Diagnostic accuracy of transient elastography (FibroScan) in detection of esophageal varices in patients with cirrhosis: A meta-analysis

Table 1 Descriptive characteristics of the eligible studies

Ref.	Location	Etiology (viral, %)	Simple	Mean age	Childs	Presence of EV	Large EV	Reference	Design	Presence of EV (Grade 0, 1)						Large EV (Grade 2, 3)
				(male,%)	score (%)	cutoff (kPa)	cutoff (kPa)	standard	method	TP	FP	FN	TN	SEN (%)	SPE (%)	TP	FP	FN	TN	SEN (%)	SPE (%)
Sporea et al[16], 2013	Romania	73.6	697	57 (57.20)	NR	NR	29.5	GIE	A							212	56	61	368	77.50	86.90
Sharma et al[17], 2013	India	29.9	174	49.3 (88.50)	A/B/C	27.3	NR	EGD	A	113	14	11	36	91.00	72.00
					32/57/11
Saad et al[18], 2013	Egypt	100	32	NR	A/B	29.7	38.2	GIE	B	19	4	1	8	95.00	67.00	10	5	0	17	100	77.30
					72/28
Nguyen-Khac et al[19], 2010	France	31.7	183	55.2 (64.50)	A/B/C	NR	48	EGD	A							30	38	11	104	73.20	73.20
					63/26/15
Li et al[20], 2012	China	100	158	47.4 (82.40)	NR	23.3	31.5	GIE	A	72	27	18	41	80.00	60.30	32	33	9	84	78.10	71.80
Li et al[21], 2014	China	84.2	260	49.4 (67.70)	NR	22.8	30.6	GIE	A	129	39	25	67	83.80	63.20	57	57	12	134	82.60	70.10
Kazemi et al[22], 2006	France	69.7	165	56 (67.30)	NR	13.9	19	UTE	A	70	52	4	39	95.00	91.00	43	47	4	71	91.00	60.00
Jung et al[23], 2008	Korea	46.4	112	53.3 (78.60)	NR	19.7	29.5	GIE	A	71	9	11	21	87.00	70.00	27	33	8	44	77.00	57.00
Hu et al[24], 2015	China	100	200	45.1 (71.00)	B/A + C	20.25	25.55	GIE	B	95	25	15	65	86.40	72.20	58	36	11	95	84.10	72.50
					84/16
Castéra et al[25], 2009	France	100	66	54.1 (60.00)	A/B + C	21.5	30.5	GIE	A	19	9	6	32	76.00	78.00	10	8	3	45	77.00	85.00
					70/30
Calvaruso et al[26], 2013	Italy	100	96	63.2 (69.80)	A	17	19	GIE	A	38	18	16	24	71.00	57.00	19	31	7	39	72.00	55.00
					100
Bintintan et al[27], 2015	Romania	45.0	60	57 (65.00)	A/B/C	15	28.8	EGD	A	45	0	2	13	95.00	100	28	5	4	23	87.20	82.76
					65/22/13
Stefanescu et al[28], 2011	Romania	NR	137	56 (56.20)	A/B/C,	28	NR	UTE	A	86	7	30	14	74.36	64.29
					65/28/7
Stefanescu et al[29], 2011	Romania	61.0	231	55.9 (58.40)	A/B/C,	19	38	UTE	A	132	50	25	24	84.00	32.39	38	40	30	123	55.56	75.32
					76/18/6
Wang et al[30], 2012	Taiwan	100	126	54.5 (73.80)	A,	12	21	EGD	A	32	18	16	60	67.00	77.00	10	15	3	98	77.00	87.00
					100

Design method: A: Cross-sectional; B: Case-control. EV: Esophageal varices; GIE: Gastrointestinal endoscopy; EGD: Esophagogastroduodenoscopy; UTE: Upper tract endoscopy; NR: No report; TP: True positive; FP: False positive; FN: False negative; TN: True negative; SEN: Sensitivity; SPE: Specificity.

Table 2 Subgroup analysis: the diagnostic accuracy of FibroScan for the detection of esophageal varices in cirrhotic patients

Subgroup	n	SEN (CI)	I2 (%)	SPE (CI)	I2 (%)	PLR (CI)	I2 (%)	NLR (CI)	I2 (%)	DOR (CI)	I2 (%)
LC etiology
One factor	5	0.76 (0.70-0.81)	56.5	0.68 (0.62-0.74)	55.6	2.26 (1.86-2.74)	37.3	0.37 (0.29-0.48)	25.3	6.17 (4.20-9.06)	30.4
Two factors	3	0.82 (0.77-0.85)	68.7	0.56 (0.48-0.63)	92.8	2.02 (0.96-4.27)	93.1	0.33 (0.19-0.58)	76.9	6.18 (1.86-20.55)	86.2
Multiple factors	5	0.89 (0.86-0.92)	62.0	0.61 (0.55-0.66)	86.2	2.48 (1.65-3.73)	81.0	0.16 (0.10-0.25)	56.8	16.74 (8.23-33.84)	57.9
Location
Europe	6	0.82 (0.79-0.86)	82.3	0.52 (0.46-0.58)	89.1	1.84 (1.33-2.55)	78.6	0.29 (0.18-0.49)	74.1	7.14 (3.06-16.66)	74.0
Asia	6	0.84 (0.81-0.87)	68.8	0.69 (0.64-0.73)	28.5	2.61 (2.25-3.03)	16.8	0.25 (0.21-0.30)	68.1	10.56 (7.93-14.07)	50.7
Africa	1	0.95	NA	0.67	NA		NA		NA		NA
Year
2006-2011	5	0.83 (0.80-0.87)	75.9	0.51 (0.44-0.57)	87.6	1.97 (1.39-2.78)	82.0	0.30 (0.19-0.46)	62.6	7.46 (3.43-16.24)	69.6
2012-2016	8	0.84 (0.81-0.87)	77.2	0.68 (0.64-0.73)	63.6	2.48 (2.0-3.07)	49.7	0.24 (0.16-0.36)	77.0	10.84 (5.94-19.77)	70.8
LS value (cutoff)
< 20 kPa	6	0.84 (0.80-0.87)	83.2	0.55 (0.50-0.61)	91.0	1.94 (1.37-2.74)	83.2	0.27 (0.16-0.47)	78.6	7.82 (3.36-18.24)	77.4
> 20 kPa	7	0.83 (0.80-0.86)	65.7	0.68 (0.63-0.72)	1.1	2.58 (2.22-3.00)	9.9	0.24 (0.20-0.29)	58.8	10.69 (7.97-14.34)	45.4

Publication year (2006-2011 year vs 2012-2016 year); Location (European vs Asia vs Africa) and Liver Stiffness Threshold (< 20 kPa vs > 20 kPa in the presence of EV; < 30 kPa vs > 30 kPa in the presence of Large EV) by using meta-regression model. SEN: Sensitivity; SPE: Specificity; NLR: Negative likelihood ratio; PLR: Positive likelihood ratio; DOR: Diagnostic odds ratio; NA: Not available; LC: Liver cirrhosis; LS: Liver stiffness.

Table 3 Subgroup analysis: the diagnostic accuracy of FibroScan for the detection of large esophageal varices in cirrhotic patients

Subgroup	n	SEN (CI)	I2 (%)	SPE (CI)	I2 (%)	PLR (CI)	I2 (%)	NLR (CI)	I2 (%)	DOR (CI)	I2 (%)
LC etiology
One factor	5	0.79 (0.69-0.86)	24.7	0.75 (0.71-0.80)	84.3	2.82 (2.31-3.45)	78.9	0.30 (0.21-0.44)	0.0	9.05 (5.50-14.90)	49.3
Two factors	2	0.7 (0.62-0.78)	92.5	0.74 (0.69-0.79)	0.0	2.67 (2.00-3.57)	38.8	0.37 (0.13-1.02)	90.9	7.21 (2.07-25.16)	85.3
Multiple factors	6	0.80 (0.76-0.83)	40.9	0.76 (0.73-0.79)	92.1	3.02 (2.01-4.55)	90.7	0.27 (0.21-0.34)	21.2	12.46 (6.99-22.18)	68.5
Location
Europe	7	0.76 (0.72-0.80)	75.2	0.77 (0.75-0.80)	90.3	3.09 (2.03-4.70)	89.6	0.31 (0.21-0.48)	79.5	10.55 (5.04-22.07)	82.2
Asia	5	0.81 (0.75-0.86)	0.0	0.72 (0.69-0.76)	81.9	2.73 (2.37-3.15)	72.1	0.27 (0.21-0.36)	0.0	10.03 (7.01-14.35)	20.7
Africa	1	0.95	NA	0.67	NA		NA		NA		NA
Year
2006-2011	4	0.72 (0.64-0.78)	84.4	0.72 (0.68-0.76)	78.1	2.58 (2.06-3.24)	39.9	0.34 (0.18-0.62)	76.2	8.22 (3.94-17.15)	61.0
2012-2016	9	0.80 (0.76-0.83)	8.4	0.77 (0.74-0.79)	88.8	3.19 (2.28-4.46)	87.2	0.27 (0.23-0.32)	0.8	11.9 (7.10-20.01)	66.4
LS value (cutoff)
< 30 kPa	7	0.80 (0.76-0.84)	30.1	0.77 (0.74-0.79)	92.6	3.11 (2.01-4.81)	91.4	0.27 (0.20-0.35)	28.3	12.39 (6.60-23.27)	71.6
> 30 kPa	6	0.73 (0.67-0.79)	74.5	0.74 (0.70-0.77)	12.3	2.78 (2.40-3.21)	1.6	0.34 (0.22-0.53)	67.3	8.33 (4.94-14.05)	48.0

Publication year (2006-2011 year vs 2012-2016 year); Location (European vs Asia vs Africa) and Liver Stiffness Threshold (< 20 kPa vs > 20 kPa in the presence of EV; < 30 kPa vs > 30 kPa in the presence of Large EV) by using meta-regression model. SEN: Sensitivity; SPE: Specificity; NLR: Negative likelihood ratio; PLR: Positive likelihood ratio; DOR: Diagnostic odds ratio; NA: Not available; LC: Liver cirrhosis; LS: Liver stiffness.