S1829 A Comparative Evaluation of Esophageal Capsule Endoscopy Versus Esophagogastroduodenoscopy for Assessing Esophageal Varices in a Veteran Population

Introduction: Screening cirrhotic patients with EGD for esophageal varices (EV) to identify those at risk for catastrophic gastrointestinal hemorrhage is the current standard of care. Esophageal capsule endoscopy (ESO) is increasingly recognized as an alternative non-invasive screening tool to detect EV. This trial was designed to determine if ESO could assess the presence and grade of EV with accuracy comparable to EGD. ESO and EGD were also compared in terms of procedural complications and their ability to detect gastric varices (GV) and stigmata of potential bleeding. Methods: 34 patients with ESLD were prospectively enrolled in an IRB-approved protocol in this study. Each underwent ESO followed by EGD on the same day. EGD and ESO were performed by separate trained Gastroenterologists who were blinded to the results of the other. Each ESO study was also evaluated by another ESO-experienced Gastroenterologist. Findings were reviewed and analyzed. Findings: Using EGD as the gold standard, detecting EV by ESO had a sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) of 100%, 66.7%, 93.3%, and 100% respectively. EV grade was classified as absent, small, medium, or large. Complete agreement of EV grade occurred in 25/34 (73.5%) cases. Strength of association using the Kendall tau-b score was 0.7991. Only 1/18 patients with small EV by ESO had medium EV on EGD. Conversely, 2/12 patients with medium or large EV by ESO had small EV on EGD. Evaluation of stigmata of potential bleeding with ESO compared to EGD had a sensitivity, specificity, PPV, and NVP of 92.6%, 85.7%, 96.1% and 75% respectively. Utility of ESO in the detection of GV was limited where sensitivity was only 33.3%. Four minor adverse events occurred with EGD that included hypotension, hypoxia and possible aspiration. No complications occurred with ESO. There was no significant difference in the side effect profiles of ESO and EGD. Conclusions: Based on minimal invasiveness, lack of need for sedation, less discomfort, and fewer side effects, ESO may be a more desirable procedure for cirrhotic patients that need EV screening. This study shows good correlation between ESO and EGD in detecting EV and assessing grade for treatment purposes as noted on published studies. ESO lacks sensitivity for assessment of gastric varices. Larger studies with additional patients are needed for further evaluation.