Defining the threshold: New data on the ability of capsule endoscopy to discriminate the size of esophageal varices

Ian Schreibman, Kevin Meitz, Allen Kunselman, Matthew Downey, Tri Le, Thomas Riley III

Research output: Contribution to journalArticle

12 Citations (Scopus)

Abstract

Background: Endoscopy (esophagogastroduodenoscopy, EGD) to screen for esophageal varices (EV) is recommended in patients with portal hypertension. Reports indicate that capsule endoscopy (CE) is capable of identifying large/medium varices (L/MV) when the varix comprises more than 25% of the circumference of the field of view. Aims: We evaluated the ability of CE to discriminate the size of EV using this grading scale. Methods: Patients underwent CE and EGD on the same day. A blinded investigator interpreted capsule findings. CE labeled EV as L/MV if ≤25% of the lumen circumference was occupied, and small/none for <25%. Results: A total of 37 patients were enrolled in this prospective, observational study at a single tertiary-care academic center. Three CE were excluded due to rapid esophageal transit time or technical malfunction. Using a 25% threshold, the sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) for EC to discriminate L/MV were 23.5%, 88.2%, 66.7%, and 53.6%, respectively (κ = 0.12). Reducing the threshold to 12.5% resulted in sensitivity, specificity, PPV, and NPV of 88.2%, 64.7%, 71.4%, and 84.6%, respectively (κ = 0.53). A receiver-operator characteristic (ROC) curve showed a 15% threshold to be optimal in discriminating EV size using CE, resulting in sensitivity, specificity, PPV, and NPV of 76.5%, 82.4%, 81.3%, and 77.8%, respectively (κ = 0.59). Conclusions: This study indicates that discriminating EV size by the current capsule scale is unreliable. Lowering the grading threshold improved the ability to discriminate EV size by CE. In the proper context, CE is an alternative to EGD to screen for EV.

Original languageEnglish (US)
Pages (from-to)220-226
Number of pages7
JournalDigestive Diseases and Sciences
Volume56
Issue number1
DOIs
StatePublished - Jan 1 2011

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Capsule Endoscopy
Esophageal and Gastric Varices
Varicose Veins
Digestive System Endoscopy
Sensitivity and Specificity
Capsules
Portal Hypertension
Tertiary Care Centers
Endoscopy
Observational Studies
Research Personnel
Prospective Studies

All Science Journal Classification (ASJC) codes

  • Physiology
  • Gastroenterology

Cite this

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title = "Defining the threshold: New data on the ability of capsule endoscopy to discriminate the size of esophageal varices",
abstract = "Background: Endoscopy (esophagogastroduodenoscopy, EGD) to screen for esophageal varices (EV) is recommended in patients with portal hypertension. Reports indicate that capsule endoscopy (CE) is capable of identifying large/medium varices (L/MV) when the varix comprises more than 25{\%} of the circumference of the field of view. Aims: We evaluated the ability of CE to discriminate the size of EV using this grading scale. Methods: Patients underwent CE and EGD on the same day. A blinded investigator interpreted capsule findings. CE labeled EV as L/MV if ≤25{\%} of the lumen circumference was occupied, and small/none for <25{\%}. Results: A total of 37 patients were enrolled in this prospective, observational study at a single tertiary-care academic center. Three CE were excluded due to rapid esophageal transit time or technical malfunction. Using a 25{\%} threshold, the sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) for EC to discriminate L/MV were 23.5{\%}, 88.2{\%}, 66.7{\%}, and 53.6{\%}, respectively (κ = 0.12). Reducing the threshold to 12.5{\%} resulted in sensitivity, specificity, PPV, and NPV of 88.2{\%}, 64.7{\%}, 71.4{\%}, and 84.6{\%}, respectively (κ = 0.53). A receiver-operator characteristic (ROC) curve showed a 15{\%} threshold to be optimal in discriminating EV size using CE, resulting in sensitivity, specificity, PPV, and NPV of 76.5{\%}, 82.4{\%}, 81.3{\%}, and 77.8{\%}, respectively (κ = 0.59). Conclusions: This study indicates that discriminating EV size by the current capsule scale is unreliable. Lowering the grading threshold improved the ability to discriminate EV size by CE. In the proper context, CE is an alternative to EGD to screen for EV.",
author = "Ian Schreibman and Kevin Meitz and Allen Kunselman and Matthew Downey and Tri Le and {Riley III}, Thomas",
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Defining the threshold : New data on the ability of capsule endoscopy to discriminate the size of esophageal varices. / Schreibman, Ian; Meitz, Kevin; Kunselman, Allen; Downey, Matthew; Le, Tri; Riley III, Thomas.

In: Digestive Diseases and Sciences, Vol. 56, No. 1, 01.01.2011, p. 220-226.

Research output: Contribution to journalArticle

TY - JOUR

T1 - Defining the threshold

T2 - New data on the ability of capsule endoscopy to discriminate the size of esophageal varices

AU - Schreibman, Ian

AU - Meitz, Kevin

AU - Kunselman, Allen

AU - Downey, Matthew

AU - Le, Tri

AU - Riley III, Thomas

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N2 - Background: Endoscopy (esophagogastroduodenoscopy, EGD) to screen for esophageal varices (EV) is recommended in patients with portal hypertension. Reports indicate that capsule endoscopy (CE) is capable of identifying large/medium varices (L/MV) when the varix comprises more than 25% of the circumference of the field of view. Aims: We evaluated the ability of CE to discriminate the size of EV using this grading scale. Methods: Patients underwent CE and EGD on the same day. A blinded investigator interpreted capsule findings. CE labeled EV as L/MV if ≤25% of the lumen circumference was occupied, and small/none for <25%. Results: A total of 37 patients were enrolled in this prospective, observational study at a single tertiary-care academic center. Three CE were excluded due to rapid esophageal transit time or technical malfunction. Using a 25% threshold, the sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) for EC to discriminate L/MV were 23.5%, 88.2%, 66.7%, and 53.6%, respectively (κ = 0.12). Reducing the threshold to 12.5% resulted in sensitivity, specificity, PPV, and NPV of 88.2%, 64.7%, 71.4%, and 84.6%, respectively (κ = 0.53). A receiver-operator characteristic (ROC) curve showed a 15% threshold to be optimal in discriminating EV size using CE, resulting in sensitivity, specificity, PPV, and NPV of 76.5%, 82.4%, 81.3%, and 77.8%, respectively (κ = 0.59). Conclusions: This study indicates that discriminating EV size by the current capsule scale is unreliable. Lowering the grading threshold improved the ability to discriminate EV size by CE. In the proper context, CE is an alternative to EGD to screen for EV.

AB - Background: Endoscopy (esophagogastroduodenoscopy, EGD) to screen for esophageal varices (EV) is recommended in patients with portal hypertension. Reports indicate that capsule endoscopy (CE) is capable of identifying large/medium varices (L/MV) when the varix comprises more than 25% of the circumference of the field of view. Aims: We evaluated the ability of CE to discriminate the size of EV using this grading scale. Methods: Patients underwent CE and EGD on the same day. A blinded investigator interpreted capsule findings. CE labeled EV as L/MV if ≤25% of the lumen circumference was occupied, and small/none for <25%. Results: A total of 37 patients were enrolled in this prospective, observational study at a single tertiary-care academic center. Three CE were excluded due to rapid esophageal transit time or technical malfunction. Using a 25% threshold, the sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) for EC to discriminate L/MV were 23.5%, 88.2%, 66.7%, and 53.6%, respectively (κ = 0.12). Reducing the threshold to 12.5% resulted in sensitivity, specificity, PPV, and NPV of 88.2%, 64.7%, 71.4%, and 84.6%, respectively (κ = 0.53). A receiver-operator characteristic (ROC) curve showed a 15% threshold to be optimal in discriminating EV size using CE, resulting in sensitivity, specificity, PPV, and NPV of 76.5%, 82.4%, 81.3%, and 77.8%, respectively (κ = 0.59). Conclusions: This study indicates that discriminating EV size by the current capsule scale is unreliable. Lowering the grading threshold improved the ability to discriminate EV size by CE. In the proper context, CE is an alternative to EGD to screen for EV.

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