Published online Feb 27, 2024. doi: 10.4240/wjgs.v16.i2.539
Peer-review started: October 15, 2023
First decision: December 6, 2023
Revised: December 20, 2023
Accepted: January 9, 2024
Article in press: January 9, 2024
Published online: February 27, 2024
To avoid acute variceal bleeding in cirrhosis, current guidelines recommend screening for high-risk esophageal varices (EVs) by determining variceal size and identifying red wale markings. However, visual measurements of EV during routine endoscopy are often inaccurate.
To determine whether biopsy forceps (BF) could be used as a reference to improve the accuracy of binary classification of variceal size.
An in vitro self-made EV model with sizes ranging from 2 to 12 mm in diameter was constructed. An online image-based survey comprising 11 endoscopic images of simulated EV without BF and 11 endoscopic images of EV with BF was assembled and sent to 84 endoscopists. The endoscopists were blinded to the actual EV size and evaluated the 22 images in random order.
The respondents included 48 academic and four private endoscopists. The accuracy of EV size estimation was low in both the visual (13.81%) and BF-based (20.28%) groups. The use of open forceps improved the ability of the endoscopists to correctly classify the varices by size (small ≤ 5 mm, large > 5 mm) from 71.85% to 82.17% (P < 0.001).
BF may improve the accuracy of EV size assessment, and its use in clinical practice should be investigated.
Core tip: This study explored whether biopsy forceps (BF) could be used as a reference to improve the accuracy of binary classification of variceal size. Our results showed that visual estimation was insufficient for accurate classification of esophageal varices according to size, and the ability of endoscopists to correctly classify the varices by size improved significantly with the use of BF.