title: Diagnostic accuracy of transient elastography (FibroScan) in detection of esophageal varices in patients with cirrhosis: A meta-analysis.
abstract: OBJECTIVE
  To investigate the diagnostic accuracy of FibroScan (FS) in detecting esophageal varices (EV) in cirrhotic patients.
  
  
  METHODS
  Through a systemic literature search of multiple databases, we reviewed 15 studies using endoscopy as a reference standard, with the data necessary to calculate pooled sensitivity (SEN) and specificity (SPE), positive and negative LR, diagnostic odds ratio (DOR) and area under receiver operating characteristics (AUROC). The quality of the studies was rated by the Quality Assessment of Diagnostic Accuracy studies-2 tool. Clinical utility of FS for EV was evaluated by a Fagan plot. Heterogeneity was explored using meta-regression and subgroup analysis. All statistical analyses were conductedviaStata12.0, MetaDisc1.4 and RevMan5.
  
  
  RESULTS
  In 15 studies (n= 2697), FS detected the presence of EV with the summary sensitivities of 84% (95%CI: 81.0%-86.0%), specificities of 62% (95%CI: 58.0%- 66.0%), a positive LR of 2.3 (95%CI: 1.81-2.94), a negative LR of 0.26 (95%CI: 0.19-0.35), a DOR of 9.33 (95%CI: 5.84-14.92) and an AUROC of 0.8262. FS diagnosed the presence of large EV with the pooled SEN of 0.78 (95%CI: 75.0%-81.0%), SPE of 0.76 (95%CI: 73.0%-78.0%), a positive and negative LR of 3.03 (95%CI: 2.38-3.86) and 0.30 (95%CI: 0.23-0.39) respectively, a summary diagnostic OR of 10.69 (95%CI: 6.81-16.78), and an AUROC of 0.8321. A meta-regression and subgroup analysis indicated different etiology could serve as a potential source of heterogeneity in the diagnosis of the presence of EV group. A Deek's funnel plot suggested a low probability for publication bias.
  
  
  CONCLUSIONS
  Using FS to measure liver stiffness cannot provide high accuracy for the size of EV due to the various cutoff and different etiologies. These limitations preclude widespread use in clinical practice at this time; therefore, the results should be interpreted cautiously given its SEN and SPE.
authors.affiliation: Ke Pu, Zhong-Qi Long, School of Clinical Medicine, Dazhou College of Chinese Medicine, Dazhou 635000, Sichuan Province, China.
authors.forename: Ke
authors.initials: K
authors.lastname: Pu
authors.affiliation: Ke Pu, Zhong-Qi Long, School of Clinical Medicine, Dazhou College of Chinese Medicine, Dazhou 635000, Sichuan Province, China.
authors.forename: Jing-Hong
authors.initials: JH
authors.lastname: Shi
authors.affiliation: Ke Pu, Zhong-Qi Long, School of Clinical Medicine, Dazhou College of Chinese Medicine, Dazhou 635000, Sichuan Province, China.
authors.forename: Xu
authors.initials: X
authors.lastname: Wang
authors.affiliation: Ke Pu, Zhong-Qi Long, School of Clinical Medicine, Dazhou College of Chinese Medicine, Dazhou 635000, Sichuan Province, China.
authors.forename: Qian
authors.initials: Q
authors.lastname: Tang
authors.affiliation: Ke Pu, Zhong-Qi Long, School of Clinical Medicine, Dazhou College of Chinese Medicine, Dazhou 635000, Sichuan Province, China.
authors.forename: Xin-Jie
authors.initials: XJ
authors.lastname: Wang
authors.affiliation: Ke Pu, Zhong-Qi Long, School of Clinical Medicine, Dazhou College of Chinese Medicine, Dazhou 635000, Sichuan Province, China.
authors.forename: Kai-Lin
authors.initials: KL
authors.lastname: Tang
authors.affiliation: Ke Pu, Zhong-Qi Long, School of Clinical Medicine, Dazhou College of Chinese Medicine, Dazhou 635000, Sichuan Province, China.
authors.forename: Zhong-Qi
authors.initials: ZQ
authors.lastname: Long
authors.affiliation: Ke Pu, Zhong-Qi Long, School of Clinical Medicine, Dazhou College of Chinese Medicine, Dazhou 635000, Sichuan Province, China.
authors.forename: Xing-Sheng
authors.initials: XS
authors.lastname: Hu
mesh_terms: D054459:Elasticity Imaging Techniques / Q000379:methods*; D004932:Esophageal and Gastric Varices / Q000000981:diagnostic imaging* / Q000209:etiology; D004945:Esophagoscopy; D004947:Esophagus / Q000000981:diagnostic imaging*; D006801:Humans; D008103:Liver Cirrhosis / Q000150:complications*; D016017:Odds Ratio; D011237:Predictive Value of Tests; D012372:ROC Curve; D012720:Severity of Illness Index
keywords: Esophageal varices; FibroScan; Liver cirrhosis; Meta-analysis; Transient elastography