A multicenter randomized comparison of the Endocapsule and the Pillcam SB

Background: Video capsule endoscopy has been shown to be the single most effective endoscopic procedure for identifying the source of obscure GI bleeding (OGIB). Objective: Our purpose was to report on the Food and Drug Administration pivotal trial in which the Endocapsule (EC) (Olympus America, Allentown, Pa) was compared with the Pillcam SB (PSB) (Given Imaging, Yoqneam, Israel) in patients with OGIB. Design: A novel trial design Was used in which the EC and the PSB were swallowed by the same patient 40 minutes apart, in randomized order. Setting: Four academic medical centers. Patients: Patients with OGIB aged 18 to 85 years who had either been transfused or who had a hematocrit of < 31% in males or < 28% in females. Interventions: Both video capsules were swallowed in random order. Videos from the PSB were read locally for patient management. All videos were then read by at least 2 independent readers for normal versus abnormal categorization, a diagnosis, capsule transit time, reading time, and a subjective assessment of image quality. Main Outcome Measurement: Categorization of videos as either normal or abnormal. Results: Data from 51 of 63 enrolled Patients Were analyzed. Nine patients were excluded for technical reasons and 3 for protocol violations. Twenty-four videos were read is normal and 14 as abnormal from both capsules. Disagreement occurred in 13. No adverse events were reported for either capsule. Overall agreement was 38 of 51 (74.5%) with a kappa of 0.48, P = .008. Limitations: Although ingestion order was randomized, the videos could not be read blind owing to 21 different shape of the image margin. Conclusions: (1) Both devices were safe and had a comparable diagnostic yield within the range previously reported. (2) There was a subjective difference in image quality favoring the K. (3) This study design provided unique information about capsule movement in the small intestine and the lack of electromechanical interference between 2 different capsules.