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5 results on '"Oesophageal varice"'

1. Bulevirtide improves liver function in liver transplant candidates with advanced HDV cirrhosis and severe portal hypertension

Author

Loglio, A, Vigano, M, Goisis, L, Farina, E, Arosio, M, Marra, P, Farina, C, Fagiuoli, S, Loglio A., Vigano M., Goisis L., Farina E., Arosio M. E. G., Marra P., Farina C., Fagiuoli S., Loglio, A, Vigano, M, Goisis, L, Farina, E, Arosio, M, Marra, P, Farina, C, Fagiuoli, S, Loglio A., Vigano M., Goisis L., Farina E., Arosio M. E. G., Marra P., Farina C., and Fagiuoli S.

Published
2024

2. Large oesophageal varice screening by a sequential algorithm using a cirrhosis blood test and optionally capsule endoscopy.

Author

Calès, Paul, Sacher‐Huvelin, Sylvie, Valla, Dominique, Bureau, Christophe, Olivier, Anne, Oberti, Frédéric, Boursier, Jérôme, Galmiche, Jean Paul, and multicenter group VO‐VCO

Subjects
*ESOPHAGEAL varices, *CIRRHOSIS of the liver, *LIVER diseases, *ENDOSCOPY, *MEDICAL screening, *DIAGNOSIS
Abstract

Background & Aims: Large oesophageal varice (LEV) screening is recommended in cirrhosis. We performed a prospective study to improve non-invasive LEV screening. Design: 287 patients with cirrhosis had upper gastrointestinal endoscopy (LEV reference), oesophageal capsule endoscopy (ECE), liver elastography and blood marker analyses. CirrhoMeter (cirrhosis blood test), the most accurate non-invasive LEV test, was segmented for cirrhosis (reference comparator) or LEV. VariScreen, a sequential and partially minimally invasive diagnostic algorithm, was developed by multivariate analysis. It uses CirrhoMeter first, then ECE if CirrhoMeter cannot rule LEV out or in, and finally endoscopy if CirrhoMeter+ECE combination remains uninformative. Results: Diagnostic effectiveness rates for LEV were: cirrhosis-segmented CirrhoMeter: 14.6%, LEV-segmented CirrhoMeter: 34.6%, ECE: 60.6% and VariScreen: 66.4% (P ≤ .001 for overall or pair comparison). The respective missed LEV rates were: 2.8%, 5.6%, 8.3% and 5.6% (P = .789). Spared endoscopy rates were, respectively: 15.6%, 36.0%, 70.6% and 69%, (P < .001 for overall or paired comparison except ECE vs VariScreen: P = .743). VariScreen spared 38% of ECE and reduced missed LEV by 87% compared to classical ECE performed in all patients. Excepting cirrhosis-segmented CirrhoMeter, these spared endoscopy rates were significantly higher than that of the Baveno VI recommendation (using platelets and Fibroscan): 18.4% (P < .001). Ascites and Child-Pugh class independently predicted endoscopy sparing by VariScreen: from 86.0% in compensated Child Pugh class A to 24.1% in Child-Pugh class C with ascites. Conclusion: VariScreen algorithm significantly reduced the missed LEV rate with ECE by 87%, ECE use by 38% and endoscopy requirement by 69%, and even 86% in compensated cirrhosis. [ABSTRACT FROM AUTHOR]

Published
2018
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3. Comparison of screening strategies with two new tests to score and diagnose varices needing treatment

Author

Paul Calès, Federico Ravaioli, Arthur Berger, Oana Farcau, Davide Festi, Horia Stefanescu, Carole Vitellius, Pierre Nahon, Christophe Bureau, Nathalie Ganne-Carriè, Annalisa Berzigotti, Victor de Ledinghen, Salvatore Petta, Calès, Paul, Ravaioli, Federico, Berger, Arthur, Farcau, Oana, Festi, Davide, Stefanescu, Horia, Vitellius, Carole, Nahon, Pierre, Bureau, Christophe, Ganne-Carriè, Nathalie, Berzigotti, Annalisa, de Ledinghen, Victor, and Petta, Salvatore

Subjects
Liver Cirrhosis, Hepatology, Non-invasive test, Platelet Count, Gastroenterology, Esophageal and Gastric Varices, Varicose Veins, Elastometry, Non-alcoholic Fatty Liver Disease, Oesophageal varice, Screening, Elasticity Imaging Techniques, Humans, Portal hypertension, Retrospective Studies
Abstract

Background and aims: We aimed to improve non-invasive screening of varices needing treatment (VNT) and compare different screening strategies. Methods: 2,290 patients with chronic liver disease were included in a retrospective study. Etiologies were: virus: 50.0%, NAFLD: 29.5%, alcohol: 20.5%, VNT: 14.9%. Test descriptors were performance (spared endoscopy) and safety (missed VNT). VNT tests were evaluated according to their safety levels either for individual screening (95% negative predictive value (NPV)), population screening (95% sensitivity) or undifferentiated screening (100% sensitivity/NPV) without missed VNT. The tests provided three categories: missed VNT

Published
2022
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4. How to clarify the Baveno VI criteria for ruling out varices needing treatment by noninvasive tests

Author

Davide Festi, Carlotta Carboni, Paul Calès, Giovanni Marasco, Federico Ravaioli, François Buisson, Arthur Berger, Calès, Paul, Buisson, Françoi, Ravaioli, Federico, Berger, Arthur, Carboni, Carlotta, Marasco, Giovanni, and Festi, Davide

Subjects
Liver Cirrhosis, Population, Paired comparison, Esophageal and Gastric Varices, 03 medical and health sciences, 0302 clinical medicine, Liver stiffness, Statistics, Humans, Medicine, Endoscopy, Digestive System, Baveno VI criteria, education, Statistical descriptors, Contingency table, education.field_of_study, Hepatology, business.industry, noninvasive diagnosi, sensitivity, Predictive value, 030220 oncology & carcinogenesis, Elasticity Imaging Techniques, 030211 gastroenterology & hepatology, oesophageal varice, Varices, business, Algorithms, Case analysis
Abstract

Background & Aims: Baveno VI criteria enabled the screening of varices needing treatment (VNT) without endoscopy but created confusion by not stating the method used to calculate the 5% missed VNT limit, resulting in different calculations across validation studies. We analysed those calculations to clarify their diagnostic meaning. Methods: (a) Literature review and recalculation of the missed VNT rates according to the three definitions encountered. (b) Contingency table comparison of these latter to determine their diagnostic meanings. (c) Real case analysis. 4/Simulation of variations in the three main statistical descriptors (VNT, missed VNT or spared endoscopies). Results: Missed VNT rates in the three definitions varied five- to 10-fold across 7 papers. The contingency table showed that the definitions based on VNT prevalence and spared endoscopy as reference corresponded, respectively, to sensitivity and negative predictive value (NPV). The whole population-based definition corresponded to diagnostic accuracy (not pertinent in that setting). Real case analysis showed that concerning liver stiffness, the 95% sensitivity and NPV cut-offs for VNT were, respectively, 14.1 and 26.5 kPa. The VNT-based definition offered a more statistically powerful paired comparison between diagnostic tests, whereas the definition based on spared endoscopies was hampered by an unpaired comparison. Case simulation showed that the VNT-based definition was the most sensitive to descriptor variations. Conclusion: The definitions of missed VNT rate placing VNT or spared endoscopy as the denominator are appropriate, providing, respectively, sensitivity and NPV for VNT. We privilege the first since it corresponds to the true proportion of missed VNT.

Published
2019

5. Interobserver Agreement on Endoscopic Classification of Oesophageal Varices in Children

Author

D'Antiga, L, Betalli, P, De Angelis, P, Davenport, M, Di Giorgio, A, Mckiernan, P, Mclin, V, Ravelli, P, Durmaz, O, Talbotec, C, Sturm, E, Woynarowski, M, Burroughs, A, McKiernan, PJ, McLin, V, Burroughs, AK, D'Antiga, L, Betalli, P, De Angelis, P, Davenport, M, Di Giorgio, A, Mckiernan, P, Mclin, V, Ravelli, P, Durmaz, O, Talbotec, C, Sturm, E, Woynarowski, M, Burroughs, A, McKiernan, PJ, McLin, V, and Burroughs, AK

Abstract

Objectives:Data regarding agreement on endoscopic features of oesophageal varices in children with portal hypertension (PH) are scant. The aim of this study was to evaluate endoscopic visualisation and classification of oesophageal varices in children by several European clinicians, to build a rational basis for future multicentre trials.Methods:Endoscopic pictures of the distal oesophagus of 100 children with a clinical diagnosis of PH were distributed to 10 endoscopists. Observers were requested to classify variceal size according to a 3-degree scale (small, medium, and large, class A), a 2-degree scale (small and large, class B), and to recognise red wales (presence or absence, class Red). Overall agreement was considered fair if Fleiss and Cohen test was 0.30, good if 0.40, excellent if 0.60, and perfect if 0.80.Results:Agreement between observers was fair with class A (=0.34) and class B (=0.38), and good with class Red (=0.49). The agreement was good on presence versus absence of varices (class A=0.53, class B=0.48). The agreement among the observers was good in class A when endoscopic features of severe PH (medium and large sizes, red marks) were grouped and compared with mild features (absent and small varices) (=0.58).Conclusions:Experts working in different centres show a fairly good agreement on endoscopic features of PH in children, although a better training of paediatric endoscopists may improve the agreement in grading severity of varices in this setting. Data regarding agreement on endoscopic features of oesophageal varices in children with portal hypertension (PH) are scant. The aim of this study was to evaluate endoscopic visualisation and classification of oesophageal varices in children by several European clinicians, to build a rational basis for future multicentre trials. METHODS: Endoscopic pictures of the distal oesophagus of 100 children with a clinical diagnosis of PH were distributed to 10 endoscopists. Observers were requested to classify

Published
2015

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