Magnetically Guided Capsule Versus Conventional Gastroscopy for Upper Abdominal Complaints A Prospective Blinded Study
Magnetically Guided Capsule Versus Conventional Gastroscopy for Upper Abdominal Complaints A Prospective Blinded Study
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DOI：
10.1097/mcg.0000000000000110
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发表时间：
2015-02-01
影响因子：
2.9
通讯作者：
Rey, Jean-Francois
中科院分区：
文献类型：
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作者：
Denzer, Ulrike W.;Roesch, Thomas;Rey, Jean-Francois
目的：上消化道内窥镜检查多在镇静状态下进行，无报警症状患者相关胃病变发生率低。更简单的筛选试验，如胶囊内窥镜检查可能会有所帮助，但目前的被动胶囊对胃的可视化是不够的。磁性引导胃胶囊在常规胃镜检查指征患者中的前瞻性评价。方法：来自法国2个中心共189例有症状的患者（男性105例，平均年龄53岁），分别由9名检查人员和6名检查人员进行胶囊胃镜检查和常规胃镜检查。最终的金标准是在异丙酚镇静下进行无盲常规胃镜活检。主要结果是胶囊胃镜诊断胃大病变的准确性（敏感性/特异性），定义为那些需要常规胃镜活检或切除的病变。结果：21例患者中发现23个主要病变。胶囊准确度为90.5%[95%可信区间（CI）， 85.4% ~ 94.3%]，特异性为94.1% (95% CI, 89.3% ~ 97.1%)，敏感性为61.9% （95% CI, 38% ~ 82%）。准确性与病变位置、胃腔可见度、检查病例量或检查时间无关。在剩下的168例患者中，94%的患者有轻微且多为多发病变；胶囊的正确诊断率为88.1% (95% CI, 82.2% ~ 92.6%)，其中胃可见性和病变位置在胃近端有显著影响。所有患者均首选胶囊胃镜检查。结论：在一项前瞻性、严格盲法研究中，磁引导胶囊胃镜在临床实践中是可行的，并且明显受到患者的青睐。胶囊技术的改进可能使这项技术成为未来胃镜检查的替代方案。
Objectives: Upper gastrointestinal endoscopy is mostly performed under sedation and has a low yield of relevant gastric lesions in patients without alarm symptoms. Simpler screening tests such as capsule endoscopy could be helpful, but gastric visualization is insufficient with the current passive capsules. A magnetically guided gastric capsule was prospectively evaluated in patients with routine indications for gastroscopy.Methods: A total of 189 symptomatic patients (105 male; mean age 53 y) from 2 French centers subsequently and blindly underwent capsule and conventional gastroscopy by 9 and 6 examiners, respectively. The final gold standard was unblinded conventional gastroscopy with biopsy under propofol sedation. Main outcome was accuracy (sensitivity/specificity) of capsule gastroscopy for diagnosis of major gastric lesions, defined as those lesions requiring conventional gastroscopy for biopsy or removal.Results: Twenty-three major lesions were found in 21 patients. Capsule accuracy was 90.5% [95% confidence interval (CI), 85.4%-94.3%] with a specificity of 94.1% (95% CI, 89.3%-97.1%) and a sensitivity of 61.9% (95% CI, 38%-82%). Accuracy did not correlate with lesion location, gastric luminal visibility, examiner case volume, or examination time. Of the remaining 168 patients, 94% had minor and mostly multiple lesions; the capsule made a correct diagnosis in 88.1% (95% CI, 82.2%-92.6%), with gastric visibility and lesion location in the proximal stomach having significant influence. All patients preferred capsule gastroscopy.Conclusions: In a prospective and strictly blinded study, magnetically guided capsule gastroscopy was shown to be feasible in clinical practice and was clearly preferred by patients. Improvements in capsule technology may render this technique a future alternative to gastroscopy.