Observational cohort study of patients with chronic liver disease undergoing variceal screening and surveillance using capsule endoscopy

Objectives Rapid transit risks inadequate oesophageal capsule endoscopy. Success rate, completion of examination, time taken to read the video and impact on management of a novel dual camera capsule capable of 35 frames per second were determined. Methods Patients referred for screening or surveillance of oesophagogastric varices who declined gastroscopy and throughout the COVID-19 pandemic were examined by capsule endoscopy using the PillCam UGI capsule. Results Capsule endoscopy was performed on 207 patients (median (IQR) age 62 (±18), 53% men). The median reading time was 4 (±2) min. Oesophageal views were complete in 205 (99%); no views were obtained in 2 (1%) patients. Cardiac views were complete in 197 (86.5%), partial in 11 (5.3%) and not seen in 17 (8.21%). Fundal views were complete in 108 (52.2%), partial in 27 (13%) and not seen in 72 (34.8%). Oesophagogastric varices were detected in 58 (28%) patients, mostly (55 (94.2%)) oesophageal varices (38 (66%) grade 1). Overall, 23 (11.1%) patients required further management on the basis of capsule endoscopy findings, and gastroscopy was avoided in 194 (94%) of patients. During a median follow-up period of 24 months (±19), two patients were successfully treated for variceal bleeding. Capsule retention required endoscopic retrieval in one patient (0.5%). Conclusions A dual camera capsule endoscope capturing 35 frames per second provided excellent oesophageal views, avoided gastroscopy in the majority of patients and effectively and safely guided management.