title: Capsule endoscopy is not as accurate as esophagogastroduodenoscopy in screening cirrhotic patients for varices.
abstract: OBJECTIVE
  Esophagogastroduodenoscopy (EGD) is the standard technique for screening cirrhotic patients for high-risk varices and other significant upper gastrointestinal lesions (HRVLs). We investigated whether esophageal capsule endoscopy (ECE) is as convenient and accurate as EGD for the detection of HRVLs.
  
  
  METHODS
  We analyzed data from 65 cirrhotic patients without prior upper gastrointestinal bleeding who were examined for varices and HRVLs by ECE and EGD (both procedures were performed on the same day). EGD was performed by 2 physicians (75% of patients were unsedated) who used standard grading for esophageal and gastric varices, portal hypertensive gastropathy, and HRVLs. Coded capsule tracings were read by 2 investigators, blinded to the EGD findings, using standard grading.
  
  
  RESULTS
  The median procedure time for EGD (with or without biopsy collection) was 3 minutes, compared with 20 minutes for ECE. The overall accuracy for diagnosis of esophageal varices was 63.2% ± 5.9%; for detection of esophageal varices red marks was 68.8% ± 5.4%; and for diagnosis of other HRVLs was 51.5% ± 4.2%. The interobserver agreement in the diagnosis of esophageal varices was 90.8%; in the detection of esophageal varices red marks was 86.2%; and in the diagnosis of other HRVLs was 7.3%.
  
  
  CONCLUSIONS
  ECE is not as accurate as EGD in the diagnosis of esophageal varices and red markings or in grading esophageal varices. Moreover, ECE had poor accuracy in grading portal hypertensive gastropathy and detecting ulcers, gastric varices, and other significant upper gastrointestinal lesions. It took significantly longer to perform ECE and interpret the results than for EGD. These findings do not support ECE as a preferred tool for screening esophageal varices and HRVLs.
authors.affiliation: Center for Ulcer Research and Education Digestive Diseases Research Center, Los Angeles, California 90073-1003, USA. disaya104@gmail.com
authors.forename: Disaya
authors.initials: D
authors.lastname: Chavalitdhamrong
authors.forename: Dennis M
authors.initials: DM
authors.lastname: Jensen
authors.forename: Bhavneet
authors.initials: B
authors.lastname: Singh
authors.forename: Thomas O G
authors.initials: TO
authors.lastname: Kovacs
authors.forename: Steven H
authors.initials: SH
authors.lastname: Han
authors.forename: Francisco
authors.initials: F
authors.lastname: Durazo
authors.forename: Sammy
authors.initials: S
authors.lastname: Saab
authors.forename: Jeffrey A
authors.initials: JA
authors.lastname: Gornbein
mesh_terms: D000328:Adult; D000368:Aged; D053704:Capsule Endoscopy / Q000379:methods*; D016145:Endoscopy, Digestive System / Q000379:methods*; D004932:Esophageal and Gastric Varices / Q000175:diagnosis*; D005260:Female; D006801:Humans; D008103:Liver Cirrhosis / Q000150:complications*; D008297:Male; D008403:Mass Screening / Q000379:methods*; D008875:Middle Aged; D012680:Sensitivity and Specificity