The noninvasive diagnosis of esophageal varices and its application in clinical practice

TitreThe noninvasive diagnosis of esophageal varices and its application in clinical practice
Type de publicationArticle de revue
AuteurPateu, Etienne, Oberti, Frédéric , Calès, Paul
EditeurElsevier
TypeArticle scientifique dans une revue à comité de lecture
Année2018
LangueAnglais
DateFévrier 2018
Numéro1
Pagination6-16
Volume42
Titre de la revueClinics and research in hepatology and gastroenterology
ISSN2210-741X
Mots-clésBlood markers, cirrhosis, Elastometry, Esophageal varices, Noninvasive diagnosis, portal hypertension
Résumé en anglais

Here, we review recent improvements made to different noninvasive tests used for the diagnosis of esophageal varices (EV) in the light of the recent Baveno VI recommendation and with an emphasis on clinical application. Like for fibrosis tests, these noninvasive EV tests can be classified as direct markers when they provide a visualization of EV (including all imaging procedures like endoscopy or radiology) and as indirect markers when they do not (blood markers or elastometry). Clinical descriptors expressed as percentages, especially the spared endoscopy rate and the missed high-risk esophageal varices (HREV) rate, are more eloquent in this setting than classical statistical descriptors like accuracy. Single biomarkers are insufficient, generally due to a missed HREV rate exceeding the acceptable limit of 5% indicated in the Baveno VI consensus. Thus, biomarker combinations are currently garnering the most interest. The Baveno VI recommendation states that in alcoholic and viral cirrhoses, screening endoscopy can be safely set aside for patients with liver stiffness<20kPa and platelets>150G/L. The Baveno rule's mean missed HREV rate is<5% but its spared endoscopy rate is<20%. New combinations or stepwise algorithms show promise but must be validated. Going forward, the Baveno rule provides a simple noninvasive method to rule out HREV in clinical practice but the need for further research continues. The noninvasive diagnosis of HREV will be significantly improved by new, simple and affordable combinations.

URL de la noticehttp://okina.univ-angers.fr/publications/ua18787
DOI10.1016/j.clinre.2017.07.006
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https://www.sciencedirect.com/science/article/pii/S2210740117301821?via%...

Titre abrégéClin Res Hepatol Gastroenterol
Identifiant (ID) PubMed28870440