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Non-invasive tests for the detection of oesophageal varices in compensated cirrhosis: systematic review and meta-analysis

Sami, SS; Harman, D; Ragunath, K; Bohning, D; Parkes, J; Guha, IN; (2018) Non-invasive tests for the detection of oesophageal varices in compensated cirrhosis: systematic review and meta-analysis. United European Gastroenterology Journal , 6 (6) pp. 806-818. 10.1177/2050640618767604. Green open access

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Abstract

INTRODUCTION: Conclusive data on the accuracy and clinical applicability of non-invasive screening tests for oesophageal varices (OV) in patients with compensated cirrhosis remain lacking. We conducted this study to identify currently available tests, estimate their diagnostic performance and then exemplify how these could be utilized in clinical practice. MATERIALS AND METHODS: A systematic literature search was performed to identify all primary studies that reported accuracy using oesophagogastroduodenoscopy (OGD) as the gold standard. Sources searched included Ovid MEDLINE, Ovid EMBASE and The Cochrane Library databases. RESULTS: Twenty-one studies with a total of 2471 patients were identified. Several tests were evaluated in more than three studies. Platelet count/spleen diameter ratio (PSR) had the highest summary area under the curve for detection of any size OV of 0.85 (95% confidence interval 0.78–0.92). At a cut-off of 909 (n = 4 studies) and prevalence rates of 10, 20, 30, 40 and 50% for OV, PSR screening correctly avoided the need for OGD in 70, 62, 55, 47 and 39% of patients, respectively. CONCLUSIONS: PSR appears to be the most accurate and validated non-invasive screening test for OV in patients with compensated cirrhosis. At a cut-off of 909, PSR could be clinically useful to avoid OGDs in a significant proportion of patients.

Type: Article
Title: Non-invasive tests for the detection of oesophageal varices in compensated cirrhosis: systematic review and meta-analysis
Open access status: An open access version is available from UCL Discovery
DOI: 10.1177/2050640618767604
Publisher version: https://doi.org/10.1177%2F2050640618767604
Language: English
Additional information: This version is the author accepted manuscript. For information on re-use, please refer to the publisher’s terms and conditions.
Keywords: Diagnosis; non-invasive markers; platelet to spleen ratio; liver stiffness measurement
UCL classification: UCL
UCL > Provost and Vice Provost Offices > School of Life and Medical Sciences
UCL > Provost and Vice Provost Offices > School of Life and Medical Sciences > Faculty of Medical Sciences
UCL > Provost and Vice Provost Offices > School of Life and Medical Sciences > Faculty of Medical Sciences > Div of Surgery and Interventional Sci
URI: https://discovery.ucl.ac.uk/id/eprint/10061281
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