Oesophageal capsule endoscopy versus oesophago-gastroduodenoscopy for the diagnosis of recurrent varices: a prospective multicentre study

Dig Liver Dis. 2014 Jun;46(6):535-40. doi: 10.1016/j.dld.2014.02.002. Epub 2014 Mar 13.

Abstract

Background: Oesophago-gastroduodenoscopy is the standard method for the diagnosis of recurrent oesophago-gastric varices after endoscopic treatment and eradication. The aim of this study was to evaluate the PillCam Eso capsule endoscopy in this setting.

Methods: Prospective, multicentre study in which patients with history of oesophageal varices treated by band ligation underwent PillCam Eso capsule and oesophago-gastroduodenoscopy. Capsule recordings were blindly read by two endoscopists. Indication for a new prophylactic treatment and patient satisfaction were determined for both procedures.

Results: 80 patients (80% males, mean age: 57±12 years) were included, after a median delay of 16 months from last endoscopic treatment. Recurrent oesophageal varices requiring a new prophylactic treatment were detected in 26 patients (32.5%). The mean oesophageal transit time of the capsule was 153 s (range 2-930 s). Capsule sensitivity, specificity, negative and positive predictive values for indication of new prophylactic treatments were 65%, 83%, 83%, and 65%, respectively. Capsule adequately classified 77.5% of the patients for prophylaxis indication. Inter-observer concordance for capsule readings was 88% for the prophylaxis indication.

Conclusion: This study demonstrates that accuracy of PillCam Eso capsule for the diagnosis of recurrent oesophageal varices after endoscopic eradication is suboptimal. PillCam Eso capsule might therefore be proposed in patients unable or unwilling to undergo oesophago-gastroduodenoscopy.

Keywords: Capsule; Cirrhosis; Diagnosis; Endoscopy; Esophageal varices; Portal hypertension; Tolerance.

Publication types

  • Clinical Trial, Phase II
  • Controlled Clinical Trial
  • Multicenter Study
  • Research Support, Non-U.S. Gov't

MeSH terms

  • Aged
  • Capsule Endoscopy*
  • Endoscopy, Gastrointestinal / methods
  • Esophageal and Gastric Varices / diagnosis*
  • Esophageal and Gastric Varices / surgery
  • False Negative Reactions
  • False Positive Reactions
  • Female
  • Humans
  • Ligation
  • Male
  • Middle Aged
  • Observer Variation
  • Patient Preference
  • Predictive Value of Tests
  • Prospective Studies
  • Recurrence
  • Single-Blind Method