Sleeve string capsule endoscopy for real-time viewing of the esophagus: a pilot study (with video)

Background Previous studies suggest that string capsule endoscopy is feasible, safe, accurate, highly acceptable, and likely to be proven as a more cost-effective technique than conventional EGD. However, this technique needs proper high-level disinfection, and the string attachment is not easy to perform. We developed a modified esophageal capsule endoscopy, called sleeve string capsule endoscopy (SSCE). Objective To assess the feasibility and safety of SSCE in the evaluation of esophageal diseases. Design A pilot study. Setting Outpatient setting in a tertiary hospital, Shanghai, China. Patients Two healthy volunteers and 8 patients with suspected esophageal diseases were enrolled. Interventions The OMOM capsule endoscope was enclosed in a small, transparent, thin, latex sleeve, with a string attached to the caudal end. Both the sleeve and the string were for single use and were discarded after completion of the procedure. Two healthy volunteers without previous EGD and 8 patients who had undergone EGD swallowed the capsules. Pictures of the esophagus were viewed in real time. Main Outcome Measurements Discomfort associated with the procedure, quality, and diagnostic value of the pictures were documented. In addition, patient preference between SSCE and conventional EGD was recorded. Results SSCE was successfully carried out in the 10 subjects. The procedures were easy and safe to perform. No sleeves and strings were disrupted or broken, and no capsule was lost. The mean overall discomfort score during SSCE in the 8 patients was 2.88 (range 2-5). Pictures generated during SSCE were generally of high quality and produced identical diagnoses to those obtained by EGD in all 8 patients. In addition, all the 8 patients preferred SSCE to EGD. Limitations This was a single-center nonrandomized study with a small sample size. Conclusions SSCE was a feasible, easy-to-operate, and safe method for the diagnosis of esophageal diseases without the need for disinfection. SSCE appears to possess the same diagnostic capacity as that of EGD.