Published online Jan 14, 2017. doi: 10.3748/wjg.v23.i2.345
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
Processing time: 167 Days and 20.1 Hours
To investigate the diagnostic accuracy of FibroScan (FS) in detecting esophageal varices (EV) in cirrhotic patients.
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.
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.
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.
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.