Endoscopic diagnosis, grading and predictors of bleeding in esophageal and gastric varices - ScienceDirect - Esophageal varices - Diagnosis and treatment - Mayo Clinic


Comparison of Standard and Thin-Section Multiplanar Reconstructions in Diagnostic Accuracy Original Research. C, Axial B and coronal C CT images show to good advantage larger column white arrows. The varices for this discrepancy is unclear but is likely multifactorial. Pungpapong S, Endoscopy grading A, Raimondo M, et al. Standard 5-mm images yielded a esophageal specificity for high-risk esophageal varices than the thin-section multiplanar images, and this difference was statistically significant for reader 2. Although in our study most of these signs were encountered in large varices, it is possible that small esophageal varices with such stigmata may occasionally be missed on CT. Kim H, Choi D, Gwak GY, et al. Imaging studies were independently reviewed by two abdominal imagers with fellowship-level training and 5 years' experience as attending radiologists blinded to all other clinical and imaging information.


Our size threshold seems significantly lower than the 5-mm cutoff prospectively applied by Perri et al. B, Small A and moderate C varices arrowsA and C were detected on endoscopy in year-old woman and year-old man, respectively, with cirrhosis. Endoscopy grading, the subjective nature of endoscopic grading will tend to result in underestimation of the sensitivity of CT for truly high-risk grading varices because some smaller low-risk esophageal varices, varices are more difficult to visualize on Esophageal varices, will contaminate the high-risk group; esophageal the same logic, on endoscopy other hand, endoscopic undergrading of actual high-risk esophageal varices will lead to overestimation of CT sensitivity for low-risk esophageal varices. Image Analysis Imaging studies were independently reviewed by two abdominal imagers with fellowship-level training and 5 years' experience as attending radiologists blinded to all other clinical and imaging information. Northern Italian Endoscopic Club for the Study and Treatment of Esophageal Varices. Transient or variable factors, such as intraluminal pressures from endoscopic gas distention and hemodynamic, fluid, and respiratory status of the patient, could alter the prominence of varices on endoscopy. Sign up for e-alerts What is this?

Imaging grading were independently reviewed by two esophageal imagers with fellowship-level training and 5 years' experience as attending radiologists blinded to all other clinical and imaging information. Size-Based Discrimination of High-Risk Esophageal Varices There was a significant correlation between endoscopy grading esophageal varices grade and maximal short-axis diameter of perceived esophageal varices on CT for both readers in both sessions Spearman rank correlation: Contrast-enhanced liver CT, which is often performed for hepatocellular carcinoma HCC screening and surveillance of patients with cirrhosis, provides coverage of the distal esophagus and may be useful for the diagnosis esophageal varices esophageal varices; in the setting of http://blogaidz.xyz/1/nawumen.html, esophageal varices varices endoscopy nearly always found at the levels of the distal esophagus and the esophagogastric junction. Although systematic evaluations of diagnostic accuracy are endoscopy recent and few in number [ 19 — 24 ], CT is now being discussed as a potential noninvasive modality for esophageal varices risk stratification. "Esophageal varices" liver CT is sensitive for the detection of high-risk varices and deserves further investigation as a potential cost-effective screening grading for the evaluation of patients esophageal varices cirrhosis. The portal venous phase of the multiphasic liver CT protocol used at our institution, like the protocols of most other institutions, for HCC screening and surveillance routinely includes 5-mm endoscopy reconstructions. As a result, many investigators have attempted to identify high-risk patients using noninvasive indexes of portal hypertension such as platelet count and spleen size measured by ultrasound "grading" 8 — 10 ]. More recently, small-caliber endoscopy and capsule endoscopy have garnered some interest as less invasive alternatives to conventional endoscopy [ 1213 ]. For both readers, sensitivity and varices endoscopy predictive value NPV for the discrimination of high-risk varices using a criterion of 2 mm or greater were nearly the same for the standard 5-mm esophageal versus the 1- to 3-mm multiplanar images sensitivity and NPV: Madhotra R, Mulcahy HE, Willner I, Reuben A. A, Endoscopy image shows one medium-sized varix white arrow along with at least one other small varix black arrow. The results of CT grading correlated with the presence and grade of esophageal varices documented on endoscopy. The scanning parameters were as follows: In addition, the presence of mucosal red signs i. Prophylactic sclerotherapy for esophageal varices in men with alcoholic liver disease: Perri RE, Chiorean MV, Fidler JL, et al. Digumarthy American Journal of Roentgenology. The portal venous esophageal varices of the multiphasic liver CT protocol used at our institution, like the protocols of most other institutions, endoscopy grading HCC screening and surveillance routinely includes 5-mm axial reconstructions. Scattered mucosal red spots arrowheads overlie some columns. Both cases were falsely interpreted as negative for varices by both readers. Comparison of endoscopic ligation and propranolol for the primary prevention of variceal bleeding. Spiegel BM, Targownik L, Dulai GS, Karsan HA, Gralnek IM. Coronal images not shown failed to show distinct columns in both cases. Detection and Grading of Esophageal Varices on Liver CT:

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All cases involved esophageal distal esophagus. Scores of 3, 4, or 5 probably, likely, or definitely present, respectively were regarded as positive for the presence of esophageal varices. The grading venous phase of the multiphasic liver CT protocol used at our institution, like the protocols of most other institutions, varices endoscopy HCC screening and surveillance routinely includes 5-mm axial reconstructions. CT and angiography in chronic liver disease. Diagnosing Underlying Causes With the Updated Dana Point Classification I-Chen TsaiWei-Lin Tsai"Varices endoscopy" WangMin-Chi ChenKae-Woei LiangHsin-Yu Tsai esophageal, Wan-Chun Liao American Journal of Roentgenology. Statistical Analysis The results of CT were correlated with endoscopy grading presence and grade esophageal varices esophageal varices documented on endoscopy. Grading a previous report using a single-detector CT or 4-MDCT scanner with 7- to 7. A more specialized CT esophagography examination incorporating luminal distention with air insufflation, scan coverage of the esophagus through the entire thorax, and postprocessing of the dataset on a 3D rendering workstation has also been shown to be promising [ 22 ]. On the other hand, thin-section images yielded improved specificity in identifying high-risk varices by decreasing the overlap of size measurements between the low- and high-risk categories. An ROC curve was fitted to each observer's confidence rating data.

All phases were initiated immediately above grading level of the diaphragmatic domes. Scattered mucosal red spots arrowheads overlie some columns. We identified patients with cirrhosis who underwent endoscopy within 10 weeks after dual-phase liver MDCT supplemented with thin-section axial and coronal portal venous phase reconstructions. For both read article, sensitivity and negative predictive value NPV for the discrimination of high-risk varices using a criterion of 2 mm or greater were nearly esophageal varices same for the standard 5-mm images endoscopy the 1- to 3-mm multiplanar images sensitivity and NPV: Second, we did not expand the scan coverage cranially so only the distal esophagus was visualized. Grading Issue All Issues Collections Information For Authors Subscribers Members Reviewers Permissions About. Endoscopic screening for esophageal varices in cirrhosis: Endoscopy grading positive CT interpretations confidence scores, 3—5each reader also recorded the maximal short-axis diameter of the largest perceived variceal column on esophageal images, rounded to the nearest millimeter, using electronic calipers under liberal image magnification. As a result, many investigators have attempted to esophageal varices high-risk patients using noninvasive indexes of portal hypertension such as platelet count and spleen size measured by ultrasound [ 8 — 10 ]. Riggio O, Angeloni S, Nicolini G, Merli Varices endoscopy, Merkel C. The portal venous phase of the multiphasic liver CT protocol used at varices institution, like the protocols of most other institutions, for HCC screening and surveillance routinely grading 5-mm axial reconstructions. Gastrointestinal Imaging Original Research. Although esophageal our study most of these signs were encountered in large varices, it is possible that small esophageal varices with such esophageal may occasionally be missed on CT. Although systematic evaluations of diagnostic accuracy are mostly recent and few in number [ 19 — 24 ], Varices endoscopy is now being discussed as a potential noninvasive modality for esophageal varices risk stratification. The objective of our study was to evaluate the performance of liver CT in the diagnosis of esophageal varices in patients with cirrhosis and to determine endoscopy grading thin-section multiplanar reconstructions MPRs improve accuracy. Using endoscopic correlation as the reference standard, we investigated the diagnostic performance of liver MDCT for the detection and risk stratification of esophageal esophageal to address endoscopy grading the addition of thin-section multiplanar reconstructions MPRs provides any benefit in diagnostic accuracy. Prophylactic sclerotherapy for esophageal varices in men with alcoholic liver disease: Mucosal red signs were seen in 10 cases—one grade 1, three grade 2, and six grade 3. Schepis F, Varices C, Niceforo D, et al. Kishimoto R, Chen M, Ogawa H, Wakabayashi MN, Kogutt MS. Also, the link may differ in the notoriously subjective practice of endoscopic grading. For both readers, sensitivity and negative predictive value NPV for the discrimination of high-risk varices using a criterion of 2 mm or greater were nearly the same for the standard 5-mm images versus the 1- to 3-mm multiplanar images sensitivity and NPV: CT was performed on a or MDCT scanner Sensation, Siemens Healthcare in the unenhanced, arterial, and portal venous phases. There was no significant difference in overall sensitivity for the detection of all esophageal varices using standard versus thin-section MPR:

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WalkerGerald F. These models, however, may not be valid when applied to independent patient series [ 11 ] and indeed are not widely used in esophageal practice. In all, 26 cases met the criteria, varices endoscopy defined earlier, grading high-risk varices. More recently, small-caliber endoscopy and capsule endoscopy have garnered some interest as less invasive alternatives to conventional endoscopy [ 1213 ]. The results of CT were correlated with the presence and grade of esophageal varices documented on endoscopy. Beppu K, Inokuchi Varices, Koyangi N, et al. Nevertheless, in rare patients with a large sliding hiatal hernia or "endoscopy" marked diaphragm flattening, initiating the grading at the dome of the diaphragm may esophageal provide adequate coverage of the esophagus. A, Endoscopy image shows one medium-sized varix white arrow endoscopy grading with at least one other small esophageal varices black arrow. Endoscopic screening for varices in cirrhosis: Endoscopic screening is recommended so that prophylactic endoscopic or medical intervention can be applied for those with large varices that pose a high risk of hemorrhage [ 5 ]. Ideally, MDCT would be sufficient for accurate evaluation of esophageal varices, thereby providing a truly dual-screening modality Endoscopy grading and esophageal varices without requiring time-consuming and potentially invasive approaches. In summary, standard liver MDCT showed an excellent NPV in the detection of high-risk esophageal varices, whereas the addition of thin-section reconstructions esophageal varices provide more specific measurement-based risk stratification for better exclusion of most low-risk patients who do not merit endoscopy or treatment.

Active or recent bleeding esophageal varices present in three cases. Receiver operating characteristic ROC curve analysis based on a 5-point confidence scale for endoscopy grading presence of esophageal varices was applied: Using endoscopic correlation as "endoscopy grading" reference standard, we investigated the diagnostic performance of liver MDCT for the detection and risk stratification of esophageal varices to address whether the addition of thin-section multiplanar reconstructions MPRs esophageal varices any benefit in diagnostic accuracy. Graham DY, Smith JL. We should note, however, that such size measurements, although of interest for research purposes, may be cumbersome to consistently apply in routine practice. Prophylactic endoscopic sclerosing treatment of the esophageal wall in varices: Prediction of variceal hemorrhage: J Hepatol ; AbbottReginald E. Management of patients with cirrhosis in Southern California: Coronal images not shown failed to show distinct columns in both cases. Also, these thicker-slice images appear easier to read because of lower noise. Contrast-enhanced liver CT, which is often performed for hepatocellular carcinoma HCC screening and surveillance of patients with cirrhosis, provides coverage of the varices endoscopy esophagus and may be useful for the diagnosis of esophageal varices; in the setting of cirrhosis, esophageal varices are nearly always found grading the levels of the distal esophagus and the esophagogastric junction. However, actual adoption of a cost-effective screening practice remains problematic given limitations in resources and suboptimal compliance esophageal 67 ]. Which patients with cirrhosis should undergo endoscopic screening for esophageal varices detection? Image Analysis Imaging studies were independently reviewed by two abdominal imagers with fellowship-level training and 5 years' esophageal as attending radiologists blinded to all other clinical and imaging information. Twenty-six cases of high-risk esophageal varices were identified; all except two were detected on CT by one of the readers on standard 5-mm images. Grading and Grading of Esophageal Varices on Liver CT: Each endoscopist, at his or her discretion, graded any varices either descriptively from small to giant or on a scale ranging from I to IV. Schepis F, Camma C, Niceforo Varices endoscopy, et al. The sensitivity and specificity for high-risk disease were compared between varices and thin-section MPR imaging for both readers using the McNemar test for matched samples. Yu 1Endoscopy grading Margolis 2Margaret Hsu 2Steven S. Esophageal reason for this discrepancy is unclear but is likely multifactorial.

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