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

Roman E. Perri, Michael V. Chiorean, Jeff L. Fidler, Joel Garland Fletcher, Jayant A. Talwalkar, Linda Stadheim, Nilay D Shah, Patrick Sequeira Kamath

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Abstract

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.

Original languageEnglish (US)
Pages (from-to)1587-1594
Number of pages8
JournalHepatology
Volume47
Issue number5
DOIs
StatePublished - May 2008

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Esophageal and Gastric Varices
Varicose Veins
Endoscopy
Patient Preference
Cost-Benefit Analysis
Pathology
Costs and Cost Analysis
Gastrointestinal Endoscopy
Fibrosis
Tomography
Radiologists

ASJC Scopus subject areas

  • Hepatology

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A prospective evaluation of computerized tomographic (CT) scanning as a screening modality for esophageal varices. / Perri, Roman E.; Chiorean, Michael V.; Fidler, Jeff L.; Fletcher, Joel Garland; Talwalkar, Jayant A.; Stadheim, Linda; Shah, Nilay D; Kamath, Patrick Sequeira.

In: Hepatology, Vol. 47, No. 5, 05.2008, p. 1587-1594.

Research output: Contribution to journalArticle

Perri, Roman E. ; Chiorean, Michael V. ; Fidler, Jeff L. ; Fletcher, Joel Garland ; Talwalkar, Jayant A. ; Stadheim, Linda ; Shah, Nilay D ; Kamath, Patrick Sequeira. / A prospective evaluation of computerized tomographic (CT) scanning as a screening modality for esophageal varices. In: Hepatology. 2008 ; Vol. 47, No. 5. pp. 1587-1594.
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