Pillcam eso capsule: An alternative diagnostic tool during the covid-19 pandemic. first irish experience

ABSTRACT

Introduction: The Covid-19 pandemic has led to unprecedented endoscopy practice. At the peak of the pandemic in Ireland, many routine and surveillance endoscopies were deferred, with only urgent procedures prioritised. To allow safe and effective upper gastrointestinal investigations continue, alternative modalities were explored. HSE national guidance document for safe endoscopy in pandemic conditions recommends that alternative non-invasive investigation be considered for all non-urgent referrals for endoscopy. The PillCam ESO® (Given Imaging Ltd., Yoqneam, Israel) offers such an alternative for evaluation of the UGI tract. We conducted a prospective analysis of PillCam ESO® as an alternative diagnostic tool during the Covid-19 pandemic to help tackle the increasing waiting list for gastroscopy at our unit. Aims & Methods: The Aim was to assess if the PillCam ESO can identify important anatomical landmarks as stated in the British Society of Gastroenterology quality standards for upper gastrointestinal endoscopy and if it can effectively identify pathology in the Upper GI Tract. Methods: Patients who fitted our inclusion criteria were prospectively invited to participate into our trial. The three main indications were 1. Patients with dyspepsia less than 40 years of age with no red flag symptoms, 2. Known cirrhosis to screen for varices, 3. UGI bleeds with a low Blatchford score (≤2). A local protocol for ingestion and series of positional guidelines was developed for the procedure. Ethical approval was granted for this study. Capsule transit time, endoscopic landmarks, and pathology detection were evaluated by two independent endoscopists. Results: 66 exams have been successfully performed in the GI Lab from June 2020 to date without complications. The two frequent indications were dyspepsia (66%) and abdominal pain (24%). IM Metoclopramide was administered in 52% of cases. Complete visualisation of the following major anatomical landmarks was achieved in 100% of cases Oesophagus, Oesophageal-gastro junction, and Gastric. A full view of the cardia, fundus, greater curve, lesser curve, incisura angularis, antrum, pylorus, and second part of Duodenum was obtained in 99%, 94%, 99%, 97%, 97%, 92%, 91%, and 80% of cases, respectively. D2 intubation was achieved in 80% of cases. The mean capsule transit times was 62 mins (SD 28). A normal exam was reported in 41% of cases. Reflux oesophagitis and gastritis were the most common pathology detected. Adenocarcinoma of the OG junction was detected in 1 case. Conclusion: The PillCam ESO achieves excellent views of the upper GI tract. In selective cases, it is a safe alternative to gastroscopy which may help reduce gastroscopy waiting times.