Esophageal Varices Screening Needs Improvement
Drawbacks seen for standard endoscopy, capsule endoscopy, computed tomography
THURSDAY, May 1 (HealthDay News) -- In patients with cirrhosis, two non-invasive methods for detecting esophageal varices -- capsule endoscopy and abdominal computed tomography (CT) -- are safe and well tolerated compared to standard endoscopy. But their sensitivity for detecting large varices is unsatisfactory, according to three studies and an accompanying editorial published in the May issue of Hepatology.
In one study, Roman E. Perri, M.D., of the Mayo Clinic in Rochester, Minn., and colleagues compared CT and standard endoscopy in 102 patients. Compared to standard endoscopy, they found that CT had about a 90 percent sensitivity but only a 50 percent specificity in the identification of large esophageal varices. In a second study, Roberto de Franchis, M.D., of the University of Milan, Italy, and colleagues compared capsule endoscopy and standard endoscopy in 288 patients. Compared to standard endoscopy, they found that capsule endoscopy had an overall agreement of 85.8 percent for detecting esophageal varices.
In a third study, Guadalupe Garcia-Tsao, M.D., of the Yale University School of Medicine in New Haven, Conn., and colleagues summarized the results of a 2008 Endpoints Single Topic Conference on "Portal Hypertension and Variceal Bleeding -- Unresolved Issues." The researchers concluded that capsule endoscopy needs further study to better define its reproducibility, reliability and accuracy.
"In conclusion, the gold standard has numerous drawbacks and the perfect screening tool has not been found," state the authors of an accompanying editorial.