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ISSN 1001-5256 (Print)
ISSN 2097-3497 (Online)
CN 22-1108/R
Volume 36 Issue 8
Aug.  2020
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Article Contents

Noninvasive diagnosis of esophageal varices in liver cirrhosis

DOI: 10.3969/j.issn.1001-5256.2020.08.036
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  • Published Date: 2020-08-20
  • Esophageal varices(EV) are the most common complication in patients with liver cirrhosis.Although achievements have been made in the development of endoscopy and other hemostatic techniques,the 6-week mortality rate is still as high as 16%-26% in patients with esophageal variceal bleeding,and therefore,early diagnosis of EV,especially high-risk EV,is of great importance.At present,gastroscopy is the gold standard for the diagnosis of EV,but its clinical application is limited by invasiveness,high cost,and patient discomfort.In recent years,several noninvasive tests have been proposed for the diagnosis of EV,among which the original Baveno VI criteria and its expanded criteria are the most commonly used ones.This article summarizes and reviews the advances in serological marker,ultrasound,CT,MRI,elastography,capsule endoscopy,and ultrathin endoscopy in the noninvasive diagnosis of EV and emphasizes the development of simple noninvasive technology,so as to provide help for the early diagnosis of EV.

     

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  • [1] REVERTER E,TANDON P,AUGUSTIN S,et al. A MELDbased model to determine risk of mortality among patients with acute variceal bleeding[J]. Gastroenterology,2014,146(2):412-419. e3.
    [2] FORTUNE BE,GARCIA-TSAO G,CIARLEGLIO M,et al.Child-Turcotte-Pugh class is best at stratifying risk in variceal hemorrhage:Analysis of a US multicenter prospective study[J]. J Clin Gastroenterol,2017,51(5):446-453.
    [3] GARCIA-TSAO G,ABRALDES JG,BERZIGOTTI A,et al.Portal hypertensive bleeding in cirrhosis:Risk stratification,diagnosis,and management:2016 practice guidance by the American Association for the Study of Liver Diseases[J].Hepatology,2017,65(1):310-335.
    [4] de FRANCHIS R,Baveno VI Faculty. Expanding consensus in portal hypertension:Report of the Baveno VI Consensus Workshop:Stratifying risk and individualizing care for portal hypertension[J]. J Hepatol,2015,63(3):743-752.
    [5] JAKAB SS,GARCIA-TSAO G. Screening and surveillance of varices in patients with cirrhosis[J]. Clin Gastroenterol Hepatol,2019,17(1):26-29.
    [6] ABRALDES JG,BUREAU C,STEFANESCU H,et al. Noninvasive tools and risk of clinically significant portal hypertension and varices in compensated cirrhosis:The“Anticipate”study[J]. Hepatology,2016,64(6):2173-2184.
    [7] THOMOPOULOS KC,LABROPOULOU-KARATZA C,MIMIDIS KP,et al. Non-invasive predictors of the presence of large oesophageal varices in patients with cirrhosis[J]. Dig Liver Dis,2003,35(7):473-478.
    [8] GIANNINI E,BOTTA F,BORRO P,et al. Platelet count/spleen diameter ratio:Proposal and validation of a non-invasive parameter to predict the presence of oesophageal varices in patients with liver cirrhosis[J]. Gut,2003,52(8):1200-1205.
    [9] BURTON JR Jr,LIANGPUNSAKUL S,LAPIDUS J,et al. Validation of a multivariate model predicting presence and size of varices[J]. J Clin Gastroenterol,2007,41(6):609-615.
    [10] BERZIGOTTI A,GILABERT R,ABRALDES JG,et al. Noninvasive prediction of clinically significant portal hypertension and esophageal varices in patients with compensated liver cirrhosis[J]. Am J Gastroenterol,2008,103(5):1159-1167.
    [11] WANG B,NIU JQ. Association of platelet count,fibrosis-4,and aspartate aminotransferase-to-platelet ratio index with the development and severity of esophageal varices in patients with liver cirrhosis[J]. J Clin Hepatol,2018,34(1):84-88.(in Chinese)王报,牛俊奇.PLT计数、FIB-4、APRI与肝硬化食管静脉曲张发生及严重程度的相关性分析[J].临床肝胆病杂志,2018,34(1):84-88.
    [12] CHEN PH,HSIEH WY,SU CW,et al. Combination of albumin-bilirubin grade and platelets to predict a compensated patient with hepatocellular carcinoma who does not require endoscopic screening for esophageal varices[J]. Gastrointest Endosc,2018,88(2):230-239. e2.
    [13] ZHANG F,LIU T,GAO P,et al. Predictive value of a noninvasive serological hepatic fibrosis scoring system in cirrhosis combined with oesophageal varices[J]. Can J Gastroenterol Hepatol,2018,2018:7671508.
    [14] SEBASTIANI G,TEMPESTA D,FATTOVICH G,et al. Prediction of oesophageal varices in hepatic cirrhosis by simple serum non-invasive markers:Results of a multicenter,largescale study[J]. J Hepatol,2010,53(4):630-638.
    [15] SAMI SS,HARMAN D,RAGUNATH K,et al. Non-invasive tests for the detection of oesophageal varices in compensated cirrhosis:Systematic review and meta-analysis[J]. United European Gastroenterol J,2018,6(6):806-818.
    [16] JAKAB SS,GARCIA-TSAO G. Screening and surveillance of varices in patients with cirrhosis[J]. Clin Gastroenterol Hepatol,2019,17(1):26-29.
    [17] BERZIGOTTI A,SEIJO S,ARENA U,et al. Elastography,spleen size,and platelet count identify portal hypertension in patients with compensated cirrhosis[J]. Gastroenterology,2013,144(1):102-111. e1.
    [18] de ALCANTARA RV,YAMADA RM,CARDOSO SR,et al. Ultrasonographic predictors of esophageal varices[J]. J Pediatr Gastroenterol Nutr,2013,57(6):700-703.
    [19] TSAKNAKIS B,MASRI R,AMANZADA A,et al. Gall bladder wall thickening as non-invasive screening parameter for esophageal varices-a comparative endoscopic-sonographic study[J]. BMC Gastroenterol,2018,18(1):123.
    [20] PETZOLD G,TSAKNAKIS B,BREMER S,et al. Evaluation of liver stiffness by 2D-SWE in combination with non-invasive parameters as predictors for esophageal varices in patients with advanced chronic liver disease[J]. Scand J Gastroenterol,2019,54(3):342-349.
    [21] DUAN ZH,ZHOU SY,LI ZK,et al. Value of platelet count-togallbladder wall thickness ratio score in predicting esophageal varices in patients with liver cirrhosis[J]. J Clin Hepatol,2019,35(12):2716-2720.(in Chinese)段志辉,周胜云,李增魁,等.血小板计数/胆囊壁厚度对肝硬化食管静脉曲张的预测价值[J].临床肝胆病杂志,2019,35(12):2716-2720.
    [22] KIM SH,KIM YJ,LEE JM,et al. Esophageal varices in patients with cirrhosis:Multidetector CT esophagography—comparison with endoscopy[J]. Radiology,2007,242(3):759-768.
    [23] DENG H,QI X,GUO X. Computed tomography for the diagnosis of varices in liver cirrhosis:A systematic review and meta-analysis of observational studies[J]. Postgrad Med,2017,129(3):318-328.
    [24] LI Q,WANG R,GUO X,et al. Contrast-enhanced CT may be a diagnostic alternative for gastroesophageal varices in cirrhosis with and without previous endoscopic variceal therapy[J]. Gastroenterol Res Pract,2019,2019:6704673.
    [25] WAN S,WEI Y,YU H,et al. Computed tomographic portography with esophageal variceal measurements in the evaluation of esophageal variceal severity and assessment of esophageal variceal volume efficacy[J]. Acad Radiol,2020,27(4):528-535.
    [26] ZHOU HY,CHEN TW,ZHANG XM,et al. Diameters of left gastric vein and its originating vein on magnetic resonance imaging in liver cirrhosis patients with hepatitis B:Association with endoscopic grades of esophageal varices[J]. Hepatol Res,2014,44(10):e110-e117.
    [27] MOTOSUGI U,ROLDN-ALZATE A,BANNAS P,et al. Fourdimensional flow MRI as a marker for risk stratification of gastroesophageal varices in patients with liver cirrhosis[J]. Radiology,2019,290(1):101-107.
    [28] MAURICE JB,BRODKIN E,ARNOLD F,et al. Validation of the Baveno VI criteria to identify low risk cirrhotic patients not requiring endoscopic surveillance for varices[J]. J Hepatol,2016,65(5):899-905.
    [29] LLOP E,LOPEZ M,de la REVILLA J,et al. Validation of noninvasive methods to predict the presence of gastroesophageal varices in a cohort of patients with compensated advanced chronic liver disease[J]. J Gastroenterol Hepatol,2017,32(11):1867-1872.
    [30] GIUFFRM,MACOR D,MASUTTI F,et al. Spleen stiffness probability index(SSPI):A simple and accurate method to detect esophageal varices in patients with compensated liver cirrhosis[J]. Ann Hepatol,2020,19(1):53-61.
    [31] SILVA MJ,BERNARDES C,PINTO J,et al. Baveno VI recommendation on avoidance of screening endoscopy in cirrhotic patients:Are we there yet?[J]. GE Port J Gastroenterol,2017,24(2):79-83.
    [32] AUGUSTIN S,PONS M,MAURICE JB,et al. Expanding the Baveno VI criteria for the screening of varices in patients with compensated advanced chronic liver disease[J]. Hepatology,2017,66(6):1980-1988.
    [33] TOSETTI G,PRIMIGNANI M,LA MURA V,et al. Evaluation of three“beyond Baveno VI”criteria to safely spare endoscopies in compensated advanced chronic liver disease[J]. Dig Liver Dis,2019,51(8):1135-1140.
    [34] JANGOUK P,TURCO L,de OLIVEIRA A,et al. Validating,deconstructing and refining Baveno criteria for ruling out high-risk varices in patients with compensated cirrhosis[J]. Liver Int,2017,37(8):1177-1183.
    [35] CASTRA L,FOUCHER J,BERNARD PH,et al. Pitfalls of liver stiffness measurement:A 5-year prospective study of 13,369 examinations[J]. Hepatology,2010,51(3):828-835.
    [36] ELKRIEF L,RAUTOU PE,RONOT M,et al. Prospective comparison of spleen and liver stiffness by using shear-wave and transient elastography for detection of portal hypertension in cirrhosis[J]. Radiology,2015,275(2):589-598.
    [37] BERZIGOTTI A. Non-invasive evaluation of portal hypertension using ultrasound elastography[J]. J Hepatol,2017,67(2):399-411.
    [38] MORISHITA N,HIRAMATSU N,OZE T,et al. Liver stiffness measurement by acoustic radiation force impulse is useful in predicting the presence of esophageal varices or high-risk esophageal varices among patients with HCV-related cirrhosis[J]. J Gastroenterol,2014,49(7):1175-1182.
    [39] HEO JY,KIM BK,PARK JY,et al. Multicenter retrospective risk assessment of esophageal variceal bleeding in patients with cirrhosis:An acoustic radiation force impulse elastography-based prediction model[J]. Gut Liver,2019,13(2):206-214.
    [40] VENKATESH SK,YIN M,EHMAN RL. Magnetic resonance elastography of liver:Technique,analysis,and clinical applications[J]. J Magn Reson Imaging, 2013, 37(3):544-555.
    [41] HUWART L,SEMPOUX C,VICAUT E,et al. Magnetic resonance elastography for the noninvasive staging of liver fibrosis[J]. Gastroenterology,2008,135(1):32-40.
    [42] MATSUI N,IMAJO K,YONEDA M,et al. Magnetic resonance elastography increases usefulness and safety of non-invasive screening for esophageal varices[J]. J Gastroenterol Hepatol,2018,33(12):2022-2028.
    [43] CASTRO FILHO EC,PERAZZO H,GUIMARAES R,et al. Reliability and safety of transnasal compared to conventional endoscopy for detecting oesophageal varices in cirrhotic patients[J]. Liver Int,2018,38(8):1418-1426.
    [44] EISEN GM,ELIAKIM R,ZAMAN A,et al. The accuracy of PillCam ESO capsule endoscopy versus conventional upper endoscopy for the diagnosis of esophageal varices:A prospective three-center pilot study[J]. Endoscopy,2006,38(1):31-35.
    [45] CHAVALITDHAMRONG D,JENSEN DM,SINGH B,et al. Capsule endoscopy is not as accurate as esophagogastroduodenoscopy in screening cirrhotic patients for varices[J]. Clin Gastroenterol Hepatol,2012,10(3):254-258. e1.
    [46] BEG S,CARD T,WARBURTON S,et al. Diagnosis of Barrett’s esophagus and esophageal varices using a magnetically assisted capsule endoscopy system[J]. Gastrointest Endosc,2020,91(4):773-781. e1.
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