Download PDF
Endoscopy 2010; 42(2): 93-97
DOI: 10.1055/s-0029-1243856
Original article

© Georg Thieme Verlag KG Stuttgart · New York

Diagnostic accuracy of esophageal capsule endoscopy versus conventional upper digestive endoscopy for suspected esophageal squamous cell carcinoma

D.  Heresbach1 , E.  Leray2 , P.  N.  d’Halluin1 , F.  Cholet3 , M.  G.  Lapalus10 , M.  Gaudric4 , E.  Ben Soussan5 , J.  L.  Gaudin6 , K.  Vahedi7 , V.  Quentin8 , B.  Filoche9 , J.  C.  Saurin6 , S.  Chaussade4 , T.  Ponchon10
  • 1Service des Maladies de l’Appareil Digestif, CHU Pontchaillou, Rennes, France
  • 2Service d’Epidémiologie et de Santé Publique CHU Pontchaillou, Rennes, France
  • 3Service d’Hépato-Gastroentérologie, CHU La Cavale Blanche, Brest, France
  • 4Service d’Hépato-Gastroentérologie, AP-HP Hôpital Cochin, Paris, France
  • 5Service d’Hépato-Gastroentérologie, CHU Charles Nicolle, Rouen, and Service d’Hépato-Gastroentérologie, Clinique de l’Alma, Paris, France
  • 6Service d’Hépato-Gastroentérologie, HCL Centre Hospitalier Lyon Sud, Pierre-Bénite, France
  • 7Service d’Hépato-Gastroentérologie, AP-HP Hôpital Lariboisière, 75475 Paris, France
  • 8Service d’Hépato-Gastroentérologie, CHU Angers, Angers, France
  • 9Service d’Hépato-Gastroentérologie, Hôpital Saint Philibert, Lomme, France
  • 10Service d’Hépato-Gastroentérologie, HCL Hôpital Edouard Herriot, Lyon, France
Further Information

Publication History

submitted 5 June 2009

accepted after revision 26 October 2009

Publication Date:
05 February 2010 (online)

Also available at
    Permissions and Reprints

Background and study aim: A video capsule similar to that used in small-bowel capsule endoscopy is now available for esophageal exploration. The aim of our study was to compare the accuracy of upper endoscopy (esophageal gastroduodenoscopy [EGE]) with esophageal capsule endoscopy (ECE) in patients at risk of esophageal squamous cell cancer (SCC).

Patients and methods: 68 patients at risk of SCC secondary to a history of head and neck neoplasia were included in this comparison of techniques for detecting SCC and dysplasia. ECE was done using the first generation Pillcam ESO and EGE was performed in accordance with the usual practice of each center, followed by examination with 2 % Lugol staining and biopsy of unstained areas (39 neoplasia comprising 5 low grade dysplasia, 8 high grade dysplasia and 26 SCC).

Results: Compared with EGE with and without Lugol staining, the sensitivities of ECE for neoplasia diagnosis were 46 % and 54 %, respectively. On a per-patient basis, the sensitivity, specificity, and positive and negative predictive value of ECE were 63 %, 86 %, 77 % and 76 %, respectively, compared with EGE without staining, and 61 %, 86 %, 77 % and 73 % compared with EGE with iodine staining. Neither the ECE transit time nor the distance between the esopharyngeal line and the neoplastic lesion differed between the 21 false-negative and 18 true-positive cases diagnosed by ECE; the only difference was a smaller median diameter among false negatives (P < 0.001).

Conclusion: In a cohort at high risk for esophageal SCC, ECE is not sensitive enough to diagnose neoplastic lesions.

References

  • 1 Jemal A, Thomas A, Murray T, Thun M. Cancer statistics.  CA Cancer J Clin. 2002;  52 23-47
    CrossrefPubMedGoogle Scholar
  • 2 Li K, Yu P. Food groups and risk of esophageal cancer in Chaoshan region of China: a high-risk area of esophageal cancer.  Cancer Invest. 2003;  21 237-240
    CrossrefPubMedGoogle Scholar
  • 3 Remontet L, Esteve J, Bouvier A M. et al . Cancer incidence and mortality in France over the period 1978 – 2000.  Rev Epidemiol Sante Publique. 2003;  51 3-30
    PubMedGoogle Scholar
  • 4 Faivre J. Variation in survival of patients with digestive tract cancers in Europe, 1978 – 1989.  Eur J Cancer Prev. 2001;  10 173
    CrossrefPubMedGoogle Scholar
  • 5 Laccourreye O, Veivers F D, Hans S. et al . Metachronous second primary cancers after successful partial laryngectomy for invasive squamous cell carcinoma of the true vocal cord.  Ann Otol Rhinol Laryngol. 2002;  111 204-209
    PubMedGoogle Scholar
  • 6 Licciardello J TW, Spitz M R, Hong W K. Multiple primary cancer in patients with cancer of the head and neck: second cancer of the head and neck, esophagus and lung.  Int J Radiat Oncol Biol Phys. 1989;  17 467-476
    PubMedGoogle Scholar
  • 7 Eliakim R, Yassin K, Shlomi I. et al . A novel diagnostic tool for detecting oesophageal pathology: The PillCam oesophageal video capsule.  Aliment Pharmacol Ther. 2004;  20 1083-1089
    CrossrefPubMedGoogle Scholar
  • 8 Eliakim R, Sharma V K, Yassin K. et al . 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;  39 572-578
    CrossrefPubMedGoogle Scholar
  • 9 Galmiche J P, Sacher-Huvelin S, Coron E. et al . Screening for esophagitis and Barrett’s esophagus with wireless esophageal capsule endoscopy: a multicenter prospective trial in patients with reflux symptoms.  Am J Gastroenterol. 2008;  103 538-545
    CrossrefPubMedGoogle Scholar
  • 10 Lin O S, Schembre D B, Mergener K. et al . Blinded comparison of esophageal capsule endoscopy versus conventional endoscopy for a diagnosis of Barrett’s esophagus in patients with chronic gastroesophageal reflux.  Gastrointest Endosc. 2007;  65 577-583
    CrossrefPubMedGoogle Scholar
  • 11 Sharma P, Wani S, Rastogi A. et al . The diagnostic accuracy of esophageal capsule endoscopy in patients with gastroesophageal reflux disease and Barrett’s esophagus: a blinded, prospective study.  Am J Gastroenterol. 2008;  103 525-532
    CrossrefPubMedGoogle Scholar
  • 12 Meyer V, Burtin P, Bour B. et al . Endoscopic detection of early oesophageal cancer in a high-risk population: does lugol staining improve videoendoscopy?.  Gastrointest Endosc. 1997;  45 480-484
    CrossrefPubMedGoogle Scholar
  • 13 Fagundes R B, de Barros S G, Putten A C. et al . Occult dysplasia is disclosed by Lugol chromoendoscopy in alcoholics at high risk for squamous cell carcinoma of the esophagus.  Endoscopy. 1999;  31 281-285
    Article in Thieme ConnectPubMedGoogle Scholar
  • 14 Misumi A, Harada K, Murakami A. et al . Role of Lugol dye endoscopy in the diagnosis of early esophageal cancer.  Endoscopy. 1990;  22 12-16
    Article in Thieme ConnectPubMedGoogle Scholar
  • 15 Dubuc J, Seyrig J A, Barbier J P. et al . Endoscopic screening for esophageal squamous cell carcinoma in high-risk patients: a prospective study conducted in 62 French endoscopy centers.  Endoscopy. 2006;  38 690-695
    Article in Thieme ConnectPubMedGoogle Scholar
  • 16 Munoz-Navas M A. Esophageal capsule endoscopy.  World J Gastroenterol. 2008;  14 5254-5260
    CrossrefPubMedGoogle Scholar
  • 17 Gralnek I M, Rabinovitz R, Afik D. et al . A simplified ingestion procedure for esophageal capsule endoscopy: initial evaluation in healthy volunteers.  Endoscopy. 2006;  38 913-918
    Article in Thieme ConnectPubMedGoogle Scholar
  • 18 Scherübl H, von Lampe B, Faiss S. et al . Screening for oesophageal neoplasia in patients with head and neck cancer.  Br J Cancer. 2002;  86 239-243
    CrossrefPubMedGoogle Scholar
  • 19 Li K, Yu P. Food groups and risk of esophageal cancer in Chaoshan region of China: a high-risk area of esophageal cancer.  Cancer Invest. 2003;  21 237-240
    CrossrefPubMedGoogle Scholar
  • 20 Gehanno P. Cancers associated with cancer of the esophagus.  Rev Prat. 1999;  49 1177-1179
    PubMedGoogle Scholar
  • 21 Makuuchi H, Machimura T, Shimada H. et al . Endoscopic screening for esophageal cancer in 788 patients with head and neck cancers.  Tokai J Exp Clin Med. 1996;  21 139-145
    PubMedGoogle Scholar
  • 22 Muto M, Hironaka S, Nakane M. et al . Association of multiple Lugol-voiding lesions with synchronous and metachronous esophageal squamous cell carcinoma in patients with head and neck cancer.  Gastrointest Endoscopy. 2002;  56 517-521
    CrossrefPubMedGoogle Scholar
  • 23 Narayana A, Vaughan A T, Fisher S G. et al . Second primary tumors in laryngeal cancer: results of long-term follow-up.  Int J Radiat Oncol Biol Phys. 1998;  42 557-562
    CrossrefPubMedGoogle Scholar
  • 24 Dikshit R P, Boffetta P, Bouchardy C. et al . Risk factors for the development of second primary tumors among men after laryngeal and hypopharyngeal carcinoma.  Cancer. 2005;  103 2326-2333
    CrossrefPubMedGoogle Scholar
  • 25 Cooper J S, Pajak T F, Rubin P. et al . Second malignancies in patients who have head and neck cancer: incidence, effect on survival and implications based on the RTOG experience.  Int J Radiat Oncol Biol Phys. 1989;  17 449-456
    PubMedGoogle Scholar
  • 26 Morita M, Araki K, Saeki H. et al . Risk factors for multicentric occurrence of carcinoma in the upper aerodigestive tract: Analysis with a serial histologic evaluation of the whole resected-esophagus including carcinoma.  J Surg Oncol. 2003;  83 216-221
    CrossrefPubMedGoogle Scholar
  • 27 Yokoyama A, Kumagai Y, Yokoyama T. et al . Health risk appraisal models for mass screening for esophageal and pharyngeal cancer: an endoscopic follow-up study of cancer-free Japanese men.  Cancer Epidemiol Biomarkers Prev. 2009;  18 651-655
    CrossrefPubMedGoogle Scholar
  • 28 Hirota W K, Zuckerman M J, Adler D G. et al . Standards of Practice Committee, American Society for Gastrointestinal Endoscopy. ASGE guideline: the role of endoscopy in the surveillance of premalignant conditions of the upper GI tract.  Gastrointest Endosc. 2006;  63 570-580
    CrossrefPubMedGoogle Scholar
  • 29 ASGE guideline: the role of endoscopy in the surveillance of premalignant conditions of the upper GI tract.  Gastrointest Endosc. 2006;  63 570-580
    CrossrefPubMedGoogle Scholar
  • 30 Allum W H, Griffin S M, Watson A. et al., on behalf of the Association of Upper Gastrointestinal Surgeons of Great Britain and Ireland, the British Society of Gastroenterology, and the British Association of Surgical Oncology . Guidelines for the management of oesophageal and gastric cancer.  Gut. 2002;  50 Suppl V v1-v23
    PubMedGoogle Scholar
  • 31 Yokoyama A, Ohmori T, Makuuchi H. et al . Successful screening for early esophageal cancer in alcoholics using endoscopy and mucosa iodine staining.  Cancer. 1995;  76 928-934
    CrossrefPubMedGoogle Scholar
  • 32 Ban S, Toyonaga A, Harada H. et al . Iodine staining for early endoscopic detection of esophageal cancer in alcoholics.  Endoscopy. 1998;  30 253-257
    Article in Thieme ConnectPubMedGoogle Scholar
  • 33 Froelicher P, Miller G. The European experience with esophageal cancer limited to the mucosa and submucosa.  Gastrointest Endosc. 1986;  32 88-90
    CrossrefPubMedGoogle Scholar
  • 34 Wang G Q, Jiao G G, Chang F B. et al . Long-term results of operation for 420 patients with early squamous cell esophageal carcinoma discovered by screening.  Ann Thorac Surg. 2004;  77 1740-1744
    CrossrefPubMedGoogle Scholar
  • 35 Shimizu Y, Omori T, Yokoyama A. et al . High-grade intra-epithelial neoplasia turns pink within a few minutes. Endoscopic diagnosis of early squamous neoplasia of the esophagus with iodine staining.  J Gastroenterol Hepatol. 2008;  23 546-550
    CrossrefPubMedGoogle Scholar
  • 36 Yoshida T, Inoue H, Usui S. et al . Narrow-band imaging system with magnifying endoscopy for superficial esophageal lesions.  Gastrointest Endosc. 2004;  59 288-295
    CrossrefPubMedGoogle Scholar
  • 37 Ponchon T, Lapalus M G, Saurin J C. et al . Could narrow band imaging replace lugol staining for the detection of esophageal squamous cell carcinoma?.  Gastrointesinal Endoscopy. 2007;  65 AB343
    PubMedGoogle Scholar
  • 38 Chiu P W, Cheung F K, Tsang R K. et al . Narrow band imaging against conventional lugol chromoendoscopy for detection of superficial esophageal neoplasia in high risk patients: a prospective comparartive study.  Gastrointest Endosc. 2007;  65 AB332
    PubMedGoogle Scholar
  • 39 Muto M, Saito Y, Ohmori T. et al . Multicenter prospective randomized study on the detection and diagnosis of superficial squamous cell carcinoma by back to back endoscopic examination with NBI and white light observation.  Gastrointest Endosc. 2007;  65 AB110
    PubMedGoogle Scholar
  • 40 Gralnek I M, Adler S N, Yassin K. et al . Detecting esophageal disease with second-generation capsule endoscopy: initial evaluation of the PillCam ESO 2.  Endoscopy. 2008;  40 275-279
    Article in Thieme ConnectPubMedGoogle Scholar
  • 41 Koslowsky B, Jacob H, Eliakim R. et al . PillCam ESO in esophageal studies: improved diagnostic yield of 14 frames per second (fps) compared with 4 fps.  Endoscopy. 2006;  38 27-30
    Article in Thieme ConnectPubMedGoogle Scholar
  • 42 Tincani A J, Brandalise N, Altemani A. et al . Diagnosis of superficial esophageal cancer and dysplasia using endoscopic screening with a 2 % Lugol dye solution in patients with head and neck cancer.  Head Neck. 2000;  22 170-174
    CrossrefPubMedGoogle Scholar
  • 43 Anani P A, Gardio L D, Savary M. et al . An extensive morphological and comparative study of clinically early and obvious squamous cell carcinoma of the esophagus.  Pathol Res Pract. 1991;  187 214-219
    PubMedGoogle Scholar
  • 44 Kuwano H, Watanabe M, Sadanaga N. et al . Squamous epithelial dysplasia associated with squamous cell carcinoma of the oesophagus.  Cancer Lett. 1993;  72 141-147
    CrossrefPubMedGoogle Scholar
  • 45 Wang G Q, Jiao G G, Chang F B. et al . Long-term results of operation for 420 patients with early squamous cell esophageal carcinoma discovered by screening.  Ann Thorac Surg. 2004;  77 1740-1744
    CrossrefPubMedGoogle Scholar

D. HeresbachMD, PhD 

Service des Maladies de l’Appareil Digestif, CHU Pontchaillou

35033 Rennes Cedex 09
France

Fax: +33-2-99284189

Email: denis.heresbach@chu-rennes.fr

      >