Esophageal Capsule Endoscopy - A Hard Pill to Swallow
December 6th, 2007 | by Mark Sapienza, M.D. |
Barrett’s esophagus and adenocarcinoma of the esophagus are complications related to chronic gastroesophageal acid reflux (GERD). Though millions of people suffer from GERD and only a small percentage of people will develop these complications, the incidence of esophageal cancer is rising and may be related to underlying Barrett’s esophagus. Barrett’s esophagus is considered a precursor lesion in the development of most types of esophageal cancer. The gold standard diagnostic test relies on endoscopy under sedation to survey the esophagus and detect Barrett’s disease - a daunting task when one looks at the vast population of people who suffer from GERD and require screening.
In recent years, new technology in the form of capsule endoscopy has emerged as a potential minimally invasive screening test. Capsule endoscopy, first introduced by the GIVEN coorporation to visualize the small intestines, is now available to look at the esophagus. A patient swallows a disposable mechanical pill containing a small battery, LED and transmitter. The pill relays signals wirelessly to an attached sensor array which then is transferred to a computer and read as a movie file of the patient’s GI tract. Though it is now a well established test for the small intestines it still remains to be seen if it will be an effective screening test for the esophagus.
A recent study published in The American Journal of Gastroenterology tested the effectiveness of this screening test. When patients with Barrett’s esophagus (confirmed by traditional endoscopy and biopsy) were examined by capsule endoscopy (in a blinded fashiobn) there was found to be high inter-observer variability and a low yield for detecting Barrett’s esophagus. The type of Barrett’s being studied was very mild (often referred to as a ’short-segment Barrett’s) and may be more difficult to detect by capsule endoscopy.
Traditional endoscopy still remains the most effective way to visualize and examine the esophagus.
Reference: Debakey M, et al, Am J Gastroenterol. 2007 Nov 28
Tags: Barrett's esophagus, capsule endoscopy, GERD