Meta-Analysis
Copyright ©The Author(s) 2017. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Gastroenterol. Jan 14, 2017; 23(2): 345-356
Published online Jan 14, 2017. doi: 10.3748/wjg.v23.i2.345
Diagnostic accuracy of transient elastography (FibroScan) in detection of esophageal varices in patients with cirrhosis: A meta-analysis
Ke Pu, Jing-Hong Shi, Xu Wang, Qian Tang, Xin-Jie Wang, Kai-Lin Tang, Zhong-Qi Long, Xing-Sheng Hu
Ke Pu, Zhong-Qi Long, School of Clinical Medicine, Dazhou College of Chinese Medicine, Dazhou 635000, Sichuan Province, China
Jing-Hong Shi, Department of Immunology, Shaanxi University of Chinese Medicine, Xi’an 712046, Shaanxi Province, China
Xu Wang, Department of Hepatobiliary Surgery, Dachuan Southern Hospital, Dazhou 635000, Sichuan Province, China
Qian Tang, School of Nursing, Georgia Southern University, Statesboro, GA 30458, United States
Xin-Jie Wang, School of Life Science, Northwest University, Xi’an 712046, Shaanxi Province, China
Kai-Lin Tang, General Surgery Department of Jinshan Hospital, The First Affiliated Hospital of Chongqing Medical University, Chongqing 400010, Sichuan Province, China
Xing-Sheng Hu, Department of Oncology, Nanchong Central Hospital (The Second Affiliated Hospital of North Sichuan Medical College), Nanchong 637000, Sichuan Province, China
Author contributions: All authors contributed equally to this paper with conception and design of the study, literature review and analysis, drafting and critical revision and editing, and final approval of the version to be published.
Conflict-of-interest statement: The authors declare that there are no conflicts of interest regarding this manuscript.
Data sharing statement: No additional data are available.
Open-Access: This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Correspondence to: Dr. Xing-Sheng Hu, Department of Oncology, Nanchong Central Hospital (The Second Affiliated Hospital of North Sichuan Medical College), No.66 Dabei Road, Shunqing District, Nanchong 637000, Sichuan Province, China. 82146476@qq.cm
Telephone: +86-18123180715 Fax: +86-818-2698292
Received: July 28, 2016
Peer-review started: August 2, 2016
First decision: September 20, 2016
Revised: September 29, 2016
Accepted: October 31, 2016
Article in press: October 31, 2016
Published online: January 14, 2017
Abstract
AIM

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 conducted via Stata12.0, 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.

CONCLUSION

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.

Keywords: Transient elastography, FibroScan, Liver cirrhosis, Meta-analysis, Esophageal varices

Core tip: Esophageal varices (EV) is the main relevant portosystemic collaterals in cirrhotic patients. Hemorrhage from EV remains the leading cause of death in cirrhosis. Although more non-invasive techniques for evaluating the severity of EV have been carried out, the cutoff value and validity are not clear. Hence, this study examining the basis for clinical application of transient elastography [FibroScan (FS)] assessed whether there is sufficient evidence to recommend FS to predict EV. The result demonstrates that the cutoff of FS cannot provide high accuracy due to the various etiologies, and the value of FS should be interpreted cautiously.