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Esophageal Varices: Evaluation with Esophagography with Barium versus Endoscopic Gastroduodenoscopy in Patients with Compensated Cirrhosis—Blinded Prospective Study¹

¹ From the Liver Unit (E.F., E.V., Y.B.), Department of Radiology (D.F., N.B., A.E., D.G.), Department of Gastroenterology (R.E., I.C., K.Y., M.L.), and Epidemiology Unit (S.L.), Rambam Medical Center, Efron St, Haifa 31096, Israel; Department of Internal Medicine A, Poriya Hospital, and Bruce Rappaport Faculty of Medicine, Technion-Israel Institute of Technology, Haifa, Israel (S.S.); and School of Public Health, Haifa University, Haifa, Israel (S.L.). Received September 22, 2004; revision requested November 26; revision received December 12; accepted January 18, 2005. Address correspondence to Y.B. (e-mail: ybaruch{at}rambam.health.gov.il).

PURPOSE: To prospectively evaluate the accuracy of esophagography with barium in diagnosis of esophageal varices (EV) in patients with compensated cirrhosis, with endoscopic gastroduodenoscopy as the reference standard.

MATERIALS AND METHODS: In this study, which was approved by the local Helsinki Committee and in which all patients consented to participate, 61 patients with cirrhosis (34 men, 27 women; mean age, 61 years; range, 36–76 years) received a diagnosis clinically or with liver biopsy. In 87% (n = 53) of patients, Child-Pugh classification was A; in 13% (n = 8), Child-Pugh classification was B. They were evaluated with endoscopic gastroduodenoscopy, according to Japanese general criteria. Esophagography was performed within 3 weeks of endoscopic gastroduodenoscopy, and EV were assigned grades as follows: 0, no EV were seen; 1, EV manifested as very mild irregularities of the folds; and 2, the irregularity of the folds (EV) was clearly present. They were also assigned grades for shape and size: grade F0, no EV detected; grade F1, small straight EV; grade F2, slightly enlarged tortuous EV occupying less than one-third of esophageal lumen; and grade F3, large coil-shaped EV that occupied more than one-third of esophageal lumen. The sensitivity and specificity and positive and negative predictive values of esophagography for identification of each grade of EV were calculated separately, as was the 95% confidence interval.

RESULTS: All large EV (grades F2 and F3) were diagnosed at esophagography. Sensitivity declined with small EV (grade F1) to 71. The overall sensitivity of esophagography was 89% (95% confidence interval: 75.9%, 96.5%), the overall specificity was 83% (95% confidence interval: 64.5%, 94.7%), the overall positive predictive value was 89%, and the overall negative predictive value was 83% (95% confidence interval: 64.5%, 94.7%). Overall accuracy was 87%.

CONCLUSION: Esophagography is highly accurate in diagnosis of EV and can be considered a viable noninvasive alternative for determination of patients who should be selected for prophylactic treatment.

© RSNA, 2005