Lapalus M-G, Dumortier J, Fumex F, Roman S, Lot M, Prost B, Mion F, Ponchon T
Dept. of Digestive Diseases, Edouard Herriot Hospital Lyon, France.
Endoscopy. 2006 Jan;38(1):36-41. doi: 10.1055/s-2006-924975.
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.
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.
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).
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.
食管胃十二指肠镜检查（EGD）是检查上消化道最有效的方法，尤其对于评估肝硬化患者的门静脉高压，特别是用于筛查目的。本研究旨在评估食管 PillCam 胶囊内镜检查在该适应症方面的可行性、安全性、准确性和耐受性。
在这项前瞻性研究中，肝硬化患者在诊断时于同一天进行了未使用镇静剂的 EGD 和胶囊内镜检查。患者使用 100 毫米视觉模拟量表对两种检查的耐受性（相对于疼痛、恶心、哽咽感等）进行量化。记录了胶囊检查的记录时间和诊断所需时间，以及与 EGD 相比患者的偏好。两名对 EGD 诊断不知情的独立内镜医师评估了所获得图像的诊断准确性。
21 名患者纳入研究（平均年龄 62 岁，终末期肝病模型评分平均为 10.5，Child-Pugh 评分平均为 7.3）。该检查方法安全。1 名患者无法吞咽胶囊。平均记录时间为 213 秒（范围为 6 - 1200 秒）；该检查准确评估了 19 名患者中 16 名（84.2%）食管静脉曲张的有无；并且在 100%的病例中正确指出了一级预防的必要性（2 级或以上食管静脉曲张和/或红色征）。胶囊内镜检查的耐受性明显更好，所有患者均更喜欢胶囊内镜检查而非 EGD（11 名患者为经鼻 EGD）。
胶囊内镜检查对于接受门静脉高压筛查的肝硬化患者是可行、安全、准确、高度可接受且更受青睐的。这项新技术需要进一步更广泛的评估以及成本效益评估。
