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Diagnosis of Barrett’s esophagus and Esophageal Varices using a Magnetically Assisted Capsule Endoscopy system

Beg, Sabina; Card, Tim; Warburton, Samantha; Rahman, Imdadur; Wilkes, Emilie; White, Jonathan; Ragunath, Krish

Authors

Sabina Beg

Dr TIM CARD tim.card@nottingham.ac.uk
Clinical Associate Professor

Samantha Warburton

Imdadur Rahman

Emilie Wilkes

Jonathan White

Krish Ragunath



Abstract

Background and Aims
Magnetically assisted capsule endoscopy (MACE) potentially offers a comfortable, patient friendly, and community-based alternative to gastroscopy (EGD). This pilot study aims to explore whether this approach can be used to accurately diagnose Barrett’s esophagus and esophageal varices.

Methods
The MiroCam Navi capsule system was used to examine the upper GI tract in patients due to undergo a clinically indicated EGD. A total of 50 participants were enrolled, of which 34 had known pathology, 17 Barrett’s esophagus (BE), 17 esophageal varices (EV), with 16 controls. Patients underwent the MACE procedure, with the operator blinded to the indication and any previous endoscopic diagnoses. The subsequent EGD was performed by an endoscopist blinded to the MACE findings. Diagnostic yield, comfort and patient preference between the 2 modalities were compared.

Results
Participants had a mean age of 61 years old, a M:F ratio of 2.1:1, a mean body mass index (BMI) of 29.5, with an average chest measurement of 105.3 cm. Forty-seven patients undertook both procedures; 3 patients were unable to swallow the capsule. With the use of the magnet, it was possible to hold the capsule within the esophagus for a mean duration of 190 seconds and up to a maximum of 634 seconds. A correct real-time MACE diagnosis was made in 11 of 15 patients with EV (sensitivity 73.3% [95% CI, 44.9% - 92.2%] and specificity 100% [95% CI, 89.1% - 100%]) and 15 of 16 patients with BE (sensitivity 93.8% [95% CI, 69.8% - 99.8%] and a specificity of 100% [95% CI, 88.8% - 100%]). MACE was considered more comfortable than conventional endoscopy (p [less than] 0.0001) with a mean score of 9.2 with MACE compared with 6.7 with EGD, when assessed on a 10-point scale. No MACE or EGD -elated adverse events occurred.

Conclusion
This pilot study demonstrates that MACE is both safe and well tolerated by patients. Accuracy for the diagnosis of BE was high and may therefore have a role in screening for this condition.

Citation

Beg, S., Card, T., Warburton, S., Rahman, I., Wilkes, E., White, J., & Ragunath, K. (2020). Diagnosis of Barrett’s esophagus and Esophageal Varices using a Magnetically Assisted Capsule Endoscopy system. Gastrointestinal Endoscopy, 91(4), 773-781.e1. https://doi.org/10.1016/j.gie.2019.10.031

Journal Article Type Article
Acceptance Date Oct 21, 2019
Online Publication Date Oct 31, 2019
Publication Date 2020-04
Deposit Date Nov 21, 2019
Publicly Available Date Nov 1, 2020
Journal Gastrointestinal Endoscopy
Print ISSN 0016-5107
Electronic ISSN 1097-6779
Publisher Elsevier
Peer Reviewed Peer Reviewed
Volume 91
Issue 4
Pages 773-781.e1
DOI https://doi.org/10.1016/j.gie.2019.10.031
Keywords Capsule endoscopy; Barrett’s esophagus; Esophageal Varices
Public URL https://nottingham-repository.worktribe.com/output/3349256
Publisher URL https://www.sciencedirect.com/science/article/pii/S0016510719324009

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Publisher Licence URL
http://creativecommons.org/licenses/by-nc-nd/4.0/





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