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| Author(s): |
Thiago Alonso Domingos
Total Authors: 1
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| Document type: | Master's Dissertation |
| Press: | São Paulo. |
| Institution: | Universidade de São Paulo (USP). Faculdade de Medicina (FM/SBD) |
| Defense date: | 2011-03-29 |
| Examining board members: |
Eduardo Guimarães Hourneaux de Moura;
Tomás Navarro Rodriguez;
Paulo Sakai
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| Advisor: | Eduardo Guimarães Hourneaux de Moura |
| Abstract | |
INTRODUCTION: Barrett\'s esophagus (BE) is a condition that substantially increases the risk of esophageal adenocarcinoma. Patients with BE should be followed throughout life in an attempt to detect cancer at an early stage. Upper gastrointestinal endoscopy (GIE) is currently the method of choice. OBJECTIVE: To evaluate the efficacy of esophageal capsule endoscopy (ECE) compared to methylene blue (MB) chromoendoscopy for detection of suspicious lesions of esophageal cancer, evaluation of extent and pattern of BE, and identifying the presence of hiatal hernia, in addition to compare the safety and patients discomfort of the two methods. METHODS: Transverse study, conducted on 22 Barretts patients submitted to Nissen fundoplication with more than five years follow-up. Patients underwent examinations of ECE and MB chromoendoscopy by different physicians blinds to each procedures. After the exams, patients discomfort and possible complications that occurred in each method were recorded. It was evaluated the concordance index between the two methods for detection of suspicious lesions of esophageal cancer, extent and pattern of BE and hiatal hernia detection. RESULTS: Nineteen patients completed the study. The ECE sensitivity, negative predictive value and accuracy were, respectively, 100%, 100% and 79% for detecting suspicious lesion of esophageal cancer and had reasonable agreement with MB chromoendoscopy (kappa = 0.27). The ECE accuracy for assessing the extent of BE was 89% and had moderate agreement (kappa = 0.60) with MB chromoendoscopy. The accuracy of the ECE for evaluation of finger-like, circumferential, and mixed BE were respectively 74%, 79% and 74%, and moderate agreement in cases of circumferencial and mixed BE and not significant agreement for finger-like BE. ECE sensitivity and accuracy for detecting hiatal hernia were, respectively, 43 % and 74%, and fair agreement (kappa = 0.38) with MB chromoendoscopy. There was no statistical difference between the discomfort of examinations and there was no complication in both endoscopic methods. CONCLUSIONS: The ECE has proved to be a good method for detecting suspicious lesions of esophageal cancer. As the evaluation of the extent and pattern of BE, the ECE had reasonable results, when compared to MB chromoendoscopy. The ECE had unsatisfactory results regarding the detection of hiatal hernia. There was no significant difference in discomfort between the ECE and GIE. Both methods proved to be safe (AU) | |