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The role of oesophageal capsule endoscopy in assessing oesophageal varices has been previously studied1 where downloaded images are evaluated subsequent to study completion. This is the first study evaluating real-time viewing of oesophagogastric findings during capsule transit through the upper gastrointestinal tract for this indication.The primary aim was to assess the accuracy of real time oesophageal capsule study in identifying oesophageal varices in patients undergoing variceal screening or surveillence. Secondary aims were to establish the ability of oesophageal capsule endoscopy to detect gastric varices or portal hypertensive gastropathy, and to ascertain post procedure patient perception of comfort compared to standard gastroscopy.Inclusion criteria was patients with cirrhosis referred within our centre for variceal screening or surveillance. Exclusion criteria were known dysphagia, suspected or known gastrointestinal tract stricture, suspected active gastrointestinal bleeding and active hepatic encephalopathy.Capsule assessment was performed by instructing the patient to ingest the oesophageal capsule with sips of water/simethicone mixture in left lateral patient position. Oesophagogastric mucosa was evaluated in real time during capsule transit through a computer attached to the video recorder unit using three sensor element leads.Standard gastroscopy was performed by another endoscopist, blinded to capsule findings, within the same day. Intravenous sedation was permitted during gastroscopy, if needed.Patient preference and comfort levels (by digital analogue scale where 0 = no pain, 5 = very painful) were recorded post-recovery.Thirty-one patients with cirrhosis (17 males, 14 females, median age 60 years) were included. There was moderate agreement level in assessing the presence of oesophageal varicose (Kappa value 0.545, p < 0.005) (See table below).Majority of patients (n = 26, 84%) preferred oesophageal capsule endoscopy compared to gastroscopy. Capsule endoscopy had better mean comfort score (0.4 vs 2.0, p < 0.001) even with intravenous sedation during gastroscopy in 17 (55%) patients.Real-time viewing of oesophageal capsule potentially offers a less invasive means of variceal screening/surveillance with better patient comfort.DeFranchis et al. Esophageal capsule endoscopy for screening and surveillance of esophageal varices in patients with portal hypertension. Hepatology 2008;47:1595–1603None Declared.