Evaluation of Performance Characteristics of Capsule Endoscopy With PillCam UGI Capsule Compared to Standard Endoscopy

This is a pilot, single center, prospective, tandem study. All veteran patients with Barrett's esophagus scheduled for an upper EGD at Veterans Affairs Medical Center (Kansas City, MO, USA) for check-up of BE will be asked to swallow the pillcam prior to an EGD. A member of the research team will approach a potential subject to discuss participation in the study, including background of the proposed study, inclusion and exclusion criteria, benefits and risks of the procedures and follow-up. If this is of interest to the subject, the informed consent form is discussed and presented. The subject must sign the consent form prior to enrollment. This form will have prior approval of the study site's Institutional Review Board (IRB). Failure to obtain informed consent renders the subject ineligible for the study

Eligible subjects at the participating institution who meet the inclusion criteria for this study will be offered the opportunity to participate in this clinical trial. To ensure that subjects are approached for potential study participation without bias, a Subject Screening Log will be maintained. This Log will track the basic demographic information of each subject approached for clinical trial inclusion and the resulting reason for exclusion from the clinical study if applicable.

The duration of the study is expected to be approximately 12 months. Enrollment of Study patients will cease when approximately 20 patients have been enrolled.

• Pill cam (Device): Patient is asked to swallow the esophageal capsule.
• EGD (Other): Patient will undergo standard EGD

Primary outcomes

• The overall diagnostic accuracy of capsule endoscopy in predicting the presence and extent of Barrett's esophagus in comparison to standard esophagogastroduodenoscopy [1 year]: The ability to accurately predict the presence of Barrett's esophagus by capsule endoscopy and standard EGD will be measured.

Secondary outcomes

• Incidence of Treatment related adverse events of capsule endoscopy in comparison to standard esophagogastroduodenoscopy [1 year]: Wireless capsule endoscopy is generally considered safe. Potential risks resulting from capsule endoscopy are reported low and may include discomfort while swallowing, accidental aspiration and capsule retention leading to small bowel obstruction and perforation. the investigator will measure tolerability of capsule endoscopy as well as standard endoscopy using visual analogue scale.

Sex: All, ages: 18 Years to 85 Years

Inclusion Criteria:

* Patients age: ≥ 18 years
* Patients with BE length ≥ 1cm undergoing upper endoscopy
* Willingness to undergo both unsedated, capsule endoscopy and conventional EGD
* Ability to provide written, informed consent and understand the responsibilities of trial participation

Exclusion Criteria:

* Coagulopathy with INR > 1.5, thrombocytopenia with platelet counts < 50,000
* Pregnant or planning a pregnancy during the study period
* Dysphagia
* Known esophageal diverticulum or stricture
* Swallowing disorder
* Known luminal, gastrointestinal stricture
* History of esophageal, gastric surgery
* Esophageal or GI motility disorder
* Subject has a known history of unresolved drug or alcohol dependency that would limit ability to comprehend or follow instructions related to informed consent, post-treatment instructions, or follow-up guidelines
* Known or suspected gastrointestinal obstruction, strictures, or fistulas based on the clinical picture or pre-procedure testing and profile.
* Subjects with cardiac pacemakers or other implanted electromedical devices.
* Anticipated magnetic resonance imaging within 1 week of capsule ingestion

• Sharma P. Clinical practice. Barrett's esophagus. N Engl J Med. 2009 Dec 24;361(26):2548-56. doi: 10.1056/NEJMcp0902173. No abstract available. PMID 20032324
• Eliakim R, Sharma VK, Yassin K, Adler SN, Jacob H, Cave DR, Sachdev R, Mitty RD, Hartmann D, Schilling D, Riemann JF, Bar-Meir S, Bardan E, Fennerty B, Eisen G, Faigel D, Lewis BS, Fleischer DE. A prospective study of the diagnostic accuracy of PillCam ESO esophageal capsule endoscopy versus conventional upper endoscopy in patients with chronic gastroesophageal reflux diseases. J Clin Gastroenterol. 2005 Aug;39(7):572-8. doi: 10.1097/01.mcg.0000170764.29202.24. PMID 16000923
• Chang JY, Talley NJ, Locke GR 3rd, Katzka DA, Schleck CD, Zinsmeister AR, Dunagan KT, Wu TT, Wang KK, Prasad GA. Population screening for barrett esophagus: a prospective randomized pilot study. Mayo Clin Proc. 2011 Dec;86(12):1174-80. doi: 10.4065/mcp.2011.0396. PMID 22134936

• Prateek Sharma, MD, Principal investigator, Kansas City VA Hospital