Enhancing Detection of Small Esophageal Varices by PillCam ESO

Esophageal variceal bleeding is a common and life-threatening complication of portal
hypertension in patients with cirrhosis of liver. It is associated with a mortality rate of
up to 50% in these patients. Prophylactic treatments to prevent variceal bleeding,
therefore, assume paramount clinical significance. Currently, primary prophylactic
treatments using pharmacologic agents with non-selective beta blockers as well as endoscopic
variceal ligation (EVL) are effectively employed in preventing variceal bleeding. The
American Association for the Study of Liver Disease (AASLD) guidelines recommend that
patients with Child's stage A cirrhosis and portal hypertension with platelet count less
than 140,000/mmq or portal vein diameter > 13mm and those patients classified as Child's B
and C cirrhosis should undergo screening endoscopy for esophageal varices. Patients with
cirrhosis and no esophageal varices detected during screening should undergo endoscopy ever
three years. Patients with small esophageal varices are recommended to be screened
endoscopically every 1 to 2 years.

Currently, esophagogastroduodenoscopy (EGD) under conscious sedation is the gold standard
for variceal screening. However, EGD has certain limitations especially when used in
patients with cirrhosis of the liver. Prolonged conscious sedation may have an adverse
effect on encephalopathy. EGD also may not be cost effective for screening esophageal
varices.

The use of PillCam ESO capsule endoscopy to detect esophageal varices has become an
attractive alternative to conventional endoscopy especially in patients unwilling to undergo
EGD. Identifying patients with small varices, which have the potential for progression to
large varices and bleeding, is an important clinical issue to address.