Abstract
Background and Aims Computed tomography portal venography (CTPV) shows potential in detecting varices that need treatment and their drainage pathways. However, its agreement with endoscopy requires further study. We investigated the feasibility of CTPV as an alternative tool to endoscopy in screening gastroesophageal varices (GEVs) and developed a CTPV-based model to provide a less invasive assessment of endotherapy for cirrhotic patients with GEVs. Methods The study included 33 cirrhotic patients with a recent history of variceal hemorrhage. The presence, grade, and classification of GEVs on endoscopy and CTPV were compared (kappa test). Twenty-four patients were treated endoscopically, including 12 for esophageal varices (EVs), 8 for gastric varices (GVs), and 4 for GEVs. Treatment efficacies were assessed with the newly developed CTPV-based method at 1 week and 1 month after treatment. Efficiency evaluated by CTPV and endoscopy was compared by Fisher's exact test to determine whether CTPV is efficient in the assessment of endotherapy efficacy. Results For the screening and grading/classification of EVs and GVs, substantial agreement (EV kappa: 0.63 and 0.68; GV kappa: 0.62 and 0.75, respectively) was noted between endoscopy and CTPV. The therapeutic efficacy of EVs was higher when assessed by CTPV than when evaluated by endoscopy (37.50% vs. 12.50% at 1 week postoperation, P = 0.22; 62.50% vs. 25.00% at 1 month postoperation, P = 0.07), but without statistical significance. The same trend was also found in the assessment of therapeutic efficacy for GVs (25.00% vs. 16.67% at 1 week postoperation, P = 1; 58.33% vs. 41.67% at 1 month postoperation, P = 0.68). Conclusion CTPV is comparable to endoscopy in the detection of GEVs and in the evaluation of endotherapy efficacy, which suggests that it could be a less invasive alternative for endoscopy in cirrhotic patients with GEVs needing treatment.
Highlights
The development of gastroesophageal varices (GEVs) is a severe complication of cirrhosis, and their rupture is a substantial cause of death in cirrhotic patients [1]
Examination by Computed tomography portal venography (CTPV) preoperatively in cirrhotic patients is necessary for better choice of treatments, as hemodynamic features vary among the different drainage pathways of GEVs [8]
In line with previous studies [11, 12], our study showed that CTPV is promising in the detection of the drainage pathway of GEVs and portosystemic collaterals, which lays the foundation for the evaluation of efficacy and complications after endotherapy
Summary
The development of gastroesophageal varices (GEVs) is a severe complication of cirrhosis, and their rupture is a substantial cause of death in cirrhotic patients [1]. The present study attempts to determine the agreement between CTPV and Gastroenterology Research and Practice endoscopy in GEV detection and evaluate the efficacy of endotherapy using CTPV. We investigated the feasibility of CTPV as an alternative tool to endoscopy in screening gastroesophageal varices (GEVs) and developed a CTPV-based model to provide a less invasive assessment of endotherapy for cirrhotic patients with GEVs. Methods. Twenty-four patients were treated endoscopically, including 12 for esophageal varices (EVs), 8 for gastric varices (GVs), and 4 for GEVs. Treatment efficacies were assessed with the newly developed CTPV-based method at 1 week and 1 month after treatment. CTPV is comparable to endoscopy in the detection of GEVs and in the evaluation of endotherapy efficacy, which suggests that it could be a less invasive alternative for endoscopy in cirrhotic patients with GEVs needing treatment
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