and sensitivity analyses with important clinical variables, performance characteristics of different endoscopic procedures, and cost estimates did not change the conclusions. Conclusion: Screening of BE by string capsule endoscopy is more cost-effective compared to strategies of no screening, PillCam Eso, and importantly by EGD. Tabled 1Screening strategies Strategy Cost QALY ICER No screening 1,077 18.967 – SCE 1,980 18.991 36,383 compared to no screening PCE 2,380 18.990 Dominated EGD 2,499 18.992 592,847 compared to SCE Open table in a new tab

The Utility and Safety of String Capsule Endoscopy (SCE) in Patients with Dysphagia

Suspected obstruction of the GI tract is a contraindication for the use of capsule endoscopy. Since string capsule endoscopy (SCE) can be retrieved from the patient, the risk of capsule retention is practically eliminated. Aim: To describe the utility and safety of SCE in patients with dysphagia. Methods: Patients with dysphagia undergoing SCE. EGD findings served as the gold standard. Sensitivity, specificity, positive- and negative-predictive values (PPV and NPV, respectively) were calculated.

Cost Effectiveness of String Capsule Endoscopy for Screening and Surveillance of Esophageal Varices

Cost Effectiveness of String Capsule Endoscopy for Screening and Surveillance of Esophageal Varices

String Capsule Endoscopy (SCE) Versus EGD in the Screening of Barrettʼs Esophagus. A Prospective, Blinded Study Using Histology as the Gold Standard

Purpose: The feasibility, safety, acceptance and tolerability of SCE have been previously reported. The major potential indications for capsule endoscopy in the esophagus are for screening of Barrett's esophagus (BE) and esophageal varices. Aim: To assess the sensitivity, specificity, positive- and negative-predictive values as well as the beyond the chance agreement (kappa index) of SCE for both the visual and histologic diagnosis of BE. Methods: Patients referred for evaluation of GERD symptoms and for screening of BE and no prior EGD were included in the study. All patients underwent SCE immediately prior to the EGD (that was performed in the standard manner using conscious sedation). All patients underwent four-quadrant biopsies of the visually suspected Barrett's segment and the squamous columnar junction in those with unsuspected Barrett's on EGD. An investigator blinded to EGD and histology results assesed the SCE pictures. Results: Ninety five patients were enrolled in the study (mean age: 65 years) The results for the visual diagnosis of BE are shown in Table 1. Table 2 shows the results of both EGD and SCE when compared to the histological diagnosis of Barrett's esophagus (presence of intestinal metaplasia or IM)Table 1: SCE versus EGD for the suspicion of Barrett'sTable 2: EGD/SCE versus Histology (Intestinal metaplasia)SCE was well tolerated, free of complications and was the preferred procedure over EGD in 80% of patients One capsule was able to be used in 24 patients. Conclusions: 1) The accuracy of SCE for the visual diagnosis of suspected BE was 83% with a substantial beyond the chance agreement (kappa index = 0.663). 2) Given the similar sensitivities between SCE and EGD for the confirmed (histological) diagnosis of BE, the value of SCE over EGD rests in its greater specificity and the avoidance of a riskier and costly procedure when not needed. 3) We propose that SCE should be considered a viable choice for the screening of BE.

The Intra and Inter Observer Variability of String Capsule Endoscopy (SCE) for the Diagnosis of Esophageal Lesions

The Intra and Inter Observer Variability of String Capsule Endoscopy (SCE) for the Diagnosis of Esophageal Lesions

String Capsule Endoscopy (SCE) for the Screening and Surveillance of Esophageal Varices: A Prospective, Blinded, Comparative Study with EGD

SCE grade 1: small-medium (Grade I EGD). SCE grade 2: medium (Grade II EGD). SCE grade 3: large (Grade III EGD). SCE grade 4: very large (Grade IV EGD)

String Capsule Endoscopy Has Better Sensitivity/Specificity Than Conventional EGD for the Diagnosis of Barrettʼs Esophagus. A Prospective Blinded Study

Purpose: EGD is the gold standard visual diagnostic test for Barrett's esophagus but is not the perfect gold standard when compared to the histological diagnosis. Aims: To compare the sensitivity, specificity, positive-, and negative-predictive values of String Capsule Endoscopy to conventional EGD when using histological diagnosis as the gold standard for Barrett's esophagus Methods: Patients undergoing EGD for the first time for the evaluation of reflux symptoms and/or screening for Barrett's esophagus underwent String Capsule Endoscopy (SCE) prior to their EGD on the same day. At least 4 biopsies were systematically taken from the squamous-columnar junction and/or the suspected Barrett's segment during EGD. IRB- approved protocol Independent endoscopist unaware of EGD diagnosis reviewed capsule endoscopy pictures and indicated if Barrett's esophagus was suspected or not. SCE was performed using the conventional small bowel capsule modified with a sleeve and “string” prior to the EGD, in the sitting position and without any local or systemic analgesia/sedation. EGD was performed using conscious sedation Sensitivity, specificity, positive and negative predictive values were calculated for SCE and EGD against histological diagnosis. The capsule underwent high-grade disinfection (2% gluteraldehyde for 45 minutes) and re-used after its retrieval from each patient. Patients were asked to indicate their preference: EGD versus SCE Results: 58 patients, all except 9 were men; mean age: 57.6 yrs. Strings remained in place without rupture/displacement and no capsule was lost. Average recording time: 6.03 min (EGD: 6.78 min). SCE was well tolerated, 81% patients preferred SCE over EGD. BE was suspected visually in 31 (53.4%) and 30 (51.7%) patients with EGD and SCE, respectively. Intestinal metaplasia was found in 21 patients (36.2%). The sensitivity, specificity, PPV and, NPV of EGD and SCE when using intestinal metaplasia as the gold standard are shown below Conclusions: This study suggests that SCE has better sensitivity, specificity, PPV and NPV than conventional EGD for the diagnosis of Barrett's esophagus when intestinal metaplasia was used as the gold standard. A larger sample size is needed to assess for statistical significance. SCE was safe and the preferred method in patients undergoing screening for Barrett's esophagus.Table. EGD: vs. SCE When Using Intestinal Metaplasia as Gold Standard

Feasibility and Safety of String Wireless Capsule Endoscopy in the Diagnosis of Esophageal Varices

To assess the feasibility, safety, accuracy, and acceptability of "string-capsule endoscopy" in the evaluation of esophageal varices. Strings were attached to the wireless capsule endoscopy device to allow its controlled movement up and down the esophagus. Time of recording and discomfort associated with the procedure was documented. Patient's preference compared to conventional esophago-gastro-duodenoscopy (EGD) was recorded. An independent endoscopist blinded to EGD diagnoses assessed the diagnostic accuracy of pictures obtained. Thirty patients with clinical liver cirrhosis (mean age: 54.4 yr; mean MELD score: 12.5, and mean Child-Pugh score: 6.3) were enrolled; 19 for surveillance and 11 for screening purposes. The procedure was safe (no strings were disrupted and no capsule was lost). The mean recording time was 5.8 min (2.9-8.7), the accuracy 96.7%, and discomfort was minimal. The majority (83.3%) of patients preferred string-capsule endoscopy to EGD. String-capsule endoscopy was feasible, safe, accurate, highly acceptable, and preferred by cirrhotic patients undergoing screening/surveillance of esophageal varices. The technique may prove to be more cost effective than conventional EGD.

Feasibility and safety of string, wireless capsule endoscopy in the diagnosis of Barrett's esophagus

Capsule endoscopy is a major technological advancement in the visualization of the small bowell. Its utility in the evaluation of the esophagus is mainly limited by its rapid and unpredictable transmission, thus limiting the number of pictures of the esophagus, in particular, the distal esophagus. Strings were attached to the wireless capsule endoscopy device to allow its controlled movement up and down the esophagus. Microbiologic cultures of the capsule's surface after high-level disinfection were carried out after the procedure. At the time of recording, discomfort associated with the procedure was documented. Patient preference compared with conventional EGD was recorded. An independent endoscopist blinded to the EGD diagnoses assessed the diagnostic accuracy of pictures obtained. Fifty patients with Barrett's esophagus were enrolled: 28 with short-segment Barrett's and 22 with long-segment Barrett's. The procedure was safe (no strings were disrupted, and no capsule was lost), and it rendered negative microbiologic cultures after high-level disinfection. The mean recording time was 7.9 minutes; all patients with both short- and long-segment Barrett's esophagus were successfully identified. The difficulty/discomfort associated with swallowing the device, throat discomfort, gagging, moving the capsule (up and down and upon retrieval of the capsule) was none or minimal in 74%, 98%, 96%, 94%, and 76%, respectively. A single capsule was used in 24 studies, and the majority of patients (92%) preferred string-capsule endoscopy to EGD. String-capsule endoscopy was feasible, safe, and highly acceptable, and was preferred by patients and may prove to be more cost effective than screening EGD.

String Capsule Endoscopy for the Screening of Barrett's Esophagus in Patients with Chronic GERD: A Prospective, Blinded Study

String Capsule Endoscopy for the Screening of Barrett's Esophagus in Patients with Chronic GERD: A Prospective, Blinded Study

String Capsule Endoscopy in the Evaluation of Suspected Esophageal Disorders. A Prospective, Blinded, Preliminary Study

The utility of wireless capsule endoscopy in diagnosing esophageal disorders is precluded by its rapid transit across the esophagus. String capsule endoscopy (SCE) circumvents this problem. Aims: To determine 1) the diagnostic agreement between SCE and conventional EGD in patients with suspected esophageal disorders and 2)patient comfort and acceptability of SCE. Methods:Patients referred for EGD evaluation of esophageal symptoms/conditions were prospectively enrolled. SCE was performed without sedation, within 2 weeks of EGD and using the capsule endoscopy device attached to strings to facilitate its movement up/down the esophagus. The device was pulled out after completing the procedure, the capsule disinfected (2% gluteraldehyde) and reused. Patients graded their difficulty/discomfort during SCE (0 = none, 1 = mild, 2 = moderate, 3 = severe) and were asked to choose between the SCE and EGD. An independent endoscopist unaware of the EGD diagnoses reviewed the SCE pictures and rendered his diagnoses. Both endoscopic diagnoses were then matched in search for agreement rates. Results: 34 patients (32 men, 2 women; 61.2 years) were enrolled. Indications for EGD were dysphagia alone: 11, GERD alone: 9; GERD and dysphagia: 6; surveillance for Barretts: 3; iron deficiency anemia: 2; surveillance of varices: 2 and abdominal pain: 1. Primary diagnoses for EGD and SCE are shown in Table 1. The agreement for primary diagnoses was 97.1% (1 patient was diagnosed with mild erosive esophagitis by EGD but was considered normal by SCE). Cultures after disinfection were negative. The mean recording time was 7.4 minutes. In 97% patients, the strings caused no/minimal gagging or discomfort; in 2/3 the capsule was easy/mildly difficult to swallow and 72% had no/minimal discomfort upon retrieval of the device. Twenty-eight patients (82.4%) indicated they would prefer SCE to EGD, 5 (14.7%) EGD to SCE and 1 (2.9%) did not voice any preference. Conclusions: 1) SCE was safe and easy to perform; 2) The agreement between SCE and EGD findings (gold standard) for primary esophageal diagnoses was 97%; 3) Patients discomfort was minimal and acceptability was high with SCE

Feasibility, Safety and Acceptability of String Capsule Endoscopy in Patients with Barrett's Esophagus

Wireless capsule endoscopy offers the possibility of assessing GI mucosal disorders. Its rapid transit through the esophagus however does not allow for an accurate evaluation of this organ. The attachment of strings to the capsule would allow a more controlled assessment of the esophagus by virtue of controlling the capsule's movement up and down along the esophagus. Aims: assess feasibility, safety and acceptability of string-capsule endoscopy in the evaluation of Barrett's esophagus. Methods: Patients with prior EGD and known Barretts esophagus (BE) were enrolled. An independent endoscopist unaware of patient's diagnosis, reviewed the string-capsule endoscopy pictures and rendered a diagnosis. This was then compared to the EGD diagnosis to determine agreement between the two modalities. Discomfort (0-3; 0=none; 1=mild; 2=moderate; 3=severe) was rated. Preference between string-capsule endoscopy and EGD was recorded. The capsule was cultured after high-grade disinfection and re-used. Results: There were 39 patients enrolled (3 could not swallow the capsule) and 36 completed the study (34: men, 2: women; 60.9 yrs; range: 35-83), mean length of Barretts esophagus: 4.5 cm. There were 19 patients with SSB (< 3 cm; mean length: 1.6 cm) and 17 with LSB (> 3 cm, mean length: 7.8 cm). Discomfort scores are shown in Table. All cultures were negative. Agreement was 100% in BE. A single capsule was used in 24 patients. Except for 2 patients who did not voice preference of one method over the other, the remaining 34 patients (94.4%) preferred string-capsule endoscopy over EGD. The mean recording time per patient was 8.41 min (1.2-13.1 min). Conclusions: 1) String capsule endoscopy is feasible, safe, well accepted and accurate for the diagnosis of Barrett's esophagus. 2) String-capsule endoscopy may prove to be cost-effective for screening purposes for Barrett's esophagus. 3) “Real-time” pictures would enhance the applicability of string-capsule endoscopy.