Observational Study
Copyright ©The Author(s) 2018. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Gastroenterol. Jul 14, 2018; 24(26): 2893-2901
Published online Jul 14, 2018. doi: 10.3748/wjg.v24.i26.2893
Upper gastrointestinal tract capsule endoscopy using a nurse-led protocol: First reported experience
Hey-Long Ching, Ailish Healy, Victoria Thurston, Melissa F Hale, Reena Sidhu, Mark E McAlindon
Hey-Long Ching, Ailish Healy, Victoria Thurston, Melissa F Hale, Reena Sidhu, Mark E McAlindon, Academic Department of Gastroenterology and Hepatology, Royal Hallamshire Hospital, Sheffield Teaching Hospitals NHS Trust, Sheffield S10 2JF, United Kingdom
Author contributions: McAlindon ME designed the study, assisted with interpretation of results and critically appraised the paper; Healy A and Thurston V led the data collection; Ching HL assisted with data collection, performed the data analysis, drafted the initial manuscript and is guarantor; Sidhu R assisted with interpretation of results and critically appraised the paper; Hale MF critically appraised the paper; all authors approved the final manuscript.
Institutional review board statement: This study was registered as service evaluation with the clinical effectiveness unit (CEU number 7073), Sheffield Teaching Hospitals NHS Foundation Trust, United Kingdom.
Informed consent statement: Capsule endoscopy was performed on patients who declined to undergo gastroscopy and all provided written informed consent for the capsule examination which was performed in all cases as part of routine clinical practice. The capsule examinations were not performed as part of a clinical research trial. In these patients who refused to have gastroscopy, the capsule endoscopy protocol was registered as a service evaluation with the department of clinical effectiveness unit (CEU number 7073, Sheffield Teaching Hospitals NHS Foundation Trust) and the evaluation is presented in this paper.
Conflict-of-interest statement: Professor McAlindon ME has acted as a consultant for Medtronic Ltd. All remaining authors have no conflict of interest to report.
Data sharing statement: No additional data are available.
STROBE statement: The authors have read and prepared the manuscript in accordance with the STROBE statement.
Open-Access: This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Correspondence to: Hey-Long Ching, MBBS, BSc, MRCP, Clinical Research Fellow, Clinical Investigations Unit, P1, Royal Hallamshire Hospital, Sheffield Teaching Hospitals, Sheffield, S10 2JF, United Kingdom. hey-long.ching@sth.nhs.uk
Telephone: +44-1142-261180 Fax: +44-1142-712692
Received: April 17, 2018
Peer-review started: April 18, 2018
First decision: May 9, 2018
Revised: May 19, 2018
Accepted: June 16, 2018
Article in press: June 16, 2018
Published online: July 14, 2018

To test the feasibility and performance of a novel upper gastrointestinal (GI) capsule endoscope using a nurse-led protocol.


We conducted a prospective cohort analysis of patients who declined gastroscopy (oesophagogastroduodenoscopy, OGD) but who consented to upper GI capsule endoscopy. Patients swallowed the upper GI capsule following ingestion of 1 liter of water (containing simethicone). A series of positional changes were used to exploit the effects of water flow and move the upper GI capsule from one gravity-dependent area to another using a nurse-led protocol. Capsule transit time, video reading time, mucosal visualisation, pathology detection and patient tolerance was evaluated.


Fifty patients were included in the study. The mean capsule transit times in the oesophagus and stomach were 28 s and 68 min respectively. Visualisation of the following major anatomical landmarks was achieved (graded 1-5: Poor to excellent): Oesophagus, 4.8 (± 0.5); gastro-oesophageal junction (GOJ), 4.8 (± 0.8); cardia, 4.8 (± 0.8); fundus, 3.8 (± 1.2); body, 4.5 (± 1); antrum, 4.5 (± 1); pylorus, 4.7 (± 0.8); duodenal bulb, 4.7 (± 0.7); second part of the duodenum (D2), 4.7 (± 1). The upper GI capsule reached D2 in 64% of patients. The mean video reading time was 48 min with standard playback mode and 20 min using Quickview (P = 0.0001). No pathology was missed using Quickview. Procedural tolerance was excellent. No complications were seen with the upper GI capsule.


The upper GI capsule achieved excellent views of the upper GI tract. Future studies should compare the diagnostic accuracy between upper GI capsule and OGD.

Keywords: Capsule endoscopy, Upper gastrointestinal, Gastroscopy, Oesophagus, Stomach

Core tip: The demand for diagnostic upper gastrointestinal (GI) endoscopy is high. Capsule endoscopy is well tolerated and is a first line small bowel investigative modality. Capsule endoscopy of the upper GI tract has previously been limited by technology and complexity of use. We demonstrate the feasibility of a nurse-led protocol using simple patient positional changes to move the novel upper GI capsule around a water-filled stomach. This technique provides excellent mucosal views in the oesophagus, stomach and (battery life allowing) duodenum and is well tolerated. The upper GI capsule might be a potential non-invasive, patient-friendly, alternative for diagnostic upper GI endoscopy.