Computed tomography in evaluating gastroesophageal varices in patients with portal hypertension: A meta-analysis.
OBJECTIVE
Gastroesophageal varices (GOV) is a common complication in patients with portal hypertension. We conducted a meta-analysis in attempt to evaluate the diagnostic accuracy of computed tomography (CT) as a noninvasive imaging tool for identifying GOV in reference to esophagogastroduodenoscopy (EGD).


METHODS
A systemic literature search of multiple databases were conducted to identify articles that investigated the diagnostic performance of CT for GOV, while employing EGD as reference standard. A 2×2 table was conducted according to the available published data for both esophageal varices (EV) and gastric varices (GV) as individual subgroups. The following indices were calculated: pooled sensitivity and specificity, positive and negative likelihood ratio, diagnostic odds ratio, and area under receiver operating characteristics. All statistical analyses were conducted via STATA13.0 and RevMan5.3.


RESULTS
A total of 11 studies were included in this meta-analysis, 10 articles evaluated the diagnostic accuracy of CT for EV (807 subjects) and 7 articles for GV (583 subjects). The pooled sensitivity and specificity for identifying EV were 0.896 (95% CI, 0.841-0.934) and 0.723 (95% CI, 0.644-0.791), respectively, with an AUROC of 0.86. The pooled sensitivity and specificity for identifying GV were 0.955 (95% CI, 0.903-0.980) and 0.658 (95% CI, 0.433-0.829), respectively, with an AUROC of 0.95. A subgroup analysis suggested varying CT technology could serve as a potential source of heterogeneity between included studies. A Deek's funnel plot indicated a low probability for publication bias.


CONCLUSIONS
Computed tomography could potentially replace EGD as a primary screening tool for diagnosing GOV, however results should be interpreted with caution given its suboptimal specificity.
Department of Gastroenterology, Zhongshan Hospital, Fudan University, Shanghai, China.
Yu-Jen
YJ
Tseng
Department of Gastroenterology, Zhongshan Hospital, Fudan University, Shanghai, China.
Xiao-Qing
XQ
Zeng
Department of Gastroenterology, Zhongshan Hospital, Fudan University, Shanghai, China.
Jie
J
Chen
Department of Gastroenterology, Zhongshan Hospital, Fudan University, Shanghai, China.
Na
N
Li
Department of Radiology, Zhongshan Hospital, Fudan University, Shanghai, China.
Peng-Ju
PJ
Xu
Department of Gastroenterology, Endoscopy Center, Evidence-based Medicine Center, Zhongshan Hospital, Fudan University, Shanghai, China. Electronic address: chen.shiyao@zs-hospital.sh.cn.
Shi-Yao
SY
Chen
D016145:Endoscopy, Digestive System; D004932:Esophageal and Gastric Varices / Q000000981:diagnostic imaging*; D006801:Humans; D006975:Hypertension, Portal / Q000150:complications*; D017594:Publication Bias; D012680:Sensitivity and Specificity; D014057:Tomography, X-Ray Computed
Computed tomography; Diagnosis; Gastroesophageal varices; Meta-analysis