The Value Of Contrast-enhanced CT And Liaoning Score For Diagnosing Gastroesophageal Varices In Liver Cirrhosis

Background and aimsGastroesophageal varices often occur in cirrhosis patients,and recur frequently after endoscopic therapy.Regular endoscopic surveillance is necessary,but invasive and poorly adhered.Liver fibrosis blood tests,platelets count to spleen diameter ratio(PSR),and contrast-enhanced computed tomography(CT)are diagnostic alternatives for gastroesophageal varices.Liaoning score is a new non-invasive approach which was developed by our previous study.But they have heterogeneous diagnostic performance among different study populations.This study is aimed at evaluating their diagnostic accuracy for esophageal varices(EVs)and gastric varices(GVs)in cirrhotic patients with and without previous endoscopic variceal therapyMethods1.Patients with liver cirrhosis who underwent blood tests and contrast-enhanced CT scans as well as endoscopic surveillance should be potentially eligible.EVs needing treatment(EVNTs)and GVs needing treatment(GVNTs)were recorded according to the endoscopic results.Area under the curves(AUCs)were calculated.The optimal cutoff values of contrast-enhanced CT by reaching the maximal negative predictive value and then calculated the rates of spared endoscopy and missed varices2.Cirrhotic patients with acute gastrointestinal bleeding(GIB)without history of endoscopic variceal therapy who underwent endoscopic examinations at their admissions were included.Subgroup analyses were performed in patients with hematemesis.Liaoning score and several non-invasive liver fibrosis scores were evaluated.Area under curves(AUCs),cut-off value,sensitivity,and specificity were calculated.Results1.Overall,279 patients were included.In 175 patients without previous endoscopic variceal therapy,including primary prophylaxis population(n=70),acute bleeding population(n=38),and previous bleeding population(n=67),the diagnostic accuracy of contrast-enhanced CT for EVNTs was higher(AUCs=0.816-0.876)as compared to blood tests and PSR;by comparison,the diagnostic accuracy of contrast-enhanced CT for GVNTs was statistically significant among primary prophylaxis population(AUC=0.731,p=0.0316),but not acute or previous bleeding population.In104 patients with previous endoscopic variceal therapy(i.e.,secondary prophylaxis population),contrast-enhanced CT was the only statistically significant alternative for diagnosing EVNTs and GVNTs but with modest accuracy(AUCs=0.673 and 0.661,respectively).2.Overall,612 patients were included.The prevalence of EVs and high-risk EVs was 96.2%and95.6%,respectively.In overall patients,the AUCs of Liaoning score for predicting EVs and high-risk EVs were higher than non-invasive liver fibrosis scores(0.737 versus 0.626-0.721;0.734 versus 0.611-0.719).The cut-off value of Liaoning score for high-risk EVs was 0.477 with a sensitivity of 81.96%and a specificity of 65.22%.In patients with hematemesis,Liaoning score could significantly predict EVs and high-risk EVs(AUCs=0.708 and 0.702,respectively),but not non-invasive liver fibrosis scores.The cut-off value of Liaoning score for high-risk EVs was 0.437 with a sensitivity of 83.16%and a specificity of 60%.ConclusionsContrast-enhanced CT might be a diagnostic alternative for EVNTs in cirrhotic patients,but its diagnostic performance was slightly weakened in secondary prophylaxis population.Additionally,contrast-enhanced CT may be considered for diagnosis of GVNTs in primary prophylaxis population without previous endoscopic variceal therapy and secondary prophylaxis population.Liaoning score should be a non-invasive alternative for predicting EVs and high-risk EVs in cirrhotic patients with acute GIB.