Published online Jul 14, 2018. doi: 10.3748/wjg.v24.i26.2893
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.
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.