Bangaru Saroja, Benhammou Jihane N, Tabibian James H
Internal Medicine, Gastroenterology, University of California at Los Angeles, Los Angeles, CA 90025, United States.
The Vatche and Tamar Manoukian Division of Digestive Diseases, University of California at Los Angeles, Los Angeles, CA 90095, United States.
World J Hepatol. 2020 Nov 27;12(11):908-918. doi: 10.4254/wjh.v12.i11.908.
The primary purpose of variceal screening in patients with cirrhosis is to detect gastroesophageal varices at high risk of hemorrhage and implement preventative intervention(s). It was previously recommended that all patients with cirrhosis undergo initial and periodic longitudinal variceal screening upper endoscopy. However, there has been growing interest and methods to identify patients with cirrhosis who may not have clinically significant portal hypertension and therefore be unlikely to have varices requiring intervention or benefit from upper endoscopy. Because the population of patients with compensated advanced chronic liver disease continues to grow, it is neither beneficial nor cost-effective to perform endoscopic variceal screening in all patients. Therefore, there is ongoing research into the development of methods to non-invasively risk stratify patients with cirrhosis for the presence of high-risk esophageal varices and effectively limit the population that undergoes endoscopic variceal screening. This is particularly important and timely in light of increasing healthcare reform and barriers to healthcare. In this review, we discuss and compare, with respect to test characteristics and clinical applicability, the available methods used to non-invasively predict the presence of esophageal varices.
肝硬化患者进行静脉曲张筛查的主要目的是检测有高出血风险的胃食管静脉曲张，并实施预防性干预措施。此前建议所有肝硬化患者接受初次及定期的纵向静脉曲张筛查——上消化道内镜检查。然而，人们越来越关注并采用多种方法来识别那些可能没有临床上显著门静脉高压、因此不太可能有需要干预的静脉曲张或从上消化道内镜检查中获益的肝硬化患者。由于代偿期晚期慢性肝病患者群体持续增加，对所有患者进行内镜下静脉曲张筛查既无益处也不具有成本效益。因此，目前正在进行研究，以开发对肝硬化患者进行非侵入性风险分层的方法，以确定是否存在高危食管静脉曲张，并有效限制接受内镜下静脉曲张筛查的人群。鉴于医疗改革不断推进以及医疗保健面临的障碍，这一点尤为重要且时机恰当。在本综述中，我们就检测特征和临床适用性，讨论并比较了用于非侵入性预测食管静脉曲张存在的现有方法。
