Detachable string magnetically controlled capsule endoscopy for detecting high-risk varices in compensated advanced chronic liver disease (CHESS1801): A prospective multicenter study

Abstract

Background Gastroesophageal varices is a serious complication of compensated advanced chronic liver disease (cACLD). Primary prophylaxis to reduce the risk of variceal hemorrhage is recommended if high-risk varices (HRV) are detected. We performed this study to compare the accuracy, patients’ satisfaction and safety of detection of HRV by detachable string magnetically controlled capsule endoscopy (DS-MCCE) with esophagogastroduodenoscopy (EGD) as the reference. Methods We prospectively recruited participants with cACLD from 12 university hospitals (11 in China and one in the United Kingdom) between November 2018 and December 2019 (ClinicalTrials.gov, NCT03749954). All participants underwent DS-MCCE, followed by EGD within a week in a blinded fashion. Following endoscopy, and on the same day, participants were asked to fill in a satisfaction questionnaire regarding their experience. Findings A total of 105 eligible participants were enrolled. With EGD as the reference standard, the concordance index, sensitivity, specificity, positive predictive value, negative predictive value, positive likelihood ratio, and negative likelihood ratio of DS-MCCE in diagnosis of HRV were 0•90 (95% confidence interval [CI]: 0•83–0•95), 92% (95% CI: 78–98%), 88% (95% CI: 78–95%), 80% (95% CI: 70–92%), 95% (95% CI: 90–100%), 7•91 (95% CI: 4•10–15•30), and 0•09 (95% CI: 0•03–0•30), respectively. The kappa score of 0•78 (95% CI: 0•65–0•90) suggested substantial agreement between DS-MCCE and EGD. Moreover, in participants undergoing EGD without sedation, the satisfaction of DS-MCCE was significantly better than that of EGD ( p < 0•0001, d = 1•15 [95%CI: 0•88–1•42]). All participants confirmed the excretion of the capsule, and no adverse events occurred. Interpretation DS-MCCE is an accurate alternative to EGD for detecting HRV in cACLD, which is safe and associated with better satisfaction. Funding A full list of funding can be found in the Funding Support section.

Magnetically controlled capsule endoscopy in one-time gastro-small intestinal joint examination: a two-centre experience

“…At present, indications for MCE examination do not include oesophageal disease and endoscopists could only describe the presentation of limited oesophageal pictures taken by the MCE in the final report. Previous studies provided the attachment of string to overcome the gravity and showed an increase in oesophageal examination time, improving diagnostic accuracy of oesophageal diseases [ 34 – 38 ]. The new method of detachable string MCE offers the possibility of complete viewing UGI and small intestine at one time.…”

A strategy for varices screening based on acoustic radiation force impulse combined with platelet (CHESS2001): An alternative of Baveno VI criteria

“…[ 18 , 19 ] However, this would be at a lower rate of spared EGDs than the ARP strategy, and most importantly, with a controversial rate of HRV missed above the accepted threshold of 5%. [ 20 , 21 , 22 , 23 ]…”

Expanding beyond endoscopy: A review of non-invasive modalities in Barrett’s esophagus screening and surveillance

“…Another solution for the rapid esophageal transit issue is the detachable string magnetically controlled capsule endoscopy (also known as wireless magnetically controlled capsule endoscopy or WMCCE) which has been shown to be feasible and well tolerated in various studies[ 24 - 26 ]. A recent prospective multicenter study showed sensitivity of 92% and specificity of 80% for high-risk esophageal varices[ 27 ]. With regards to cost-effectiveness of ECE compared to traditional endoscopy, the results have been equivocal[ 28 - 30 ].…”