Diagnostic accuracy of magnetically guided capsule endoscopy with a detachable string for detecting oesophagogastric varices in adults with cirrhosis: prospective multicentre study
Xi Jiang, Jun Pan, Qing Xu, Yuhu Song, Huanhuan Sun, Cheng Peng, Xiaolong Qi, Yang‐Yang Qian, Wen‐Bin Zou, Yang Yang, Shaoqin Jin, Bensong Duan, Shan Wu, Ye Chu, Dinghua Xiao, Lijuan Hu, Jun-Zhi Cao, Jinfeng Dai, Xiao Liu, Tian Xia, Wei Zhou, Tao Chen, Chunhua Zhou, Wei Wu, Shaojun Liu, Zhenyu Yang, Fen Wang, Lu Zhang, Chengzhong Li, Hao Xu, Jun-Xue Wang, Bo Wei, Yong Lin, Xing Deng, Lihong Qu, Ying-Qiu Shen, Hui Wang, Yifei Huang, Haibiao Bao, Shuo Zhang, Li Li, Yihai Shi, Xiaoyan Wang, Duowu Zou, Xinjian Wan, Mei‐Dong Xu, Hua Mao, Chaohui He, Zhen Li, Xiuli Zuo, Shuixiang He, Xiaoping Xie, Xiao-Ping Xie, Changqing Yang, Cristiano Spada, Zhao‐Shen Li, Zhuan Liao, Zhao‐Shen Li, Zhuan Liao
Abstract
OBJECTIVE: To evaluate the diagnostic accuracy and safety of using magnetically guided capsule endoscopy with a detachable string (ds-MCE) for detecting and grading oesophagogastric varices in adults with cirrhosis. DESIGN: Prospective multicentre diagnostic accuracy study. SETTING: 14 medical centres in China. PARTICIPANTS: 607 adults (>18 years) with cirrhosis recruited between 7 January 2021 and 25 August 2022. Participants underwent ds-MCE (index test), followed by oesophagogastroduodenoscopy (OGD, reference test) within 48 hours. The participants were divided into development and validation cohorts in a ratio of 2:1. MAIN OUTCOME MEASURES: The primary outcomes were the sensitivity and specificity of ds-MCE in detecting oesophagogastric varices compared with OGD. Secondary outcomes included the sensitivity and specificity of ds-MCE for detecting high risk oesophageal varices and the diagnostic accuracy of ds-MCE for detecting high risk oesophagogastric varices, oesophageal varices, and gastric varices. RESULTS: ds-MCE and OGD examinations were completed in 582 (95.9%) of the 607 participants. Using OGD as the reference standard, ds-MCE had a sensitivity of 97.5% (95% confidence interval 95.5% to 98.7%) and specificity of 97.8% (94.4% to 99.1%) for detecting oesophagogastric varices (both P<0.001 compared with a prespecified 85% threshold). When using the optimal 18% threshold for luminal circumference of the oesophagus derived from the development cohort (n=393), the sensitivity and specificity of ds-MCE for detecting high risk oesophageal varices in the validation cohort (n=189) were 95.8% (89.7% to 98.4%) and 94.7% (88.2% to 97.7%), respectively. The diagnostic accuracy of ds-MCE for detecting high risk oesophagogastric varices, oesophageal varices, and gastric varices was 96.3% (92.6% to 98.2%), 96.9% (95.2% to 98.0%), and 96.7% (95.0% to 97.9%), respectively. Two serious adverse events occurred with OGD but none with ds-MCE. CONCLUSION: The findings of this study suggest that ds-MCE is a highly accurate and safe diagnostic tool for detecting and grading oesophagogastric varices and is a promising alternative to OGD for screening and surveillance of oesophagogastric varices in patients with cirrhosis. TRIAL REGISTRATION: ClinicalTrials.gov NCT03748563.