37, 53 FibroScan has poor accuracy for predicting esophageal varices in patients with cirrhosis and at present cannot replace endoscopy for varices screening. Recently, more complicated procedures have been investigated for the detection of esophageal varices; these include CT scanning, capsule endoscopy,

and spleen stiffness. The results of different studies are summarized in Table 3. Abdominal CT scanning has been evaluated as a screening tool for esophageal varices in three studies,54-56 and the results are summarized in Table 4. Notably, the methodology was very good in all these studies: the CT scan images were reviewed by two radiologists in two studies,54, MG-132 chemical structure 55 and in one study,56 five endoscopists analyzed the images. With different techniques (single versus multidetector), the results had a sensitivity ranging from 63% to 93% for the detection of all varices and a sensitivity ranging

from 56% to 92% for the detection of large varices. The specificity ranged from 76% to 97% and from 84% to 92%, respectively. Although the interobserver agreement was good for radiologists, one study showed that the endoscopist’s experience played a major role in detecting the presence and size of varices.56 In that study, CT scanning was shown to be safe and to be much better tolerated and more cost-effective than Lumacaftor endoscopic screening. Video capsule endoscopy has been tested in five studies for the detection of varices in patients with portal hypertension.57-61 The size of the study populations was low except in two studies.60, 61 This technique was compared to conventional upper endoscopy in all the studies. A significant

correlation was found between capsule and standard endoscopy for the detection of varices. The sensitivity of capsule endoscopy ranged from 68% Cyclooxygenase (COX) to 100% with a specificity ranging from 88% to 100%. For the detection of large varices, the sensitivity was 78% with a specificity of 96%.60 In one large study, one patient who was determined to have large varices with capsule endoscopy but not with conventional endoscopy underwent a second endoscopic examination that confirmed the presence of large varices. This suggests that standard endoscopy may not be the gold standard for detecting esophageal varices. Patients in all these studies significantly preferred capsule endoscopy to standard endoscopy. Therefore, video capsule endoscopy appears to be a very promising tool for the detection of esophageal varices. The variceal pressure can be measured and reflects portal hypertension. This technique can be used in patients with large varices but cannot be used in patients with moderate portal hypertension or in patients with severe portal hypertension without varices. Two different techniques have been reported.