A Meta-analysis of the Diagnostic Accuracy of Esophageal Capsule Endoscopy for Barrett's Esophagus in Patients with Gastroesophageal Reflux Disease

Objectives: To evaluate the diagnostic accuracy of esophageal capsule endoscopy (ECE) for Barrett's esophagus (BE) in patients with gastroesophageal reflux disease (GERD).

Methods: Literature was searched for blinded studies evaluating the diagnostic accuracy of ECE for BE in patients with GERD. Meta-analysis was carried out to calculate pooled sensitivity and specificity of ECE for diagnosis of BE. Subgroup analysis was also carried out based on the reference standard used.

Results: Nine studies comprising a total of 618 patients met the inclusion criteria. The pooled sensitivity and specificity of ECE for the diagnosis of BE for all studies were 77 and 86% respectively. The pooled sensitivity and specificity of ECE for the diagnosis of BE using esophagogastroduodenoscopy (EGD) as the reference standard were 78 and 90%, respectively; using histologically confirmed intestinal metaplasia (IM) as the reference standard pooled sensitivity and specificity were 78 and 73%, respectively. Statistical heterogeneity was not evident among studies for sensitivity results (P=0.270, I(2)=19), but heterogeneity was present for specificity results (P<0.001, I(2)=74). There was no evidence of publication bias. The ECE was found to be safe and had a high rate of patient preference.

Conclusions: Capsule endoscopy of esophagus has a moderate sensitivity and specificity for the diagnosis of BE in patients with GERD. The EGD remains the modality of choice for evaluation of suspected BE.