A study comparing tolerability, satisfaction and acceptance of three different techniques for esophageal endoscopy: sedated conventional, unsedated peroral ultra thin, and esophageal capsule

Abstract

Three methods of esophagoscopy are available until now: sedated conventional endoscopy, unsedated ultrathin endoscopy, and esophageal capsule endoscopy. The three methods carry comparable diagnostic accuracy and different complication rates. Although all of them have been found well accepted from patients, no comparative study comprising the three techniques has been published. The aim of this study was to compare the three methods of esophagoscopy regarding tolerability, satisfaction, and acceptance. Twenty patients with large esophageal varices and 10 with gastroesophageal reflux disease were prospectively included. All patients underwent consecutively sedated conventional endoscopy, unsedated ultrathin endoscopy, and esophageal capsule endoscopy. After each procedure, patients completed a seven-item questionnaire. The total positive attitude of patients toward all methods was high. However, statistical analysis revealed the following differences in favor of esophageal capsule endoscopy: (i) total positive attitude has been found higher (chi(2)= 18.2, df = 2, P= 0.00), (ii) less patients felt pain (chi(2)= 6.9, df = 2, P= 0.03) and discomfort (chi(2)= 22.1, df = 2, P= 0.00), (iii) less patients experienced difficulty (chi(2)= 13.7, df = 2, P= 0.01), and (iv) more patients were willing to undergo esophageal capsule endoscopy in the future (chi(2)= 12.1, df = 2, P= 0.002). Esophageal capsule endoscopy was characterized by a more positive general attitude and caused less pain and discomfort. Sedated conventional endoscopy has been found more difficult. More patients would repeat esophageal capsule endoscopy in the future. Patients' total position for all three available techniques for esophageal endoscopy was excellent and renders the observed advantage of esophageal capsule endoscopy over both sedated conventional and unsedated ultrathin endoscopy a statistical finding without a real clinical benefit.

Asia-Pacific consensus on the management of gastro-oesophageal reflux disease: an update focusing on refractory reflux disease and Barrett's oesophagus

“…For endoscopy, both standard endoscopy and ultrathin transnasal endoscopy without sedation can be utilised 183–186. Capsule endoscopy is not recommended as the results are inferior and histology cannot be obtained 186 187. Although objective data demonstrating the benefit of screening are limited, there appeared to be patient acceptance for screening.…”

Defining the Threshold: New Data on the Ability of Capsule Endoscopy to Discriminate the Size of Esophageal Varices

“…Capsule endoscopy (CE) is performed with less anxiety, pain, and discomfort. The risk for adverse events is more remote with CE, being e.g., retained capsule in a stricture or diverticula, or difficulty swallowing the capsule [11,12].…”

Esophageal capsule endoscopy is a useful tool in patients with hemophilia

“…Although current guidelines suggest administering clotting factors only for therapeutic endoscopy, it is common practice to correct clotting factor abnormalities prior to conventional EGD. Consequently, less invasive endoscopic modalities, such as esophageal capsule endoscopy (ECE) and/or transnasal endoscopy, have been considered to avoid the need for clotting factors [5]. However, the latter is less attractive due to an increased risk of nosebleeds and possible contamination from lymphoid tissue in those people considered at risk of nvCJD [6].…”

“…Recent studies and meta-analyses have shown that ECE has acceptable sensitivity and specificity in the detection of varices, but it is inferior to EGD [3,4]. However, it can be used as an acceptable alternative in patients with hemophilia and portal hypertension who undergo regular surveillance for varices, and it may be of particular value − if negative for varices − in reassuring patients [5,7]. There is only scant literature on this topic.…”