Noninvasive Procedures Show Promise for Esophageal Bleeding
They offer cost-effective look at dilated veins seen with cirrohosis but aren't sensitive enough
TUESDAY, May 6, 2008 (HealthDay News) -- New noninvasive methods to detect esophageal bleeding in people with cirrhosis show promise, according to two studies by Italian and American researchers.
About 25 percent of patients with cirrhosis suffer bleeding of esophageal varices, which are extremely dilated veins commonly seen with cirrhosis. Variceal bleeding can cause death within six weeks in up to 20 percent of cases.
It's recommended that all patients with cirrhosis be screened for varices. Those with medium to large varices can be treated with beta-blockers or band ligation to reduce their risk by 50 percent, according to background information in the study.
Endoscopy is the current gold standard for varices screening, but is invasive, uncomfortable and expensive, so researchers have been trying to develop other screening methods.
In a study of 290 patients, Italian researchers compared esophageal capsule endoscopy to esophago-gastro-duodenoscopy (EGD) ,and found that EGD was 15.6 percent more effective in diagnosing esophageal varices.
"We recommend that EGD be used to screen patients with cirrhosis for large esophageal varices. However, the minimal invasiveness, good tolerance and good agreement of capsule endoscopy with EGD might increase adherence to screening programs," the researchers wrote.
In another study of 102 patients, American researchers compared computerized tomographic (CT) scanning to endoscopic screening.
"CT was found to have an approximately 90 percent sensitivity in the identification of esophageal varices determined to be large on endoscopy, but only about 50 percent specificity," the researchers wrote. "The sensitivity of CT in detecting gastric varices was 87 percent."
They also found that patients preferred CT to endoscopy, and that CT was much more cost-effective.
The studies were published in the May issue of Hepatology.
The studies showed that both capsule endoscopy and CT could be good screening tools, but neither method showed adequate sensitivity for detecting large varices, Didier Lebrec, of the Hopital Beaujon, and colleagues wrote in an accompanying editorial.
"One third of patients with large varices would have been misdiagnosed by CT, and sensitivity for the capsule was only 78 percent, which is insufficient," they wrote. "Therefore replacing endoscopy with one of these two techniques would result in more misdiagnosed patients with large varices, which is not reasonable."
The MedlinePlus Medical Encyclopedia has more about bleeding esophageal varices.