Magnetic-controlled Capsule Endoscopy Vs.Conventional Gastroscopy In The Diagnose Of Upper Gastrointestinal Tract Diseases

Background:Upper gastrointestinal diseases affect people’s life greatly and its gold diagnostic standard, the traditional electronic endoscopy, is painful and poorly accepted. MCE, as a non-invasive examination methods, has been proved safe and feasible with high consistent rate with EGD in the diagnosis of gastric diseases. But with limited sample size, early studies rarely compared the diagnostic value of MCE and EGD in upper gastrointestinal diseases.Objective:To determine the diagnostic value of magnetic capsule endoscopy of upper gastrointestinal diseases and provide a basis for the selection of clinical examination methods by a large sample, single-center and self-controlled clinical study comparing with the gold standard, conventional gastroendoscopy.Methods:90 patients were included from Augster to November,2014. All underwent traditional gastroendoscopy and MCE. Comparison of the diagnostic rate of two methods was done by a single-center and self-controlled study.Result:1.90 patients were included with 53 males and 37 females. The average age was 48.7±13.3 years. The average BMI was 23.4±3.9kg/m2 and average waistline was 84.9±9.6cm. An average of 104.3±74.8min (4-401) were spent in the stomache by MCE with average of 4850±2187 (507-5989) pictures taken.2.Stomach preparation was quite ideal. Overall effective rate of cleanliness was 90.0% with 23 excellents (26%) and 58 fines (64%). Effective rate of each anatomic structures was rising from cardia to pylorus:52.2%,75.6%,90.0%,98.9%,100% and 100%.3.The display degree of stomache was quite ideal. Full display was obtained in 6(7%) patients.>75% display was obtained in 42 (47%) patients. Display rate of each anatomic structures was rising from cardia to pylorus:33.3%,46.7%,47.8%,81.1%,95.6%,98.9%.4. Comparison of diagnostic value of MCE and EDG in upper gastrointestinal diseases:with EDG as the gold standard, MCE has good the sensitivity, specificity, accuracy (82.8%,93.5% and 90.1%). The positive predictive value and negtive predictive value is 85.4% and 92.2%, respectively. The consistency was good (k=0.769 (>0.750), P<0.01).The rate of focal lesions was high (31.6%)(1) esophagus:The average time of MCE through the esophagus was 1.6±1.4min (0-6). The sensitivity of MCE was relatively low(50%) and the specificity and accuracy were high (97.5% and 91.3%) with good consistency(K=0.650 (0.400-0.750), P<0.001). The rate of lesion detection was 13.0% and incidence of positive lesion was low.(2) stomache:1) In the field of the number of detected lesions, the sensitivity of MCE was high (98%). The specificity and accuracy were good (86% and 92.9%). The positive predictive value was good (89.5%). The negtive predictive value was high (98.0%). The local lesion rate was 54.8%. The two methods have good consistency (k=0.854(0.750), P<0.01).2) In the field of the categories of the diseases, MCE and EGD had same result in SMT, gastric cancer, ectopic pancreas and gastric veinthe sensitivity, specificity, accuracy, positive predictive value and negtive predictive valyue of which were all 100%. The sensitivity predictive rate, negative predictive rate and accuracy of MCE in the diagnosis of polyps were high (100%,96.5%,97.6%). The incidence of focal lesions was high (32.5%). The specificity, specificity and accuracy of gastric ulcer was 94.1%,100% and 99.2%. The incidence of focal lesions was 13.5%.3) In the aspect of the location of lesions, MCE had a same diagnostic rate with EDG in cardia, fundus and pylorus with high accuracy, specificity and positive predictive rate (100%,100% and 100%) and low incidence of focal lesions (2.4%,5.6% and 0.8%). The highest sensitivity of MCE was found in gastric body and antrum, followed by gastric angle (100% VS.100% VS.95.2%). The highest specificity and accuracy of MCE was found in gastric angle, followed by the body and then the autrum (92.6% VS.92.3% VS.80.0%). The highest positive predictive rate of MCE was found in gastric body, followed by angle and the lowest value was found in the autrum (92.6% VS.92.3% VS.80.0%). The highest consistency of MCE was found in gastric angle, followed by body and the lowest value was found in the autrum (0.956 VS.0.952 VS.0.841). The highest diagnostic rate of focal lesions of MCE was found in gastric body and autrum, followed by angle and the lowest value was found in the autrum (100%、100%、99.0%).4) In the aspect of the size, MCE has better diagnostic value in focal lesions larger than 5 mm:specificity (98.9% VS.92.7%), accuracy (99.2% VS.94.4%), positive predictive rate (97.5% VS.81.1%) and consistency k (0.982 VS.0.858), P<0.001。(3) duodenum:MCE had a relatively low diagnostic value for positive lesions (44.4%) and high diagnostic value for negative lesions (94.8%). Accuracy was high (85.3%) but consistency was not ideal (k=0.450, P<0.01). Incidence of focal lesions was low (18.9%).5.89 (98.9%) patients preferred MCE while the other 1 (1.1%) preffered EGD.55 patients excreted the capsule in 3 days,38 (42.2%) of which excreted in 2 days.27 patients had no clear excretion time and were confirmed of exretion by x ray or detector in 2 weeks follow-up.5 patients were lost to follow-up.6.17 lesions were detected by MCE in jejunum and ileum. MCE reached colon in 44 (48.9%) patients with no lesions detected. The average excretion time of MCE was 2.4±0.7 days (2-5 days).Conclusion:among upper gastrointestinal diseases, MCE has better diagnostic value in gastric diseases than esophagus and duodenum. Among gastric diseases, MCE has higher sensitivity in gastric body (followed by autrum) and focal lesions larger than 5mm. Highest sensitivity was found in polyps of all focal lesions, followed by ulcers. Although MCE has a high observation indexes in gastric ulcer, SMT, gastric caner, eptopic pancreas and gastric vein in gastric cardia, fundus and angle, the incidence of focal lesions is low and further larger size studies are needed. The diagnostic rate of esophagus and duodenum of MCE is not satisfactory. Considering the result and the advantage as a non-invassive method, MCE is expected to play a larger role in the screening of stomach diseases in the future. As the incidences of esophagus and duodenum diseases were low in the study, the diagnostic value of MCE for esophagus and duodenum diseases need to be discussed in further studies among populations with higher risks.