BACKGROUND: Endoscopy (esophagogastroduodenoscopy, EGD) to screen for esophageal varices (EV) is recommended in patients with portal hypertension. Reports indicate that capsule endoscopy (CE) is capable of identifying large/medium varices (L/MV) when the varix comprises more than 25% of the circumference of the field of view. AIMS: We evaluated the ability of CE to discriminate the size of EV using this grading scale. METHODS: Patients underwent CE and EGD on the same day. A blinded investigator interpreted capsule findings. CE labeled EV as L/MV if ≥25% of the lumen circumference was occupied, and small/none for <25%. RESULTS: A total of 37 patients were enrolled in this prospective, observational study at a single tertiary-care academic center. Three CE were excluded due to rapid esophageal transit time or technical malfunction. Using a 25% threshold, the sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) for EC to discriminate L/MV were 23.5%, 88.2%, 66.7%, and 53.6%, respectively (κ=0.12). Reducing the threshold to 12.5% resulted in sensitivity, specificity, PPV, and NPV of 88.2%, 64.7%, 71.4%, and 84.6%, respectively (κ=0.53). A receiver-operator characteristic (ROC) curve showed a 15% threshold to be optimal in discriminating EV size using CE, resulting in sensitivity, specificity, PPV, and NPV of 76.5%, 82.4%, 81.3%, and 77.8%, respectively (κ=0.59). CONCLUSIONS: This study indicates that discriminating EV size by the current capsule scale is unreliable. Lowering the grading threshold improved the ability to discriminate EV size by CE. In the proper context, CE is an alternative to EGD to screen for EV.
BACKGROUND: Endoscopy (esophagogastroduodenoscopy, EGD) to screen for esophageal varices (EV) is recommended in patients with portal hypertension. Reports indicate that capsule endoscopy (CE) is capable of identifying large/medium varices (L/MV) when the varix comprises more than 25% of the circumference of the field of view. AIMS: We evaluated the ability of CE to discriminate the size of EV using this grading scale. METHODS:Patients underwent CE and EGD on the same day. A blinded investigator interpreted capsule findings. CE labeled EV as L/MV if ≥25% of the lumen circumference was occupied, and small/none for <25%. RESULTS: A total of 37 patients were enrolled in this prospective, observational study at a single tertiary-care academic center. Three CE were excluded due to rapid esophageal transit time or technical malfunction. Using a 25% threshold, the sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) for EC to discriminate L/MV were 23.5%, 88.2%, 66.7%, and 53.6%, respectively (κ=0.12). Reducing the threshold to 12.5% resulted in sensitivity, specificity, PPV, and NPV of 88.2%, 64.7%, 71.4%, and 84.6%, respectively (κ=0.53). A receiver-operator characteristic (ROC) curve showed a 15% threshold to be optimal in discriminating EV size using CE, resulting in sensitivity, specificity, PPV, and NPV of 76.5%, 82.4%, 81.3%, and 77.8%, respectively (κ=0.59). CONCLUSIONS: This study indicates that discriminating EV size by the current capsule scale is unreliable. Lowering the grading threshold improved the ability to discriminate EV size by CE. In the proper context, CE is an alternative to EGD to screen for EV.
Authors: G M Eisen; R Eliakim; A Zaman; J Schwartz; D Faigel; E Rondonotti; F Villa; E Weizman; K Yassin; R deFranchis Journal: Endoscopy Date: 2006-01 Impact factor: 10.093
Authors: L Carpinelli; M Primignani; P Preatoni; P Angeli; G Battaglia; L Beretta; A Bortoli; A Capria; R Cestari; F Cosentino; S Crotta; G Gerunda; I Lorenzini; P Maiolo; A Merighi; A Rossi; A Sangiovanni; R de Franchis Journal: Ital J Gastroenterol Hepatol Date: 1997-12
Authors: Roberto de Franchis; Glenn M Eisen; Loren Laine; Inaki Fernandez-Urien; Juan Manuel Herrerias; Russell D Brown; Laurel Fisher; Hugo E Vargas; John Vargo; Julie Thompson; Rami Eliakim Journal: Hepatology Date: 2008-05 Impact factor: 17.425
Authors: M G Lapalus; E Ben Soussan; M Gaudric; J C Saurin; P N D'Halluin; O Favre; B Filoche; F Cholet; A de Leusse; M Antonietti; J L Gaudin; P Sogni; D Heresbach; T Ponchon; J Dumortier Journal: Am J Gastroenterol Date: 2009-03-31 Impact factor: 10.864
Authors: G Nakos; S Karagiannis; S Ballas; P Galanis; G Alevizopoulos; A Nakos; C Mavrogiannis Journal: Dis Esophagus Date: 2009-01-23 Impact factor: 3.429
Authors: Agostino Colli; Juan Cristóbal Gana; Dan Turner; Jason Yap; Thomasin Adams-Webber; Simon C Ling; Giovanni Casazza Journal: Cochrane Database Syst Rev Date: 2014-10-01