Exploratory evaluation of magnetic capsule endoscopy with detachable-string for detecting esophageal lesions including early squamous cell carcinoma

Background and study aims: Research regarding utilization of capsule endoscopy for detecting early esophageal squamous cell carcinoma (ESCC) is limited. This study was designed to preliminarily explore diagnostic performance of magnetically controlled capsule endoscopy with a detachable string (DS-MCCE) for detecting early ESCC. Patients and methods: In this retrospective cross-sectional diagnostic study, 496 asymptomatic individuals with high-risk lesions suspicious for early ESCC in esophagus, suspected neoplastic gastric and duodenal lesions, and all ulcers in the upper gastrointestinal tract first underwent DS-MCCE followed by esophagogastroduodenoscopy (EGD) and biopsy within 1 week. Outcomes included diagnostic performance of DS-MCCE for esophageal mucosal lesions and early ESCC, examination time, patient comfort and preference, and safety. Results: DS-MCCE had a sensitivity of 95.36 % (95% confidence interval [CI] 90.32%-97.95%) and specificity of 88.99% (85.08%-91.99%) for detecting esophageal mucosal lesions, whereas for detecting early ESCC, it showed a sensitivity of 66.67% (95% CI 38.38%-88.18%) and specificity of 99.17% (95% CI 97.88%-99.77%). DS-MCCE demonstrated superiority to EGD without sedation in terms of patient comfort, and participants preferred DS-MCCE to EGD. Median examination time was 9.1 minutes. There were no adverse events associated with DS-MCCE. Conclusions: DS-MCCE has potential in detecting early ESCC, mainly for lesions that are larger in size or exhibit pronounced morphological features. These preliminary findings support a further large-sample prospective study and technical refinement.