de Franchis Roberto
Department of Medical Sciences, University of Milan, Fondazione Ospedale IRCCS Maggiore Policlinico, Mangiagalli and Regina Elena, Milan, Italy.
J Hepatol. 2008 Oct;49(4):520-7. doi: 10.1016/j.jhep.2008.07.009. Epub 2008 Jul 26.
Current guidelines recommend screening all cirrhotic patients by endoscopy, to identify patients at risk of bleeding who should undergo prophylactic treatment. However, since the prevalence of varices in cirrhotic patients is variable, universal screening would imply a large number of unnecessary endoscopies and a heavy burden for endoscopy units. In addition, compliance to screening programs may be hampered by the perceived unpleasantness of endoscopy. Predicting the presence of oesophageal varices by non-invasive means might increase compliance and would permit to restrict the performance of endoscopy to those patients with a high probability of having varices. Over the years, several studies have addressed this issue by assessing the potential of biochemical, clinical and ultrasound parameters, transient elastography, CT scanning and video capsule endoscopy. The platelet count/spleen diameter ratio, CT scanning and video capsule endoscopy have shown promising performance characteristics, although none of them is equivalent to EGD. These methods are perceived by patients as preferable to endoscopy and thus might increase adherence to screening programs. Whether this will compensate for the lower sensitivity of these alternative techniques, and ultimately improve the outcomes if more patients undergo screening, is the crucial question that will have to be answered in the future.
当前指南建议对所有肝硬化患者进行内镜检查筛查，以识别有出血风险的患者，这些患者应接受预防性治疗。然而，由于肝硬化患者静脉曲张的患病率各不相同，普遍筛查将意味着大量不必要的内镜检查，给内镜科室带来沉重负担。此外，内镜检查带来的不适感可能会妨碍患者对筛查项目的依从性。通过非侵入性手段预测食管静脉曲张的存在可能会提高依从性，并允许将内镜检查仅用于那些静脉曲张可能性高的患者。多年来，多项研究通过评估生化、临床和超声参数、瞬时弹性成像、CT扫描和视频胶囊内镜的潜力来解决这一问题。血小板计数/脾脏直径比值、CT扫描和视频胶囊内镜已显示出有前景的性能特征，尽管它们都不等同于上消化道内镜检查。患者认为这些方法比内镜检查更可取，因此可能会提高对筛查项目的依从性。这些替代技术较低的敏感性是否会因此得到弥补，以及如果更多患者接受筛查最终是否会改善结果，是未来必须回答的关键问题。
