The PillCam: Safe and Effective Alternative to Upper Endoscopy

Upper endoscopy, known as eso?ph??-agogastroduodenoscopy (EGD), is the current gold standard for detecting esophageal varices in patients with cirrhosis, but it is usually an uncomfortable procedure that requires at least partial sedation. It has also been associated with rare adverse events. Two new studies published in Endoscopy have concluded that capsule endoscopy with the PillCam ESO is an accurate, non?invasive alternative to conventional upper endoscopy and that most patients would prefer it.

The first trial, a multicenter, multinational study, was conducted by Glenn M. Eisen, of Oregon Health and Science University, Portland, and colleagues elsewhere (Endoscopy. 2006;38:27-30). It included 32 patients (20 men, 12 women) with cirrhosis.

PillCam ESO proved to be as accurate as conventional endoscopy in detecting varices (in 23 patients) and signs of portal hypertension (in 19 patients). The PillCam also identified small varices in 1 patient that were not found with conventional upper endoscopy. For the detection of esophageal varices, capsule endoscopy had a sensitivity of 100%, a specificity of 89%, a positive likelihood ratio of 9.1, and a negative likelihood ratio of 0.0 versus EGD. For the detection of portal hypertensive gastropathy, capsule endoscopy had a sensitivity of 100%, a specificity of 77%, a positive likelihood ratio of 4.3, and a negative likelihood ratio of 0.0 versus EGD. In addition, all participants reported that the PillCam ESO was more convenient and comfortable than conventional endoscopy.

"The results confirm that the capsule endoscopy technique is an accurate, safe, well-tolerated, rapid alternative screening method to detect esophageal varices without the need for conscious sedation and the costs associated with it," said Dr Eisen.

In the second study, Thier?ry Ponchon, PhD, of Edouard Herriot Hospital, Lyon, France, and colleagues assessed 21 patients with cirrhosis to determine the utility of the PillCam for portal hyper?tension screening (Endo?scopy. 2006;38:36-41). There was ?complete diagnostic agreement on the presence or absence of esophageal variances in 85% of the patients. The sensitivity of PillCam ESO for all large varices requiring treatment was 100%. In addition, all 20 patients who swallowed the capsule said that they preferred it over standard upper endoscopy.

Chronic liver disease affects 360 out of every 100,000 people in the United States. It results in 300,000 ?hos?pi?talizations per year and costs >$2 billion annually, according to the Na?tional Institutes of Health. The 2 most common liver diseases are cirrhosis and fibrosis.?R.M.