Prospective randomized comparison between axial- and lateral-viewing capsule endoscopy systems in patients with obscure digestive bleeding

Background and study aim: Video capsule endoscopy (VCE) is recommended as the first exploration in obscure digestive bleeding. The efficiency of the PillCam SB2 (Given Imaging) has been widely reported. The CapsoCam capsule (Capsovision) has four cameras allowing the exploration of the small bowel through 360° lateral viewing. This system does not include a recording system so the capsule has to be retrieved by the patient after expulsion in order for the film to be downloaded. The aim of this study was to evaluate diagnostic concordance (kappa value) of the PillCam SB2 and CapsoCam capsules in the same patients.

Methods: This was a prospective comparative study in four French referral endoscopy units. Consecutive patients ingested the two capsules 1 hour apart and in a randomized order.

Results: In the 73 included patients there were 13 technical issues (11 CapsoCam, 2 PillCam SB2). Of the 60 patients with analyzable data, and following expert review of all discordant cases, a concordant positive diagnosis was obtained in 23 (38.3 %) and a negative diagnosis was obtained and 26 patients (43.3 %). Concordance was good, with a kappa value of 0.63 in analyzable patients, and 46.7 % diagnosis with CapsoCam vs. 48.3 % with PillCam SB2. CapsoCam and PillCam SB2 procedures identified 81.8 % (27 /33) and 84.8 % (28 /33) of positive patients, respectively (P = 0.791). In a per lesion analysis, the CapsoCam capsule detected significantly more lesions (108 vs. 85 lesions; P = 0.001). Reading time was longer for CapsoCam procedures (32.0 vs. 26.2 minutes; P = 0.002).

Conclusion: This study shows comparable efficiency of the CapsoCam and PillCam SB2 capsule systems in terms of diagnostic yield and image quality.

• References

• 1 Zuckerman GR, Prakash C, Askin MP et al. AGA technical review on the evaluation and management of occult and obscure gastrointestinal bleeding. Gastroenterology 2000; 118: 201-221
• 2 Gong F, Swain P, Mills T. Wireless endoscopy. Gastrointest Endosc 2000; 51: 725-729
• 3 Bandorski D, Irnich W, Brück M et al. Capsule endoscopy and cardiac pacemakers: investigation for possible interference. Endoscopy 2008; 40: 36-39
• 4 Appleyard M, Glukhovsky A, Swain P. Wireless-capsule diagnostic endoscopy for recurrent small-bowel bleeding. N Engl J Med 2001; 344: 232-233
• 5 Appleyard M, Fireman Z, Glukhovsky A et al. A randomized trial comparing wireless capsule endoscopy with push enteroscopy for the detection of small-bowel lesions. Gastroenterology 2000; 119: 1431-1438
• 6 Ogata H, Kumai K, Imaeda H et al. Clinical impact of a newly developed capsule endoscope: usefulness of a real-time image viewer for gastric transit abnormality. J Gastroenterol 2008; 43: 186-192
• 7 Hartmann D, Eickhoff A, Damian U et al. Diagnosis of small-bowel pathology using paired capsule endoscopy with two different devices: a randomized study. Endoscopy 2007; 39: 1041-1045
• 8 Hong SP, Cheon JH, Kim TI et al. Comparison of the diagnostic yield of “MiroCam” and “PillCam SB” capsule endoscopy. Hepatogastroenterology 2012; 59: 778-781
• 9 Pioche M, Gaudin J-L, Filoche B et al. Prospective, randomized comparison of two small-bowel capsule endoscopy systems in patients with obscure GI bleeding. Gastrointest Endosc 2011; 73: 1181-1188
• 10 Scapa E, Jacob H, Lewkowicz S et al. Initial experience of wireless-capsule endoscopy for evaluating occult gastrointestinal bleeding and suspected small bowel pathology. Am J Gastroenterol 2002; 97: 2776-2779
• 11 Saurin JC, Delvaux M, Vahedi K et al. Clinical impact of capsule endoscopy compared to push enteroscopy: 1-year follow-up study. Endoscopy 2005; 37: 318-323
• 12 Saurin J-C, Delvaux M, Gaudin J-L et al. Diagnostic value of endoscopic capsule in patients with obscure digestive bleeding: blinded comparison with video push-enteroscopy. Endoscopy 2003; 35: 576-584
• 13 Triester SL, Leighton JA, Leontiadis GI et al. A meta-analysis of the yield of capsule endoscopy compared to other diagnostic modalities in patients with obscure gastrointestinal bleeding. Am J Gastroenterol 2005; 100: 2407-2418
• 14 Adler DG, Knipschield M, Gostout C. A prospective comparison of capsule endoscopy and push enteroscopy in patients with GI bleeding of obscure origin. Gastrointest Endosc 2004; 59: 492-498
• 15 De Leusse A, Vahedi K, Edery J et al. Capsule endoscopy or push enteroscopy for first-line exploration of obscure gastrointestinal bleeding?. Gastroenterology 2007; 132: 855-862 ; quiz 1164-1165
• 16 Cave DR, Fleischer DE, Leighton JA et al. A multicenter randomized comparison of the Endocapsule and the Pillcam SB. Gastrointest Endosc 2008; 68: 487-494
• 17 Dolak W, Kulnigg-Dabsch S, Evstatiev R et al. A randomized head-to-head study of small-bowel imaging comparing MiroCam and EndoCapsule. Endoscopy 2012; 44: 1012-1020
• 18 Saurin J-C, Lapalus MG, Cholet F et al. Can we shorten the small-bowel capsule reading time with the “Quick-view” image detection system?. Dig Liver Dis 2012; 44: 477-481