Study Concludes PillCam ESO(R) Correlates Well With EGD in Detecting and Grading Esophageal Varices -- A Potentially Lethal Complication of Advanced Liver Disease

Market Wire, June, 2009

Given Imaging Ltd. (NASDAQ: GIVN) today announced the results of a study showing that capsule endoscopy with PillCam® ESO demonstrated good correlation with upper endoscopy as a tool to diagnose and grade esophageal varices (EVs), a potentially lethal complication of advanced liver disease. In addition, since PillCam ESO requires no sedation and is substantially less invasive than esophagogastroduodenoscopy (EGD), study investigators suggested that patients may be more willing to comply with the need to get screened regularly to prevent potentially lethal gastrointestinal hemorrhage. Neil R. Sharma, M.D., Division of Digestive Diseases and Nutrition, University of South Florida in Tampa, presented the findings in a poster presentation (#S1829) at the annual Digestive Disease Week® (DDW) 2009 conference, taking place in Chicago from May 30 - June 4.

"Detecting and monitoring varices is critical in this patient population," said Dr. Neil R. Sharma. "Requiring no sedation, esophageal capsule endoscopy provides a less invasive but equally effective option for the screening of esophageal varices."

The current standard of care for screening, esophagogastroduodenoscopy, also called EGD or "upper endoscopy," is invasive and requires sedation, which may limit adherence to screening programs(1). Fifty percent of cirrhotic patients develop varices within 10 years(2). Ten to twenty percent of patients whose varices hemorrhage, or bleed, die within six weeks(3).

About the Study

This prospective study enrolled 34 patients with end-stage liver disease who underwent esophageal capsule endoscopy and EGD on the same day. Each capsule endoscopy study was evaluated by a gastroenterologist experienced in reading and interpreting these studies, and physicians were blinded to the results. EVs were graded as absent, small, medium or large. EGD was considered to be the gold standard for the purposes of the study. Key findings included:

--  Esophageal capsule endoscopy had sensitivity and specificity of 100
    and 66.7 percent, respectively, compared to EGD in the detection of
    esophageal varices;
--  Complete agreement of EV grade occurred in 73.5 (25 of 34) percent of
    cases;
--  Two of twelve patients whose EV were evaluated as "medium" or "large"
    by capsule endoscopy were evaluated to be "small" using EGD; 1 of 18
    patients whose EV was evaluated as "small" using esophageal capsule
    endoscopy was evaluated as "medium" with EGD;
--  Evaluation of stigmata, a specific diagnostic sign of potential
    bleeding, with capsule endoscopy showed sensitivity and specificity of 92.6
    and 85.7 percent, respectively; and
--  Based on minimal invasiveness, lack of need for sedation, less
    discomfort and fewer side effects, ESO may be a more desirable procedure
    for cirrhotic patients that need EV screening.
    

About Esophageal Varices

Chronic liver disease affects 360 out of every 100,000 people in the U.S., results in 300,000 hospitalizations annually and costs more than $2 billion a year, according to the National Institutes of Health. The two most common diseases leading to varices are cirrhosis and fibrosis of the liver. In cirrhosis of the liver, scar tissue replaces normal, healthy tissue, blocking the flow of blood through the organ and preventing it from working as it should. Portal hypertension and esophageal varices (enlarged veins) are two of the main complications of the disease.

In advanced cases of liver cirrhosis, scar tissue spreads and restricts the blood from flowing through the liver. This can cause the veins in the esophagus to enlarge. It is vital to monitor for the appearance of these enlarged veins, or varices, and to keep track of their size.

About PillCam ESO

Cleared by the U.S. Food and Drug Administration in November 2004 to visualize the esophagus in adult patients in a patient-friendly way, physicians can use PillCam ESO to aid in the detection of disorders such as Barrett's esophagus, a potential precursor for esophageal cancer and esophageal varices, which if left untreated, can result in fatal bleeding. Now in its second generation, PillCam ESO 2 contains imaging devices and light sources at both ends of the capsule that capture up to 18 images per second as it passes down the esophagus in a twenty-minute procedure.

About Digestive Disease Week

DDW is the largest international gathering of physicians, researchers and academics in the fields of gastroenterology, hepatology, endoscopy and gastrointestinal surgery. Jointly sponsored by the American Association for the Study of Liver Diseases, the American Gastroenterological Association (AGA) Institute, the American Society for Gastrointestinal Endoscopy and the Society for Surgery of the Alimentary Tract, DDW takes place May 30 - June 4, 2009, at the McCormick Place, Chicago, IL. The meeting showcases approximately 5,000 abstracts and hundreds of lectures on the latest advances in GI research, medicine and technology. For more information, visit www.ddw.org .