Capsule endoscopy for the detection of oesophageal mucosal disorders: a comparison of two different ingestion protocols

Objective. To assess the accuracy of a new ingestion protocol for capsule endoscopy (CE) in evaluating patients with gastro-oesophageal reflux disease (GORD). Methods. Oesophago-gastroduodenoscopy (OGD) was performed 1 week prior to CE. The first 28 subjects swallowed the capsule following the original ingestion protocol (OIP) and the subsequent 30 subjects following a simplified ingestion protocol (SIP). CE videos were reviewed by two independent investigators who were blinded to the OGD findings. Results. Of 48 patients included, 24 were diagnosed with reflux oesophagitis (67% male, mean age 49.5 +/- 13 years) and 24 with Barrett oesophagus (BO) (88% male, 55.6 +/- 10 years) by OGD. In addition, 10 asymptomatic healthy controls (50% male, 45.8 +/- 7.1 years) were included. Oesophageal transit time was faster in patients using the SIP compared to the OIP (126 +/- 26 s versus 214 +/- 33; p=0.04). Complete evaluation of the Z-line was possible in 19/28 (68%) of the OIPs compared to 28/30 (93%) of the SIPs (p=0.04). Sensitivity for detecting any oesophageal abnormality was higher in the SIP group than in the OIP group (97% versus 89%; p=0.11). Overall, CE detected oesophagitis in 22/24 patients (sensitivity, 92%; specificity, 88%) and BO in 23/24 patients (sensitivity, 96%; specificity, 91%). Furthermore, 41/44 (93%) preferred CE over OGD and experienced less discomfort and pain during CE. Conclusion. CE is an accurate method for detecting mucosal oesophageal abnormalities. The new ingestion protocol improves the visualization of the Z-line, which is likely to increase the diagnostic yield of CE.