Large oesophageal varice screening by a sequential algorithm using a cirrhosis blood test and optionally capsule...

Area of Science:

• Hepatology
• Gastroenterology
• Diagnostic Imaging

Background:

• Screening for large oesophageal varices (LEV) is crucial for patients with cirrhosis.
• Current non-invasive screening methods require improvement for accuracy and efficiency.

Purpose of the Study:

• To develop and evaluate a novel non-invasive diagnostic algorithm, VariScreen, for improved LEV screening in cirrhosis.
• To compare the effectiveness of VariScreen against existing methods like oesophageal capsule endoscopy (ECE) and blood marker analyses.

Main Methods:

• A prospective study involving 287 cirrhosis patients.
• Utilized upper gastrointestinal endoscopy as the reference standard.
• Assessed CirrhoMeter (a blood test), oesophageal capsule endoscopy (ECE), and liver elastography.
• Developed the sequential VariScreen algorithm using multivariate analysis, incorporating CirrhoMeter and ECE.

Main Results:

• VariScreen achieved a diagnostic effectiveness of 66.4% for LEV, significantly outperforming CirrhoMeter and ECE.
• The VariScreen algorithm reduced the requirement for endoscopy by 69% compared to standard ECE use.
• Significantly spared ECE use by 38% and reduced missed LEV diagnoses by 87% in compensated cirrhosis patients.

Conclusions:

• The VariScreen algorithm offers a significant advancement in non-invasive LEV screening for cirrhosis.
• VariScreen enhances diagnostic accuracy while substantially reducing the need for invasive procedures and associated costs.
• Patient factors like ascites and Child-Pugh class influence the effectiveness of endoscopy sparing with VariScreen.