Eliakim R, Yassin K, Shlomi I, Suissa A, Eisen G M
Department of Gastroenterology, Rambam Medical Center, Technion School of Medicine, Haifa, Israel.
Aliment Pharmacol Ther. 2004 Nov 15;20(10):1083-9. doi: 10.1111/j.1365-2036.2004.02206.x.
Gastro-oesophageal reflux disease is a common entity. Erosive oesophagitis, ulcers and Barrett's oesophagus, which is found in up to 10% of gastro-oesophageal reflux disease patients, characterize severe gastro-oesophageal reflux disease. Patients with Barrett's oesophagus have 0.5% per patient-year risk of developing oesophageal adenocarcinoma. Currently, it appears that a minority of those at risk for Barrett's oesophagus undergo screening in part because of the costs associated with endoscopy as well as risks of sedation. A new ingestible PillCam oesophageal capsule developed may offer an alternative office-based approach to visualize the oesophagus without sedation.
To compare the oesophageal capsule to conventional upper endoscopy for detection of oesophageal pathologies.
A newly developed capsule, which acquires video images from both ends of the device at a 4 frame/s rate, was ingested by 17 fasting patients with suspected oesophageal disorders. An ingestion procedure aimed to lengthen capsule transit time in the oesophagus was utilized. Subsequently, a standard upper endoscopy was carried out. The investigator interpreting the capsule findings was blinded to the endoscopy results and vice versa. Patients with dysphagia, known Zenker's diverticulum, intestinal obstruction, cardiac pacemaker or pregnancy were excluded.
Twelve of the 17 patients examined had oesophageal findings using the endoscope as the gold standard. Capsule endoscopy identified oesophageal pathology in all 12 of these patients and an additional pathology in one patient that was missed during endoscopy. For the purpose of this study, this finding was regarded as a false-positive. The mean oesophageal passage time was 189 +/- 280 s. The positive predictive value of the oesophageal capsule for any oesophageal pathology was 92% and the negative predictive value was 100%. Oesophageal capsule sensitivity was 100% and specificity 80%. There were neither swallowing difficulties nor complications subsequent to ingestion in any subjects. Seventy-three percentage of patients preferred the oesophageal capsule procedure on conventional endoscopy. Only one patient preferred oesophagogastroduodenoscopy.
This pilot study has shown that oesophageal capsule endoscopy is an accurate, convenient, safe and well-tolerated method to screen patients for significant oesophageal disorders. No sedation is required, which may allow simple, office-based screening and assessment. Further, large-scale studies are necessary to more fully assess this novel diagnostic tool.
胃食管反流病是一种常见病症。糜烂性食管炎、溃疡以及巴雷特食管（在高达10%的胃食管反流病患者中发现）是严重胃食管反流病的特征。患有巴雷特食管的患者每年有0.5%的风险发展为食管腺癌。目前，似乎少数有巴雷特食管风险的人未接受筛查，部分原因是与内镜检查相关的费用以及镇静风险。新开发的可吞咽式食管胶囊内镜（PillCam）可能提供一种无需镇静的基于门诊的食管可视化替代方法。
比较食管胶囊内镜与传统上消化道内镜检查对食管病变的检测效果。
17名疑似食管疾病的空腹患者吞服了一种新开发的胶囊，该胶囊以每秒4帧的速率从设备两端获取视频图像。采用了旨在延长胶囊在食管中传输时间的吞服程序。随后进行标准的上消化道内镜检查。解读胶囊检查结果的研究人员对内镜检查结果不知情，反之亦然。排除有吞咽困难、已知的Zenker憩室、肠梗阻、心脏起搏器或怀孕的患者。
以内镜检查作为金标准，17名接受检查的患者中有12名有食管病变。胶囊内镜检查在所有这12名患者中均发现了食管病变，并且在一名患者中发现了内镜检查遗漏的另一种病变。在本研究中，这一发现被视为假阳性。食管平均通过时间为189±280秒。食管胶囊对任何食管病变的阳性预测值为92%，阴性预测值为100%。食管胶囊的敏感性为100%，特异性为80%。所有受试者在吞服后均未出现吞咽困难或并发症。73%的患者更喜欢食管胶囊检查程序而非传统内镜检查。只有一名患者更喜欢食管胃十二指肠镜检查。
这项初步研究表明，食管胶囊内镜检查是一种准确、方便、安全且耐受性良好的用于筛查患者是否患有严重食管疾病的方法。无需镇静，这可能允许进行简单的基于门诊的筛查和评估。此外，需要进行大规模研究以更全面地评估这种新型诊断工具。
