Capsule endoscopy for the diagnosis of oesophageal varices in people with chronic liver disease or portal vein thrombosis

Colli, Agostino; Gana, Juan Cristóbal; Turner, Dan; Yap, Jason; Adams‐Webber, Thomasin; Ling, Simon C.; Casazza, Giovanni

doi:10.1002/14651858.cd008760.pub2

Cited by 30 publications

(35 citation statements)

References 64 publications

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“…While our reported results are similar to a previous Cochrane Database Systematic Review by Colli et al, the addition of more recent studies, implementation of the Fagan nomogram, and assessment of clinical utility are paramount to reporting the best evidence on the effectiveness of capsule endoscopy. 15 Furthermore, this pooled data coupled with an understanding of clinical utility, may provide a pivotal tool to guide primary care physicians, practicing gastroenterologists, and hepatologists caring for these patients with portal hypertension. At present, there is a paradigm shift in the field of gastroenterology and hepatology with regard to the diagnosis and screening of liver disease (i.e.…”

Section: Discussionmentioning

confidence: 99%

“…Although capsule endoscopy has been studied and not recommended to be a viable replacement for EGD given the lack of a therapeutic basis, the minimally-invasive approach, potential for widespread screening, and diagnostic capability warrant further exploration amongst a cirrhotic population at risk for significant variceal hemorrhage associated morbidity and mortality. 15 …”

Section: Introductionmentioning

confidence: 99%

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Use of Wireless Capsule Endoscopy for the Diagnosis and Grading of Esophageal Varices in Patients With Portal Hypertension

McCarty

Afinogenova²,

Njei³

2017

Journal of Clinical Gastroenterology

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INTRODUCTION Esophageal variceal bleeding is a severe complication of portal hypertension with significant morbidity and mortality. While traditional screening and grading of esophageal varices has been performed by endogastroduodenoscopy (EGD), wireless video capsule endoscopy provides a minimally-invasive alternative that may improve screening and surveillance compliance. AIM To perform a systematic review and structured meta-analysis of all eligible studies to evaluate the efficacy of wireless capsule endoscopy for screening and diagnosis of esophageal varices among patients with portal hypertension. METHODS Searches of PubMed, EMBASE, Web of Science, and the Cochrane Library databases were performed through December 2015. Bivariate and hierarchical models were used to compute the pooled sensitivity and specificity, and to plot the summary receiver operating characteristics curve with summary point and corresponding 95 % confidence region. Bias of included studies was assessed using the quality assessment of diagnostic accuracy studies (QUADAS-2). RESULTS Seventeen studies from 2005 to 2015 were included in this meta-analysis (n=1,328). The diagnostic accuracy of wireless capsule endoscopy in the diagnosis of esophageal varices was 90% (95% CI, 0.88–0.93). The diagnostic pooled sensitivity and specificity were 83% (95% CI, 0.76 – 0.89) and 85% (95% CI, .75–0.91), respectively. The diagnostic accuracy of wireless capsule endoscopy for the grading of medium to large varices was 92% (95% CI, 0.90–0.94). The pooled sensitivity and specificity were 72% (95% CI, 0.54–0.85) and 91% (95% CI, 0.86–0.94), respectively, for the grading of medium to large varices. The use of capsule demonstrated only mild adverse events. A sensitivity analysis limited to only high quality studies revealed similar results. DISCUSSION Wireless esophageal capsule endoscopy is well tolerated and safe in patients with liver cirrhosis and suspicion of portal hypertension. The sensitivity of capsule endoscopy is not currently sufficient to replace EGD as a first exploration in these patients, but given its high accuracy, it may have a role in cases of refusal or contraindication to EGD.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Use of Wireless Capsule Endoscopy for the Diagnosis and Grading of Esophageal Varices in Patients With Portal Hypertension

McCarty

Afinogenova²,

Njei³

2017

Journal of Clinical Gastroenterology

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“…Actually, according to the point prevalence of medium and significant varices the highest risk of hemorrhage is only 15% to 25%, and the majority of patients with cirrhosis who undergo screening EGD either do not have varices or have small EV that do not require prophylactic therapy[6]. To avoid unnecessary endoscopy in low-risk patients, more noninvasive tests have been carried out as substitution to replace endoscopy for EV screening.…”

Section: Introductionmentioning

confidence: 99%

Diagnostic accuracy of transient elastography (FibroScan) in detection of esophageal varices in patients with cirrhosis: A meta-analysis

Pu¹,

Shi²,

Wang³

et al. 2017

WJG

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AIMTo investigate the diagnostic accuracy of FibroScan (FS) in detecting esophageal varices (EV) in cirrhotic patients.METHODSThrough a systemic literature search of multiple databases, we reviewed 15 studies using endoscopy as a reference standard, with the data necessary to calculate pooled sensitivity (SEN) and specificity (SPE), positive and negative LR, diagnostic odds ratio (DOR) and area under receiver operating characteristics (AUROC). The quality of the studies was rated by the Quality Assessment of Diagnostic Accuracy studies-2 tool. Clinical utility of FS for EV was evaluated by a Fagan plot. Heterogeneity was explored using meta-regression and subgroup analysis. All statistical analyses were conducted via Stata12.0, MetaDisc1.4 and RevMan5.RESULTSIn 15 studies (n = 2697), FS detected the presence of EV with the summary sensitivities of 84% (95%CI: 81.0%-86.0%), specificities of 62% (95%CI: 58.0%- 66.0%), a positive LR of 2.3 (95%CI: 1.81-2.94), a negative LR of 0.26 (95%CI: 0.19-0.35), a DOR of 9.33 (95%CI: 5.84-14.92) and an AUROC of 0.8262. FS diagnosed the presence of large EV with the pooled SEN of 0.78 (95%CI: 75.0%-81.0%), SPE of 0.76 (95%CI: 73.0%-78.0%), a positive and negative LR of 3.03 (95%CI: 2.38-3.86) and 0.30 (95%CI: 0.23-0.39) respectively, a summary diagnostic OR of 10.69 (95%CI: 6.81-16.78), and an AUROC of 0.8321. A meta-regression and subgroup analysis indicated different etiology could serve as a potential source of heterogeneity in the diagnosis of the presence of EV group. A Deek’s funnel plot suggested a low probability for publication bias.CONCLUSIONUsing FS to measure liver stiffness cannot provide high accuracy for the size of EV due to the various cutoff and different etiologies. These limitations preclude widespread use in clinical practice at this time; therefore, the results should be interpreted cautiously given its SEN and SPE.

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“…During procedure patient will sip 15 ml of water for every 30 sec. then it takes images as it is propelled (Figure 6) forward by peristalsis [13,14].…”

Section: Image Acquisitionmentioning

confidence: 99%

Capsule Based Gastric Rhythm Analyzer: A Tool for Diagnosing Gastric Diseases

Gokul¹,

N²,

C³

2017

J Gastrointest Dig Syst

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The proposal of this revolutionary project is a mission which has never been thought by any human kind and which is now on the verge of production by us. Electrogastrography and capsule endoscopy are contributing in the diagnosis of Gastric diseases. On their individual functioning, as a diagnostic tool, they are not capable of producing appropriate results such as the position of tumor in the GI tract. The recording of electrical rhythmic activity can mimic the disability of gastric cells which can't be diagnosed by endoscopic procedures. Integrating the gastric rhythmic information and capsule endoscopy can lead to an ultimate diagnosis of gastric diseases. The structural information which is captured by a capsule consisting of a camera, LEDs and transmitter provides a visual diagnosis of the gastric disorders/infection. The functional information is obtained by recording the electrical rhythmic activity of the gastric cell via surface electrodes. By mapping the electrical rhythmic signal with the image acquired from the capsule provides the accurate localization of the abnormality.

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Capsule endoscopy for the diagnosis of oesophageal varices in people with chronic liver disease or portal vein thrombosis

Cited by 30 publications

References 64 publications

Use of Wireless Capsule Endoscopy for the Diagnosis and Grading of Esophageal Varices in Patients With Portal Hypertension

Use of Wireless Capsule Endoscopy for the Diagnosis and Grading of Esophageal Varices in Patients With Portal Hypertension

Diagnostic accuracy of transient elastography (FibroScan) in detection of esophageal varices in patients with cirrhosis: A meta-analysis

Capsule Based Gastric Rhythm Analyzer: A Tool for Diagnosing Gastric Diseases

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