medwireNews: A magnetically guided capsule endoscopy with a detachable string (ds-MCE) offers a “highly accurate and safe method” for detecting and grading esophagogastric varices in patients with cirrhosis, say the CENTERS study investigators.
Using esophagogastroduodenoscopy (EGD) as the reference standard, the researchers found that the ds-MCE device (Ankon Technologies, Wuhan, China) detected esophagogastric varices with a sensitivity of 97.5% and a specificity of 97.8%, significantly higher than the 85% thresholds set by the researchers.
“As the population with cirrhosis increases worldwide, the incidence of oesophagogastric varices will increase,” write Zhuan Liao (Naval Medical University, Shanghai, China) and colleagues in The BMJ.
“It is therefore vital to improve the screening and surveillance of oesophagogastric varices and thus possibly to intervene at an early stage to prevent variceal hemorrhage.”
The study involved 582 patients with cirrhosis from 14 centers in China. The participants fasted overnight and took the defoaming agent dimethicone 2.5 g, before drinking between 500 and 1000 mL of water and ingesting the ds-MCE without sedation. The capsule was guided through the esophagus using a detachable string and in the stomach via a magnetic field. Within 48 hours of undergoing ds-MCE, the patients underwent EGD.
The median age of the participants was 55 years and 68.4% were men. They had been diagnosed with cirrhosis a median of 2.5 years before inclusion in the study, and the most common cause of the condition was hepatitis B infection (58.4%), followed by alcoholic liver disease (10.5%).
The majority (61.2%) of participants had decompensated cirrhosis. And the cohort overall scored a median of 6 points, equivalent to class A (well-compensated disease), on the Child-Pugh scale (a measure of cirrhosis severity ranging from 5–15 points), and a median of 9 points on the Model For End-Stage Liver Disease (a measure of liver disease severity ranging from 6–40 points).
Liao and colleagues found that the results from ds-MCE and EGD were in agreement for 97.6% of the participants. Among the 14 participants for whom the two results differed, four had esophagogastric varices detected by ds-MCE that were unconfirmed by EGD and 10 had esophagogastric varices picked up by EGD that were missed by ds-MCE.
The original cohort was then divided into a development cohort of 393 patients and a validation cohort of 189 patients with cirrhosis. In the development cohort, ds-MCE detected large esophageal varices occupying more than 18% of the esophageal circumference with a sensitivity of 98.3%, a specificity of 97.6%, and a diagnostic accuracy of 97.7%. And this was confirmed in the validation group, with a sensitivity of 95.3%, a specificity of 93.3%, and a diagnostic accuracy of 94.2%.
The corresponding detection values for high-risk esophageal varices, which occur in the presence of red color signs, were 95.8%, 94.7%, and 95.2%, for high-risk esophagogastric varices they were 96.6%, 95.9%, and 96.3%, and for gastric varices they were 96.2%, 97.1% and 96.7%
The researchers were also able to examine the small bowel using ds-MCE in 510 participants and observed portal hypertensive enteropathy in 65% of the participants, with spontaneous bleeding in 0.6% of the patients.
There were four adverse events (AEs) during ds-MCE, such as capsule retention in the esophagus and glucopenia, but there were no serious AEs. By contrast, two participants receiving EGD each experienced a serious AE – variceal esophageal and hemorrhage – and required hospital admission and endoscopic band ligation.
Liao et al note that “ds-MCE is a reliable tool to evaluate portal hypertensive gastropathy and small bowel abnormalities during one examination.”
In an editorial related to the study, Basile Njei (Yale University, New Haven, Connecticut, USA) and colleagues write that this study has “important implications for patients with cirrhosis and esophagogastric varices, healthcare providers, researchers, and policy makers,” given that “compliance and timely screening remain challenging in the US and Europe.”
They conclude that “ds-MCE presents a promising alternative to traditional methods,” but caution that its adoption “may face challenges in regions with limited resources or differing healthcare priorities.
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