Barritt A S, Arguedas M R
Division of Gastroenterology and Hepatology, University of North Carolina-Chapel Hill, NC 27599-7080, United States.
Dig Liver Dis. 2009 Sep;41(9):676-82. doi: 10.1016/j.dld.2009.01.002. Epub 2009 Feb 28.
Guidelines recommend screening for gastroesophageal varices. Regional studies suggest screening is underutilized, but information from across the United States is unavailable. We explored practice patterns and adherence to guidelines in a random sample of physicians and sought to define whether differences existed according to practice type, setting and years of practice.
Surveys were randomly sent to 600 gastroenterologists and hepatologists. Descriptive data is presented as percentage and comparisons were performed by chi-square analysis. Significance was defined at a p value <0.05.
180 completed surveys were returned. Mean age was 48.9+/-10 years and 87% were male. 50% were community-based and 74% had been in practice >10 years. 53% (78% hepatologists versus 45% of gastroenterologists) screened consistently (>75% of the time), (p<0.001). No differences in screening frequency were found according to practice setting or years in practice. 62% screened all cirrhotics whereas 38% screened based on clinical characteristics. In patients without gastroesophageal varices, 60% repeated esophagogastroduodenoscopy in 2-3 years. In those with small gastroesophageal varices, repeat esophagogastroduodenoscopy was recommended in 1-2 years by 73%. In patients with small and large varices, 40% and 54% of physicians respectively, recommended prophylaxis. 6% of physicians recommend prophylaxis regardless of the presence or size of varices.
Screening for varices is under-implemented. Many screened based on clinical findings that have not been shown to reliably predict high-risk gastroesophageal varices. Continued education and removal of financial barriers to screening are central to increasing screening rates and improving patient outcomes.
指南推荐对食管胃静脉曲张进行筛查。区域研究表明筛查未得到充分利用，但全美范围内的相关信息尚不可知。我们在随机抽取的医生样本中探究了实践模式及对指南的遵循情况，并试图确定是否因实践类型、环境及从业年限存在差异。
随机向600名胃肠病学家和肝病学家发送调查问卷。描述性数据以百分比呈现，比较采用卡方分析。显著性定义为p值<0.05。
共收回180份完整调查问卷。平均年龄为48.9±10岁，87%为男性。50%为社区医生，74%从业超过10年。53%（肝病学家为78%，胃肠病学家为45%）始终进行筛查（>75%的时间），（p<0.001）。根据实践环境或从业年限，筛查频率未发现差异。62%对所有肝硬化患者进行筛查，而38%根据临床特征进行筛查。在无食管胃静脉曲张的患者中，60%在2至3年内重复进行食管胃十二指肠镜检查。在有小食管胃静脉曲张的患者中，73%建议在1至2年内重复进行食管胃十二指肠镜检查。在有小静脉曲张和大静脉曲张的患者中，分别有40%和54%的医生建议进行预防。6%的医生无论静脉曲张的有无或大小均建议进行预防。
静脉曲张筛查实施不足。许多人根据尚未被证明能可靠预测高危食管胃静脉曲张的临床发现进行筛查。持续教育并消除筛查的经济障碍对于提高筛查率和改善患者预后至关重要。
