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Published on: June 13, 2025
Detachable string magnetically controlled capsule endoscopy for detecting high-risk varices in compensated advanced
Shuai Wang1, Yifei Huang2,3, Weiling Hu4
1CHESS Center, Department of Liver Diseases, The Fifth Medical Center, Chinese PLA General Hospital, Beijing, China.
Insights
Detachable string magnetically controlled capsule endoscopy (DS-MCCE) accurately detects high-risk varices in advanced liver disease. This safe method offers better patient satisfaction than traditional endoscopy for primary prophylaxis.
Area of Science:
- Gastroenterology
- Hepatology
- Medical Devices
Background:
- Gastroesophageal varices are a severe complication of compensated advanced chronic liver disease (cACLD).
- Primary prophylaxis is recommended for patients with high-risk varices (HRV) to prevent variceal hemorrhage.
- Esophagogastroduodenoscopy (EGD) is the current reference standard for detecting HRV.
Purpose of the Study:
- To compare the accuracy, patient satisfaction, and safety of DS-MCCE versus EGD for detecting HRV in cACLD patients.
- To evaluate DS-MCCE as a potential alternative diagnostic tool.
Main Methods:
- Prospective study involving 105 cACLD participants across 12 university hospitals.
- Participants underwent DS-MCCE followed by blinded EGD within one week.
- Patient satisfaction was assessed using a questionnaire on the day of endoscopy.
Main Results:
- DS-MCCE demonstrated substantial agreement with EGD (kappa = 0.78).
- Key diagnostic metrics for DS-MCCE included: concordance index 0.90, sensitivity 92%, specificity 88%.
- DS-MCCE showed significantly higher patient satisfaction compared to unsedated EGD (p < 0.0001). No adverse events were reported.
Conclusions:
- DS-MCCE is a safe and accurate method for detecting HRV in cACLD patients.
- DS-MCCE offers a patient-preferred alternative to EGD for primary prophylaxis screening.
- This capsule endoscopy technique improves patient experience without compromising diagnostic efficacy.
Background:
Gastroesophageal varices is a serious complication of compensated advanced chronic liver disease (cACLD). Primary prophylaxis to reduce the risk of variceal hemorrhage is recommended if high-risk varices (HRV) are detected. We performed this study to compare the accuracy, patients' satisfaction and safety of detection of HRV by detachable string magnetically controlled capsule endoscopy (DS-MCCE) with esophagogastroduodenoscopy (EGD) as the reference.
Methods:
We prospectively recruited participants with cACLD from 12 university hospitals (11 in China and one in the United Kingdom) between November 2018 and December 2019 (ClinicalTrials.gov, NCT03749954). All participants underwent DS-MCCE, followed by EGD within a week in a blinded fashion. Following endoscopy, and on the same day, participants were asked to fill in a satisfaction questionnaire regarding their experience.
Findings:
A total of 105 eligible participants were enrolled. With EGD as the reference standard, the concordance index, sensitivity, specificity, positive predictive value, negative predictive value, positive likelihood ratio, and negative likelihood ratio of DS-MCCE in diagnosis of HRV were 0•90 (95% confidence interval [CI]: 0•83-0•95), 92% (95% CI: 78-98%), 88% (95% CI: 78-95%), 80% (95% CI: 70-92%), 95% (95% CI: 90-100%), 7•91 (95% CI: 4•10-15•30), and 0•09 (95% CI: 0•03-0•30), respectively. The kappa score of 0•78 (95% CI: 0•65-0•90) suggested substantial agreement between DS-MCCE and EGD. Moreover, in participants undergoing EGD without sedation, the satisfaction of DS-MCCE was significantly better than that of EGD (p < 0•0001, d = 1•15 [95%CI: 0•88-1•42]). All participants confirmed the excretion of the capsule, and no adverse events occurred.
Interpretation:
DS-MCCE is an accurate alternative to EGD for detecting HRV in cACLD, which is safe and associated with better satisfaction.
Funding:
A full list of funding can be found in the Funding Support section.
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