Galloro Giuseppe, Musella Mario, Siciliano Saverio, Berardi Giovanna, Vitiello Antonio, Velotti Nunzio, Rizzello Fernando, Gionchetti Paolo, Calabrese Carlo
University of Naples Federico II - School of Medicine, Department of Clinical Medicine and Surgery - Surgical Endoscopy Unit, Naples, Italy.
University of Naples Federico II - School of Medicine, Department of Advanced Biomedical Sciences - Bariatric and Metabolic Surgery Unit, Naples, Italy.
Endosc Int Open. 2022 Feb 15;10(2):E183-E191. doi: 10.1055/a-1723-3109. eCollection 2022 Feb.
Obesity represents a major health concern; bariatric surgery is the most effective treatment reducing and maintaining weight loss. The role of a routine esophagogastroduodenoscopy (EGD) prior bariatric surgery is still debated. Moreover, in this scenario of COVID-19 pandemic, EGD is even more questionable due to the procedural risk of viral transmission. A new model of video-endoscopic capsule (VEC) recently has been introduced as a good alternative to the EGD. The aim of this study was to determine if this new capsule is an adequate diagnostic alternative to EGD in the work-up of patients selected for bariatric surgery, particularly in the setting of COVID-19. From January to November 2020, 27 patients selected for bariatric surgery were enrolled in this pilot study to assess for noninferiority of VEC compared to EGD in detection of upper gastrointestinal disease. VEC had sensitivity, specificity, and positive and negative predictive values in identification of significant lesions of 91.3 %, 83.33 %, 98.01 %, and 51.57 %, respectively, compared with EGD as the standard criterion. The accuracy was 90.51 % (95 % CI, 73.75 %-98.18 %) and the chi-square statistic is 0.1153 ( = 0.73). Our report confirms the diagnostic noninferiority of VEC in preoperative work-up of patients selected for bariatric surgery, compared to EGD. This is very important, particularly during the COVID-19 pandemic, given the high risk of contamination with EGD. Larger multicenter studies are required to confirm our preliminary results.
肥胖是一个主要的健康问题；减肥手术是减轻体重并维持体重减轻的最有效治疗方法。减肥手术前常规进行食管胃十二指肠镜检查（EGD）的作用仍存在争议。此外，在新冠疫情的背景下，由于EGD存在病毒传播的操作风险，其使用更值得怀疑。一种新型视频内镜胶囊（VEC）最近被引入，作为EGD的良好替代方案。本研究的目的是确定这种新型胶囊在接受减肥手术患者的检查中，是否是EGD的一种充分的诊断替代方法，尤其是在新冠疫情背景下。2020年1月至11月，27名接受减肥手术的患者被纳入这项前瞻性研究，以评估VEC在检测上消化道疾病方面与EGD相比是否非劣效。与作为标准对照的EGD相比，VEC在识别重大病变方面的敏感性、特异性、阳性和阴性预测值分别为91.3%、83.33%、98.01%和51.57%。准确率为90.51%（95%CI，73.75%-98.18%），卡方统计量为0.1153（P=0.73）。我们的报告证实，与EGD相比，VEC在接受减肥手术患者的术前检查中具有诊断非劣效性。这非常重要，尤其是在新冠疫情期间，因为EGD存在高污染风险。需要更大规模的多中心研究来证实我们的初步结果。
