***TASK*** the task is to summarize an input biomedical literature in six sentences 
    ***INPUT*** the input is a biomedical literature 
    ***OUTPUT*** the output is the summary of an input biomedical literature in six sentences 
    ***DOCUMENTATION*** 
    ***EXAMPLES*** 
    Input: Background Endoscopy ( esophagogastroduodenoscopy , EGD ) to screen for esophageal varices ( EV ) is recommended in patients with portal hypertension . Reports indicate that capsule endoscopy ( CE ) is capable of identifying large/medium varices ( L/MV ) when the varix comprises more than 25 % of the circumference of the field of view . Aims We evaluated the ability of CE to discriminate the size of EV using this grading scale . Methods Patients underwent CE and EGD on the same day . A blinded investigator interpreted capsule findings . CE labeled EV as L/MV if ≥25 % of the lumen circumference was occupied , and small/none for < 25 % . Results A total of 37 patients were enrolled in this prospect i ve , observational study at a single tertiary-care academic center . Three CE were excluded due to rapid esophageal transit time or technical malfunction . Using a 25 % threshold , the sensitivity , specificity , positive predictive value ( PPV ) , and negative predictive value ( NPV ) for EC to discriminate L/MV were 23.5 % , 88.2 % , 66.7 % , and 53.6 % , respectively ( κ = 0.12 ) . Reducing the threshold to 12.5 % result ed in sensitivity , specificity , PPV , and NPV of 88.2 % , 64.7 % , 71.4 % , and 84.6 % , respectively ( κ = 0.53 ) . A receiver-operator characteristic ( ROC ) curve showed a 15 % threshold to be optimal in discriminating EV size using CE , result ing in sensitivity , specificity , PPV , and NPV of 76.5 % , 82.4 % , 81.3 % , and 77.8 % , respectively ( κ = 0.59 ) . Conclusions This study indicates that discriminating EV size by the current capsule scale is unreliable . Lowering the grading threshold improved the ability to discriminate EV size by CE . In the proper context , CE is an alternative to EGD to screen for EV AIM To investigate the utility of esophageal capsule endoscopy in the diagnosis and grading of esophageal varices . METHODS Cirrhotic patients who were undergoing esophagogastroduodenoscopy ( EGD ) for variceal screening or surveillance underwent capsule endoscopy .  Two separate blinded investigators read each capsule endoscopy for the following results : variceal grade , need for treatment with variceal b and ing or prophylaxis with beta-blocker therapy , degree of portal hypertensive gastropathy , and gastric varices . RESULTS Fifty patients underwent both capsule and EGD .  Forty-eight patients had both procedures on the same day , and 2 patients had capsule endoscopy within 72 h of EGD . The accuracy of capsule endoscopy to decide on the need for prophylaxis was 74 % , with sensitivity of 63 % and specificity of 82 % . Inter-rater agreement was moderate ( kappa = 0.56 ) . Agreement between EGD and capsule endoscopy on grade of varices was 0.53 ( moderate ) . Inter-rater reliability was good ( kappa = 0.77 ) . In diagnosis of portal hypertensive gastropathy , accuracy was 57 % , with sensitivity of 96 % and specificity of 17 % . Two patients had gastric varices seen on EGD , one of which was seen on capsule endoscopy . There were no complications from capsule endoscopy . CONCLUSION We conclude that capsule endoscopy has a limited role in deciding which patients would benefit from EGD with b and ing or beta-blocker therapy . More data is needed to assess accuracy for staging esophageal varices , PHG , and the detection of gastric varices BACKGROUND Nonselective beta-adrenergic blockers decrease portal pressure and prevent variceal hemorrhage . Their effectiveness in preventing varices is unknown . METHODS We r and omly assigned 213 patients with cirrhosis and portal hypertension ( minimal hepatic venous pressure gradient [ HVPG ] of 6 mm Hg ) to receive  timolol , a nonselective beta-blocker  ( 108 patients ) , or  placebo ( 105 patients ) . The primary end point was the development of gastroesophageal varices or variceal hemorrhage . Endoscopy and HVPG measurements were repeated yearly . RESULTS During a median follow-up of 54.9 months , the rate of the primary end point did not differ significantly between the timolol group and the placebo group ( 39 percent and 40 percent , respectively ; P=0.89 ) , nor were there significant differences in the rates of ascites , encephalopathy , liver transplantation , or death . Serious adverse events were more common among patients in the timolol group than among those in the placebo group ( 18 percent vs. 6 percent , P=0.006 ) . Varices developed less frequently among patients with a baseline HVPG of less than 10 mm Hg and among those in whom the HVPG decreased by more than 10 percent at one year and more frequently among those in whom the HVPG increased by more than 10 percent at one year . CONCLUSIONS Nonselective beta-blockers are ineffective in preventing varices in unselected patients with cirrhosis and portal hypertension and are associated with an increased number of adverse events . ( Clinical Trials.gov number , NCT00006398 . Several treatments have been proven to be effective for variceal bleeding in patients with cirrhosis . The aim of this multicenter , prospect i ve , cohort study was to assess how these treatments are used in clinical practice and what are the posttherapeutic prognosis and prognostic indicators of upper digestive bleeding in patients with cirrhosis . A training set of 291 and a test set of 174 bleeding cirrhotic patients were included . Treatment was according to the preferences of each center and the follow-up period was 6 weeks . Predictive rules for 5-day failure ( uncontrolled bleeding , rebleeding , or death ) and 6-week mortality were developed by the logistic model in the training set and vali date d in the test set . Initial treatment controlled bleeding in 90 % of patients , including vasoactive drugs in 27 % , endoscopic therapy in 10 % , combined ( endoscopic and vasoactive ) in 45 % , balloon tamponade alone in 1 % , and none in 17 % . The 5-day failure rate was 13 % , 6-week rebleeding was 17 % , and mortality was 20 % . Corresponding findings for variceal versus nonvariceal bleeding were 15 % versus 7 % ( P = .034 ) , 19 % versus 10 % ( P = .019 ) , and 20 % versus 15 % ( P = .22 ) . Active bleeding on endoscopy , hematocrit levels , aminotransferase levels , Child-Pugh class , and portal vein thrombosis were significant predictors of 5-day failure ; alcohol-induced etiology , bilirubin , albumin , encephalopathy , and hepatocarcinoma were predictors of 6-week mortality . Prognostic re assessment including blood transfusions improved the predictive accuracy . All the developed prognostic models were superior to the Child-Pugh score . In conclusion , prognosis of digestive bleeding in cirrhosis has much improved over the past 2 decades . Initial treatment stops bleeding in 90 % of patients . Accurate predictive rules are provided for early recognition of high-risk patients BACKGROUND / AIMS The incidence and natural history of small esophageal varices ( EV ) in cirrhotics may influence the frequency of endoscopies and the decision to start a pharmacological treatment in these patients . METHODS We prospect ively evaluated 206 cirrhotics , 113 without varices and 93 with small EV , during a mean follow-up of 37+/-22 months . Patients with previous gastrointestinal bleeding or receiving any treatment for portal hypertension were excluded .  Endoscopy was performed every 12 months . RESULTS The rate of incidence of EV was 5 % ( 95%CI : 0.8 - 8.2 % ) at 1 year and 28 % ( 21.0 - 35.0 % ) at 3 years . The rate of EV progression was 12 % ( 5.6 - 18.4 % ) at 1 year and 31 % ( 21.2 - 40.8 % ) at 3 years . Post-alcoholic origin of cirrhosis , Child-Pugh 's class ( B or C ) and the finding of red wale marks at first examination were predictors for the variceal progression . The two-years risk of bleeding from EV was higher in patients with small varices upon enrollment than in those without varices : 12 % ( 95 % CI : 5.2 - 18.8 % ) vs. 2 % ( 0.1 - 4.1 % ) ; ( P<0.01 ) . Predictor for bleeding was the presence of red wale marks at first endoscopy . CONCLUSIONS In patients with no or small EV , endoscopy surveillance should be planned taking into account cause and degree of liver dysfunction This is one of a series of statements discussing the utilization of GI endoscopy in common clinical situations . The St and ards of Practice Committee of the American Society for Gastrointestinal Endoscopy prepared this text . In preparing this guideline , a MEDLINE literature search was performed and additional references were obtained from the bibliographies of the identified articles and from recommendations of expert consultants . When little or no data exist from well design ed prospect i ve trials , emphasis is given to results from large series and reports from recognized experts . Guidelines for appropriate utilization of endoscopy are based on a critical review of the available data and expert consensus . Further controlled clinical studies are needed to clarify aspects of this statement , and revision may be necessary as new data appear . Clinical consideration may justify a course of action at variance to these recommendations . This document is intended to provide the principles by which credentialing organizations may create policy and practical guidelines for granting privileges to perform capsule endoscopy . For information on credentialing for other endoscopic procedures , please refer to ‘ ‘ Guidelines for Credentialing and Granting Privileges for Gastrointestinal Endoscopy . ’ BACKGROUND AND STUDY AIMS Esophagogastroduodenoscopy ( EGD ) is the most effective method for examining the upper gastrointestinal tract , and particularly for evaluating portal hypertension in cirrhotic patients , especially for screening purpose s. The aim of this study was to assess the feasibility , safety , accuracy , and tolerance of PillCam ESO capsule endoscopy for this indication . PATIENTS AND METHODS In this prospect i ve study , unse date d EGD and capsule endoscopy examinations were conducted on the same day in cirrhotic patients at the time of diagnosis . The patients quantified the tolerability ( relative to pain , nausea , choking sensations , etc . ) of the two procedures using a 100-mm visual analogue scale . The time required for the recording and for diagnosis with the capsule examination were documented , as were the patients ' preferences in comparison with EGD . Two independent endoscopists blinded to the EGD diagnoses assessed the diagnostic accuracy of the images obtained . RESULTS Twenty-one patients were included in the study ( mean age 62 , mean Model for End-Stage Liver Disease score 10.5 , mean Child-Pugh score 7.3 ) . The procedure was safe . One patient was unable to swallow the capsule . The mean recording time was 213 s ( range 6 - 1200 s ) ; the procedure accurately assessed the presence or absence of esophageal varices in 16 of 19 patients ( 84.2 % ) ; and it correctly indicated a need for primary prophylaxis ( esophageal varices of grade 2 or more and /or red signs ) in 100 % of cases . The tolerability of the capsule endoscopy examination was significantly better , and all of the patients preferred capsule endoscopy to EGD ( which was transnasal in 11 patients ) . CONCLUSIONS Capsule endoscopy was feasible , safe , accurate , highly acceptable , and preferred by cirrhotic patients undergoing screening for portal hypertension . This new technique requires further and more extensive evaluation , as well as assessment of its cost-effectiveness OBJECTIVES : Esophagogastroduodenoscopy ( EGD ) is the st and ard method for the diagnosis of esophago-gastric varices . The aim of this prospect i ve multicenter study was to evaluate the PillCam esophageal capsule endoscopy ( ECE ) for this indication . METHODS : Patients presenting with cirrhotic or noncirrhotic portal hypertension underwent ECEfollowed by EGD at the time of diagnosis . Capsule recordings were blindly read by two endoscopists . RESULTS : A total of 120 patients ( 72 males , mean age : 58 years ; mean Child – Pugh score : 7.2 ) were included .  Esophageal varices were detected in 74 patients . No adverse event was observed after either EGD or ECE . Seven ( 6 % ) patients were unable to swallow the capsule . The mean recording time was 204 s ( range 1–876 ) . Sensitivity , specificity , negative predictive value , and positive predictive value of ECE  for the detection of esophageal varices were 77 % , 86 % , 69 % , and 90 % , respectively . Sensitivity , specificity , negative and positive predictive 
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Discussion : Wireless esophageal capsule endoscopy is well tolerated and safe in patients with liver cirrhosis and suspicion of portal hypertension .
The sensitivity of capsule endoscopy is not currently sufficient to replace EGD as a first exploration in these patients , but given its high accuracy , it may have a role in cases of refusal or contraindication to EGD