Letters to the Editor 685
Letters to the Editor European Journal of Gastroenterology & Hepatology 2014, 26:685–688
Is string esophageal capsule endoscopy really better than esophageal capsule endoscopy in the right supine position for z-line examination?
procedures. Our question to the authors is whether the capsule was administered by physicians or physician extenders in their study.
Ignacio Fernandez-Urien and Francisco Javier Jimenez-Perez, Department of Gastroenterology, Hospitalary Complex of Navarra (CHN), Pamplona, Spain
Acknowledgements
Correspondence to Ignacio Fernandez-Urien, MD, PhD, Department of Gastroenterology, Hospitalary Complex of Navarra, Irunlarrea, 3, 31008 Pamplona, Spain Tel: + 34 647 612 350; fax: + 34 948 296 500; e-mail: [email protected]
Conflicts of interest
There are no conflicts of interest.
References 1
Received 10 February 2014 Accepted 28 February 2014 2
We have read with interest the article by Chen et al. [1] on the improvement of distal esophageal visualization using string esophageal capsule endoscopy (SECE) with realtime viewing compared with standard esophageal capsule endoscopy (ECE). In fact, esophageal visualization during capsule endoscopy is feasible but the number and quality of the images obtained depend on the ingestion protocol used. The authors of the present study compared SECE with ECE performed in the right supine position. As demonstrated by our group, the right supine position allows the capsule to capture z-line images in 90% of the patients, with the mean number of z-line frames being 5.5 per patient and the mean percentage of z-lines detected being 71.3% [2]. These results are consistent with those obtained by other authors [2,3]. Surprisingly, our results are much better than those obtained by Chen et al. [1] on using the same ingestion protocol (1.5 frames of the z-line per patient and visualization of >75% of the z-line in 36.7% of patients). There are no apparent reasons for the poor results obtained in the right supine position. On the one hand, esophageal transit times, which are usually the main limiting factor, were long enough (mean of 131 s). On the other hand, the presence of bubbles and/or saliva should be minimized using small amounts of clear water before and during the capsule endoscopy procedure. Hence, definitively, it seems difficult to imagine an esophageal capsule taking 14 frames/s in 131 s in the distal esophagus failing to obtain good z-line images. As stated before, our group obtained good results in the right supine position, and we use this position in daily practice in all capsule endoscopy procedures. Our experience has shown that the availability of help from physicians leads to better results when technical issues are evaluated. Physician extenders without experience in ECE or not directly involved in the study could alter the expected results of new or complex c 2014 Wolters Kluwer Health | Lippincott Williams & Wilkins 0954-691X
3
Chen WS, Zhu LH, Li DZ, Chen L, Wu YL, Wang W. String esophageal capsule endoscopy with real-time viewing improves visualization of the distal esophageal Z-line: a prospective, comparative study. Eur J Gastroenterol Hepatol 2014; 26:309–312. Fernandez-Urien I, Borobio E, Elizalde I, Irisarri R, Vila JJ, Urman JM, et al. Z-line examination by the PillCam SB: prospective comparison of three ingestion protocols. World J Gastroenterol 2010; 16:63–68. Gralnek IM, Rabinovitz R, Afik D, Eliakim R. A simplified ingestion procedure for esophageal capsule endoscopy: initial evaluation in healthy volunteers. Endoscopy 2006; 38:913–918.
String-mounted double-headed capsule and Z-line detection: is string really the thing? Leonidas Bartzis and Anastasios Koulaouzidis, Endoscopy Unit, Centre for Liver & Digestive Disorders, Royal Infirmary of Edinburgh, Scotland, UK Correspondence to Anastasios Koulaouzidis, MD, FEBG, FRSPH, FRCP Edin, Endoscopy Unit, Centre for Liver & Digestive Disorders, The Royal Infirmary of Edinburgh, 51 Little France Crescent, Old Dalkeith Road, Scotland EH16 4SA, UK Tel: + 44 131 242 1126; fax: + 44 131 242 1618; e-mail: [email protected] Received 29 January 2014 Accepted 28 February 2014
We read with great interest the recent study by Chen et al. [1] on the use of string oesophageal capsule endoscopy (OCE) in the visualization of the gastrooesophageal junction or Z-line. The authors used a string attached to an oesophageal capsule endoscope (PillCam ESO1; GivenImaging Ltd, Yoqneam, Israel) and reported that use of this modification resulted in a significantly greater number of images of the Z-line, as well as partial or incomplete visualization of the distal oesophagus in the majority of examined individuals. To date, all string capsule endoscopy procedures have been performed using small-bowel capsule endoscopes for two main reasons: (a) potential to reuse the capsule after appropriate sterilization, and (b) to improve the capsule’s performance in the oesophagus. With regard to the latter, we have already demonstrated that small-bowel capsule endoscopes have the disadvantage of limited image capture in the upper GI tract [2]. DOI: 10.1097/MEG.0000000000000090
Copyright © Lippincott Williams & Wilkins. Unauthorized reproduction of this article is prohibited.
Letters to the Editor European Journal of Gastroenterology & Hepatology 2014, 26:685–688
Is string esophageal capsule endoscopy really better than esophageal capsule endoscopy in the right supine position for z-line examination?
procedures. Our question to the authors is whether the capsule was administered by physicians or physician extenders in their study.
Ignacio Fernandez-Urien and Francisco Javier Jimenez-Perez, Department of Gastroenterology, Hospitalary Complex of Navarra (CHN), Pamplona, Spain
Acknowledgements
Correspondence to Ignacio Fernandez-Urien, MD, PhD, Department of Gastroenterology, Hospitalary Complex of Navarra, Irunlarrea, 3, 31008 Pamplona, Spain Tel: + 34 647 612 350; fax: + 34 948 296 500; e-mail: [email protected]
Conflicts of interest
There are no conflicts of interest.
References 1
Received 10 February 2014 Accepted 28 February 2014 2
We have read with interest the article by Chen et al. [1] on the improvement of distal esophageal visualization using string esophageal capsule endoscopy (SECE) with realtime viewing compared with standard esophageal capsule endoscopy (ECE). In fact, esophageal visualization during capsule endoscopy is feasible but the number and quality of the images obtained depend on the ingestion protocol used. The authors of the present study compared SECE with ECE performed in the right supine position. As demonstrated by our group, the right supine position allows the capsule to capture z-line images in 90% of the patients, with the mean number of z-line frames being 5.5 per patient and the mean percentage of z-lines detected being 71.3% [2]. These results are consistent with those obtained by other authors [2,3]. Surprisingly, our results are much better than those obtained by Chen et al. [1] on using the same ingestion protocol (1.5 frames of the z-line per patient and visualization of >75% of the z-line in 36.7% of patients). There are no apparent reasons for the poor results obtained in the right supine position. On the one hand, esophageal transit times, which are usually the main limiting factor, were long enough (mean of 131 s). On the other hand, the presence of bubbles and/or saliva should be minimized using small amounts of clear water before and during the capsule endoscopy procedure. Hence, definitively, it seems difficult to imagine an esophageal capsule taking 14 frames/s in 131 s in the distal esophagus failing to obtain good z-line images. As stated before, our group obtained good results in the right supine position, and we use this position in daily practice in all capsule endoscopy procedures. Our experience has shown that the availability of help from physicians leads to better results when technical issues are evaluated. Physician extenders without experience in ECE or not directly involved in the study could alter the expected results of new or complex c 2014 Wolters Kluwer Health | Lippincott Williams & Wilkins 0954-691X
3
Chen WS, Zhu LH, Li DZ, Chen L, Wu YL, Wang W. String esophageal capsule endoscopy with real-time viewing improves visualization of the distal esophageal Z-line: a prospective, comparative study. Eur J Gastroenterol Hepatol 2014; 26:309–312. Fernandez-Urien I, Borobio E, Elizalde I, Irisarri R, Vila JJ, Urman JM, et al. Z-line examination by the PillCam SB: prospective comparison of three ingestion protocols. World J Gastroenterol 2010; 16:63–68. Gralnek IM, Rabinovitz R, Afik D, Eliakim R. A simplified ingestion procedure for esophageal capsule endoscopy: initial evaluation in healthy volunteers. Endoscopy 2006; 38:913–918.
String-mounted double-headed capsule and Z-line detection: is string really the thing? Leonidas Bartzis and Anastasios Koulaouzidis, Endoscopy Unit, Centre for Liver & Digestive Disorders, Royal Infirmary of Edinburgh, Scotland, UK Correspondence to Anastasios Koulaouzidis, MD, FEBG, FRSPH, FRCP Edin, Endoscopy Unit, Centre for Liver & Digestive Disorders, The Royal Infirmary of Edinburgh, 51 Little France Crescent, Old Dalkeith Road, Scotland EH16 4SA, UK Tel: + 44 131 242 1126; fax: + 44 131 242 1618; e-mail: [email protected] Received 29 January 2014 Accepted 28 February 2014
We read with great interest the recent study by Chen et al. [1] on the use of string oesophageal capsule endoscopy (OCE) in the visualization of the gastrooesophageal junction or Z-line. The authors used a string attached to an oesophageal capsule endoscope (PillCam ESO1; GivenImaging Ltd, Yoqneam, Israel) and reported that use of this modification resulted in a significantly greater number of images of the Z-line, as well as partial or incomplete visualization of the distal oesophagus in the majority of examined individuals. To date, all string capsule endoscopy procedures have been performed using small-bowel capsule endoscopes for two main reasons: (a) potential to reuse the capsule after appropriate sterilization, and (b) to improve the capsule’s performance in the oesophagus. With regard to the latter, we have already demonstrated that small-bowel capsule endoscopes have the disadvantage of limited image capture in the upper GI tract [2]. DOI: 10.1097/MEG.0000000000000090
Copyright © Lippincott Williams & Wilkins. Unauthorized reproduction of this article is prohibited.
