Kovalak Mary, Lake Jeremy, Mattek Nora, Eisen Glenn, Lieberman David, Zaman Atif
Providence Portland Medical Center, Portland, Oregon, USA.
Gastrointest Endosc. 2007 Jan;65(1):82-8. doi: 10.1016/j.gie.2006.08.023.
The current guidelines for primary prophylaxis of variceal hemorrhage in cirrhotic patients recommend screening for varices with upper endoscopy (EGD). Utilization and outcomes of screening in clinical practice are unknown.
Our purpose was to determine the use of endoscopic variceal screening in diverse practice settings and to determine factors associated with the finding of esophageal varices.
Endoscopic reports generated by the Clinical Outcomes Research Initiative (CORI) repository were analyzed to determine the use, changes over time, and findings of screening upper endoscopies between January 1, 2000, and December 31, 2003.
Data from 68 CORI practices (70% community/17% academic/13% Veterans Affairs Medical Center [VAMC]) were evaluated.
A total of 1688 of 172,854 EGDs were performed for the purpose of screening for varices.
Overall, there was a linear increase in annual proportion of screening EGDs performed (P < .0001). A significantly greater proportion of variceal screening EGDs are performed in academic centers compared with VAMC and community practices. Varices were found in 881 screened patients (52.2%). Varices were found more often in Child-Pugh class B/C (71.9%) compared with Child-Pugh class A (42.7%) patients. Of those with varices found, patients with Child-Pugh class B/C were more likely to have large varices than were patients with Child-Pugh class A (P = .02).
A limitation of this study was the inability to determine the total number of cirrhotic patients cared for at each CORI site included in this study.
Endoscopic screening for varices represents a small proportion of all upper endoscopies performed. This proportion increased between 2000 and 2003. Varices were found more frequently in patients with more severe liver disease.
目前肝硬化患者静脉曲张出血一级预防指南推荐采用上消化道内镜检查（EGD）筛查静脉曲张。临床实践中筛查的应用情况及结果尚不清楚。
我们的目的是确定在不同实践环境中内镜下静脉曲张筛查的使用情况，并确定与食管静脉曲张发现相关的因素。
分析临床结局研究倡议（CORI）数据库生成的内镜报告，以确定2000年1月1日至2003年12月31日期间筛查性上消化道内镜检查的使用情况、随时间的变化以及检查结果。
评估了来自68个CORI医疗机构（70%为社区/17%为学术机构/13%为退伍军人事务医疗中心[VAMC]）的数据。
在172,854例EGD检查中，共有1688例是为了筛查静脉曲张而进行的。
总体而言，筛查性EGD检查的年度比例呈线性增加（P <.0001）。与VAMC和社区医疗机构相比，学术中心进行的静脉曲张筛查EGD检查比例显著更高。在881例接受筛查的患者中发现了静脉曲张（52.2%）。与Child-Pugh A级（42.7%）患者相比，Child-Pugh B/C级（71.9%）患者中静脉曲张的发现更为常见。在发现有静脉曲张的患者中，Child-Pugh B/C级患者比Child-Pugh A级患者更有可能出现大静脉曲张（P =.02）。
本研究的一个局限性是无法确定本研究中纳入的每个CORI机构所护理的肝硬化患者总数。
内镜下静脉曲张筛查占所有上消化道内镜检查的比例较小。这一比例在2000年至2003年期间有所增加。在肝病更严重的患者中静脉曲张的发现更为频繁。
