Lapalus M G, Ben Soussan E, Gaudric M, Saurin J C, D'Halluin P N, Favre O, Filoche B, Cholet F, de Leusse A, Antonietti M, Gaudin J L, Sogni P, Heresbach D, Ponchon T, Dumortier J
Fédération des Spécialités Digestives, Hôpital Edouard Herriot, Lyon, France.
Am J Gastroenterol. 2009 May;104(5):1112-8. doi: 10.1038/ajg.2009.66. Epub 2009 Mar 31.
Esophagogastroduodenoscopy (EGD) is the standard method for the diagnosis of esophago-gastric varices. The aim of this prospective multicenter study was to evaluate the PillCam esophageal capsule endoscopy (ECE) for this indication.
Patients presenting with cirrhotic or noncirrhotic portal hypertension underwent ECEfollowed by EGD at the time of diagnosis. Capsule recordings were blindly read by two endoscopists.
A total of 120 patients (72 males, mean age: 58 years; mean Child-Pugh score: 7.2) were included. Esophageal varices were detected in 74 patients. No adverse event was observed after either EGD or ECE. Seven (6%) patients were unable to swallow the capsule. The mean recording time was 204 s (range 1-876). Sensitivity, specificity, negative predictive value, and positive predictive value of ECE for the detection of esophageal varices were 77%, 86%, 69%, and 90%, respectively. Sensitivity, specificity, negative and positive predictive values of ECE for the indication of primary prophylaxis (esophageal varices > or = grade 2 and/or red signs) were 77, 88, 90, and 75%, respectively, and 85% of the patients were adequately classified for the indication (or not) of prophylaxis. Interobserver concordance for ECE readings was 79.4% for the diagnosis of varices, 66.4% for the grading of varices, and 89.7% for the indication of prophylaxis.
This large multicenter study confirms the safety and acceptable accuracy of ECE for the evaluation of esophageal varices. ECE might be proposed as an alternative to EGD for the screening of portal hypertension, especially in patients unable or unwilling to undergo EGD.
食管胃十二指肠镜检查（EGD）是诊断食管胃静脉曲张的标准方法。这项前瞻性多中心研究的目的是评估用于该适应症的 PillCam 食管胶囊内镜检查（ECE）。
诊断时，患有肝硬化或非肝硬化门静脉高压症的患者先接受 ECE 检查，随后进行 EGD 检查。两名内镜医师对胶囊记录进行盲法解读。
共纳入 120 例患者（72 例男性，平均年龄：58 岁；平均 Child-Pugh 评分：7.2）。74 例患者检测到食管静脉曲张。EGD 或 ECE 检查后均未观察到不良事件。7 例（6%）患者无法吞咽胶囊。平均记录时间为 204 秒（范围 1 - 876 秒）。ECE 检测食管静脉曲张的敏感性、特异性、阴性预测值和阳性预测值分别为 77%、86%、69%和 90%。ECE 用于初级预防（食管静脉曲张≥2 级和/或红色征）指征的敏感性、特异性、阴性和阳性预测值分别为 77%、88%、90%和 75%，85%的患者对于预防指征（是否）被充分分类。ECE 读数的观察者间一致性在静脉曲张诊断方面为 79.4%，在静脉曲张分级方面为 66.4%，在预防指征方面为 89.7%。
这项大型多中心研究证实了 ECE 评估食管静脉曲张的安全性和可接受的准确性。ECE 可作为 EGD 的替代方法用于门静脉高压症的筛查，尤其是在无法或不愿接受 EGD 的患者中。
