Safe Use of the PillCam ESO in a Patient with an Implantable Cardioverter Defibrillator

Purpose: There has been concern regarding the use of capsule endoscopy in patients who have an electromedical device based on the fact that both agents work on a similar radiofrequency. While it is a contraindication to use the PillCam in a patient with an implantable electromedical device, many are performing the test on a case-by-case scenario. This is the first published report using PillCam ESO in such a patient. A 62 year old man presents for evaluation of his progressive liver disease that is secondary to Hepatitis B and excessive alcohol use. He serologically has evidence of cirrhosis and no history of gastrointestinal bleeding. His past medical history is significant for a dilated cardiomyopathy with an ejection fraction of 15% for which he takes coumadin and he had an automatic implantable cardioverter defibrillator (Guidant Contak Renewal 3-CRT-D) implanted. An evaluation of his esophagus was recommended regarding the potential for primary prophylaxis, should he have varices. After a discussion with the patient about the different options of evaluation, he chose to swallow the PillCam ESO. In light of his cardiac status, risk of bleeding, inability to get a ride home, and patient preference, there were multiple reasons why he chose to avoid an esophagogastroduodenoscopy. During the time of the procedure, the patient was closely monitored. The pulse generator was located in the left upper chest wall, in relative close proximity to the 3 sensors for the study. There were no apparent cardiac changes, both clinically and on the monitor in this pacemaker dependent subject. After completion of the exam marked by the change in the lights on the data recorder signifying no further transmission, he was monitored for an additional 5 minutes. The images acquired demonstrated an abnormality in the esophagus that on further evaluation was consistent with high grade dysplasia in a short segment Barrett's esophagus and no varices. There was no loss of images acquired during the examination. Several series have performed capsule endoscopy in such patients without interference to the implantable electromedical device or image acquisition. In one study there was a loss of the images while the capsule was in close proximity to a patient's abdominal pacemaker pulse generator. This was a specific concern as in a study using the PillCam ESO, as the sensor arrays are in the vicinity of the pulse generator. However, in this case, there was no loss or alterations of the images during the 22 minutes of the study.