ICCE Consensus for Esophageal Capsule Endoscopy

Introduction

Gastroesophageal reflux disease (GERD) and its complications are a common and increasing health-care problem in the developed nations. The National Ambulatory Medical Care Survey 2000, a national survey designed to provide information about the use of ambulatory care services in the United States, revealed that GERD is the second most common diagnosis, resulting in 2.5 million outpatient visits annually [1]. A publication on selected digestive diseases in the United States suggested that GERD was the third most prevalent disease in the United States with the highest annual direct costs ($ 9.3 billion/year) [2].

Barrett’s esophagus or specialized intestinal metaplasia (SIM) of the tubular esophagus is a premalignant condition that occurs in approximately 15 % of patients with chronic GERD symptoms and may lead to esophageal adenocarcinoma. Esophageal adenocarcinoma arising from Barrett’s esophagus is the second fastest-increasing cancer in the Western world [3] [4] [5]. In patients with Barrett’s esophagus, the risk of esophageal adenocarcinoma is approximately 0.4 % per patient-year [6]. Some practice guidelines therefore recommend endoscopic screening for Barrett’s esophagus in patients with chronic GERD [6]. However, because of the risks, invasiveness, and costs associated with conventional upper endoscopy, screening for Barrett’s esophagus is not uniformly recommended by all experts or clinicians.

Erosive esophagitis, esophageal ulcer, stricture, or Barrett’s esophagus are the complications of chronic severe GERD. Approximately 20 - 50 % of patients with GERD are found to have erosive esophagitis. In addition, ulcers or strictures are found in approximately 5 % of GERD patients [7]. These endoscopic findings have implications for management of GERD patients, in that maintenance antisecretory therapy is recommended by many experts once erosive esophagitis is documented. Upper endoscopy is routinely employed to diagnose GERD and its complications, including esophagitis, stricture, and Barrett’s esophagus. However, endoscopic screening for Barrett’s esophagus is costly and has poor patient compliance. A simple, safe, and less invasive endoscopic procedure for evaluating GERD patients and for screening GERD patients for Barrett’s esophagus may be advantageous.

In addition, it is estimated that there are 10 million Americans and untold millions worldwide presently suffering from cirrhosis. Bleeding from esophageal varices is a known complication of portal hypertension, with at least a 20 % mortality associated with each bleeding episode. Prophylactic treatment of varices that have not bled with either band ligation or nonselective beta-blockade has been shown to decrease mortality. National guidelines from the American Association for the Study of Liver Disease (AASLD) and the United Kingdom recommend endoscopic screening of patients with cirrhosis and treatment of patients with medium to large varices to prevent bleeding. Recommended screening intervals are 1 - 3 years, depending on the presence or absence of varices and whether the patient has compensated or decompensated liver disease. Endoscopic surveillance is performed in patients after obliteration of varices. The application of the esophageal capsule endoscope has been considered in this group of patients as well. It has been suggested that this patient population could benefit from a noninvasive diagnostic test that does not require sedation. In addition, patient acceptance of an alternative screening modality could improve adherence to recommendations and appropriate treatment after risk stratification.

References

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