Su1501 Comparative Evaluation of the Epithelium of Barrett's Esophagus Through the Esophageal Capsule Endoscopy and Methylene Blue Chromoendoscopy

Comparative Evaluation of the Epithelium of Barrett’s Esophagus Through the Esophageal Capsule Endoscopy and Methylene Blue Chromoendoscopy Eduardo G H De Moura, Thiago Alonso Domingos, Manoel Galvao Neto, Sonia N. Fylyk, Paulo Sakai, Rubens A. Sallum, Ivan Cecconello Gastrointestinal Endoscopy Unit, Department of Gastroenterology, University of Sao Paulo Medical School, Sao Paulo, Brazil; Digestive Surgery, Department of Gastroenterology, University of Sao Paulo Medical School, Sao Paulo, Brazil; Obesity Surgery, Gastro Obeso Center, Sao Paulo, Brazil Introduction: Barrett’s esophagus (EB) is a condition that substantially increases the risk of esophageal adenocarcinoma. Patients with EB should be followed throughout life in an attempt to detect cancer at an early stage. Upper endoscopy (EGD) is currently the method of choice. Aims: To evaluate the efficacy of esophageal capsule endoscopy (ECE) compared to methylene blue chromoendoscopy for detection of suspicious lesions of esophageal cancer, evaluation of morphological characteristics of Barrett’s esophagus, and identifying the presence of hiatal hernia, in addition to compare the safety and patient’s discomfort of the two methods. Methods: Transverse study, conducted on 22 Barrett’s patients submitted to Nissen fundoplication with more than five year’s follow-up. Patients underwent examinations of ECE and EGD with chromoscopy by different physicians blinds to each procedures. After the exams, patient’s discomfort and possible complications that occurred in each method were recorded. It was evaluated the concordance index between the two methods for detection of suspicious lesions of esophageal cancer, characteristics of Barrett’s esophagus and hiatal hernia detection. Results: Nineteen patients completed the study. The ECE sensitivity, negative predictive value and accuracy were, respectively, 100%, 100% and 79% for detecting suspicious lesion of esophageal cancer and had reasonable agreement with EGD (kappa 0.27). The CEE accuracy for assessing the extent of Barrett’s esophagus was 89% and had moderate agreement (kappa 0.60) with EGD. The accuracy of the ECE for evaluation of digitiform, circumferential, and mixed EB were respectively 74%, 79% and 74%, and moderate agreement in cases of circumferencial and mixed EB and not significant agreement for digitiform EB. ECE sensitivity and accuracy for detecting hiatal hernia were, respectively, 43 % and 74%, and fair agreement (kappa 0.38) with EGD. There was no statistical difference between the discomfort of examinations and there was no complication in both endoscopic methods. Conclusions: The ECE has proved to be a good method for detecting suspicious lesions of esophageal cancer. As the evaluation of the extent and pattern of EB, the EEC had reasonable results, when compared to EGD. The ECE had unsatisfactory results regarding the detection of hiatal hernia. There was no significant difference in discomfort between the ECE and EGD. Both methods proved to be safe. Descriptors: esophageal capsule endoscopy, upper endoscopy, chromoendoscopy, Barrett’s esophagus. Su1502 Capsule Endoscopy After a Standard Meal Identifies More Cirrhotic Patients With Esophageal Varices That Need for Prophylaxis Than Fiberoptic Endoscopy Maria Elena Riccioni, Brigida E. Annicchiarico, Cristiano Spada, Gianluigi Caracciolo, Massimo Siciliano, Antonio Gasbarrini, Guido Costamagna Internal Medicine and Gastroenterology Unit, Sacred Heart Catholic University, Rome, Italy; Digestive Endoscopy Unit, Sacred Heart Catholic University, Rome, Italy Background: In cirrhotic patients with portal hypertension, portal pressure and flow increase of about 30% thirty minutes after a meal (1). This effect is likely to induce changes in size and aspect of esophageal varices (EV) and could be utilised to enhance the sensitivity of endoscopy in detecting high-risk EV, i.e. medium to large varices and those with red signs. Fiberoptic esophagogastroduodenoscopy (EGDS), the current gold standard for EV detection and grading, is unsuitable to be performed on a full stomach, due to the risk of pulmonary aspiration. Differently, capsule endoscopy (CE) can be safely performed even after a meal, because it does not require sedation and does not cause vomiting. Aim: To compare CE after a standard meal with fiberoptic EGDS for the detection of high-risk EV. Methods: Twenty-five cirrhotic patients (aged 37 to 83 years, 15 males) were submitted to CE (PillCam ESO2®, Given Imaging, Yoqneam, Israel) thirty minutes after a standard flavoured liquid meal (Fresubin®, Fresenius, Bad Homburg, Germany, 5ml/kg b.w.), followed by 250 ml of tap water. Later in the same day, patients were submitted to EGDS, and, when indicated, EV were band ligated. CE and EGDS were performed, and video registrations reviewed, by two blinded, experienced endoscopists (M.E.R. and C.S.). Data were collected by a third, independent investigator (G.C.). Results: Data are shown in the table. Overall, EV requiring prophylaxis were detected by CE in 13 patients and by EGDS in 5 patients (52% vs 20%, p 0.018). The liquid meal was very well tolerated by all patients. No complications were registered during or immediately after the endoscopic procedures or band ligation. Conclusions: In our study, CE after a standard meal identified a greater number of patients with high-risk EV than fiberoptic EGDS. The significance of our finding needs to be confirmed by follow-up studies comparing the results of bleeding prevention strategies based on these two different endoscopic procedures. Reference: (1) Schiedermaier P, et al. Aliment Pharmacol Ther 2003; 18:777-784.