Farber Evgeny, Fischer Doron, Eliakim Rami, Beck-Razi Nira, Engel Ahuva, Veitsman Ella, Chermesh Irit, Yassin Kamel, Gaitini Diana, Libes Michael, Linn Shai, Soboh Soboh, Baruch Yaacov
Liver Unit, Rambam Medical Center, Efron St, Haifa 31096, Israel.
Radiology. 2005 Nov;237(2):535-40. doi: 10.1148/radiol.2372041631.
To prospectively evaluate the accuracy of esophagography with barium in diagnosis of esophageal varices (EV) in patients with compensated cirrhosis, with endoscopic gastroduodenoscopy as the reference standard.
In this study, which was approved by the local Helsinki Committee and in which all patients consented to participate, 61 patients with cirrhosis (34 men, 27 women; mean age, 61 years; range, 36-76 years) received a diagnosis clinically or with liver biopsy. In 87% (n = 53) of patients, Child-Pugh classification was A; in 13% (n = 8), Child-Pugh classification was B. They were evaluated with endoscopic gastroduodenoscopy, according to Japanese general criteria. Esophagography was performed within 3 weeks of endoscopic gastroduodenoscopy, and EV were assigned grades as follows: 0, no EV were seen; 1, EV manifested as very mild irregularities of the folds; and 2, the irregularity of the folds (EV) was clearly present. They were also assigned grades for shape and size: grade F0, no EV detected; grade F1, small straight EV; grade F2, slightly enlarged tortuous EV occupying less than one-third of esophageal lumen; and grade F3, large coil-shaped EV that occupied more than one-third of esophageal lumen. The sensitivity and specificity and positive and negative predictive values of esophagography for identification of each grade of EV were calculated separately, as was the 95% confidence interval.
All large EV (grades F2 and F3) were diagnosed at esophagography. Sensitivity declined with small EV (grade F1) to 71. The overall sensitivity of esophagography was 89% (95% confidence interval: 75.9%, 96.5%), the overall specificity was 83% (95% confidence interval: 64.5%, 94.7%), the overall positive predictive value was 89%, and the overall negative predictive value was 83% (95% confidence interval: 64.5%, 94.7%). Overall accuracy was 87%.
Esophagography is highly accurate in diagnosis of EV and can be considered a viable noninvasive alternative for determination of patients who should be selected for prophylactic treatment.
以前瞻性方式，以内镜下胃十二指肠镜检查作为参考标准，评估钡剂食管造影对代偿期肝硬化患者食管静脉曲张（EV）的诊断准确性。
本研究经当地赫尔辛基委员会批准，所有患者均同意参与。61例肝硬化患者（34例男性，27例女性；平均年龄61岁；范围36 - 76岁）经临床诊断或肝活检确诊。87%（n = 53）的患者Child-Pugh分级为A；13%（n = 8）的患者Child-Pugh分级为B。根据日本通用标准，对患者进行内镜下胃十二指肠镜检查评估。在进行内镜下胃十二指肠镜检查后的3周内进行食管造影，将EV分为以下等级：0级，未见EV；1级，EV表现为非常轻微的皱襞不规则；2级，明显存在皱襞不规则（EV）。还对其形状和大小进行分级：F0级，未检测到EV；F1级，小的直形EV；F2级，轻度扩张迂曲的EV，占据食管腔不到三分之一；F3级，大的盘绕形EV，占据食管腔超过三分之一。分别计算食管造影对各等级EV识别的敏感性、特异性、阳性预测值和阴性预测值，以及95%置信区间。
所有大的EV（F2级和F3级）在食管造影中均被诊断出来。对于小的EV（F1级），敏感性降至71。食管造影的总体敏感性为89%（95%置信区间：75.9%，96.5%），总体特异性为83%（95%置信区间：64.5%，94.7%），总体阳性预测值为89%，总体阴性预测值为83%（95%置信区间：64.5%，94.7%）。总体准确率为87%。
食管造影对EV的诊断具有高度准确性，可被视为确定应选择进行预防性治疗患者的一种可行的非侵入性替代方法。
