Annicchiarico Brigida Eleonora, Riccioni Maria Elena, Siciliano Massimo, Urgesi Riccardo, Spada Cristiano, Caracciolo Gianluigi, Gasbarrini Antonio, Costamagna Guido
Department of Internal Medicine, Catholic University of Sacred Heart, Rome, Italy.
Digestive Endoscopy Unit, Catholic University of Sacred Heart, Rome, Italy.
Dig Liver Dis. 2014 Nov;46(11):997-1000. doi: 10.1016/j.dld.2014.08.030. Epub 2014 Sep 2.
Capsule endoscopy has been proposed as an alternative to fibreoptic endoscopy for oesophageal varices evaluation in cirrhotics. However, it shows only moderate sensitivity compared to fibreoptic endoscopy.
To compare post-meal capsule endoscopy to fibreoptic endoscopy, based on the hypothesis that meal-induced increase of portal pressure can enhance its sensitivity.
Twenty-five patients were submitted to fibreoptic endoscopy and, after a standard meal, capsule endoscopy.
Post-meal capsule endoscopy detected varices in the 18 patients in whom fibreoptic endoscopy detected varices plus 3 more subjects (sensitivity 100%, specificity 70%); large varices in the 4 patients in whom fibreoptic endoscopy graded varices as large, plus 5 more subjects; red markers in the 5 patients in whom fibreoptic endoscopy detected red markers, plus 3 more subjects. High-risk varices were identified in 11 patients by post-meal capsule endoscopy and in 10 by fibreoptic endoscopy (sensitivity 100%, specificity 93.8%).
Post-meal capsule endoscopy identified more varices, large varices and red markers than fibreoptic endoscopy. The two methods detected similar proportions of high-risk varices. These data suggest that a standard meal can enhance the sensitivity of capsule endoscopy in the detection and grading of oesophageal varices in cirrhotics.
对于肝硬化患者食管静脉曲张的评估，胶囊内镜已被提议作为纤维内镜的替代方法。然而，与纤维内镜相比，其敏感性仅为中等。
基于餐后门静脉压力升高可提高其敏感性这一假设，比较餐后胶囊内镜与纤维内镜。
25例患者接受了纤维内镜检查，并在标准餐后接受了胶囊内镜检查。
餐后胶囊内镜在纤维内镜检测到静脉曲张的18例患者中又检测到3例（敏感性100%，特异性70%）；在纤维内镜将静脉曲张分级为大的4例患者中又检测到5例大静脉曲张；在纤维内镜检测到红色征的5例患者中又检测到3例红色征。餐后胶囊内镜在11例患者中识别出高危静脉曲张，纤维内镜在10例患者中识别出高危静脉曲张（敏感性100%，特异性93.8%）。
餐后胶囊内镜比纤维内镜识别出更多的静脉曲张、大静脉曲张和红色征。两种方法检测到的高危静脉曲张比例相似。这些数据表明，标准餐可提高胶囊内镜在肝硬化患者食管静脉曲张检测和分级中的敏感性。
