Screening of esophageal varices in children using esophageal capsule endoscopy: a multicenter prospective study

Abstract

Background Esophagogastroduodenoscopy (EGD) is the standard method for diagnosis of esophageal and gastric varices in children. In this prospective study we evaluated the use of PillCam esophageal capsule endoscopy (ECE) in pediatric patients. Methods Patients aged 7 to 18 years presenting with portal hypertension and/or cirrhosis underwent ECE (PillCam ESO 2, Given Imaging Ltd.) followed by EGD. Results 102 patients were screened, 81 (52 boys; mean age 13.96 ± 0.25 years) were included and 21 were excluded (16 for “candy test” failure). Esophageal varices were identified by EGD in 62 patients (77 %) and by ECE in 57 patients (70 %) using the de Franchis classification (DFC). The sensitivity of ECE for esophageal varices was 92 % and the specificity was 100 % using DFC. Based upon 57/81 patients with small, medium, and large varices on both ECE and EGD, using DFC, the sensitivity, specificity, positive (PPV) and negative predictive value (NPV) were 55 %, 92 %, 89 %, and 63 %, respectively, giving a total overall accuracy of 72 %. To improve sensitivity and specificity in classification of esophageal varices, we propose using a modified score. This score detected esophageal varices with 100 % sensitivity, 93 % specificity, 94 % PPV, and 100 % NPV, giving a total overall accuracy of 97 %. All patients preferred ECE over EGD. No capsule retention was recorded. Conclusions ECE is a well-tolerated and safe procedure in children. Using the modified score, the sensitivity of ECE is currently sufficient to detect esophageal varices and replace EGD in infants with suspicion of esophageal varices or when EGD is refused.

Duodenal obstruction due to accidental swallowing of a dental prosthesis: a case report and review of the literature

“…Table 1 provides a summary of specific characteristics of these studies and also our present case report, including demographic and risk factors, chief complaints, physical examinations, abdominal radiological findings, endoscopy for extraction of the denture if done, location of obstruction or perforation, and kind of surgery. According to our report and the six previous reports mentioned [ 9 – 14 ], if there is evidence of duodenal perforation or if the endoscope is unable to remove the foreign body early, surgical intervention is recommended.…”

“…There are very rare case reports on denture ingestion-induced duodenal obstruction and perforation, and we found six previous reports to use in our review of the literature, as shown in Table 1 [ 9 – 14 ]. The aim of this study was to report a rare case of accidental ingestion of a dental prosthesis with duodenal obstruction and perforation that could not be treated with endoscopic management and was managed with duodenal kocherization and gastrostomy.…”

USB capsule endoscope for retrograde imaging of the esophagus

“…During the endoscope testing, it was possible to observe the peristaltic contraction of the esophagus in various places due to the possibility of adjusting the position to different parts of the esophagus by a lead-in cable. Since the thickness of the lead-in cable was only 1.2 mm, the physiological activity of the esophagus was just minimally influenced.Figures 4-9also document that the imaging properties of the prepared capsule endoscope are comparable to the commercial capsule endoscope systems 20.…”

“…Although the conventional EGD represents the gold standard and the preferred endoscopic techniques for the study of the esophagus, some esophageal diseases may be detected using a capsule device. 20,21 In this paper, we describe the fabrication method, properties, and results from the testing of the new capsule endoscope for retrograde imaging of the esophagus. By precise design of the optical input of the endoscopic module, we were able to suppress the effects of the internal light reflections, which are a common problem when lighting and imaging equipment are situated under the same dome.…”

Utility of Transabdominal Ultrasonography Enhanced by Oral Cellulose-Based Contrast Agent in Depicting Varices at Cardia and Fundus

“…However, none have been thoroughly evaluated through prospective studies, and their predictive accuracy is in question, leaving gastroscopy as the chief method of diagnosis (Garcia-Tsao et al 2007. Capsule endoscopy is a promising means of direct variceal observation, but its cost is prohibitive (Lapalus et al 2009;Sacher-Huvelin et al 2015;Cardey et al 2019).…”