title: Esophageal capsule endoscopy is not the optimal technique to determine the need for primary prophylaxis in patients with cirrhosis.
abstract: BACKGROUND
  Capsule endoscopy has been suggested as a potential alternative to endoscopy for detection of esophagogastric varices and severe portal hypertensive gastropathy (PHG). The aim of the study was to determine whether PillCam esophageal capsule endoscopy could replace endoscopy for screening purposes.
  
  
  METHODS
  Sixty-two patients with cirrhosis with no previous variceal bleeding had PillCam capsule endoscopy and video endoscopy performed on the same day. Sensitivity, specificity, and positive and negative predictive values (PPV, NPV) of capsule endoscopy were compared to endoscopy for the presence and severity of esophageal and gastric varices, PHG and the need for primary prophylaxis. Patients' preference was assessed by a questionnaire.
  
  
  RESULTS
  Four (6%) patients were unable to swallow the capsule. Sensitivity, specificity, PPV and NPV of capsule endoscopy for detecting any esophageal varices (92%, 50%, 92%, 50%), large varices (55%, 91%, 75%, 80%), variceal red signs (58%, 87%, 69%, 80%), PHG (95%, 50%, 95%, 50%), and the need for primary prophylaxis (91%, 57%, 78%, 80%) were not optimal, with only moderate agreement (κ) between capsule and upper GI endoscopy. Had only a capsule endoscopy been performed, 12 (21.4%) patients would have received inappropriate treatment. Capsule endoscopy also failed to detect (0/13) gastric varices. The majority of patients ranked capsule endoscopy as more convenient (69%) and their preferred (61%) method.
  
  
  CONCLUSIONS
  Despite the preference expressed by patients for capsule endoscopy, we believe that upper GI endoscopy should remain the preferred screening method for primary prophylaxis.
authors.affiliation: Division of Gastroenterology, Hershey Medical Center, Hershey, Pennsylvania, USA.
authors.forename: Karen L
authors.initials: KL
authors.lastname: Krok
authors.affiliation: Division of Gastroenterology and Hepatology, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA.
authors.forename: Rebecca Rankin
authors.initials: RR
authors.lastname: Wagennar
authors.affiliation: Institute for Digestive Health and Liver Disease, Mercy Medical Center, Baltimore, Maryland, USA.
authors.forename: Sergey V
authors.initials: SV
authors.lastname: Kantsevoy
authors.affiliation: Institute for Digestive Health and Liver Disease, Mercy Medical Center, Baltimore, Maryland, USA; University of Maryland School of Medicine, Baltimore, USA.
authors.forename: Paul J
authors.initials: PJ
authors.lastname: Thuluvath
keywords: capsule endoscopy; esophageal varices