Is esophageal capsule endoscopy feasible? Results of a pilot.

BACKGROUND AND STUDY AIMS: Capsule endoscopy (CE) has been shown to be accurate in the evaluation of small-bowel bleeding and possibly also other small-bowel disorders. It is commonly believed that other organs are not suitable for CE. We report here on our experience in studying the distal esophagus using CE under various conditions. PATIENTS AND METHODS: A prospective evaluation of CE was carried out in three groups: evaluation of the distal esophagus in routine patients (n = 58) mostly examined for suspected small-intestinal bleeding (group 1); in eight patients with signs of grade I - II reflux esophagitis on upper gastrointestinal endoscopy, who were examined in a supine position for esophageal passage (group 2); and in four volunteers who swallowed the capsule attached to a string (group 3).
RESULTS: In 62 routine patients initially included in group 1, the median CE exposure time was 2 s (range 0 - 217 s; median of four pictures, range 0 - 434), excluding four patients with extremely delayed esophageal transit (esophageal times: 45 - 226 min); at least one image of the Z line was obtained in 24.1 % of cases, but adequate assessment of 50 % and 100 % of the circumference of the distal esophagus was possible in only 10.4 % and 0 % of these cases, respectively. In group 2, the values were better (adequate visibility rates of 50 % and 100 % in 12.5 % and 37.5 % of the eight patients, respectively), but the correct diagnosis of reflux lesions was obtained in only three of the eight. In group 3, the visibility of the Z line was good, but all four volunteers experienced the procedure with the attached string as being quite unpleasant.
CONCLUSIONS: Distal esophageal assessment by CE with the aim of providing an easy screening method for reflux lesions is not at present feasible. Technical developments will be necessary to achieve this.