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

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Ramirez, Francisco C., M.D.; Akins, Rodney, LPN; Shaukat, Masud S., M.D.

American Journal of Gastroenterology: September 2005 - Volume 100 - Issue - p S25
Supplement Abstracts Submitted for the 70th Annual Scientific Meeting of the American College of Gastroenterology: ESOPHAGUS
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Gastroenterology, Carl T Hayden VA Medical Center, Phoenix, AZ.

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. E

Table. E

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