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Laparoscopic Splenectomy with Pericardial Devascularization for Hypersplenism and Esophageal Variceal Hemorrhage Due to Portal Hypertension
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Screening of esophageal varices in children using esophageal capsule endoscopy: a multicenter prospective study

Jacques Cardey1, Catherine Le Gall2, Laurent Michaud3

  • 1Gastroentérologie, hépatologie, nutrition pédiatrique, Hôpital Necker-Enfants malades, Paris, France.

Endoscopy
|September 6, 2018
PubMed

Insights

PillCam esophageal capsule endoscopy (ECE) is a safe and preferred alternative to esophagogastroduodenoscopy (EGD) for diagnosing esophageal varices in children. A modified scoring system significantly improves ECE

Area of Science:

  • Pediatric Gastroenterology
  • Endoscopic Imaging
  • Hepatology

Background:

  • Esophageal and gastric varices are diagnosed using esophagogastroduodenoscopy (EGD).
  • PillCam esophageal capsule endoscopy (ECE) is a novel technique for evaluating esophageal varices in pediatric patients.
  • Portal hypertension and cirrhosis are common conditions necessitating variceal screening in children.

Purpose of the Study:

  • To prospectively evaluate the efficacy and safety of PillCam esophageal capsule endoscopy (ECE) in pediatric patients with suspected esophageal varices.
  • To compare the diagnostic performance of ECE with the gold standard EGD.
  • To assess patient tolerance and preference for ECE versus EGD.

Main Methods:

  • Prospective study involving pediatric patients (7-18 years) with portal hypertension or cirrhosis.
  • Patients underwent ECE followed by EGD.
  • Esophageal varices were classified using the de Franchis classification (DFC) and a modified scoring system.

Main Results:

  • ECE identified esophageal varices in 70% of patients, compared to 77% with EGD.
  • Using the de Franchis classification, ECE showed 92% sensitivity and 100% specificity for detecting esophageal varices.
  • A modified scoring system significantly improved ECE performance, achieving 100% sensitivity, 93% specificity, and 97% overall accuracy.
  • All patients preferred ECE over EGD, and no capsule retention occurred.

Conclusions:

  • Esophageal capsule endoscopy (ECE) is a well-tolerated and safe procedure for diagnosing esophageal varices in children.
  • The modified scoring system enhances the diagnostic accuracy of ECE, making it a viable alternative to EGD.
  • ECE may replace EGD in pediatric patients with suspected esophageal varices, particularly when EGD is refused or contraindicated.
Abstract

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