FEASIBILITY AND ACCURACY OF “STRING” CAPSULE ENDOSCOPY (SCE) IN THE DIAGNOSIS OF ESOPHAGEAL VARICES

Abstract

Purpose: To determine: 1) feasibility and accuracy of SCE for esophageal varices, 2) procedure-associated discomfort and, 3) patient's acceptability when compared to the gold standard EGD. Methods: SCE was swallowed with water, in the sitting position and no sedation. Once a 50 cm mark was reached, SCE was slowly pulled across the LES into the lower esophagus and up to the UES. The process was repeated 3 times. The SCE was retrieved from the patient's esophagus, the strings disposed and the capsule underwent high level disinfection (2% gluteraldehyde for 45 min) and re-used. An independent endoscopist unaware of the patient's diagnosis reviewed the pictures and determined whether esophageal varices were present or not and then graded their size as 1 = small, 2 = small-medium, 3 = medium, 4 = medium-large, and 5 = large. The corresponding EGD grading (I-IV) was defined as follows: I = 1 and 2; II = 3; III = 4 and IV = 5. The grading system kept in mind that grades III and IV on EGD definitively require therapeutic intervention (for primary or secondary prophylaxis). Patients graded their difficulty experienced during the procedure and were asked their preference between SCE and conventional EGD. Results: 30 cirrhotic patients (ETOH and/or HCV: 93.1%) underwent EGD and SCE. All were men, mean age = 54.4 years, mean Child-Pugh score = 6.2. Eleven patients were for screening and 19 for surveillance. No capsule was lost during any of the procedures. The agreement for the presence/absence of varices was 96.7% (1 patient had Grade I varices on EGD but no varices on SCE). Size of varices was in agreement in 16/21 (76%) patients with varices. In the remaining 6, 3 were undersized and 2 oversized by SCE. Twenty-five patients (86.2%) preferred SCE to EGD, 2 had no preference and 2 EGD to SCE. The mean recording time was 5.78 minutes. Patient's discomfort is shown in Table.Table: Percent of patients and discomfort scoreConclusions: (1) SCE was well tolerated, safe and easy to perform; 2) Agreement of SCE for presence/absence of esophageal varices was over 95% in patients with cirrhosis; 3) SCE is an alternative to EGD in the screening/surveillance of esophageal varices and may be more cost-effective than EGD.