Screening of esophageal varices by esophageal capsule endoscopy: results of a French multicenter prospective study

Sacher‐Huvelin, Sylvie; Calès, Paul; Bureau, Christophe; Valla, Dominique; Vinel, Jean Pierre; Duburque, Clotilde; Attar, Alain; Archambeaud, Isabelle; Bénamouzig, Robert; Gaudric, M; Luet, Dominique; Couzigou, Patrice; Planche, Lucie; Galmiche, Jean Paul; Coron, Emmanuel

doi:10.1055/s-0034-1391393

Cited by 32 publications

(43 citation statements)

References 20 publications

(28 reference statements)

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“…37 A total of 7 studies evaluated the use of wireless capsule endoscopy for medium or large varices. 22,27,28,32–34,37 A forest plot is shown in Figure 2. The accuracy of each individual study assessing the diagnosis and grading of esophageal varices is illustrated in Figure 3.…”

Section: Resultsmentioning

confidence: 99%

“…Of these 2 significant adverse events, only one required EGD for the recovery of capsule. 22,26,29,31,32,37 …”

Section: Resultsmentioning

confidence: 99%

“…In this French study, the sensitivity of capsule endoscopy in correctly diagnosing and staging esophageal varices was 76% and 64%, respectively; the specificity of the test was 91% and 93%, demonstrating that although capsule endoscopy is not sufficient at this time for the initial diagnosis of esophageal varices, the high specificity of the test may allow its use in cases where patients are refusing or are unable to undergo EGD. 32 The accuracy of capsule for diagnosis and grading was 84% and 81%, respectively. This lower value may indicate the pooled accuracy of this study may be overestimated; thereby requiring more studies with the newer generation before a change in guidelines or surveillance recommendations are made.…”

Section: Discussionmentioning

confidence: 97%

“…Only one study, by Sacher-Huvelin and colleagues, used the second generation Pillcam. 32 All other studies included used the first generation modality. In this French study, the sensitivity of capsule endoscopy in correctly diagnosing and staging esophageal varices was 76% and 64%, respectively; the specificity of the test was 91% and 93%, demonstrating that although capsule endoscopy is not sufficient at this time for the initial diagnosis of esophageal varices, the high specificity of the test may allow its use in cases where patients are refusing or are unable to undergo EGD.…”

Section: Discussionmentioning

confidence: 99%

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Use of Wireless Capsule Endoscopy for the Diagnosis and Grading of Esophageal Varices in Patients With Portal Hypertension

McCarty

Afinogenova²,

Njei³

2017

Journal of Clinical Gastroenterology

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INTRODUCTION Esophageal variceal bleeding is a severe complication of portal hypertension with significant morbidity and mortality. While traditional screening and grading of esophageal varices has been performed by endogastroduodenoscopy (EGD), wireless video capsule endoscopy provides a minimally-invasive alternative that may improve screening and surveillance compliance. AIM To perform a systematic review and structured meta-analysis of all eligible studies to evaluate the efficacy of wireless capsule endoscopy for screening and diagnosis of esophageal varices among patients with portal hypertension. METHODS Searches of PubMed, EMBASE, Web of Science, and the Cochrane Library databases were performed through December 2015. Bivariate and hierarchical models were used to compute the pooled sensitivity and specificity, and to plot the summary receiver operating characteristics curve with summary point and corresponding 95 % confidence region. Bias of included studies was assessed using the quality assessment of diagnostic accuracy studies (QUADAS-2). RESULTS Seventeen studies from 2005 to 2015 were included in this meta-analysis (n=1,328). The diagnostic accuracy of wireless capsule endoscopy in the diagnosis of esophageal varices was 90% (95% CI, 0.88–0.93). The diagnostic pooled sensitivity and specificity were 83% (95% CI, 0.76 – 0.89) and 85% (95% CI, .75–0.91), respectively. The diagnostic accuracy of wireless capsule endoscopy for the grading of medium to large varices was 92% (95% CI, 0.90–0.94). The pooled sensitivity and specificity were 72% (95% CI, 0.54–0.85) and 91% (95% CI, 0.86–0.94), respectively, for the grading of medium to large varices. The use of capsule demonstrated only mild adverse events. A sensitivity analysis limited to only high quality studies revealed similar results. DISCUSSION Wireless esophageal capsule endoscopy is well tolerated and safe in patients with liver cirrhosis and suspicion of portal hypertension. The sensitivity of capsule endoscopy is not currently sufficient to replace EGD as a first exploration in these patients, but given its high accuracy, it may have a role in cases of refusal or contraindication to EGD.

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Section: Resultsmentioning

confidence: 99%

“…Of these 2 significant adverse events, only one required EGD for the recovery of capsule. 22,26,29,31,32,37 …”

Section: Resultsmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 97%

Section: Discussionmentioning

confidence: 99%

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Use of Wireless Capsule Endoscopy for the Diagnosis and Grading of Esophageal Varices in Patients With Portal Hypertension

McCarty

Afinogenova²,

Njei³

2017

Journal of Clinical Gastroenterology

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“…The employed endoscopic procedures are detailed elsewhere . The reference standard was conventional endoscopy according to guidelines .…”

Section: Methodsmentioning

confidence: 99%

Large oesophageal varice screening by a sequential algorithm using a cirrhosis blood test and optionally capsule endoscopy

Calès

Sacher‐Huvelin

Valla

et al. 2017

Liver International

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Background & Aims Large oesophageal varice (LEV) screening is recommended in cirrhosis. We performed a prospective study to improve non‐invasive LEV screening. Design 287 patients with cirrhosis had upper gastrointestinal endoscopy (LEV reference), oesophageal capsule endoscopy (ECE), liver elastography and blood marker analyses. CirrhoMeter (cirrhosis blood test), the most accurate non‐invasive LEV test, was segmented for cirrhosis (reference comparator) or LEV. VariScreen, a sequential and partially minimally invasive diagnostic algorithm, was developed by multivariate analysis. It uses CirrhoMeter first, then ECE if CirrhoMeter cannot rule LEV out or in, and finally endoscopy if CirrhoMeter+ECE combination remains uninformative. Results Diagnostic effectiveness rates for LEV were: cirrhosis‐segmented CirrhoMeter: 14.6%, LEV‐segmented CirrhoMeter: 34.6%, ECE: 60.6% and VariScreen: 66.4% (P ≤ .001 for overall or pair comparison). The respective missed LEV rates were: 2.8%, 5.6%, 8.3% and 5.6% (P = .789). Spared endoscopy rates were, respectively: 15.6%, 36.0%, 70.6% and 69%, (P < .001 for overall or paired comparison except ECE vs VariScreen: P = .743). VariScreen spared 38% of ECE and reduced missed LEV by 87% compared to classical ECE performed in all patients. Excepting cirrhosis‐segmented CirrhoMeter, these spared endoscopy rates were significantly higher than that of the Baveno VI recommendation (using platelets and Fibroscan): 18.4% (P < .001). Ascites and Child‐Pugh class independently predicted endoscopy sparing by VariScreen: from 86.0% in compensated Child Pugh class A to 24.1% in Child‐Pugh class C with ascites. Conclusion VariScreen algorithm significantly reduced the missed LEV rate with ECE by 87%, ECE use by 38% and endoscopy requirement by 69%, and even 86% in compensated cirrhosis.

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Varices

Bonder

Alfaro

Cárdenas

2017

Endoscopy in Liver Disease

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Screening of esophageal varices by esophageal capsule endoscopy: results of a French multicenter prospective study

Abstract: EudraCT (ID RCB 2009-A00532-55) and ClinicalTrials.gov (NCT00941421).

Cited by 32 publications

References 20 publications

Use of Wireless Capsule Endoscopy for the Diagnosis and Grading of Esophageal Varices in Patients With Portal Hypertension

Use of Wireless Capsule Endoscopy for the Diagnosis and Grading of Esophageal Varices in Patients With Portal Hypertension

Large oesophageal varice screening by a sequential algorithm using a cirrhosis blood test and optionally capsule endoscopy

Varices

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