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. 2021 Jul;76(7):550.e1-550.e7.
doi: 10.1016/j.crad.2021.02.029. Epub 2021 Mar 18.

Optimal diagnostic tool for surveillance of oesophageal varices during COVID-19 pandemic

D Jothimani  1 , S Danielraj  2 , B Nallathambi  2 , B Pandurangan  3 , S Kalyanasundaram  4 , K Subbiah  4 , H Ramachandran  5 , R Venugopal  2 , D Dhas  4 , M Rela  2
Affiliations

Optimal diagnostic tool for surveillance of oesophageal varices during COVID-19 pandemic

D Jothimani et al. Clin Radiol. 2021 Jul.

Abstract

Aim: To study the diagnostic accuracy and utility of triphasic abdominal computed tomography (CT) in the diagnosis and grading of oesophageal varices (OVs) as an alternative to endoscopy during the COVID-19 pandemic.

Materials and methods: A prospective analysis was undertaken of retrospective data from cirrhotic patients who underwent oesophago-gastro-duodenoscopy (OGD) and a triphasic abdominal CT from January to December 2019. Endoscopists and radiologists provided their respective independent assessment of OV grading after being blinded to the clinical details. Performance of CT grading of OVs was compared with the reference standard endoscopic grading using weighted kappa (k). Non-invasive scores such, as aspartate transaminase (AST)-to-platelet ratio index (APRI), Fibrosis-4 (FIB-4) Index, platelet: spleen (PS) ratio were correlated between the two techniques.

Results: OV grading between endoscopists and radiologists showed 81.73% agreement (85 out of 104 patients) in the comparative analysis of 104 cirrhotic patients, of which no varices (57.1%, n=4), small (85.1%, n=23), medium (72.2%%, n=26), and large varices (94.1%, n=32) with a weighted k score of 0.88 (95% confidence interval 0.82-0.94). Overall, the sensitivity of CT in the diagnosis of no, small, medium, and large OVs was 66.6%, 79.3%, 89.6%, and 94.1%, respectively, with an area under the receiver operating curve (AUROC) score of 0.775, 0.887, 0.839, and 0.914. Performance of APRI, FIB-4, and PS ratio correlated well with the severity of OVs with no difference between OGD and CT grading.

Conclusion: Triphasic abdominal CT can be an invaluable tool in the diagnosis and grading of OVs during the COVID-19 pandemic.

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Figures

Figure 1
Figure 1
(a–d) Endoscopic and (e–h) CT images for OV grading. Endoscopy: (a) no varices, (b) small varices, (c) medium varices, and (d) large varices. CT images: (e) no varices, (f) small varices, (g) medium varices, and (h) large varices.
Figure 2
Figure 2
Illustrates the flow of patient selection for the study.
Figure 3
Figure 3
Comparison on non-invasive markers (APRI, FIB-4 and PS ratio) to endoscopy and CT-guided OV grading.
See this image and copyright information in PMC

Comment in

References

    1. Ng K., Poon B.H., Kiat Puar T.H. COVID-19 and the risk to health care workers: a case report. Ann Intern Med. 2020;172(11):766–767. doi: 10.7326/L20-0175. - DOI - PMC - PubMed
    1. Chiu P.W.Y., Ng S.C., Inoue H. Practice of endoscopy during COVID-19 pandemic: position statements of the Asian Pacific Society for Digestive Endoscopy (APSDE-COVID statements) Gut. 2020;69(6):991–996. doi: 10.1136/gutjnl-2020-321185. - DOI - PMC - PubMed
    1. Al-Balas M., Al-Balas H.I., Al-Balas H. Surgery during the COVID-19 pandemic: a comprehensive overview and perioperative care. Am J Surg. 2020;219(6):903–906. doi: 10.1016/j.amjsurg.2020.04.018. - DOI - PMC - PubMed
    1. Turon F., Casu S., Hernández-Gea V. Variceal and other portal hypertension related bleeding. Best Pract Res Clin Gastroenterol. 2013;27(5):649–664. doi: 10.1016/j.bpg.2013.08.004. - DOI - PubMed
    1. Merli M., Lucidi C., Giannelli V. Cirrhotic patients are at risk for health care-associated bacterial infections. Clin Gastroenterol Hepatol. 2010;8(11):979–985. doi: 10.1016/j.cgh.2010.06.024. - DOI - PubMed