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World J Hepatol. Nov 27, 2020; 12(11): 908-918
Published online Nov 27, 2020. doi: 10.4254/wjh.v12.i11.908
Noninvasive scores for the prediction of esophageal varices and risk stratification in patients with cirrhosis
Saroja Bangaru, Jihane N Benhammou, James H Tabibian
Saroja Bangaru, Internal Medicine, Gastroenterology, University of California at Los Angeles, Los Angeles, CA 90025, United States
Jihane N Benhammou, The Vatche and Tamar Manoukian Division of Digestive Diseases, University of California at Los Angeles, Los Angeles, CA 90095, United States
James H Tabibian, Department of Medicine, Olive View-University of California at Los Angeles Medical Center, Sylmar, CA 91342, United States
James H Tabibian, David Geffen School of Medicine at UCLA, Los Angeles, CA 90095, United States
Author contributions: Bangaru S drafted the manuscript; Benhammou JN provided critical revision of the manuscript; Tabibian JH provided supervision and critical revisions; all authors approved the submitted manuscript.
Conflict-of-interest statement: No potential conflicts of interest, no financial support.
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (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/
Corresponding author: James H Tabibian, MD, PhD, FACP, Health Sciences Clinical Associate Professor, Department of Medicine, Olive View-University of California at Los Angeles Medical Center, 14445 Olive View Drive, 2B-182, Sylmar, CA 91342, United States. jtabibian@dhs.lacounty.gov
Received: June 24, 2020
Peer-review started: June 24, 2020
First decision: July 30, 2020
Revised: August 13, 2020
Accepted: September 10, 2020
Article in press: September 10, 2020
Published online: November 27, 2020
Processing time: 153 Days and 8 Hours
Abstract

The primary purpose of variceal screening in patients with cirrhosis is to detect gastroesophageal varices at high risk of hemorrhage and implement preventative intervention(s). It was previously recommended that all patients with cirrhosis undergo initial and periodic longitudinal variceal screening via upper endoscopy. However, there has been growing interest and methods to identify patients with cirrhosis who may not have clinically significant portal hypertension and therefore be unlikely to have varices requiring intervention or benefit from upper endoscopy. Because the population of patients with compensated advanced chronic liver disease continues to grow, it is neither beneficial nor cost-effective to perform endoscopic variceal screening in all patients. Therefore, there is ongoing research into the development of methods to non-invasively risk stratify patients with cirrhosis for the presence of high-risk esophageal varices and effectively limit the population that undergoes endoscopic variceal screening. This is particularly important and timely in light of increasing healthcare reform and barriers to healthcare. In this review, we discuss and compare, with respect to test characteristics and clinical applicability, the available methods used to non-invasively predict the presence of esophageal varices.

Keywords: Gastroesophageal varices; Variceal screening; Advanced chronic liver disease; Cirrhosis; Non-invasive screening; Upper endoscopy

Core Tip: Because the population of patients with compensated advanced chronic liver disease continues to grow, it is neither beneficial nor cost-effective to perform endoscopic variceal screening in all patients. Therefore, there is ongoing research into the development of methods to non-invasively risk stratify patients with cirrhosis for the presence of high risk esophageal varices and effectively limit the population that undergoes endoscopic variceal screening. These topics are reviewed in this article.