Screening for esophageal varices: Endoscopy, other tools, or endoscopy and other tools?

Thabut, Dominique; Moreau, Richard; Lebrec, Didier

doi:10.1002/hep.22315

Cited by 27 publications

(21 citation statements)

References 75 publications

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“…patients with LOV or with small OV and red wale marks or Child C class), a criteria that has been taken into account in one study only [47]. Also the assessment of OV size was rather subjective: no details were provided in most of these studies regarding the quality of this assessment even though endoscopy is known to be an imperfect gold standard with considerable inter-observer variability for detecting and grading varices [51]. Fourth, the proposed cut-offs for detecting OV or LOV were discrepant between studies, thus the optimal cut-off remains to be defined.…”

Section: Detection Of Oesophageal Varicesmentioning

confidence: 99%

Non invasive evaluation of portal hypertension using transient elastography

Castéra

Pinzani

Bosch

2012

Journal of Hepatology

285

224

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The development of portal hypertension is a common consequence of chronic liver diseases leading to the formation of esophageal and gastric varices responsible for variceal bleeding, associated with a high mortality rate, as well as other severe complications such as portosystemic encephalopathy and sepsis. Measurement of hepatic venous pressure gradient (HVPG) and upper GI endoscopy are considered the gold standards for portal hypertension assessment in patients with cirrhosis. However, both types of investigation are invasive and HVPG measurement is routinely available and/or performed with adequate standards only in expert centres. There is thus a need for non invasive methods able to predict, with acceptable diagnostic accuracy, the progression of portal hypertension toward the levels of clinically significant (i.e. HVPG ≥ 10 mmHg) and severe (HVPG ≥ 12 mmHg) as well as the presence and the size of oesophageal varices. Transient elastography (TE) is a novel non invasive technology that allows measuring liver stiffness and that has gained popularity over the past few years. Although TE has been initially proposed to assess liver fibrosis, a good correlation has been reported between liver stiffness values and HVPG as well as the presence of oesophageal varices, suggesting that it could be an interesting tool for the non invasive evaluation of portal hypertension. This review is aimed at discussing the advantages and limits of TE and the perspectives for its rationale use in clinical practice for the management of patients with portal hypertension.

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Section: Detection Of Oesophageal Varicesmentioning

confidence: 99%

Non invasive evaluation of portal hypertension using transient elastography

Castéra

Pinzani

Bosch

2012

Journal of Hepatology

285

224

View full text Add to dashboard Cite

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“…Although effective, the strategy of endoscopic screening in all cirrhotic patients is very expensive and suffers from the lack of compliance from patients. Moreover, there are recent studies which show that more than 50% of the screened cirrhotic patients will not develop EV within a period of 10 years follow-up [20]. In conclusion, there is a real need for complementary non-invasive diagnostic tools that can select for endoscopy only the subsets of patients that really need it.…”

Section: Disscusionsmentioning

confidence: 99%

Value of hepatic elastography and Doppler indexes for predictions of esophageal varices in liver cirrhosis

Bințințan

Chira

Bințințan³

et al. 2015

Med Ultrason

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Aims: Non-invasive methods are required to diagnose presence and grading of esophageal varices in patients with hepatic cirrhosis and in this respect we have evaluated the role of transient elastography and abdominal ultrasound parameters. Material and methods: Cirrhotic patients were prospectively evaluated by transient elastography and Doppler ultrasound for diagnosis of presence and grading of esophageal varices, the results being compared with the findings of the esophagogastroduodenoscopy. Results: Sixty patients with hepatic cirrhosis were analysed. The parameters that reached statistical significance for diagnosis of esophageal varices were: liver stiffness (LSM) > 15 kPa, hemodynamic liver index (PVr1) ≥ 0.66, portal vascular resistance (PVR) > 17.66 and splenoportal index (SPI) > 4.77. The only parameter that reached statistical power for the diagnosis of large esophageal varices was LSM at a cut-off value of 28.8 kPa. Conclusions: Assessment of LSM in patients with liver cirrhosis can predict both the presence of esophageal varices and of large esophageal varices. The PVr1, PVR and SPI Doppler indexes can be used to diagnose the presence of esophageal varices but have no role in the prediction of large esophageal varices. Further studies are required to confirm these results and offer a stronger clinical significance.

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“…A study by Perri et al used a CT cutoff of 5 mm, and concluded that CT could be a cost-effective screening test for esophageal varices. One of the critiques of this study, however, was that using CT as a primary screening modality would result in patients with large varices being misdiagnosed [16]. The aim of our study was to retrospectively evaluate the effectiveness of CT and/or MRI imaging modalities to detect esophageal varices, when compared to gold standard EGD findings in cirrhotic patients who had imaging performed for other indications.…”

Section: Introductionmentioning

confidence: 96%