Camera-in-a-capsule technology may be as effective as the more invasive conventional upper endoscopy at detecting esophageal varices, according to tandem studies.
In a pilot trial, American, Israeli, and French investigators compared conventional esophagogastroduodenoscopy (EGD) with the commercially available PillCam ESO.
The targets were esophageal varices, which affect a large majority of patients with cirrhosis and portal hypertension, according to Dr. Glenn M. Eisen and colleagues at Oregon Health and Science University, Portland (Endoscopy 2006;38:31–5).
The study involved 32 patients with cirrhosis who were undergoing clinically indicated EGD for screening or surveillance for esophageal varices. All underwent a PillCam ESO study followed by an EGD within 48 hours. Capsule videos were assessed by an investigator who was blinded to the patients' medical histories and EGD findings. The median esophageal transit time for the PillCam capsule was 134.5 seconds.
Both methods detected esophageal varices in 23 patients, with the PillCam detecting small varices in one patient that were missed by EGD. In addition, both detected hypertensive gastropathy in 19 patients.
While a larger trial is needed to confirm these findings, the authors said, “this is the first pilot study showing that the esophageal capsule can be used to screen patients with liver cirrhosis for the presence of varices.”
In the second study, conducted by French scientists, unsedated EGD and capsule endoscopy examinations were conducted on the same day in 21 cirrhotic patients (Endoscopy 2006;38:36–41). The PillCam ESO, which transmits 14 color images per second as it moves through the esophagus, had 81% sensitivity for the diagnosis of esophageal varices, compared with EGD, and had 100% sensitivity for the diagnosis of large varices and/or red signs.
The study, conducted at Edouard Herriot Hospital in Lyon, France, also showed that all 20 patients who swallowed a PillCam (one was unable to do so) preferred it over EGD.