EGD Still Better Than Spleen Stiffness Measurement
(HealthDay News) — Current techniques of spleen stiffness measurement (SSM) are inadequate to replace esophagogastroduodenoscopy (EGD) as the screening modality of choice for detecting esophageal varices (EV), according to a review published in the June issue of Clinical Gastroenterology and Hepatology.
Siddharth Singh, MBBS, from the Mayo Clinic in Rochester, MN, and colleagues conducted a systematic literature review to identify studies that reported the accuracy of SSM, compared with EGD, in the diagnosis of any and/or clinically significant EV in adults with chronic liver disease. Measures of test performance of individual studies were combined in meta-analysis.
The researchers found in pooled estimates that SSM detected the presence of any EV with 78% sensitivity, 76% specificity, a positive likelihood ratio (LR) of 3.4, a negative LR of 0.2, and a diagnostic odds ratio of 19.3. SSM detected the presence of clinically significant EV with 81% sensitivity, 66% specificity, a positive LR of 2.5, a negative LR of 0.2, and a diagnostic odds ratio of 12.6 based on meta-analysis of nine studies. Differences in elastography techniques and study locations contributed to significant heterogeneity among studies. There was risk for spectrum bias, review bias, and disease progression bias among the included studies.
"Based on a meta-analysis, current techniques for measuring spleen stiffness are limited in their accuracy of EV diagnosis; these limitations preclude widespread use in clinical practice at this time," the authors write.