Veena Shivukumar

Medical Student Prize Winner

“Capsule Endoscopy is Safe, Effective and Avoids the Need for Gastroscopy in a Varices Surveillance Programme: An Observational Cohort Study.”

Ms Shivakumar looked into chronic liver disease and the fact that this is increasing worldwide. With this, the prevalence of associated complications can be related such as varices. Ms Shivakumar describes how traditionally, those with chronic liver disease are screened for varices using endoscopy and how this procedure is invasive and generally, poorly tolerated. She also noted how Covid-19 halted routine gastroscopy services due to the high risk of infection spread related to the gastroscopy procedure.

Ms Shivakumar explains:

Pillcam UGI is the latest generation of upper GI capsules which are used as an alternative to endoscopy. It is a non-invasive means of visualising the gastrointestinal tract; it can be performed remotely and has a greater field of vision (348-degrees), and highest number of frames per second (35fps) compared to previous models.

This observational cohort study aimed to look at the safety and feasibility of using Pillcam UGI as an alternative to gastroscopy for varices surveillance, as well as evaluating the impact it had on further disease management, along with recording patient outcomes.

Of the 207 patients who underwent varices surveillance using Pillcam
UGI, 58 had varices detected. Of these, 16 (28%) required further management. Of the remaining 149 who did not have varices detected, 9 (6%), required further management for other findings for example polyps or oesophagitis.

Ongoing management included medical therapy or further gastroscopy which was needed in 13 (6%) of all the patients, demonstrating that capsule endoscopy resulted in 194 patient avoiding gastroscopy. Only one individual experienced a complication (capsule retention) which was successfully removed by gastroscopy, whilst two other patient experienced variceal bleeding in the median 24 month follow-up period.

We concluded from this study that overall, capsule endoscopy is safe and a feasible alternative to gastroscopy for varices surveillance.

Why did you choose this project?

“Capsule endoscopy, particularly magnet-assisted capsule endoscopy, uses robotics as a means of visualising the GI tract. As I am particularly interested in how artificial intelligence could impact medicine in the future, this was a project which really attracted me. This project has also furthered my interest in gastroenterology, highlighting this area as a potential speciality to take up in the future.”