Comparison of esophageal capsule endoscopy and esophagogastroduodenoscopy for diagnosis of esophageal varices

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http://www.wjgnet.com/1007-9327/abstract_en.asp?f=4480 & v=14

Frenette CT, Kuldau JG, Hillebrand DJ, Lane J, Pockros PJ.Comparison of esophageal capsule endoscopy and esophagogastroduodenoscopy for diagnosis of esophageal varices.World J Gastroenterol 2008 July;14(28):4480-4485Comparison of esophageal capsule endoscopy and esophagogastroduodenoscopy for diagnosis of esophageal varicesFrenette CT, Kuldau JG, Hillebrand DJ, Lane J, Pockros PJ.Division of Gastroenterology and Hepatology, Scripps Clinic, 2340 Clay Street, 3rd Floor, San Francisco 94115, United States. frenetc@...AIM: 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.

CONCLUSION: 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.