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Systematic review with meta‐analysis: ultra‐thin gastroscopy compared to conventional gastroscopy for the diagnosis of oesophageal varices in people with cirrhosis
Journal article   Peer reviewed

Systematic review with meta‐analysis: ultra‐thin gastroscopy compared to conventional gastroscopy for the diagnosis of oesophageal varices in people with cirrhosis

Tehara Wickremeratne, Stephanie Turner and James O'Beirne
Alimentary Pharmacology and Therapeutics, Vol.49(12), pp.1464-1473
2019
DOI: https://doi.org/10.1111/apt.15282
url
https://doi.org/10.1111/apt.15282View
Published Version

Abstract

Background: Haemorrhage from ruptured oesophageal varices is a common cause of death in people with cirrhosis. Guidelines recommend screening for varices at time of cirrhosis diagnosis and throughout the course of the disease. Conventional gas -troscopy is the criterion standard for variceal screening; however, is invasive, costly, and carries risks related to use of sedation. Ultra-thin gastroscopy (using endoscopes with a shaft diameter ≤6 mm) has been proposed as an alternative method of variceal screening that mitigates these risks.Aim: To determine the diagnostic accuracy of ultra-thin gastroscopy compared to conventional gastroscopy for the diagnosis of varices in people with cirrhosis.Methods: MEDLINE, EMBASE and Cochrane library databases were searched for studies that evaluated the accuracy of ultra-thin gastroscopy compared to conven-tional gastroscopy in the diagnosis of oesophageal varices.Results: Ten studies, 7 in known cirrhosis, with 752 participants were included in this systematic review. The overall prevalence of oesophageal varices was 42%. On bivariate modelling, pooled estimates of sensitivity and specificity were 98% (95% CI 93%-99%) and 96% (95% CI 91%-99%) respectively. The positive and negative likelihood ratios were 28 (95% CI 10.7-73.2) and 0.02 (95% CI 0.01-0.72) respectively. Kappa coefficient for inter-observer agreement for any varices ranged from 0.45 to 0.90. No serious adverse events related to ultra-thin gastroscopy were reported.Conclusions: Ultra-thin gastroscopy is accurate in the diagnosis of oesophageal varices, safe and well tolerated. It is a valid alternative to conventional gastroscopy for the screening and surveillance of varices in people with cirrhosis.

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Gastroenterology & Hepatology
Pharmacology & Pharmacy

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