Endoscopic screening for varices in cirrhotic patients: data from a national endoscopic database
Endoscopic screening for varices in cirrhotic patients: data from a national endoscopic database
复制标题
DOI：
10.1016/j.gie.2006.08.023
复制
发表时间：
2007-01-01
影响因子：
7.7
通讯作者：
Zaman, Atif
中科院分区：
文献类型：
--
作者：
Kovalak, Mary;Lake, Jeremy;Zaman, Atif
背景：目前肝硬化患者静脉曲张出血的初级预防指南推荐用上内窥镜（EGD）筛查静脉曲张。筛查在临床实践中的应用和结果尚不清楚。目的：我们的目的是确定内镜下静脉曲张筛查在不同实践环境中的应用，并确定与食管静脉曲张发现相关的因素。设计：分析由临床结果研究倡议（CORI）资料库生成的内窥镜报告，以确定2000年1月1日至2003年12月31日期间筛查上内窥镜的使用、随时间的变化和结果。环境：来自68个CORI实践（70%社区/17%学术/13%退伍军人事务医疗中心[VAMC]）的数据进行评估。患者：172,854例egd中有1688例用于筛查变异。结果：总体而言，每年筛查egd的比例呈线性增加（P < 0.0001）。与VAMC和社区实践相比，在学术中心进行静脉曲张筛查EGDs的比例要大得多。881例（52.2%）患者发现静脉曲张。Child-Pugh B/C级患者静脉曲张发生率为71.9%，Child-Pugh A级患者为42.7%。在发现有静脉曲张的患者中，Child-Pugh B/C级患者比Child-Pugh A级患者更容易出现大静脉曲张（P = 0.02）。局限性：本研究的一个局限性是无法确定在本研究中包括的每个CORI部位接受治疗的肝硬化患者总数。结论：内镜下静脉曲张筛查只占所有上腔镜检查的一小部分。这一比例在2000年至2003年间有所上升。静脉曲张更常见于肝病较严重的患者。
Background: The current guidelines for primary prophylaxis of variceal hemorrhage in cirrhotic patients recommend screening for varices with upper endoscopy (EGD). Utilization and outcomes of screening in clinical practice are unknown.Objective: Our purpose was to determine the use of endoscopic variceal screening in diverse practice settings and to determine factors associated with the finding of esophageal varices.Design: Endoscopic reports generated by the Clinical Outcomes Research Initiative (CORI) repository were analyzed to determine the use, changes over time, and findings of screening upper endoscopies between January 1, 2000, and December 31, 2003.Setting: Data from 68 CORI practices (70% community/17% academic/13% Veterans Affairs Medical Center [VAMC]) were evaluated.Patients: A total of 1688 of 172,854 EGDs were performed for the purpose of screening for varicesResults: Overall, there was a linear increase in annual proportion of screening EGDs performed (P < .0001). A significantly greater proportion of variceal screening EGDs are performed in academic centers compared with VAMC and community practices. Varices were found in 881 screened patients (52.2%). Varices were found more often in Child-Pugh class B/C (71.9%) compared with Child-Pugh class A (42.7%) patients. Of those with varices found, patients with Child-Pugh class B/C were more likely to have large varices than were patients with Child-Pugh class A (P = .02).Limitations: A limitation of this study was the inability to determine the total number of cirrhotic patients cared for at each CORI site included in this study.Conclusions: Endoscopic screening for varices represents a small proportion of all upper endoscopies performed. This proportion increased between 2000 and 2003. Varices were found more frequently in patients with more severe liver disease.