NDLI: A prospective evaluation of computerized tomographic (CT) scanning as a screening modality for esophageal varices.

Content Provider	World Health Organization (WHO)-Global Index Medicus
Author	Perri, Roman E. Chiorean, Michael V. Fidler, Jeff L. Fletcher, Joel G. Talwalkar, Jayant A. Stadheim, Linda Shah, Nilay D. Kamath, Patrick S.
Description	Country affiliation: United States Author Affiliation: Perri RE ( Advanced Liver Diseases Study Group, Miles and Shirley Fiterman Center for Digestive Diseases, Mayo Clinic, Rochester, MN 55905, USA.)
Abstract	UNLABELLED: Patients with cirrhosis require endoscopic screening for large esophageal varices. The aims of this study were to determine the cost-effectiveness and patient preferences of a strategy employing abdominal computerized tomography (CT) as the initial screening test for identifying large esophageal varices. In a prospective evaluation,102 patients underwent both CT and endoscopic screening for gastroesophageal varices. Two radiologists read each CT independently; standard upper gastrointestinal endoscopy was the reference standard. Agreement between radiologists, and between endoscopists regarding size of varices was determined using kappa statistic. Cost-effectiveness analysis was performed to determine the optimal screening strategy for varices. Patient preference was assessed by questionnaire. CT was found to have approximately 90% sensitivity in the identification of esophageal varices determined to be large on endoscopy, but only about 50% specificity. The sensitivity of CT in detecting gastric varices was 87%. In addition, a significant number of gastric varices, peri-esophageal varices, and extraluminal pathology were identified by CT that were not identified by endoscopy. Patients overwhelmingly preferred CT over endoscopy. Agreement between radiologists was good regarding the size of varices (Kappa = 0.56), and exceeded agreement between endoscopists (Kappa = 0.36). Use of CT as the initial screening modality for the detection of varices was significantly more cost-effective compared to endoscopy irrespective of the prevalence of large varices. CONCLUSION: Abdominal CT as the initial screening test for varices could be cost-effective. CT also permits evaluation of extra-luminal pathology that impacts management.
File Format	HTM / HTML
ISSN	02709139
Issue Number	5
Volume Number	47
e-ISSN	15273350
Journal	Hepatology
Language	English
Publisher	Wiley
Publisher Date	2008-05-01
Publisher Place	United States
Access Restriction	Subscribed
Subject Keyword	Discipline Hepatology Esophageal And Gastric Varices Tomography, X-ray Computed Methods Adult Aged Contrast Media Endoscopy Classification Etiology Pathology Female Humans Liver Cirrhosis Complications Liver Diseases Male Mass Screening Middle Aged Patient Selection Reproducibility Of Results Journal Article Research Support, Non-u.s. Gov't
Content Type	Text
Resource Type	Article
Subject	Hepatology

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