Case series
Esophageal capsule endoscopy is a useful tool in patients with hemophilia
Authors
Anastasios Koulaouzidis1, Yun Lin Ang2, Sarah Douglas1, John N. Plevris1, 3
Institutions
1
Centre for Liver and Digestive Disorders, Royal Infirmary of Edinburgh, Scotland, United Kingdom Medical School, University of Edinburgh, Edinburgh, Scotland, United Kingdom 3 Department of Haematology, Royal Infirmary of Edinburgh, Edinburgh, United Kingdom 2
Bibliography DOI http://dx.doi.org/ 10.1055/s-0034-1377630 Published online: 10.9.2014 Endoscopy 2014; 46: 1116– 1118 © Georg Thieme Verlag KG Stuttgart · New York ISSN 0013-726X Corresponding author Anastasios Koulaouzidis, MD Endoscopy Unit The Royal Infirmary of Edinburgh 51 Little France Crescent Edinburgh EH16 4SA Scotland United Kingdom Fax: +44-132-2421618 [email protected]
Esophageal capsule endoscopy (ECE) is considered to be an alternative to conventional esophagogastroduodenoscopy (EGD); however, its indications continue to expand. This report presents results from the use of ECE in patients with hemophilia at a tertiary referral academic center over a 7-year period. A total of 16 patients with hemophilia, who were all at risk of new-variant Creutzfeldt-Jakob disease due to previous treatment with UK plasma-derived pooled blood products, underwent a total of 28 ECE examinations. Main outcomes were the diagnostic yield of ECE, re-
quirement for subsequent conventional EGD, and any variceal bleeding episodes during the followup period. The overall diagnostic yield was 67.8 % (19 /28 ECEs). Only one patient underwent conventional EGD, for esophageal biopsies. There were no variceal hemorrhage events in any of the patients on variceal screening follow-up. ECE is a useful and acceptable alternative to conventional endoscopy in selected patient groups (i. e. patients with hemophilia). In this group, ECE can eliminate the need for prior administration of clotting factors.
Introduction
ting factors pre-procedure. Recent studies and meta-analyses have shown that ECE has acceptable sensitivity and specificity in the detection of varices, but it is inferior to EGD [3, 4]. However, it can be used as an acceptable alternative in patients with hemophilia and portal hypertension who undergo regular surveillance for varices, and it may be of particular value − if negative for varices − in reassuring patients [5, 7]. There is only scant literature on this topic. The aim of this retrospective cohort study was to evaluate the use of ECE in a tertiary referral center for capsule endoscopy for Lothian (Southeast Scotland).
!
Many patients with hemophilia who received treatment with pooled plasma-derived clotting factors before the mid-1980 s, were infected with hepatitis C virus (HCV). Some are also considered to be “at risk of the new-variant Creutzfeldt-Jakob disease (nvCJD) for public health purposes” as a result of treatment with UK plasma-derived pooled-blood products [1]. Chronic HCV infection can progress to cirrhosis and portal hypertension leading to gastroesophageal varices [2]. To date, esophagogastroduodenoscopy (EGD) remains the gold standard for evaluation of varices [3, 4]. Although current guidelines suggest administering clotting factors only for therapeutic endoscopy, it is common practice to correct clotting factor abnormalities prior to conventional EGD. Consequently, less invasive endoscopic modalities, such as esophageal capsule endoscopy (ECE) and/or transnasal endoscopy, have been considered to avoid the need for clotting factors [5]. However, the latter is less attractive due to an increased risk of nosebleeds and possible contamination from lymphoid tissue in those people considered at risk of nvCJD [6]. ECE is better tolerated than conventional endoscopy, with high patient acceptability. Furthermore, there is no need for administration of clot-
Materials and methods !
A retrospective review of the ECE database (May 2005 – April 2012) was performed. The PillCam ESO1 (Given Imaging Ltd., Yoqneam, Israel) was first introduced at the Royal Infirmary of Edinburgh in May 2005; its successor, the PillCam ESO2, has been used since 2009. Data on the clinical background, presence or absence of fibrosis and/or cirrhosis, referral indications, and ECE findings were retrieved.
Koulaouzidis Anastasios et al. Esophageal capsule endoscopy for patients with hemophilia … Endoscopy 2014; 46: 1116–1118
This document was downloaded for personal use only. Unauthorized distribution is strictly prohibited.
1116
Case series
Patient
Patients with hemophilia who underwent esophageal capsule endoscopy.
ECE
Cirrhosis
examinations
Indication for ECE Variceal
ECE findings Other indication1
surveillance 1
2 3
4
5
Esophageal
PHG/gastric
varices
varices
Other findings
1
No
Yes
No
Yes
No
Esophagitis
2
No
No
GERD
Yes
No
Gastritis, duodenitis
3
No
No
GERD
Yes
No
Esophagitis
1
Probable
No
Esophagitis assessment
Yes
No
Gastritis
2
Probable
Yes
No
No
No
No
1
Yes
Yes
No
No
PHG
No
2
Yes
Yes
No
No
PHG
No
3
Yes
Yes
No
No
PHG
No
1
Probable
Yes
No
No
No
No
2
Probable
Yes
No
Yes
No
Gastritis
3
Probable
Yes
No
Yes
No
Esophagitis
4
Probable
Yes
No
No
No
No
1
Probable
Yes
No
No
No
No
2
Probable
Yes
No
Yes
PHG
No
3
Probable
Yes
No
Yes
No
No No
4
Probable
Yes
No
Yes
PHG / gastric varices
5
Probable
Yes
No
Yes
No
No
6
1
No
No
Dyspepsia
No
No
Esophagitis, gastritis
7
1
Yes
Yes
No
No
No
Gastritis?
8
1
Yes
Yes
No
No
PHG
No
9
1
No
No
GERD
No
No
No
10
1
Probable
No
GERD, dyspepsia
No
No
No
11
1
No
No
Dysphagia
No
No
Eosinophilic esophagitis?
12
1
Probable
Yes
No
Yes
PHG
Esophagitis
13
1
No
No
GERD
No
No
Esophagitis, gastritis
14
1
No
No
Barrett’s assessment
No
No
Esophagitis, Barrett’s esophagus, gastritis
15
1
No
No
GERD, dyspepsia
No
No
Esophagitis, gastritis
16
1
No
No
GERD, dyspepsia
No
No
Gastritis?
ECE, esophageal capsule endoscopy; GERD, gastroesophageal reflux disease; PHG, portal hypertension gastropathy. 1 Investigation of gastrointestinal symptoms or signs.
Capsule endoscopy procedure
Results
For ECE with the PillCam ESO1, the protocol required 6 hours of fasting prior to the examination. The PillCam ESO was ingested with the patient in a supine position. The patient was gradually raised over a period of 6 minutes to the upright position, and remained seated upright until the capsule battery expired. For ECE with the PillCam ESO2, the simplified ingestion protocol was employed [8]. This study was conducted in accordance with UK research ethics guidelines. After review by the local ethics committee, further specific ethical review and approval were not required, as the study was considered an evaluation of previously collected data, obtained as part of regular clinical care.
!
Demographics A total of 28 ECEs in 16 patients with hemophilia (13 hemophilia A, 3 hemophilia B; mean age 47.5 ± 9.8 years, range 31 – 65) were performed. All patients with hemophilia were infected with HCV and considered to be “at risk of nvCJD for public health purposes.” Three patients (18.8 %) with hemophilia had established cirrhosis, 5 /16 (31.3 %) had advanced fibrosis or probable cirrhosis, and the remaining 8 (50.0 %) did not have evidence of cirrhosis but were followed up for the risk of developing cirrhosis. Repeat ECEs (n = 12) were performed in 5 patients. PillCam ESO1 was used in 15 /28 examinations (53.6 %) whereas the PillCam ESO2 was used in 13 /28 ECEs (46.4 %).
Statistical analysis Numerical data are presented as mean (±SD) and range. The Fisher’s exact test was used (GraphPad Software, Inc., La Jolla, California, USA). A two-tailed P value of < 0.05 was considered to be statistically significant.
Indications Indications were: variceal screening or surveillance (n = 17 ECEs) and assessment of upper gastrointestinal symptoms or signs in " Table 1). Findings were classified as: varices, portal (n = 11) (●
Koulaouzidis Anastasios et al. Esophageal capsule endoscopy for patients with hemophilia … Endoscopy 2014; 46: 1116–1118
This document was downloaded for personal use only. Unauthorized distribution is strictly prohibited.
Table 1
1117
Case series
hypertensive gastropathy (PHG), or other findings unrelated to portal hypertension (e. g. esophagitis [including evidence of dysmotility], gastritis, duodenitis, and Barrett’s esophagus). A portal hypertension-related diagnostic yield was defined as the presence of C1 /C2 esophageal varices, gastric varices, or PHG [9].
Completion rate and diagnostic yield The mean esophageal transit time was 166 seconds (range 3 – 1171 seconds). All capsules reached the stomach, and in 8 /28 ECE examinations (28.6 %), visualization of the duodenum was achieved. The portal hypertension-related diagnostic yield (for esophageal varices, gastric varices, or PHG) of ECE was 67.8 % (19 relevant findings in 28 ECE). The overall diagnostic yield per indication was equivalent (screening or surveillance ECEs 70.6 % (12 / 17), ECEs for gastrointestinal symptoms and signs 63.6 % (7 /11); P = 1.0). It is noteworthy that 27.3 % (3 /11) of ECEs performed for investigation of gastrointestinal symptoms and signs detected incidental C1 varices, despite the referral indication being gastrointestinal symptoms. One patient with suspected eosinophilic esophagitis subsequently underwent EGD for esophageal biopsies. There was no variceal hemorrhage event in any of the patients on variceal screening follow-up.
Discussion !
Patients who received UK plasma-derived pooled blood products between 1980 and 2001 were considered to be “at risk of nvCJD for public health purposes” [6, 10]. Some of these individuals with hemophilia are infected with HCV, as a result of treatment with contaminated plasma-derived coagulation products [1, 10]. In such patients, precautionary measures to minimize secondary transmission are employed when undergoing certain types of surgery or other invasive procedures. The mortality rate after an acute variceal hemorrhage remains high [2, 9]. Therefore, patients with medium or large esophageal varices should receive primary prophylaxis [2, 7]. In the current cohort, 50 % of patients with hemophilia referred for ECE had cirrhosis or probable cirrhosis. The overall diagnostic yield of ECE in this subgroup was high (70.6 %), making ECE a cost-effective modality at our center. Furthermore, a significant proportion of ECEs (42.9 %) were repeat examinations to establish whether there was progression of portal hypertension when cirrhosis was strongly suspected. None of the patients with small or no varices appeared to have been misdiagnosed, as they had no up-
per gastrointestinal bleeding episodes during follow-up. Therefore, the use of ECE in these patients influenced clinical management by informing clinicians, and reassured patients while avoiding administration of expensive clotting factors [11]. The main limitations of this retrospective cohort study are its small size and the fact that it was limited to a tertiary hemophilia center. Nonetheless, although the value of ECE may be limited, in well-selected groups such as patients with hemophilia, ECE is a cost-effective diagnostic tool. Competing interests: Dr. Koulaouzidis has received research support from Given Imaging and SynMed UK, lecture honoraria from Dr Falk Pharma UK, and travel support from Abbott, Dr Falk Pharma UK, Almirall, and MSD.
References 1 Meijer K, Haagsma EB. HCV-related liver cancer in people with haemophilia. Haemophilia 2012; 18: 17 – 24 2 Sarin SK, Kumar A, Angus PW et al. Asian Pacific Association for the Study of the Liver (APASL) Working Party on Portal Hypertension. Diagnosis and management of acute variceal bleeding: Asian Pacific Association for Study of the Liver recommendations. Hepatol Int 2011; 5: 607 – 624 3 Laurain A, de Leusse A, Gincul R et al. Oesophageal capsule endoscopy versus oesophagogastroduodenoscopy for the diagnosis of recurrent varices: a prospective multicentre study. Dig Liver Dis 2014; 46: 535 – 540 4 Guturu P, Sagi SV, Ahn D et al. Capsule endoscopy with PILLCAM ESO for detecting esophageal varices: a meta-analysis. Minerva Gastroenterol Dietol 2011; 57: 1 – 11 5 Nakos G, Karagiannis S, Ballas S et al. A study comparing tolerability, satisfaction and acceptance of three different techniques for esophageal endoscopy: sedated conventional, unsedated peroral ultra thin, and esophageal capsule. Dis Esophagus 2009; 22: 447 – 452 6 Zaman SM, Hill FG, Palmer B et al. The risk of variant Creutzfeldt-Jakob disease among UK patients with bleeding disorders, known to have received potentially contaminated plasma products. Haemophilia 2011; 17: 931 – 937 7 de Franchis R, Dell’Era A, Primignani M. Diagnosis and monitoring of portal hypertension. Dig Liver Dis 2008; 40: 312 – 317 8 Gralnek IM, Rabinovitz R, Afik D et al. A simplified ingestion procedure for esophageal capsule endoscopy: initial evaluation in healthy volunteers. Endoscopy 2006; 38: 913 – 918 9 de Franchis R, Eisen GM, Laine L et al. Esophageal capsule endoscopy for screening and surveillance of esophageal varices in patients with portal hypertension. Hepatology 2008; 47: 1595 – 1603 10 Head MW, Ironside JW. vCJD and the gut: implications for endoscopy. Gut 2007; 56: 9 – 11 11 Spiegel BM, Esrailian E, Eisen G. The budget impact of endoscopic screening for esophageal varices in cirrhosis. Gastrointest Endosc 2007; 66: 679 – 692
Koulaouzidis Anastasios et al. Esophageal capsule endoscopy for patients with hemophilia … Endoscopy 2014; 46: 1116–1118
This document was downloaded for personal use only. Unauthorized distribution is strictly prohibited.
1118
Copyright of Endoscopy is the property of Georg Thieme Verlag Stuttgart and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use.
Esophageal capsule endoscopy is a useful tool in patients with hemophilia
Authors
Anastasios Koulaouzidis1, Yun Lin Ang2, Sarah Douglas1, John N. Plevris1, 3
Institutions
1
Centre for Liver and Digestive Disorders, Royal Infirmary of Edinburgh, Scotland, United Kingdom Medical School, University of Edinburgh, Edinburgh, Scotland, United Kingdom 3 Department of Haematology, Royal Infirmary of Edinburgh, Edinburgh, United Kingdom 2
Bibliography DOI http://dx.doi.org/ 10.1055/s-0034-1377630 Published online: 10.9.2014 Endoscopy 2014; 46: 1116– 1118 © Georg Thieme Verlag KG Stuttgart · New York ISSN 0013-726X Corresponding author Anastasios Koulaouzidis, MD Endoscopy Unit The Royal Infirmary of Edinburgh 51 Little France Crescent Edinburgh EH16 4SA Scotland United Kingdom Fax: +44-132-2421618 [email protected]
Esophageal capsule endoscopy (ECE) is considered to be an alternative to conventional esophagogastroduodenoscopy (EGD); however, its indications continue to expand. This report presents results from the use of ECE in patients with hemophilia at a tertiary referral academic center over a 7-year period. A total of 16 patients with hemophilia, who were all at risk of new-variant Creutzfeldt-Jakob disease due to previous treatment with UK plasma-derived pooled blood products, underwent a total of 28 ECE examinations. Main outcomes were the diagnostic yield of ECE, re-
quirement for subsequent conventional EGD, and any variceal bleeding episodes during the followup period. The overall diagnostic yield was 67.8 % (19 /28 ECEs). Only one patient underwent conventional EGD, for esophageal biopsies. There were no variceal hemorrhage events in any of the patients on variceal screening follow-up. ECE is a useful and acceptable alternative to conventional endoscopy in selected patient groups (i. e. patients with hemophilia). In this group, ECE can eliminate the need for prior administration of clotting factors.
Introduction
ting factors pre-procedure. Recent studies and meta-analyses have shown that ECE has acceptable sensitivity and specificity in the detection of varices, but it is inferior to EGD [3, 4]. However, it can be used as an acceptable alternative in patients with hemophilia and portal hypertension who undergo regular surveillance for varices, and it may be of particular value − if negative for varices − in reassuring patients [5, 7]. There is only scant literature on this topic. The aim of this retrospective cohort study was to evaluate the use of ECE in a tertiary referral center for capsule endoscopy for Lothian (Southeast Scotland).
!
Many patients with hemophilia who received treatment with pooled plasma-derived clotting factors before the mid-1980 s, were infected with hepatitis C virus (HCV). Some are also considered to be “at risk of the new-variant Creutzfeldt-Jakob disease (nvCJD) for public health purposes” as a result of treatment with UK plasma-derived pooled-blood products [1]. Chronic HCV infection can progress to cirrhosis and portal hypertension leading to gastroesophageal varices [2]. To date, esophagogastroduodenoscopy (EGD) remains the gold standard for evaluation of varices [3, 4]. Although current guidelines suggest administering clotting factors only for therapeutic endoscopy, it is common practice to correct clotting factor abnormalities prior to conventional EGD. Consequently, less invasive endoscopic modalities, such as esophageal capsule endoscopy (ECE) and/or transnasal endoscopy, have been considered to avoid the need for clotting factors [5]. However, the latter is less attractive due to an increased risk of nosebleeds and possible contamination from lymphoid tissue in those people considered at risk of nvCJD [6]. ECE is better tolerated than conventional endoscopy, with high patient acceptability. Furthermore, there is no need for administration of clot-
Materials and methods !
A retrospective review of the ECE database (May 2005 – April 2012) was performed. The PillCam ESO1 (Given Imaging Ltd., Yoqneam, Israel) was first introduced at the Royal Infirmary of Edinburgh in May 2005; its successor, the PillCam ESO2, has been used since 2009. Data on the clinical background, presence or absence of fibrosis and/or cirrhosis, referral indications, and ECE findings were retrieved.
Koulaouzidis Anastasios et al. Esophageal capsule endoscopy for patients with hemophilia … Endoscopy 2014; 46: 1116–1118
This document was downloaded for personal use only. Unauthorized distribution is strictly prohibited.
1116
Case series
Patient
Patients with hemophilia who underwent esophageal capsule endoscopy.
ECE
Cirrhosis
examinations
Indication for ECE Variceal
ECE findings Other indication1
surveillance 1
2 3
4
5
Esophageal
PHG/gastric
varices
varices
Other findings
1
No
Yes
No
Yes
No
Esophagitis
2
No
No
GERD
Yes
No
Gastritis, duodenitis
3
No
No
GERD
Yes
No
Esophagitis
1
Probable
No
Esophagitis assessment
Yes
No
Gastritis
2
Probable
Yes
No
No
No
No
1
Yes
Yes
No
No
PHG
No
2
Yes
Yes
No
No
PHG
No
3
Yes
Yes
No
No
PHG
No
1
Probable
Yes
No
No
No
No
2
Probable
Yes
No
Yes
No
Gastritis
3
Probable
Yes
No
Yes
No
Esophagitis
4
Probable
Yes
No
No
No
No
1
Probable
Yes
No
No
No
No
2
Probable
Yes
No
Yes
PHG
No
3
Probable
Yes
No
Yes
No
No No
4
Probable
Yes
No
Yes
PHG / gastric varices
5
Probable
Yes
No
Yes
No
No
6
1
No
No
Dyspepsia
No
No
Esophagitis, gastritis
7
1
Yes
Yes
No
No
No
Gastritis?
8
1
Yes
Yes
No
No
PHG
No
9
1
No
No
GERD
No
No
No
10
1
Probable
No
GERD, dyspepsia
No
No
No
11
1
No
No
Dysphagia
No
No
Eosinophilic esophagitis?
12
1
Probable
Yes
No
Yes
PHG
Esophagitis
13
1
No
No
GERD
No
No
Esophagitis, gastritis
14
1
No
No
Barrett’s assessment
No
No
Esophagitis, Barrett’s esophagus, gastritis
15
1
No
No
GERD, dyspepsia
No
No
Esophagitis, gastritis
16
1
No
No
GERD, dyspepsia
No
No
Gastritis?
ECE, esophageal capsule endoscopy; GERD, gastroesophageal reflux disease; PHG, portal hypertension gastropathy. 1 Investigation of gastrointestinal symptoms or signs.
Capsule endoscopy procedure
Results
For ECE with the PillCam ESO1, the protocol required 6 hours of fasting prior to the examination. The PillCam ESO was ingested with the patient in a supine position. The patient was gradually raised over a period of 6 minutes to the upright position, and remained seated upright until the capsule battery expired. For ECE with the PillCam ESO2, the simplified ingestion protocol was employed [8]. This study was conducted in accordance with UK research ethics guidelines. After review by the local ethics committee, further specific ethical review and approval were not required, as the study was considered an evaluation of previously collected data, obtained as part of regular clinical care.
!
Demographics A total of 28 ECEs in 16 patients with hemophilia (13 hemophilia A, 3 hemophilia B; mean age 47.5 ± 9.8 years, range 31 – 65) were performed. All patients with hemophilia were infected with HCV and considered to be “at risk of nvCJD for public health purposes.” Three patients (18.8 %) with hemophilia had established cirrhosis, 5 /16 (31.3 %) had advanced fibrosis or probable cirrhosis, and the remaining 8 (50.0 %) did not have evidence of cirrhosis but were followed up for the risk of developing cirrhosis. Repeat ECEs (n = 12) were performed in 5 patients. PillCam ESO1 was used in 15 /28 examinations (53.6 %) whereas the PillCam ESO2 was used in 13 /28 ECEs (46.4 %).
Statistical analysis Numerical data are presented as mean (±SD) and range. The Fisher’s exact test was used (GraphPad Software, Inc., La Jolla, California, USA). A two-tailed P value of < 0.05 was considered to be statistically significant.
Indications Indications were: variceal screening or surveillance (n = 17 ECEs) and assessment of upper gastrointestinal symptoms or signs in " Table 1). Findings were classified as: varices, portal (n = 11) (●
Koulaouzidis Anastasios et al. Esophageal capsule endoscopy for patients with hemophilia … Endoscopy 2014; 46: 1116–1118
This document was downloaded for personal use only. Unauthorized distribution is strictly prohibited.
Table 1
1117
Case series
hypertensive gastropathy (PHG), or other findings unrelated to portal hypertension (e. g. esophagitis [including evidence of dysmotility], gastritis, duodenitis, and Barrett’s esophagus). A portal hypertension-related diagnostic yield was defined as the presence of C1 /C2 esophageal varices, gastric varices, or PHG [9].
Completion rate and diagnostic yield The mean esophageal transit time was 166 seconds (range 3 – 1171 seconds). All capsules reached the stomach, and in 8 /28 ECE examinations (28.6 %), visualization of the duodenum was achieved. The portal hypertension-related diagnostic yield (for esophageal varices, gastric varices, or PHG) of ECE was 67.8 % (19 relevant findings in 28 ECE). The overall diagnostic yield per indication was equivalent (screening or surveillance ECEs 70.6 % (12 / 17), ECEs for gastrointestinal symptoms and signs 63.6 % (7 /11); P = 1.0). It is noteworthy that 27.3 % (3 /11) of ECEs performed for investigation of gastrointestinal symptoms and signs detected incidental C1 varices, despite the referral indication being gastrointestinal symptoms. One patient with suspected eosinophilic esophagitis subsequently underwent EGD for esophageal biopsies. There was no variceal hemorrhage event in any of the patients on variceal screening follow-up.
Discussion !
Patients who received UK plasma-derived pooled blood products between 1980 and 2001 were considered to be “at risk of nvCJD for public health purposes” [6, 10]. Some of these individuals with hemophilia are infected with HCV, as a result of treatment with contaminated plasma-derived coagulation products [1, 10]. In such patients, precautionary measures to minimize secondary transmission are employed when undergoing certain types of surgery or other invasive procedures. The mortality rate after an acute variceal hemorrhage remains high [2, 9]. Therefore, patients with medium or large esophageal varices should receive primary prophylaxis [2, 7]. In the current cohort, 50 % of patients with hemophilia referred for ECE had cirrhosis or probable cirrhosis. The overall diagnostic yield of ECE in this subgroup was high (70.6 %), making ECE a cost-effective modality at our center. Furthermore, a significant proportion of ECEs (42.9 %) were repeat examinations to establish whether there was progression of portal hypertension when cirrhosis was strongly suspected. None of the patients with small or no varices appeared to have been misdiagnosed, as they had no up-
per gastrointestinal bleeding episodes during follow-up. Therefore, the use of ECE in these patients influenced clinical management by informing clinicians, and reassured patients while avoiding administration of expensive clotting factors [11]. The main limitations of this retrospective cohort study are its small size and the fact that it was limited to a tertiary hemophilia center. Nonetheless, although the value of ECE may be limited, in well-selected groups such as patients with hemophilia, ECE is a cost-effective diagnostic tool. Competing interests: Dr. Koulaouzidis has received research support from Given Imaging and SynMed UK, lecture honoraria from Dr Falk Pharma UK, and travel support from Abbott, Dr Falk Pharma UK, Almirall, and MSD.
References 1 Meijer K, Haagsma EB. HCV-related liver cancer in people with haemophilia. Haemophilia 2012; 18: 17 – 24 2 Sarin SK, Kumar A, Angus PW et al. Asian Pacific Association for the Study of the Liver (APASL) Working Party on Portal Hypertension. Diagnosis and management of acute variceal bleeding: Asian Pacific Association for Study of the Liver recommendations. Hepatol Int 2011; 5: 607 – 624 3 Laurain A, de Leusse A, Gincul R et al. Oesophageal capsule endoscopy versus oesophagogastroduodenoscopy for the diagnosis of recurrent varices: a prospective multicentre study. Dig Liver Dis 2014; 46: 535 – 540 4 Guturu P, Sagi SV, Ahn D et al. Capsule endoscopy with PILLCAM ESO for detecting esophageal varices: a meta-analysis. Minerva Gastroenterol Dietol 2011; 57: 1 – 11 5 Nakos G, Karagiannis S, Ballas S et al. A study comparing tolerability, satisfaction and acceptance of three different techniques for esophageal endoscopy: sedated conventional, unsedated peroral ultra thin, and esophageal capsule. Dis Esophagus 2009; 22: 447 – 452 6 Zaman SM, Hill FG, Palmer B et al. The risk of variant Creutzfeldt-Jakob disease among UK patients with bleeding disorders, known to have received potentially contaminated plasma products. Haemophilia 2011; 17: 931 – 937 7 de Franchis R, Dell’Era A, Primignani M. Diagnosis and monitoring of portal hypertension. Dig Liver Dis 2008; 40: 312 – 317 8 Gralnek IM, Rabinovitz R, Afik D et al. A simplified ingestion procedure for esophageal capsule endoscopy: initial evaluation in healthy volunteers. Endoscopy 2006; 38: 913 – 918 9 de Franchis R, Eisen GM, Laine L et al. Esophageal capsule endoscopy for screening and surveillance of esophageal varices in patients with portal hypertension. Hepatology 2008; 47: 1595 – 1603 10 Head MW, Ironside JW. vCJD and the gut: implications for endoscopy. Gut 2007; 56: 9 – 11 11 Spiegel BM, Esrailian E, Eisen G. The budget impact of endoscopic screening for esophageal varices in cirrhosis. Gastrointest Endosc 2007; 66: 679 – 692
Koulaouzidis Anastasios et al. Esophageal capsule endoscopy for patients with hemophilia … Endoscopy 2014; 46: 1116–1118
This document was downloaded for personal use only. Unauthorized distribution is strictly prohibited.
1118
Copyright of Endoscopy is the property of Georg Thieme Verlag Stuttgart and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use.
