A prospective evaluation of computerized tomographic (CT) scanning as a screening modality for esophageal varices

Abstract

Patients with cirrhosis require endoscopic screening for large esophageal varices. The aims of this study were to determine the cost-effectiveness and patient preferences of a strategy employing abdominal computerized tomography (CT) as the initial screening test for identifying large esophageal varices. In a prospective evaluation,102 patients underwent both CT and endoscopic screening for gastroesophageal varices. Two radiologists read each CT independently; standard upper gastrointestinal endoscopy was the reference standard. Agreement between radiologists, and between endoscopists regarding size of varices was determined using kappa statistic. Costeffectiveness analysis was performed to determine the optimal screening strategy for varices. Patient preference was assessed by questionnaire. CT was found to have approximately 90% sensitivity in the identification of esophageal varices determined to be large on endoscopy, but only about 50% specificity. The sensitivity of CT in detecting gastric varices was 87%. In addition, a significant number of gastric varices, peri-esophageal varices, and extraluminal pathology were identified by CT that were not identified by endoscopy. Patients overwhelmingly preferred CT over endoscopy . Agreement between radiologists was good regarding the size of varices (Kappa ‫؍‬ 0.56), and exceeded agreement between endoscopists (Kappa ‫؍‬ 0.36). Use of CT as the initial screening modality for the detection of varices was significantly more costeffective compared to endoscopy irrespective of the prevalence of large varices. Conclusion: Abdominal CT as the initial screening test for varices could be cost-effective. CT also permits evaluation of extra-luminal pathology that impacts management. (HEPATOLOGY 2008;47:1587-1594

High-Risk Esophageal Varices in Patients Treated with Locoregional Therapies for Hepatocellular Carcinoma: Evaluation with Regular Follow-Up Liver CT

“…Perri et al suggested that CT was the better initial screening modality compared to endoscopy in terms of cost-effectiveness and patient preferences irrespective of the prevalence of large varices [16]. Liver CT always covers the distal esophagus where all varices occur, and the recent use of multi-detector row CT (MDCT) can provide excellent image quality.…”

“…Several recent studies reported the possibility of evaluation of esophageal varices with CT scans [14][15][16]. Perri et al suggested that CT was the better initial screening modality compared to endoscopy in terms of cost-effectiveness and patient preferences irrespective of the prevalence of large varices [16].…”

Diagnostic non-invasive model of large risky esophageal varices in cirrhotic hepatitis C virus patients

“…Several previous studies have investigated the interconnection between findings from both CT and endoscopy, and have demonstrated an agreement between variceal size and radiologic interpretations rather than between variceal size and endoscopic valuation [16,34] . However, CT scanning cannot adequately differentiate between small and large varices nor can it detect red signs on small varices that are also subject to a higher risk of bleeding [35] .…”

The shear effort of measurement of portal hypertension

“…Cross-sectional radiologic examinations such as computed tomography and magnetic resonance have been used to measure liver fibrosis and to identify specific complications of portal hypertension. 4,5 Transient elastography (TE) has demonstrated reliability in noninvasively staging hepatic fibrosis and has been widely accepted for this indication. TE has also been used to assess for the presence of portal hypertension through LS or SS measurements, although performance characteristics have not been sufficient for widespread application.…”

“…Like chlorcyclizine, phenothiazines also inhibit a late stage of HCV entry, and their anti-HCV activity is unrelated to their antihistamine function. However, unlike chlorcyclizine, phenothiazines inhibit the entry of both HCVpp and HCVcc, 4 suggestive of an antiviral…”