Comparison of esophageal capsule endoscopy and esophagogastroduodenoscopy for diagnosis of esophageal varices.
OBJECTIVE
To investigate the utility of esophageal capsule endoscopy in the diagnosis and grading of esophageal varices.


METHODS
Cirrhotic patients who were undergoing esophagogastroduodenoscopy (EGD) for variceal screening or surveillance underwent capsule endoscopy. Two separate blinded investigators read each capsule endoscopy for the following results: variceal grade, need for treatment with variceal banding or prophylaxis with beta-blocker therapy, degree of portal hypertensive gastropathy, and gastric varices.


RESULTS
Fifty patients underwent both capsule and EGD. Forty-eight patients had both procedures on the same day, and 2 patients had capsule endoscopy within 72 h of EGD. The accuracy of capsule endoscopy to decide on the need for prophylaxis was 74%, with sensitivity of 63% and specificity of 82%. Inter-rater agreement was moderate (kappa = 0.56). Agreement between EGD and capsule endoscopy on grade of varices was 0.53 (moderate). Inter-rater reliability was good (kappa = 0.77). In diagnosis of portal hypertensive gastropathy, accuracy was 57%, with sensitivity of 96% and specificity of 17%. Two patients had gastric varices seen on EGD, one of which was seen on capsule endoscopy. There were no complications from capsule endoscopy.


CONCLUSIONS
We conclude that capsule endoscopy has a limited role in deciding which patients would benefit from EGD with banding or beta-blocker therapy. More data is needed to assess accuracy for staging esophageal varices, PHG, and the detection of gastric varices.
Frenette
Catherine T
CT
Division of Gastroenterology and Hepatology, Scripps Clinic, San Francisco 94115, USA. frenetc@sutterhealth.org
Kuldau
John G
JG
Hillebrand
Donald J
DJ
Lane
Jill
J
Pockros
Paul J
PJ
D000319:Adrenergic beta-Antagonists / Q000627:therapeutic use; D000328:Adult; D000368:Aged; D053704:Capsule Endoscopy / Q000379:methods*; D016145:Endoscopy, Digestive System / Q000379:methods*; D004932:Esophageal and Gastric Varices / Q000175:diagnosis* / Q000517:prevention & control; D005260:Female; D006801:Humans; D006975:Hypertension, Portal / Q000175:diagnosis; D008297:Male; D008875:Middle Aged; D012680:Sensitivity and Specificity; D012720:Severity of Illness Index; D016037:Single-Blind Method
D000319:Adrenergic beta-Antagonists