Defining the Threshold: New Data on the Ability of Capsule Endoscopy to Discriminate the Size of Esophageal Varices

Abstract

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.

Screening of esophageal varices in children using esophageal capsule endoscopy: a multicenter prospective study

“…With the DFC, esophageal varices were identified with a sensitivity of 92 % and a specificity of 100 %. It is known that this referenced reading technique underestimates C2 varices [12].…”

“…In this classification, to grade esophageal varices, we used a cutoff value of 16.6 % instead of 12.5 %. The reasons for this choice are related to the fact that the 25 % threshold defined by the DFC corresponds to a quarter of the circumference of the screen but minimizes the presence of varicose veins [12]. Subsequent studies [4,12] have proposed a threshold of 15 % [12] but, to make reading easier, we proposed a threshold of 16.6 %, which corresponds to around 2/3 of the quarter of the circumference (▶ Fig.…”

“…In order to improve the detection of esophageal varices, we proposed using a modified score (MS) based on the reading technique described by Schreibman [12] but using a cutoff value fixed at 16.6 % (2/3 of a quarter of the circumference of the thumbnail) instead of 12.5 % (▶ Fig. 1), Esophageal transit time (ETT), gastric transit time (GTT), pyloric passage, and procedure duration were also recorded.…”

Towards Noninvasive Detection of Oesophageal Varices

“…Several studies have been performed, assessing the ability of these capsule endoscopy devices to detect any varices and identify large varices requiring primary prophylaxis [68–73]. Conventional OGD was used as the gold standard.…”

String capsule endoscopy for screening and surveillance of esophageal varices in patients with cirrhosis

“…18 Our study also compares favorably to a recent observational study where using a 25% lumen circumference for discriminating large/medium size varices by capsule endoscopy, was deemed unreliable with sensitivity, specificity, PPV and NPV of 23.5%, 88.2%, 66.7% and 53.6%, respectively. 19 The steps to ensure a more accurate evaluation include: 1) once the capsule is swallowed, to let it pass across the esophago-gastric junction into the stomach; 2) to pull the capsule into the distal esophagus and slowly up into the upper esophagus (when felt against the resistance caused by the upper esophageal sphincter); 3) by swallowing small sips of water to repeat the process 3 times; 4) if the real time reader is used the area of interest can be assessed multiple times pulling and letting the capsule travel distally or, to remain in the area for a longer period of time. The real time reader allows cleaning the lens of any bubbles or secretions by allowing the patient to swallow water while maintaining the position of the capsule.…”