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 25 May 2018

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News

Upper endoscopy remains the gold standard to diagnose GERD and Barrett's

This month's American Journal of Gastroenterology examines the diagnostic accuracy of esophageal capsule endoscopy for GERD and Barrett's esophagus.

News image

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Esophageal capsule endoscopy is a novel technique that offers noninvasive evaluation of esophageal pathology in gastroesophageal reflux disease (GERD) patients.

Dr Prateek Sharma and colleagues from Missouri, USA assessed the diagnostic accuracy of esophageal capsule endoscopy for Barrett's esophagus, erosive esophagitis, and hiatal hernia.

The researchers assessed the safety profile of esophageal capsule endoscopy.

The sensitivity, of endoscopy for Barrett's was 79%
American Journal of Gastroenterology

The team enrolled patients with gastroesophageal reflux disease symptoms, and those undergoing Barrett's esophagus surveillance.

All patients underwent esophageal capsule endoscopy followed by standard upper endoscopy.

Esophageal capsule endoscopy findings were interpreted by examiners blinded to endoscopy results.

The gold standard was the findings at endoscopy, and esophageal capsule endoscopy results were compared with those at endoscopy.

The researchers enrolled 100 patients of which 94 completed the study.

At upper endoscopy, Barrett's esophagus was suspected in 53 and confirmed in 45 patients.

The team identified erosive esophagus, and hiatal hernia in 18 and 70 patients, respectively.

The sensitivity, and specificity of esophageal capsule endoscopy for Barrett's esophagus in gastroesophageal reflux disease patients were 67%, 87%, respectively.

The positive and negative predictive values of esophageal capsule endoscopy for Barrett's esophagus in gastroesophageal reflux disease patients were 60%, and 90%, respectively.

The sensitivity, and specificity of esophageal capsule endoscopy for Barrett's esophagus patients undergoing surveillance were 79%, and 78%, respectively.

The positive and negative predictive values of esophageal capsule endoscopy for Barrett's esophagus patients undergoing surveillance were 94%, and 44%, respectively.

The sensitivity, specificity, positive and negative predictive values for erosive esophagitis were 50%, 90%, 56%, and 88%, respectively.

The team noted that the sensitivity, specificity, positive and negative predictive value for hiatal hernia were 54%, 67%, 83%, and 33%, respectively.

Dr Sharmas' team concluded, "Current diagnostic rates of esophageal capsule endoscopy for Barrett's esophagus are not yet accurate enough for application in clinical practice."

"An improvement in technology and learning curve assessments are required, until then standard upper endoscopy remains the gold standard."

Am J Gastroenterol 2008: 103(3): 525-32
19 March 2008

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