Computed tomography for the diagnosis of varices in liver cirrhosis: a systematic review and meta-analysis of observational studies

<p><b>Objectives:</b> This systematic review and meta-analysis aimed to evaluate the diagnostic accuracy of contrast-enhanced computed tomography (CT) for varices in liver cirrhosis.</p> <p><b>Methods</b>: PubMed and EMBASE databases were searched for the literature identification. The area under the summary receiver operating characteristic curve (AUSROC), sensitivity, specificity, positive and negative likelihood ratio (PLR and NLR), and diagnostic odds ratio (DOR) were calculated. We performed the subgroup analyses according to the location of varices, CT technique, and study design. The study quality was assessed according to the QUADAS-2 tool.</p> <p><b>Results:</b> Seventeen papers were eligible. The study quality was modest. The AUSROC was 0.8975 and 0.9494 for predicting any size and high-risk varices, respectively. Summary sensitivity, specificity, PLR, NLR, and DOR of CT for predicting any size and high-risk varices were 0.87/0.80/3.67/0.18/22.70 and 0.87/0.88/7.52/0.12/65.55, respectively. According to the location of varices, the AUSROC was 0.9127 for predicting any size gastric varices alone; and the AUSROC was 0.8958 and 0.9461 for predicting any size and high-risk esophageal varices alone, respectively. According to the CT technique, the AUSROC of multi-detector CT (MDCT) was 0.9047 and 0.9490 for predicting any size and high-risk varices, respectively; and the AUSROC of MDCT esophagograms for predicting any size and high-risk varices was 0.8735 and 0.9664, respectively. In the subgroup analysis of prospective studies, the AUSROC was 0.9122 and 0.9507 for predicting any size and high-risk varices, respectively.</p> <p><b>Conclusion:</b> CT had a high accuracy for the diagnosis of varices in liver cirrhosis.</p

Acid suppression in patients treated with endoscopic therapy for the management of gastroesophageal varices: a systematic review and meta-analysis

<p><b>Background and aim</b>: Endoscopic therapy is the cornerstone choice for the management of varices and variceal hemorrhage. The aim of the present systematic review and meta-analysis was to evaluate the efficacy of acid suppression in patients treated with endoscopic therapy for gastroesophageal varices.</p> <p><b>Methods</b>: All eligible studies were searched via the PubMed, EMBASE, and Cochrane Library databases. Incidence of bleeding, mortality, ulcers, chest pain, and dysphagia after endoscopic therapy and length of stay were analyzed. Subgroup analyses were performed according to the types and major indications of endoscopic treatments. Odds ratios (ORs) with 95% confidence intervals (95%CIs) were calculated.</p> <p><b>Results</b>: Nine studies with 1470 patients were included. Acid suppression could significantly decrease the incidence of bleeding (OR = 0.39, 95%CI: 0.19–0.81, P = 0.01) and diminish the ulcer size (OR = 0.78, 95%CI: 0.38–1.57, P = 0.48) after endoscopic therapy. The subgroup analyses showed that acid suppression could significantly decrease the incidence of bleeding in patients undergoing prophylactic EVL, rather than in patients undergoing therapeutic EVL. There was no significant difference in the incidence of mortality, ulcers, chest pain, and dysphagia and length of stay between patients treated with and without acid suppression.</p> <p><b>Conclusion</b>: Acid suppression might be considered in patients undergoing prophylactic EVL for gastroesophageal varices.</p

Survival and prognostic indicators of Budd–Chiari syndrome: a systematic review of 79 studies

<p>This paper aimed to systematically review the survival of Budd–Chiari syndrome and to identify the most robust prognostic predictors. Overall, 79 studies were included. According to the treatment modalities, the median 1-, 5- and 10-year survival rate was 93, 83 and 73% after interventional radiological treatment; 81, 75 and 72.5% after surgery other than liver transplantation; 82.5, 70.2 and 66.5% after liver transplantation and 68.1, 44.4% and unavailable after medical therapy alone. According to the publication years, the median 1-, 5- and 10-year survival rate was 68.6, 44.4% and unavailable before 1990; 75.1, 69.5 and 57% during the year 1991–1995; 77, 69.6 and 65.6% during the year 1996–2000; 86.5, 74 and 63.5% during the year 2001–2005 and 90, 82.5 and 72% after 2006. Bilirubin, creatinine and ascites were more frequently identified as significant prognostic factors in univariate analyses. But their statistical significance was less frequently achieved in multivariate analyses.</p

Supersonic shear imaging for the diagnosis of liver fibrosis and portal hypertension in liver diseases: a meta-analysis

<p><b>Background and aims</b>: The meta-analysis aimed to summarize the technical success rate of supersonic shear imaging (SSI) and to evaluate the diagnostic performance of liver and spleen stiffness measurement (LSM and SSM) with SSI for the detection of liver fibrosis, portal hypertension, and gastroesophageal varices in liver diseases.</p> <p><b>Methods</b>: PubMed, EMBASE, and Cochrane Library databases were searched. Technical success rate of SSI was pooled. Area under curve (AUC), sensitivity, and specificity with corresponding 95% confidence interval (CI) were calculated.</p> <p><b>Results</b>: Included studies regarding the diagnostic performance of SSI for liver fibrosis, portal hypertension, and esophageal varices numbered 28, 4, and 4 respectively. The pooled technical success rates of LSM and SSM were 95.3% and 75.5%, respectively. The AUC, sensitivity, and specificity of LSM/SSM for different stages of liver fibrosis were 0.85–0.94, 0.7–0.89, and 0.82–0.92, respectively. The AUC, sensitivity, and specificity of LSM were 0.84 (95%CI = 0.8–0.86), 0.79 (95%CI = 0.7–0.85), and 0.82 (95%CI = 0.72–0.88) for clinically significant portal hypertension, 0.85 (95%CI = 0.82–0.88), 0.8 (95%CI = 0.68–0.88), and 0.8 (95%CI = 0.6–0.92) for any varices, and 0.86 (95%CI = 0.83–0.89), 0.86 (95%CI = 0.76–0.92), and 0.61 (95%CI = 0.35–0.83) for high-risk varices, respectively.</p> <p><b>Conclusions</b>: LSM with SSI had a high diagnostic accuracy for liver fibrosis, but a moderate diagnostic accuracy for portal hypertension and esophageal varices.</p

Supplementary Tables -Supplemental material for Association of proton pump inhibitors with the risk of hepatic encephalopathy during hospitalization for liver cirrhosis

<p>Supplemental material, Supplementary Tables for Association of proton pump inhibitors with the risk of hepatic encephalopathy during hospitalization for liver cirrhosis by Jia Zhu, Xingshun Qi, Haonan Yu, Eric M Yoshida, Nahum Mendez-Sanchez, Xintong Zhang, Ran Wang, Han Deng, Jing Li, Dan Han and Xiaozhong Guo in United European Gastroenterology Journal</p

Supplementary Figure 1 -Supplemental material for Association of proton pump inhibitors with the risk of hepatic encephalopathy during hospitalization for liver cirrhosis

<p>Supplemental material, Supplementary Figure 1 for Association of proton pump inhibitors with the risk of hepatic encephalopathy during hospitalization for liver cirrhosis by Jia Zhu, Xingshun Qi, Haonan Yu, Eric M Yoshida, Nahum Mendez-Sanchez, Xintong Zhang, Ran Wang, Han Deng, Jing Li, Dan Han and Xiaozhong Guo in United European Gastroenterology Journal</p

Supplementary Figure 2 -Supplemental material for Association of proton pump inhibitors with the risk of hepatic encephalopathy during hospitalization for liver cirrhosis

<p>Supplemental material, Supplementary Figure 2 for Association of proton pump inhibitors with the risk of hepatic encephalopathy during hospitalization for liver cirrhosis by Jia Zhu, Xingshun Qi, Haonan Yu, Eric M Yoshida, Nahum Mendez-Sanchez, Xintong Zhang, Ran Wang, Han Deng, Jing Li, Dan Han and Xiaozhong Guo in United European Gastroenterology Journal</p