Letter to the Editor
Copyright ©The Author(s) 2024. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Gastrointest Endosc. Mar 16, 2024; 16(3): 175-177
Published online Mar 16, 2024. doi: 10.4253/wjge.v16.i3.175
Computed tomography for prediction of esophageal variceal bleeding
Mohammed Elhendawy, Ferial Elkalla
Mohammed Elhendawy, Ferial Elkalla, Department of Tropical Medicine and Infectious Diseases, Tanta University, Tanta 31111, Egypt
Author contributions: Elhendawy M contributed to this work and wrote this letter; Elkalla F edited and revised this letter.
Conflict-of-interest statement: All the authors report no relevant conflicts of interest for this article.
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: https://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Mohammed Elhendawy, MD, Doctor, Professor, Research Assistant Professor, Department of Tropical Medicine and Infectious Diseases, Tanta University, Elbahr, Tanta 31111, Egypt. elhendawymohammed@gmail.com
Received: December 16, 2023
Peer-review started: December 16, 2023
First decision: January 9, 2024
Revised: January 12, 2024
Accepted: February 19, 2024
Article in press: February 19, 2024
Published online: March 16, 2024
Abstract

This letter to the editor relates to the study entitled “The role of computed tomography for the prediction of esophageal variceal bleeding: Current status and future perspectives”. Esophageal variceal bleeding (EVB) is one of the most common and severe complications related to portal hypertension (PH). Despite marked advances in its management during the last three decades, EVB is still associated with significant morbidity and mortality. The risk of first EVB is related to the severity of both PH and liver disease, and to the size and endoscopic appearance of esophageal varices. Indeed, hepatic venous pressure gradient (HVPG) and esophagogastroduodenoscopy (EGD) are currently recognized as the “gold standard” and the diagnostic reference standard for the prediction of EVB, respectively. However, HVPG is an invasive, expensive, and technically complex procedure, not widely available in clinical practice, whereas EGD is mainly limited by its invasive nature. In this scenario, computed tomography (CT) has been recently proposed as a promising modality for the non-invasive prediction of EVB. While CT serves solely as a diagnostic tool and cannot replace EGD or HVPG for delivering therapeutic and physiological information, it has the potential to enhance the prediction of EVB more effectively when combined with liver disease scores, HVPG, and EGD. However, to date, evidence concerning the role of CT in this setting is still lacking, therefore we aim to summarize and discuss the current evidence concerning the role of CT in predicting the risk of EVB.

Keywords: Esophageal variceal bleeding, Variceal upper gastrointestinal bleeding, Portal hypertension, Computed tomography, Computed tomography angiography

Core Tip: Esophagogastroduodenoscopy is presently regarded as the established diagnostic standard for anticipating esophageal variceal bleeding (EVB) in individuals with cirrhosis. Computed tomography (CT) has recently surfaced as a potential non-invasive method for predicting EVB. However, comprehensive evidence on the role and efficacy of CT in this context is currently insufficient. Consequently, the study seeks to assess the existing evidence concerning the use of CT in predicting EVB.