The Lancet Regional Health. Western Pacific (Jan 2021)
Detachable string magnetically controlled capsule endoscopy for detecting high-risk varices in compensated advanced chronic liver disease (CHESS1801): A prospective multicenter study
- Shuai Wang,
- Yifei Huang,
- Weiling Hu,
- Hua Mao,
- Mark Edward McAlindon,
- Yanna Liu,
- Li Yang,
- Chunqing Zhang,
- Ming Xu,
- Chaohui He,
- Tong Dang,
- Bin Wu,
- Dong Ji,
- Liting Zhang,
- Xiaorong Mao,
- Lei Zhang,
- Chuan Liu,
- Dan Xu,
- Yasong Li,
- Guoan Li,
- Juqiang Han,
- Fangfang Lv,
- Xiao Liang,
- Shaoqin Jin,
- Shaoheng Zhang,
- Foong Way David Tai,
- Qing Xu,
- Changqing Yang,
- Guangchuan Wang,
- Lifen Wang,
- Bo Li,
- Haiyun Yang,
- Ping Xie,
- Lulin Deng,
- Limei Ren,
- Zhiheng Chang,
- Xing Wang,
- Shan Wang,
- Xiaoqin Gao,
- Junfeng Li,
- Longdong Zhu,
- Fangzhao Wang,
- Lingen Zhang,
- Guo Zhang,
- Xi Jiang,
- Jun Pan,
- Wenbo Meng,
- Xun Li,
- Jinlin Hou,
- Xavier Dray,
- Zhuan Liao,
- Xiaolong Qi
Affiliations
- Shuai Wang
- CHESS Center, Department of Liver Diseases, The Fifth Medical Center, Chinese PLA General Hospital, Beijing, China
- Yifei Huang
- CHESS Center, Institute of Portal Hypertension, The First Hospital of Lanzhou University, Lanzhou, China; Department of Gastroenterology, Zhujiang Hospital, Southern Medical University, Guangzhou, China
- Weiling Hu
- Department of Gastroenterology, Sir Run Run Shaw Hospital, Medical School; Institute of Gastroenterology, Zhejiang University, Hangzhou, China
- Hua Mao
- Department of Gastroenterology, Zhujiang Hospital, Southern Medical University, Guangzhou, China
- Mark Edward McAlindon
- Academic Department of Gastroenterology and Hepatology, Sheffield Teaching Hospitals NHS Trust, Sheffield, UK
- Yanna Liu
- CHESS Center, Institute of Portal Hypertension, The First Hospital of Lanzhou University, Lanzhou, China
- Li Yang
- Division of Gastroenterology and Hepatology, Digestive Disease Institute, Shanghai Tongji Hospital, Tongji University School of Medicine, Shanghai, China
- Chunqing Zhang
- Department of Gastroenterology, Shandong Provincial Hospital Affiliated to Shandong First Medical University, Jinan, China
- Ming Xu
- Department of Gastroenterology, Guangdong Second Provincial General Hospital, Guangzhou, China
- Chaohui He
- Department of Gastroenterology, The Fifth Affiliated Hospital of Zunyi Medical University, Zhuhai, China
- Tong Dang
- Department of Gastroenterology, The Second Affiliated Hospital of Baotou Medical College, Baotou, China
- Bin Wu
- Department of Gastroenterology, Third Affiliated Hospital of Sun Yat-sen University, Guangdong Province Engineering and Technology Research Center of Digestive Endoscopy, Guangzhou, China
- Dong Ji
- CHESS Center, Department of Liver Diseases, The Fifth Medical Center, Chinese PLA General Hospital, Beijing, China
- Liting Zhang
- Department of Hepatology, The First Hospital of Lanzhou University, Lanzhou, China
- Xiaorong Mao
- Department of Infectious Diseases, The First Hospital of Lanzhou University, Lanzhou, China
- Lei Zhang
- Department of General Surgery, The First Hospital of Lanzhou University, Lanzhou, China
- Chuan Liu
- CHESS Center, Institute of Portal Hypertension, The First Hospital of Lanzhou University, Lanzhou, China
- Dan Xu
- CHESS Center, Institute of Portal Hypertension, The First Hospital of Lanzhou University, Lanzhou, China
- Yasong Li
- CHESS Center, Department of Liver Diseases, The Fifth Medical Center, Chinese PLA General Hospital, Beijing, China; CHESS Center, Institute of Portal Hypertension, The First Hospital of Lanzhou University, Lanzhou, China; Department of Gastroenterology, Zhujiang Hospital, Southern Medical University, Guangzhou, China; Department of Gastroenterology, Sir Run Run Shaw Hospital, Medical School; Institute of Gastroenterology, Zhejiang University, Hangzhou, China; Academic Department of Gastroenterology and Hepatology, Sheffield Teaching Hospitals NHS Trust, Sheffield, UK; Division of Gastroenterology and Hepatology, Digestive Disease Institute, Shanghai Tongji Hospital, Tongji University School of Medicine, Shanghai, China; Department of Gastroenterology, Shandong Provincial Hospital Affiliated to Shandong First Medical University, Jinan, China; Department of Gastroenterology, Guangdong Second Provincial General Hospital, Guangzhou, China; Department of Gastroenterology, The Fifth Affiliated Hospital of Zunyi Medical University, Zhuhai, China; Department of Gastroenterology, The Second Affiliated Hospital of Baotou Medical College, Baotou, China; Department of Gastroenterology, Third Affiliated Hospital of Sun Yat-sen University, Guangdong Province Engineering and Technology Research Center of Digestive Endoscopy, Guangzhou, China; Department of Hepatology, The First Hospital of Lanzhou University, Lanzhou, China; Department of Infectious Diseases, The First Hospital of Lanzhou University, Lanzhou, China; Department of General Surgery, The First Hospital of Lanzhou University, Lanzhou, China; Department of Liver Diseases, the Seventh Medical Center, Chinese PLA General Hospital, Beijing, China; Department of Infectious Diseases, Sir Run Run Shaw Hospital, School of Medicine, Zhejiang University, Hangzhou, China; Department of General Surgery, Sir Run Run Shaw Hospital, School of Medicine, Zhejiang University, Hangzhou, China; Department of Gastroenterology, The People's Hospital of Guangxi Zhuang Autonomous Region, Nanning, China; National Clinical Research Center for Digestive Diseases, Department of Gastroenterology, Changhai Hospital, Shanghai, China; The First Hospital of Lanzhou University, Lanzhou, China; Department of Infectious Diseases, Nanfang Hospital, Southern Medical University, Guangzhou, China; Sorbonne University, Centre for Digestive Endoscopy, Saint Antoine Hospital, APHP, Paris, France
- Guoan Li
- CHESS Center, Department of Liver Diseases, The Fifth Medical Center, Chinese PLA General Hospital, Beijing, China; CHESS Center, Institute of Portal Hypertension, The First Hospital of Lanzhou University, Lanzhou, China; Department of Gastroenterology, Zhujiang Hospital, Southern Medical University, Guangzhou, China; Department of Gastroenterology, Sir Run Run Shaw Hospital, Medical School; Institute of Gastroenterology, Zhejiang University, Hangzhou, China; Academic Department of Gastroenterology and Hepatology, Sheffield Teaching Hospitals NHS Trust, Sheffield, UK; Division of Gastroenterology and Hepatology, Digestive Disease Institute, Shanghai Tongji Hospital, Tongji University School of Medicine, Shanghai, China; Department of Gastroenterology, Shandong Provincial Hospital Affiliated to Shandong First Medical University, Jinan, China; Department of Gastroenterology, Guangdong Second Provincial General Hospital, Guangzhou, China; Department of Gastroenterology, The Fifth Affiliated Hospital of Zunyi Medical University, Zhuhai, China; Department of Gastroenterology, The Second Affiliated Hospital of Baotou Medical College, Baotou, China; Department of Gastroenterology, Third Affiliated Hospital of Sun Yat-sen University, Guangdong Province Engineering and Technology Research Center of Digestive Endoscopy, Guangzhou, China; Department of Hepatology, The First Hospital of Lanzhou University, Lanzhou, China; Department of Infectious Diseases, The First Hospital of Lanzhou University, Lanzhou, China; Department of General Surgery, The First Hospital of Lanzhou University, Lanzhou, China; Department of Liver Diseases, the Seventh Medical Center, Chinese PLA General Hospital, Beijing, China; Department of Infectious Diseases, Sir Run Run Shaw Hospital, School of Medicine, Zhejiang University, Hangzhou, China; Department of General Surgery, Sir Run Run Shaw Hospital, School of Medicine, Zhejiang University, Hangzhou, China; Department of Gastroenterology, The People's Hospital of Guangxi Zhuang Autonomous Region, Nanning, China; National Clinical Research Center for Digestive Diseases, Department of Gastroenterology, Changhai Hospital, Shanghai, China; The First Hospital of Lanzhou University, Lanzhou, China; Department of Infectious Diseases, Nanfang Hospital, Southern Medical University, Guangzhou, China; Sorbonne University, Centre for Digestive Endoscopy, Saint Antoine Hospital, APHP, Paris, France
- Juqiang Han
- CHESS Center, Department of Liver Diseases, The Fifth Medical Center, Chinese PLA General Hospital, Beijing, China; CHESS Center, Institute of Portal Hypertension, The First Hospital of Lanzhou University, Lanzhou, China; Department of Gastroenterology, Zhujiang Hospital, Southern Medical University, Guangzhou, China; Department of Gastroenterology, Sir Run Run Shaw Hospital, Medical School; Institute of Gastroenterology, Zhejiang University, Hangzhou, China; Academic Department of Gastroenterology and Hepatology, Sheffield Teaching Hospitals NHS Trust, Sheffield, UK; Division of Gastroenterology and Hepatology, Digestive Disease Institute, Shanghai Tongji Hospital, Tongji University School of Medicine, Shanghai, China; Department of Gastroenterology, Shandong Provincial Hospital Affiliated to Shandong First Medical University, Jinan, China; Department of Gastroenterology, Guangdong Second Provincial General Hospital, Guangzhou, China; Department of Gastroenterology, The Fifth Affiliated Hospital of Zunyi Medical University, Zhuhai, China; Department of Gastroenterology, The Second Affiliated Hospital of Baotou Medical College, Baotou, China; Department of Gastroenterology, Third Affiliated Hospital of Sun Yat-sen University, Guangdong Province Engineering and Technology Research Center of Digestive Endoscopy, Guangzhou, China; Department of Hepatology, The First Hospital of Lanzhou University, Lanzhou, China; Department of Infectious Diseases, The First Hospital of Lanzhou University, Lanzhou, China; Department of General Surgery, The First Hospital of Lanzhou University, Lanzhou, China; Department of Liver Diseases, the Seventh Medical Center, Chinese PLA General Hospital, Beijing, China; Department of Infectious Diseases, Sir Run Run Shaw Hospital, School of Medicine, Zhejiang University, Hangzhou, China; Department of General Surgery, Sir Run Run Shaw Hospital, School of Medicine, Zhejiang University, Hangzhou, China; Department of Gastroenterology, The People's Hospital of Guangxi Zhuang Autonomous Region, Nanning, China; National Clinical Research Center for Digestive Diseases, Department of Gastroenterology, Changhai Hospital, Shanghai, China; The First Hospital of Lanzhou University, Lanzhou, China; Department of Infectious Diseases, Nanfang Hospital, Southern Medical University, Guangzhou, China; Sorbonne University, Centre for Digestive Endoscopy, Saint Antoine Hospital, APHP, Paris, France
- Fangfang Lv
- Department of Infectious Diseases, Sir Run Run Shaw Hospital, School of Medicine, Zhejiang University, Hangzhou, China
- Xiao Liang
- Department of General Surgery, Sir Run Run Shaw Hospital, School of Medicine, Zhejiang University, Hangzhou, China
- Shaoqin Jin
- Department of Gastroenterology, Zhujiang Hospital, Southern Medical University, Guangzhou, China
- Shaoheng Zhang
- Department of Gastroenterology, Zhujiang Hospital, Southern Medical University, Guangzhou, China
- Foong Way David Tai
- Academic Department of Gastroenterology and Hepatology, Sheffield Teaching Hospitals NHS Trust, Sheffield, UK
- Qing Xu
- Division of Gastroenterology and Hepatology, Digestive Disease Institute, Shanghai Tongji Hospital, Tongji University School of Medicine, Shanghai, China
- Changqing Yang
- Division of Gastroenterology and Hepatology, Digestive Disease Institute, Shanghai Tongji Hospital, Tongji University School of Medicine, Shanghai, China
- Guangchuan Wang
- Department of Gastroenterology, Shandong Provincial Hospital Affiliated to Shandong First Medical University, Jinan, China
- Lifen Wang
- Department of Gastroenterology, Shandong Provincial Hospital Affiliated to Shandong First Medical University, Jinan, China
- Bo Li
- Department of Gastroenterology, Guangdong Second Provincial General Hospital, Guangzhou, China
- Haiyun Yang
- Department of Gastroenterology, Guangdong Second Provincial General Hospital, Guangzhou, China
- Ping Xie
- Department of Gastroenterology, The Fifth Affiliated Hospital of Zunyi Medical University, Zhuhai, China
- Lulin Deng
- Department of Gastroenterology, The Fifth Affiliated Hospital of Zunyi Medical University, Zhuhai, China
- Limei Ren
- Department of Gastroenterology, The Second Affiliated Hospital of Baotou Medical College, Baotou, China
- Zhiheng Chang
- Department of Gastroenterology, The Second Affiliated Hospital of Baotou Medical College, Baotou, China
- Xing Wang
- Department of Gastroenterology, Third Affiliated Hospital of Sun Yat-sen University, Guangdong Province Engineering and Technology Research Center of Digestive Endoscopy, Guangzhou, China
- Shan Wang
- Department of Hepatology, The First Hospital of Lanzhou University, Lanzhou, China
- Xiaoqin Gao
- Department of Hepatology, The First Hospital of Lanzhou University, Lanzhou, China
- Junfeng Li
- Department of Infectious Diseases, The First Hospital of Lanzhou University, Lanzhou, China
- Longdong Zhu
- Department of Infectious Diseases, The First Hospital of Lanzhou University, Lanzhou, China
- Fangzhao Wang
- Department of General Surgery, The First Hospital of Lanzhou University, Lanzhou, China
- Lingen Zhang
- Department of General Surgery, The First Hospital of Lanzhou University, Lanzhou, China
- Guo Zhang
- Department of Gastroenterology, The People's Hospital of Guangxi Zhuang Autonomous Region, Nanning, China
- Xi Jiang
- National Clinical Research Center for Digestive Diseases, Department of Gastroenterology, Changhai Hospital, Shanghai, China
- Jun Pan
- National Clinical Research Center for Digestive Diseases, Department of Gastroenterology, Changhai Hospital, Shanghai, China
- Wenbo Meng
- The First Hospital of Lanzhou University, Lanzhou, China
- Xun Li
- The First Hospital of Lanzhou University, Lanzhou, China
- Jinlin Hou
- Department of Infectious Diseases, Nanfang Hospital, Southern Medical University, Guangzhou, China
- Xavier Dray
- Sorbonne University, Centre for Digestive Endoscopy, Saint Antoine Hospital, APHP, Paris, France
- Zhuan Liao
- National Clinical Research Center for Digestive Diseases, Department of Gastroenterology, Changhai Hospital, Shanghai, China
- Xiaolong Qi
- CHESS Center, Institute of Portal Hypertension, The First Hospital of Lanzhou University, Lanzhou, China; Corresponding author.
- Journal volume & issue
-
Vol. 6
p. 100072
Abstract
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.
