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. 2024 Feb 27;16(2):539-545.
doi: 10.4240/wjgs.v16.i2.539.

Biopsy forceps are useful for measuring esophageal varices in vitro

Zhi-Hui Duan  1 , Sheng-Yun Zhou  2
Affiliations

Biopsy forceps are useful for measuring esophageal varices in vitro

Zhi-Hui Duan et al. World J Gastrointest Surg. .

Abstract

Background: 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.

Aim: To determine whether biopsy forceps (BF) could be used as a reference to improve the accuracy of binary classification of variceal size.

Methods: 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.

Results: 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).

Conclusion: BF may improve the accuracy of EV size assessment, and its use in clinical practice should be investigated.

Keywords: Accuracy; Endoscopy; Esophageal varices; Liver cirrhosis; Measurement.

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Conflict of interest statement

Conflict-of-interest statement: All the authors report no relevant conflicts of interest for this article.

Figures

Figure 1
Figure 1
Flow chart of this study. EV: Esophageal varices.
Figure 2
Figure 2
Examples of images for online testing in this study. A: The actual size of the varices in picture (traditional visual method) was 3 mm; B: The actual size of the varices in the picture (biopsy forceps as a reference) was 3 mm; C: The actual size of the varices in the picture (visual method) was 7 mm; D: The actual size of the varices in the picture (biopsy forceps method) was 7 mm.
See this image and copyright information in PMC

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References

    1. Masood I, Moshksar A, Wong B, Khan H, Saleem A. A comprehensive review of transvenous obliteration techniques in the management of gastric varices. DiagnInterv Radiol. 2023;29:146–154. - PMC - PubMed
    1. de Franchis R, Bosch J, Garcia-Tsao G, Reiberger T, Ripoll C Baveno VII Faculty. Baveno VII – Renewing consensus in portal hypertension. J Hepatol. 2022;76:959–974. - PMC - PubMed
    1. Gralnek IM, Camus Duboc M, Garcia-Pagan JC, Fuccio L, Karstensen JG, Hucl T, Jovanovic I, Awadie H, Hernandez-Gea V, Tantau M, Ebigbo A, Ibrahim M, Vlachogiannakos J, Burgmans MC, Rosasco R, Triantafyllou K. Endoscopic diagnosis and management of esophagogastric variceal hemorrhage: European Society of Gastrointestinal Endoscopy (ESGE) Guideline. Endoscopy. 2022;54:1094–1120. - PubMed
    1. Calès P, Zabotto B, Meskens C, Caucanas JP, Vinel JP, Desmorat H, Fermanian J, Pascal JP. Gastroesophageal endoscopic features in cirrhosis. Observer variability, interassociations, and relationship to hepatic dysfunction. Gastroenterology. 1990;98:156–162. - PubMed
    1. Bendtsen F, Skovgaard LT, Sørensen TI, Matzen P. Agreement among multiple observers on endoscopic diagnosis of esophageal varices before bleeding. Hepatology. 1990;11:341–347. - PubMed