Oesophageal capsule endoscopy versus oesophago-gastroduodenoscopy for the diagnosis of recurrent varices: A prospective multicentre study

Background: Oesophago-gastroduodenoscopy is the standard method for the diagnosis of recurrent oesophago-gastric varices after endoscopic treatment and eradication. The aim of this study was to evaluate the PillCam® ;Eso capsule endoscopy in this setting. Methods: Prospective, multicentre study in which patients with history of oesophageal varices treated by band ligation underwent PillCam® ;Eso capsule and oesophago-gastroduodenoscopy. Capsule recordings were blindly read by two endoscopists. Indication for a new prophylactic treatment and patient satisfaction were determined for both procedures. Results: 80 patients (80% males, mean age: 57. ±. 12 years) were included, after a median delay of 16 months from last endoscopic treatment. Recurrent oesophageal varices requiring a new prophylactic treatment were detected in 26 patients (32.5%). The mean oesophageal transit time of the capsule was 153. s (range 2-930. s). Capsule sensitivity, specificity, negative and positive predictive values for indication of new prophylactic treatments were 65%, 83%, 83%, and 65%, respectively. Capsule adequately classified 77.5% of the patients for prophylaxis indication. Inter-observer concordance for capsule readings was 88% for the prophylaxis indication. Conclusion: This study demonstrates that accuracy of PillCam® ;Eso capsule for the diagnosis of recurrent oesophageal varices after endoscopic eradication is suboptimal. PillCam® ;Eso capsule might therefore be proposed in patients unable or unwilling to undergo oesophago-gastroduodenoscopy. © 2014 Editrice Gastroenterologica Italiana S.r.l.