Esophageal Capsule Endoscopy versus Esophagogastroduodenoscopy for Evaluating Portal Hypertension: a Prospective Comparative Study of Performance and Tolerance

Background and Study Aims: Esophagogastroduodenoscopy (EGD) is the most effective method for examining the upper gastrointestinal tract, and particularly for evaluating portal hypertension in cirrhotic patients, especially for screening purposes. The aim of this study was to assess the feasibility, safety, accuracy, and tolerance of PillCam ESO capsule endoscopy for this indication.
Patients and Methods: In this prospective study, unsedated EGD and capsule endoscopy examinations were conducted on the same day in cirrhotic patients at the time of diagnosis. The patients quantified the tolerability (relative to pain, nausea, choking sensations, etc.) of the two procedures using a 100-mm visual analogue scale. The time required for the recording and for diagnosis with the capsule examination were documented, as were the patients’ preferences in comparison with EGD. Two independent endoscopists blinded to the EGD diagnoses assessed the diagnostic accuracy of the images obtained.
Results: Twenty-one patients were included in the study (mean age 62, mean Model for End-Stage Liver Disease score 10.5, mean Child-Pugh score 7.3). The procedure was safe. One patient was unable to swallow the capsule. The mean recording time was 213 s (range 6 - 1200 s); the procedure accurately assessed the presence or absence of esophageal varices in 16 of 19 patients (84.2 %); and it correctly indicated a need for primary prophylaxis (esophageal varices of grade 2 or more and/or red signs) in 100 % of cases. The tolerability of the capsule endoscopy examination was significantly better, and all of the patients preferred capsule endoscopy to EGD (which was transnasal in 11 patients).
Conclusions: Capsule endoscopy was feasible, safe, accurate, highly acceptable, and preferred by cirrhotic patients undergoing screening for portal hypertension. This new technique requires further and more extensive evaluation, as well as assessment of its cost-effectiveness.

• 1 De Franchis R, Dell’Era A, Iannuzzi F. Diagnosis and treatment of portal hypertension.  Dig Liver Dis. 2004;  36 787-798
• 2 De Franchis R. Evolving consensus in portal hypertension: report of the Baveno IV Consensus Workshop on methodology of diagnosis and therapy in portal hypertension.  J Hepatol. 2005;  43 167-176
• 3 Lapalus M G, Saurin J C. Complications of gastrointestinal endoscopy: gastroscopy and colonoscopy.  Gastroenterol Clin Biol. 2003;  27 909-921
• 4 Keeffe E B, O’Connor K W. 1989 ASGE survey of endoscopic sedation and monitoring practices.  Gastrointest Endosc. 1990;  36 S13-S18
• 5 Daneshmend T K, Bell G D, Logan R F. Sedation for upper gastrointestinal endoscopy: results of a nationwide survey.  Gut. 1991;  32 12-15
• 6 Froehlich F, Gonvers J J, Fried M. Conscious sedation, clinically relevant complications and monitoring of endoscopy: results of a nationwide survey in Switzerland.  Endoscopy. 1994;  26 231-234
• 7 Dean R, Dua K, Massey B. et al . A comparative study of unsedated transnasal esophagogastroduodenoscopy and conventional EGD.  Gastrointest Endosc. 1996;  44 422-424
• 8 Campo R, Montserrat A, Brullet E. Transnasal gastroscopy compared to conventional gastroscopy: a randomized study of feasibility, safety, and tolerance.  Endoscopy. 1998;  30 448-452
• 9 Dumortier J, Ponchon T, Scoazec J Y. et al . Prospective evaluation of transnasal esophagogastroduodenoscopy: feasibility and study on performance and tolerance.  Gastrointest Endosc. 1999;  49 285-291
• 10 Saeian K, Townsend W F, Rochling F A. et al . Unsedated transnasal EGD: an alternative approach to conventional esophagogastroduodenoscopy for documenting Helicobacter pylori eradication.  Gastrointest Endosc. 1999;  49 297-301
• 11 Dumortier J, Napoleon B, Hedelius F. et al . Unsedated transnasal EGD in daily practice: results with 1100 consecutive patients.  Gastrointest Endosc. 2003;  57 198-204
• 12 Saeian K, Staff D, Knox J. et al . Unsedated transnasal endoscopy: a new technique for accurately detecting and grading esophageal varices in cirrhotic patients.  Am J Gastroenterol. 2002;  97 2246-2249
• 13 Madhotra R, Mokhashi M, Willner I. et al . Prospective evaluation of a 3.1-mm battery-powered esophagoscope in screening for esophageal varices in cirrhotic patients.  Am J Gastroenterol. 2003;  98 807-812
• 14 Keuchel M, Hagenmuller F. Small bowel endoscopy.  Endoscopy. 2005;  37 122-132
• 15 Ramirez F C, Shaukat M S, Young M A. et al . Feasibility and safety of string, wireless capsule endoscopy in the diagnosis of Barrett’s esophagus.  Gastrointest Endosc. 2005;  61 741-746
• 16 Ramirez F C, Hakim S, Tharalson E M. et al . Feasibility and safety of string wireless capsule endoscopy in the diagnosis of esophageal varices.  Am J Gastroenterol. 2005;  100 1065-1071
• 17 Spiegel B M, Targownik L, Dulai G S. et al . Endoscopic screening for esophageal varices in cirrhosis: is it ever cost effective?.  Hepatology. 2003;  37 366-377
• 18 Schepis F, Camma C, Niceforo D. et al . Which patients with cirrhosis should undergo endoscopic screening for esophageal varices detection?.  Hepatology. 2001;  33 333-338
• 19 Thabut D, Ratziu V, Trabut J B, Poynard T. Prediction of oesophageal varices with platelet count/spleen diameter ratio or platelets alone.  Gut. 2004;  53 913-914