The Cost of Screening Esophageal Varices

Lotfipour, Ashley K.; Douek, Michael; Shimoga, Sandhya V; Sayer, James; Han, Steven; Jutabha, Rome; Lu, David

doi:10.1097/rct.0000000000000147

Cited by 11 publications

(5 citation statements)

References 43 publications

(33 reference statements)

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“…The main disadvantage of CT is the radiation dose, although, considering the high mean age of cirrhotic patients, the benefits are likely to outweigh the risk of radiation-induced carcinogenesis [ 60 ]. The cost of the method is higher compared to other non-invasive methods, but lower compared to endoscopy [ 61 ]. Additionally, intravenous contrast injection is required, which may be contraindicated in patients with impaired renal function or allergy to iodine.…”

Section: Resultsmentioning

confidence: 99%

Νon-invasive screening for esophageal varices in patients with liver cirrhosis

Karatzas¹,

Konstantakis

Αγγελετοπούλου³

et al. 2018

aog

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Esophageal varices are one of the main complications of liver cirrhosis. Upper gastrointestinal endoscopy is the gold standard for the detection of esophageal varices. Many less invasive methods for screening of varices have been investigated and the most recent Baveno VI guidelines suggest that endoscopy is not necessary in patients with liver stiffness <20 kPa and platelets >150,000/μL. A critical review of the literature was performed concerning non-invasive or minimally invasive methods of screening for esophageal varices. Liver and spleen elastography, imaging methods including computed tomography, magnetic resonance imaging and ultrasound, laboratory tests and capsule endoscopy are discussed. The accuracy of each method, and its advantages and limitations compared to endoscopy are analyzed. There are data to support the Baveno VI guidelines, but there is still a lack of large prospective studies and low specificity has been reported for the liver stiffness and platelet count combination. Spleen elastography has shown promising results, as there are data to support its superiority to liver elastography, but it needs further assessment. Computed tomography has shown high diagnostic accuracy and can be part of the diagnostic work up of cirrhotic patients in the future, including screening for varices.

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Section: Resultsmentioning

confidence: 99%

Νon-invasive screening for esophageal varices in patients with liver cirrhosis

Karatzas¹,

Konstantakis

Αγγελετοπούλου³

et al. 2018

aog

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“…The reason relies on costs and ease of access, particularly for MRI. In fact, in the United States, CT scan is cost-effective for the diagnosis of gastroesophageal varices [ 135 ], but the technique is less costly than in Europe, where endoscopy is usually cheaper. About CT, scan irradiation represents another factor weighing on its use.…”

Section: Noninvasive Tests (Nits)mentioning

confidence: 99%

Noninvasive Assessment of Portal Hypertension in Advanced Chronic Liver Disease: An Update

Ravaioli

Montagnani

Lisotti³

et al. 2018

Gastroenterology Research and Practice

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The assessment of portal hypertension is a relevant step in the evaluation of newly diagnosed advanced chronic liver disease (ACLD). The current gold standard includes the invasive evaluation of hepatic venous pressure gradient (HVPG) and endoscopy. However, noninvasive or minimally invasive techniques to assess portal hypertension have been proposed and well established. In the present manuscript, we review clinical studies on the use of noninvasive or minimally invasive techniques to assess portal hypertension in ACLD patients.

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“…19 The cost of the method is highe r compared to other non-invasive methods, but lower compared to endoscopy. 20 Several studies have compared CT and endoscopy findings. A cut off point of 5 mm was previously shown to have approximately 90% sensitivity and 50% specificity for large varices.…”

Section: Discussionmentioning

confidence: 99%

Accuracy of Multi-Detector Computed Tomography in Detection of Esophageal Varices in Chronic Liver Disease

Shah

Ajmal

Siddiqui

2020

JIMDC

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Background: Patients with chronic liver disease should undergo screening endoscopy, but this approach places a heavy burden upon endoscopy units along with other limitations. The aim of this study was to determine the diagnostic accuracy of multi-detector computed tomography scan in detecting esophageal varices taking endoscopy as gold standard.Material and Methods: This cross-sectional study was done from 1st Jan 2018 to 31st Dec 2018 at Department of Radiology, PIMS Hospital Islamabad. A total of 180 patients of both gender with chronic liver disease for at least 12 months were included in this study with an age range of 25-65 years. Patients with active gastrointestinal hemorrhage, hypersensitivity to iodinated contrast agent, chronic renal failure, claustrophobic and pregnant females were excluded. All the patients underwent endoscopy and computed tomography of lower chest and the upper abdomen before and after intravenous contrast administration. Multi detector computed tomography (MDCT) scan findings for esophageal varices were compared with endoscopy findings.Results: In MDCT positive patients (n=102), 98 were true positive and 04 were false positive. Among 78 MDCT negative patients, 07 were false negative, whereas 71 were true negative. Overall sensitivity and specificity were 93.33%, and 94.67% respectively. The positive and negative predictive values were 96.08% and 91.03% respectively, while diagnostic accuracy of MDCT in detecting esophageal varices in chronic liver disease patients was 93.89%, taking endoscopy as gold standard.Conclusions: Multi-detector computed tomography scan is a highly sensitive and accurate non-invasive modality for detecting esophageal varices in chronic liver disease patients.Key words: Accuracy, Chronic liver disease, Esophageal varices, Multi-detector computed tomography

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The Cost of Screening Esophageal Varices

Cited by 11 publications

References 43 publications

Νon-invasive screening for esophageal varices in patients with liver cirrhosis

Νon-invasive screening for esophageal varices in patients with liver cirrhosis

Noninvasive Assessment of Portal Hypertension in Advanced Chronic Liver Disease: An Update

Accuracy of Multi-Detector Computed Tomography in Detection of Esophageal Varices in Chronic Liver Disease

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