Computed tomography in evaluating gastroesophageal varices in patients with portal hypertension: A meta-analysis

AimsGastroesophageal varices (GOV) is a common complication in patients with portal hypertension. We conducted a meta-analysis in attempt to evaluate the diagnostic accuracy of computed tomography (CT) as a noninvasive imaging tool for identifying GOV in reference to esophagogastroduodenoscopy (EGD).MethodsA systemic literature search of multiple databases were conducted to identify articles that investigated the diagnostic performance of CT for GOV, while employing EGD as reference standard. A 2 × 2 table was conducted according to the available published data for both esophageal varices (EV) and gastric varices (GV) as individual subgroups. The following indices were calculated: pooled sensitivity and specificity, positive and negative likelihood ratio, diagnostic odds ratio, and area under receiver operating characteristics. All statistical analyses were conducted via STATA13.0 and RevMan5.3.ResultsA total of 11 studies were included in this meta-analysis, 10 articles evaluated the diagnostic accuracy of CT for EV (807 subjects) and 7 articles for GV (583 subjects). The pooled sensitivity and specificity for identifying EV were 0.896 (95% CI, 0.841–0.934) and 0.723 (95% CI, 0.644–0.791), respectively, with an AUROC of 0.86. The pooled sensitivity and specificity for identifying GV were 0.955 (95% CI, 0.903–0.980) and 0.658 (95% CI, 0.433–0.829), respectively, with an AUROC of 0.95. A subgroup analysis suggested varying CT technology could serve as a potential source of heterogeneity between included studies. A Deek's funnel plot indicated a low probability for publication bias.ConclusionComputed tomography could potentially replace EGD as a primary screening tool for diagnosing GOV, however results should be interpreted with caution given its suboptimal specificity.