Eisen G M, Eliakim R, Zaman A, Schwartz J, Faigel D, Rondonotti E, Villa F, Weizman E, Yassin K, deFranchis R
Department of Medicine, Oregon Health and Science University, Portland, Oregon, USA.
Endoscopy. 2006 Jan;38(1):31-5. doi: 10.1055/s-2005-921189.
Variceal bleeding is a major complication of cirrhosis, and is associated with a 20 % mortality at 6 weeks. Current international guidelines recommend that patients with cirrhosis are screened by conventional upper endoscopy (esophagogastroduodenoscopy, EGD) in order to detect esophageal varices. The recently developed PillCam ESO esophageal capsule endoscope has been shown to be an accurate diagnostic tool in the investigation of patients with gastroesophageal reflux and Barrett's esophagus. We compared the PillCam ESO capsule endoscope with EGD for the detection of esophagogastric varices and portal hypertensive gastropathy in patients with cirrhosis.
A pilot trial was conducted at three sites. Patients with cirrhosis who were undergoing clinically indicated EGD for screening or surveillance for esophageal varices underwent a PillCam ESO study followed by an EGD within 48 hours. Capsule videos were assessed by an investigator who was blinded to the patient's medical history and EGD findings.
A total of 23 of the 32 enrolled patients were found to have esophageal varices at both EGD and PillCam ESO endoscopy. In one patient PillCam ESO detected small varices that were not seen at EGD. The overall concordance between PillCam ESO and EGD was 96.9 % for the diagnosis of esophageal varices and 90.6 % for the diagnosis of portal hypertensive gastropathy. There were no adverse events related to PillCam ESO endoscopy.
In a high-prevalence population, PillCam ESO may represent an accurate noninvasive alternative to EGD for the detection of esophageal varices and portal hypertensive gastropathy. A large-scale trial is underway to validate and expand these findings.
静脉曲张破裂出血是肝硬化的主要并发症，6周内死亡率达20%。当前国际指南建议对肝硬化患者进行传统上消化道内镜检查（食管胃十二指肠镜检查，EGD）以检测食管静脉曲张。最近研发的PillCam ESO食管胶囊内镜已被证明是调查胃食管反流和巴雷特食管患者的准确诊断工具。我们比较了PillCam ESO胶囊内镜与EGD在检测肝硬化患者食管胃静脉曲张和门静脉高压性胃病方面的效果。
在三个地点进行了一项试点试验。因临床需要接受EGD以筛查或监测食管静脉曲张的肝硬化患者在48小时内先进行PillCam ESO检查，随后进行EGD。由一名对患者病史和EGD检查结果不知情的研究人员评估胶囊视频。
32名入组患者中，共有23名在EGD和PillCam ESO内镜检查中均发现有食管静脉曲张。在一名患者中，PillCam ESO检测到了EGD未发现的小静脉曲张。PillCam ESO与EGD在食管静脉曲张诊断方面的总体一致性为96.9%，在门静脉高压性胃病诊断方面为90.6%。未发生与PillCam ESO内镜检查相关的不良事件。
在高患病率人群中，PillCam ESO可能是EGD检测食管静脉曲张和门静脉高压性胃病的一种准确的非侵入性替代方法。一项大规模试验正在进行，以验证和扩展这些发现。
