Background and Aims

Patients with many different digestive diseases undergo repeated EGDs throughout their lives. Tethered capsule endomicroscopy (TCE) is a less-invasive method for obtaining high-resolution images of the GI mucosa for diagnosis and treatment planning of GI tract diseases. In this article, we present our results from a single-center study aimed at testing the safety and feasibility of TCE for imaging the esophagus, stomach, and duodenum.

Methods

After being swallowed by a participant without sedation, the tethered capsule obtains cross-sectional, 10 μm–resolution, optical coherence tomography images as the device traverses the alimentary tract. After imaging, the device is withdrawn through the mouth, disinfected, and reused. Safety and feasibility of TCE were tested, focusing on imaging the esophagus of healthy volunteers and patients with Barrett’s esophagus (BE) and the duodenum of healthy volunteers. Images were compared with endoscopy and histopathology findings when available.

Results

Thirty-eight patients were enrolled. No adverse effects were reported. The TCE device swallowing rate was 34 of 38 (89%). The appearance of a physiologic upper GI wall, including its microscopic pathology, was visualized with a tissue coverage of 85.4% ± 14.9% and 90.3% ± 6.8% in the esophagus of BE patients with and without endoscopic evidence of a hiatal hernia, respectively, as well as 84.8% ± 7.4% in the duodenum. A blinded comparison of TCE and endoscopic BE measurements showed a strong to very strong correlation (r = 0.7-0.83; P < .05) for circumferential extent and a strong correlation (r = 0.77-0.78; P < .01) for maximum extent (Prague classification). TCE interobserver correlation was very strong, at r = 0.92 and r = 0.84 (P < .01), for Prague classification circumferential (C) and maximal (M) length measurements, respectively.

Conclusions

TCE is a safe and feasible procedure for obtaining high-resolution microscopic images of the upper GI tract without endoscopic assistance or sedation.

中文翻译：

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系留胶囊内窥镜检查技术，用于在不产生镇静作用的情况下对食道，胃和十二指肠进行显微成像（视频）。

背景和目标

患有许多不同消化系统疾病的患者在一生中都会经历多次EGD。系留胶囊内窥镜检查（TCE）是一种侵入性较小的方法，可用于获取胃肠道粘膜的高分辨率图像，用于胃肠道疾病的诊断和治疗计划。在本文中，我们介绍了一项单中心研究的结果，该研究旨在测试TCE对食道，胃和十二指肠成像的安全性和可行性。

方法

在参与者镇静剂吞下且没有镇静剂后，当装置横穿消化道时，栓塞胶囊将获得横截面分辨率为10μm的光学相干断层扫描图像。成像后，将设备从口腔中取出，消毒并重新使用。对TCE的安全性和可行性进行了测试，重点是对健康志愿者和巴雷特食管（BE）的患者的食道以及健康志愿者的十二指肠进行成像。可用图像与内窥镜检查和组织病理学检查结果进行比较。

结果

招募了38名患者。没有不良反应的报道。TCE装置的吞咽率为38的34（89％）。在有内镜证据和无食管裂孔疝的BE患者食管中，生理性上消化道壁的出现（包括其微观病理）可见，组织覆盖率分别为85.4％±14.9％和90.3％±6.8％，以及十二指肠中的84.8％±7.4％。对TCE和内窥镜BE测量的盲目比较显示 ，圆周范围具有很强的相关性（r = 0.7-0.83; P <.05），最大程度具有很强的相关性（r = 0.77-0.78; P  <.01） （布拉格分类）。TCE观察者之间的相关性非常强，在r = 0.92和r = 0.84时（P <.01），分别用于布拉格分类的圆周（C）和最大（M）长度测量。

结论

对于没有内镜辅助或镇静作用的上胃肠道的高分辨率显微图像，TCE是一种安全可行的程序。