Is capsule endoscopy effective for screening and surveillance of esophageal varices in patients with portal hypertension?

Abstract

Guidelines for the treatment of portal hypertension recommend that individuals with chronic liver disease undergo endoscopy at diagnosis to screen for esophageal varices, with subsequent periodic surveillance. This strategy is costly, inconvenient, and can have poor compliance. In this commentary, we discuss a study by de Franchis et al. that compared the accuracy of esophageal capsule endoscopy (ECE) with that of esophagogastroduodenoscopy (EGD) for the detection of esophageal varices in patients with portal hypertension. EGD and ECE results were concordant in 86% of cases (kappa score = 0.73). There was agreement between EGD and ECE results for the grading of esophageal varices in 79% of cases (kappa score = 0.68). For differentiating absent or small esophageal varices from medium or large varices, ECE showed an overall agreement with EGD of 91% (kappa score = 0.77). This study demonstrated substantial agreement between ECE and EGD for detecting esophageal varices; however, EGD was superior overall for the detection of esophageal varices and, therefore, remains the gold standard diagnostic procedure in this setting.