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

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