New procedure 1.Practice drinking sips of ~15ml of water Please note; we found that training the patient pre- ingestion improves the procedure significantly!

New procedure

1. Practice drinking sips of ~15ml of water

Please note; we found that training the patient pre-ingestion improves the procedure significantly!

New procedure

2. Drink 100 ml of water to clear saliva

New procedure

2. Lie on right side, ingest Capsule with sip of water, and stay in right side position

Drink 15 ml sips of water every ~30 sec.

0:00 7:00 min

New procedure

3. Drink sip of water

7:00 min

New procedure

4. Walk

7:30 – 20:00 min

Results(Demonstrated by some examples)

Original Procedure New Procedure

Study Images (1) 36

TT = 00:13 min TT = 00:09 min

Study Images (2)

Original Procedure New Procedure

265

TT = 05:13 min TT = 00:37 min

Original Procedure New Procedure

Study Images (3) 266

TT = 05:01 min TT = 00:11 min

Original Procedure New Procedure

Study Images (4) 3

TT = 01:11 min TT = 00:15 min

Original Procedure New Procedure

Study Images (5) 263

TT = 00:39 min TT = 00:06 min

Original Procedure New Procedure

Study Images (6)

TT = 01:10 min TT = 00:06 min

101

Conclusions • Presence of bubbles/saliva which obscures

the Z-line was significantly reduced, therefore enhancing visualization

• Z-line circumferential view is significantly increased

• Procedure appears much easier and simple for both subjects and staff*

• Shorter esophageal transit time (0:38 ± 1:25 minutes)

* Based on staff testimonies

Conclusions(continued)

• Accuracy (sensitivity, specificity, NPV, PPV) of PillCam ESO utilized in the new procedure needs to be evaluated against EGD in a comparative study

• Impact of new procedure on detection esophageal varices needs to be evaluated

• Further potential improvement using real time viewer (to stop water sips when capsule reaches Z-line region) should also be evaluated