Moctezuma-Velazquez Carlos, Abraldes Juan G
Division of Gastroenterology (Liver Unit), University of Alberta, Zeidler Ledcor Centre, 8540 112 St NW, Edmonton, AB, T6G 2X8, Canada.
Curr Gastroenterol Rep. 2025 Mar 29;27(1):26. doi: 10.1007/s11894-025-00976-6.
tTo assess the evolving role of endoscopy assessment for esophageal varices in cirrhosis.
The approach to screening endoscopy for varices has significantly changed in the last 10 years with the refinement of non-diagnostic tests. Non-invasive diagnostic methods have reduced the need of upper endoscopies for variceal screening in patients with compensated cirrhosis, focusing primarily on those with ambiguous risk assessments or contraindications to non-selective beta-blockers (NSBBs). In contrast, decompensated cirrhosis patients require more frequent endoscopic evaluations due to their heightened risk of complications and the potential benefit of combination therapy (NSBBs + variceal ligation). In patients with hepatocellular carcinoma (HCC) the performance of non-invasive tests is suboptimal and most patients require endoscopy. Emerging applications of artificial intelligence (AI) can assist in patient triage and the interpretation of endoscopic findings, potentially improving care. Further research is essential to validate these technologies within clinical practice and optimize their integration into patient management strategies.
评估内镜检查在肝硬化食管静脉曲张评估中不断演变的作用。
在过去10年中，随着非诊断性检查的完善，静脉曲张筛查内镜检查的方法发生了显著变化。非侵入性诊断方法减少了代偿期肝硬化患者进行静脉曲张筛查的上消化道内镜检查需求，主要针对那些风险评估不明确或对非选择性β受体阻滞剂（NSBBs）有禁忌证的患者。相比之下，失代偿期肝硬化患者由于并发症风险较高以及联合治疗（NSBBs+静脉曲张结扎）的潜在益处，需要更频繁的内镜评估。在肝细胞癌（HCC）患者中，非侵入性检查的表现并不理想，大多数患者需要进行内镜检查。人工智能（AI）的新兴应用可以协助患者分类和内镜检查结果的解读，可能改善治疗效果。进一步的研究对于在临床实践中验证这些技术并优化其纳入患者管理策略至关重要。
