Magnetically guided capsule endoscope with detachable string promising for diagnosing esophagogastric varices

1. In a large prospective multicentre diagnostic accuracy study, magnetically guided capsule endoscopy with a detachable string (ds-MCE) demonstrated high accuracy and safety in the detection and grading of esophagogastric varcies in patients with cirrhosis.

Evidence Rating: 1 (Excellent)

Esophagogastric varices are highly prevalent in patients with cirrhosis and are a major cause of mortality and morbidity. While capsule endoscopy has been proposed as a standard to esophagoduodenoscopy (EGD) in the past, prior studies have demonstrated an inferior accuracy rating compared to EGD, owing to a poor visualization of the esophagus and stomach due to rapid transit times. To rectify this, researchers developed a ds-MCE and enrolled patients in a multicentre prospective study to assess its diagnostic accuracy. 607 adult patients with cirrhosis were recruited, and had ds-MCE followed by standard EGD. The sensitivity and specificity of ds-MCE for the detection of esophagogastric varices were then compared to EGD via diagnostic accuracy testing. When compared to EGD as the reference standard, ds-MCE demonstrated a sensitivity of 97.5% and specificity of 97.8%, without occurrence of any serious adverse events. This compares to a historical sensitivity of 74% in one prior multicentre study. Overall, the modification of standard capsule endoscopy with a ds-MCE appeared to be an effective, and safe alternative to EGD in the detection of esophagogastric varices in patients with cirrhosis. In patients that would be poor candidates for sedation, or who would otherwise not tolerate EGD, ds-MCE may present itself as an effective alternative diagnostic tool.

Click to read the study in BMJ

Image: PD

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