Screening for Barrett’s Esophagus: Endoscopy in a Pill?

Imagine going to the doctor to get a pill—a pill that contains an imaging system that creates microscopic images of the wall of your esophagus—eliminating the need for an endoscopy.

This is what researchers at the Wellman Center for Photomedicine at Massachusetts General Hospital have developed.

Screening for Barrett’s Esophagus: the Endo-Pill

The purpose of the endo-pill is to screen for Barrett’s esophagus, a possible complication of chronic acid reflux that can lead to esophageal cancer.

“By showing the three-dimensional, microscopic structure of the esophageal lining, it reveals much more detail than can be seen with even high-resolution endoscopy,” says Gary Tearney, MD, in the 2013 paper.

The little capsule contains optical frequency domain imaging technology: a rapidly rotating laser tip that emits sensors and a beam of near-infrared light.

The device records light that’s reflected back from the esophageal lining.

The Patient Swallows It on a String

The multivitamin-sized capsule, which the patient swallows, is connected to a string-like tether that attaches to the imaging console, allowing a medical professional to control the system.

The capsule can be pulled out of the patient with the tether.

Barrett’s Esophagus Screening in Super Short Time

The capsule was tested on 13 non-sedated patients. The entire esophagus was imaged in under a minute. Compare that to an endoscopy which requires 90 minutes of the patient’s time.

The capsule’s images revealed details not easily seen with endoscopy, and showed cellular alterations significant of Barrett’s esophagus.

“We originally were concerned that we might miss a lot of data because of the small size of the capsule,” says Dr. Tearney in the paper, “but we were surprised to find that, once the pill has been swallowed, it is firmly ‘grasped’ by the esophagus, allowing complete microscopic imaging of the entire wall.”

What’s the Update on the Endo-Pill for Barrett’s Esophagus Screening?

“Gary Tearney’s Endo-Pill is still considered experimental,” says Alan Gingold, DO, a board certified gastroenterologist with the Digestive Healthcare Center of NJ.

“He had created a pill that was attached to a wire which in turn sent images to a monitor,” continues Dr. Gingold.

“The patient in theory could be un-sedated, swallow this pill, and using the wire, the pill could be pulled back from the stomach to image the gastroesophageal junction to screen for Barrett’s esophagus.

“Barrett’s esophagus is a cell transformation from normal squamous epithelium to mucosa similar to gastric mucosa called intestinal metaplasia.

“Barrett’s esophagus is a pathological diagnosis, and so the gold standard to screen for Barrett’s is still endoscopy with biopsy.

“The Endo-Pill — while having the advantage of no sedation and speed of use — cannot take biopsies, and so it is still consider experimental and not universally used.”

Dr. Gingold attributes his success to the extra time he spends with his patients. His areas of expertise include reflux disease, Barrett’s esophagus, capsule endoscopy, chronic liver disease and inflammatory bowel disease.