Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2012 Apr;2(2):54-60.
doi: 10.4161/jig.22173. Epub 2012 Apr 1.

String capsule endoscopy for screening and surveillance of esophageal varices in patients with cirrhosis

Sally Stipho  1 , Erin Tharalson, Shahina Hakim, Rodney Akins, Masud Shaukat, Francisco C Ramirez
Affiliations

String capsule endoscopy for screening and surveillance of esophageal varices in patients with cirrhosis

Sally Stipho et al. J Interv Gastroenterol. 2012 Apr.

Abstract

Background: EGD is the gold standard for the screening and surveillance of esophageal varices. A less invasive, safer and sedationless alternative procedure is needed.

Objective: To assess the sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV) as well as the beyond the chance agreement (kappa index), of string capsule endoscopy (SCE) in the diagnosis of esophageal varices.

Methods: Cirrhotic patients underwent string capsule endoscopy (SCE) and EGD for screening and surveillance purposes. Varices were graded at EGD and SCE as small, medium and large. Descriptors at SCE were added as follows: PLUS, for the presence of red wale signs or, MINUS for their absence, irrespective of the estimated variceal size. Clinically significant varices were defined by their size (medium/large at either EGD or SCE) and/or, the PLUS descriptor irrespective of the estimated size at SCE. Sensitivity, specificity, PPV, NPV, accuracy and kappa index were calculated. Procedure time, procedure-related discomfort and patient's preference were documented.

Results: 100 patients (33 for screening and 67 for surveillance) were enrolled. The sensitivity and specificity of SCE for clinically significant varices when using the PLUS/MINUS descriptors were 82% and 90%, respectively with a PPV of 84% and NPV of 89% and a kappa of 0.73.

Conclusion: String capsule endoscopy had an acceptable sensitivity and specificity for the diagnosis of clinically significant esophageal varices but the lack of air insufflation still hampers its correlation with the grading used with EGD.

Keywords: cirrhosis; sensitivity; specificity; string capsule endoscopy; varices.

PubMed Disclaimer

Figures

Figure 1a and 1b
Figure 1a and 1b
String Capsule Endoscopy Device: strings and sleeve in place
Figure 2a and 2b
Figure 2a and 2b
Original string capsule endoscopy device (strings only; no sleeve)
Figure 3
Figure 3
Small varices with “red signs”
Figure 4
Figure 4
Small varices with “red signs”
Figure 5
Figure 5
Medium varices
Figure 6
Figure 6
Medium varices with “red signs”
Figure 7
Figure 7
Large varices
Figure 8
Figure 8
Large varices
Figure 9
Figure 9
SCE over a small caliber feeding tube
See this image and copyright information in PMC

Similar articles

See all similar articles

Cited by

See all "Cited by" articles

References

    1. Garcia-Tsao G, Sanyal AJ, Grace ND, Carey W. Practice Guidelines Committee of the American Association for the Study of Liver Diseases; Practice Parameters Committee of the American College of Gastroenterology. Prevention and management of gastroesophageal varices and variceal hemorrhage in cirrhosis. Hepatology. 2007;46:922–938. - PubMed
    1. Graham DY, Smith JL. The course of patients after variceal hemorrhage. Gastroenterology. 1981;80:800–809. - PubMed
    1. Sharara A I, Rockey DC. Gastroesophageal variceal hemorrhage. N Engl J Med. 2001;345:660–681. - PubMed
    1. Ramirez FC, Hakim S, Tharalson EM, Shaukat MS, Akins R. Feasibility and safety of string wireless capsule endoscopy in the diagnosis of esophageal varices. Am J Gastroenterol. 2005;100:1065–1071. - PubMed
    1. Ramirez FC, Shaukat MS, Young MA, Johnson DA, Akins R. Feasibility and safety of string wireless capsule endoscopy in the diagnosis of Barrett's esophagus. Gastrointest Endosc. 2005;61:741–746. - PubMed

LinkOut - more resources