Detection Of High-risk Varices Research Articles

A Model for Early Endoscopic Detection of High-Risk Gastroesophageal Varices in Children With Biliary Atresia.

In children with biliary atresia and portal hypertension, progression to gastroesophageal varices carrying a risk of bleeding depends on age, total serum bilirubin concentration and initial endoscopic features. We report an attempt to use these factors for early detection of high-risk varices (HRVs). Based on different combinations of these factors, a model was set to estimate the probabilities of emergence of HRVs at various time intervals. A 10% probability was chosen to set the date of the next endoscopy in children who did not display HRVs initially. A total of 113 children without HRVs who underwent their first endoscopy before age 8 in 2013-2020 were included. A comparison was made with children seen during the period 1990-2012 when this model was not used. In all, 65 of the 113 children underwent one to five additional endoscopies at dates set according to the model. The emergence of HRVs was recorded in 22 children after a mean interval of 14 months and was managed by endoscopic primary prophylaxis in all but one who underwent liver transplantation. Three other children bled before the next planned endoscopy. Compared with 175 children of the same age ranges without HRVs in the period 1990-2012, the use of the model was associated with a faster detection of HRVs with a lower number of endoscopic procedures (P = 0.0022 and P = 0.023, respectively). The results suggest that the model reported may be a useful tool for the early detection of HRVs to allow primary prophylaxis of bleeding.

Detachable string magnetically controlled capsule endoscopy for detecting high-risk varices in compensated advanced chronic liver disease (CHESS1801): A prospective multicenter study

BackgroundGastroesophageal varices is a serious complication of compensated advanced chronic liver disease (cACLD). Primary prophylaxis to reduce the risk of variceal hemorrhage is recommended if high-risk varices (HRV) are detected. We performed this study to compare the accuracy, patients’ satisfaction and safety of detection of HRV by detachable string magnetically controlled capsule endoscopy (DS-MCCE) with esophagogastroduodenoscopy (EGD) as the reference. MethodsWe prospectively recruited participants with cACLD from 12 university hospitals (11 in China and one in the United Kingdom) between November 2018 and December 2019 (ClinicalTrials.gov, NCT03749954). All participants underwent DS-MCCE, followed by EGD within a week in a blinded fashion. Following endoscopy, and on the same day, participants were asked to fill in a satisfaction questionnaire regarding their experience. FindingsA total of 105 eligible participants were enrolled. With EGD as the reference standard, the concordance index, sensitivity, specificity, positive predictive value, negative predictive value, positive likelihood ratio, and negative likelihood ratio of DS-MCCE in diagnosis of HRV were 0•90 (95% confidence interval [CI]: 0•83–0•95), 92% (95% CI: 78–98%), 88% (95% CI: 78–95%), 80% (95% CI: 70–92%), 95% (95% CI: 90–100%), 7•91 (95% CI: 4•10–15•30), and 0•09 (95% CI: 0•03–0•30), respectively. The kappa score of 0•78 (95% CI: 0•65–0•90) suggested substantial agreement between DS-MCCE and EGD. Moreover, in participants undergoing EGD without sedation, the satisfaction of DS-MCCE was significantly better than that of EGD (p < 0•0001, d = 1•15 [95%CI: 0•88–1•42]). All participants confirmed the excretion of the capsule, and no adverse events occurred. InterpretationDS-MCCE is an accurate alternative to EGD for detecting HRV in cACLD, which is safe and associated with better satisfaction. FundingA full list of funding can be found in the Funding Support section.

Development and validation of a radiomics signature as a non-invasive complementary predictor of gastroesophageal varices and high-risk varices in compensated advanced chronic liver disease: A multicenter study.

Gastroesophageal varices (GEV) present in compensated advanced chronic liver disease (cACLD) and can develop into high-risk varices (HRV). The gold standard for diagnosing GEV is esophagogastroduodenoscopy (EGD). However, EGD is invasive and less tolerant. This study aimed to develop and validate radiomics signatures based on noncontrast-enhanced computed tomography (CT) images for non-invasive diagnosis of GEV and HRV in patients with cACLD. The multicenter trial enrolled 161 patients with cACLD from six university hospitals in China between January 2015 and September 2019, who underwent both EGD and noncontrast-enhanced CT examination within 14days prior to the endoscopy. Two radiomics signatures, termed rGEV and rHRV, respectively, were built based on CT images in a training cohort of 129 patients and validated in a prospective validation cohort of 32 patients (ClinicalTrials. gov identifier: NCT03749954). In the training cohort, both rGEV and rHRV exhibited high discriminative abilities on determining the existence of GEV and HRV with the area under receiver operating characteristic curve (AUC) of 0.941 (95% confidence interval [CI] 0.904-0.978) and 0.836 (95% CI 0.766-0.905), respectively. In validation cohort, rGEV and rHRV showed high discriminative abilities with AUCs of 0.871 (95% CI 0.739-1.000) and 0.831 (95% CI 0.685-0.978), respectively. This study demonstrated that rGEV and rHRV could serve as the satisfying auxiliary parameters for detection of GEV and HRV with good diagnostic performance.

A comparative study of multi-detector CT portography versus endoscopy in evaluation of gastro-esophageal varices in portal hypertension patients

BackgroundPortal hypertension is a major complication resulting from obstruction of portal blood flow, like cirrhosis or portal vein thrombosis, that leads to portal hypertension. MDCT angiography has become an important tool for investigation of the liver as well as potentially challenging varices by detailing the course of these tortuous vessels. This information is decisive for liver transplantation as well as for common procedures in which an unexpected varix can cause significant bleeding.ResultsThis study included an assessment of 60 cases of portal hypertension (28 males and 32 females), their age ranged from 42 to 69 years (mean age = 57.2 ± 6.63). All patients were diagnosed with portal hypertension, underwent upper GI endoscopy followed by a triphasic CT scan with CT angiographic assessment for the screening of gastro-esophageal varices.CT is highly sensitive as compared to upper GI endoscopy (sensitivity 93%) in detecting esophageal varices. Gastric varices detected by CT in 22 patients (37%) compared to 14 patients (23%) detected by endoscopy. While paraesophageal varices were detected in 63% of patients and retro-gastric varices in 80% of patients that were not visualized by endoscopy. Our study reported that the commonest type of collaterals were the splenic collaterals, and we also found there is a significant correlation between the portal vein diameter and the number of collaterals as well as between the portal vein diameter and splenic vein diameter.ConclusionsMulti-slice CT serves as an important non-invasive imaging modality in the diagnosis of collaterals in cases of portal hypertension. CT portography can replace endoscopy in the detection of high-risk varices. It also proved that there is a correlation between portal vein diameter, splenic vein diameter, and number of collaterals.

New Non-Invasive Index for Detecting Esophageal Varices in Patients with Liver Cirrhosis

Introduction: Many studies have shown that clinical, biochemical and ultrasonographic parameter are predictive of the presence and grading of esophageal varices. Aim of Study: Validation of a noninvasive test called P2/MS and its comparison with other noninvasive tests for the detection of high risk esophageal varices. Patients and Methods: We prospectively enrolled 125 consecutive patients with liver cirrhosis. Complete blood count [CBC], Platelet count by direct method, Liver functions [serum bilirubin, AST, ALT, prothrombin time and concentration and serum albumin], kidney functions, hepatitis markers for B & C, abdominal ultrasonography and upper gastrointestinal endoscopy were done for each patient. Calculation of P2/MS [Platelet count)2/{monocyte fraction (%) × segmented neutrophil fraction (%)], API [age-platelet index], APRI [AST-to-platelet ratio index], SPRI [spleen-to-platelet ratio index], ASPRI [age-spleen-to-platelet ratio index] scores and correlating the different scores with the grade of esophageal varices found on upper endoscopy. Results: During processing of our patient’s data, we found certain relation between segmented neutrophils, monocytes, platelet count, total bilirubin and the degree of esophageal varices for the detection of high risk varices and a new equation was formulated and we called it P2/MS-B. In predicting high risk esophageal varices HREV, the area under the curve for this new variable was [0.909, 95% confidence interval 0.858 - 0.961, p = 0.000] which was significantly higher than all the other variables including P2/MS for the detection of HREV. The sensitivity of the new equation for the detection of HREV is 85.3%, the specificity is 83.1%, the positive predictive value is 87.9%, the negative predicative value is 86.0 % and the overall accuracy of the test is 85.6%. Conclusion: A newly detected noninvasive variable for detecting HREV may reliably screen liver cirrhosis patients for HREV and avoid unnecessary endoscopy in low risk patients.