{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2025,10,31]],"date-time":"2025-10-31T14:18:29Z","timestamp":1761920309922,"version":"3.37.3"},"reference-count":37,"publisher":"Wiley","issue":"1","license":[{"start":{"date-parts":[[2017,7,7]],"date-time":"2017-07-07T00:00:00Z","timestamp":1499385600000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"}],"funder":[{"name":"French Ministry of Health"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Liver International"],"published-print":{"date-parts":[[2018,1]]},"abstract":"Abstract<\/jats:title>Background & Aims<\/jats:title>Large oesophageal varice (LEV<\/jats:styled-content>) screening is recommended in cirrhosis. We performed a prospective study to improve non\u2010invasive LEV<\/jats:styled-content> screening.<\/jats:p><\/jats:sec>Design<\/jats:title>287 patients with cirrhosis had upper gastrointestinal endoscopy (LEV<\/jats:styled-content> reference), oesophageal capsule endoscopy (ECE<\/jats:styled-content>), liver elastography and blood marker analyses. CirrhoMeter (cirrhosis blood test), the most accurate non\u2010invasive LEV<\/jats:styled-content> test, was segmented for cirrhosis (reference comparator) or LEV<\/jats:styled-content>. VariScreen, a sequential and partially minimally invasive diagnostic algorithm, was developed by multivariate analysis. It uses CirrhoMeter first, then ECE<\/jats:styled-content> if CirrhoMeter cannot rule LEV<\/jats:styled-content> out or in, and finally endoscopy if CirrhoMeter+ECE<\/jats:styled-content> combination remains uninformative.<\/jats:p><\/jats:sec>Results<\/jats:title>Diagnostic effectiveness rates for LEV<\/jats:styled-content> were: cirrhosis\u2010segmented CirrhoMeter: 14.6%, LEV<\/jats:styled-content>\u2010segmented CirrhoMeter: 34.6%, ECE<\/jats:styled-content>: 60.6% and VariScreen: 66.4% (P<\/jats:italic>\u00a0\u2264\u00a0.001 for overall or pair comparison). The respective missed LEV<\/jats:styled-content> rates were: 2.8%, 5.6%, 8.3% and 5.6% (P<\/jats:italic>\u00a0=\u00a0.789). Spared endoscopy rates were, respectively: 15.6%, 36.0%, 70.6% and 69%, (P<\/jats:italic>\u00a0<\u00a0.001 for overall or paired comparison except ECE<\/jats:styled-content> vs VariScreen: P<\/jats:italic>\u00a0=\u00a0.743). VariScreen spared 38% of ECE<\/jats:styled-content> and reduced missed LEV<\/jats:styled-content> by 87% compared to classical ECE<\/jats:styled-content> performed in all patients. Excepting cirrhosis\u2010segmented CirrhoMeter, these spared endoscopy rates were significantly higher than that of the Baveno VI<\/jats:styled-content> recommendation (using platelets and Fibroscan): 18.4% (P<\/jats:italic>\u00a0<\u00a0.001). Ascites and Child\u2010Pugh class independently predicted endoscopy sparing by VariScreen: from 86.0% in compensated Child Pugh class A to 24.1% in Child\u2010Pugh class C with ascites.<\/jats:p><\/jats:sec>Conclusion<\/jats:title>VariScreen algorithm significantly reduced the missed LEV<\/jats:styled-content> rate with ECE<\/jats:styled-content> by 87%, ECE<\/jats:styled-content> use by 38% and endoscopy requirement by 69%, and even 86% in compensated cirrhosis.<\/jats:p><\/jats:sec>","DOI":"10.1111\/liv.13497","type":"journal-article","created":{"date-parts":[[2017,6,16]],"date-time":"2017-06-16T17:22:45Z","timestamp":1497633765000},"page":"84-93","source":"Crossref","is-referenced-by-count":21,"title":["Large oesophageal varice screening by a sequential algorithm using a cirrhosis blood test and optionally capsule endoscopy"],"prefix":"10.1111","volume":"38","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-4866-5274","authenticated-orcid":false,"given":"Paul","family":"Cal\u00e8s","sequence":"first","affiliation":[{"name":"Department of Liver\u2010Gastroenterology University Hospital HIFIH Laboratory UNIV Angers Bretagne Loire University Angers France"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Sylvie","family":"Sacher\u2010Huvelin","sequence":"additional","affiliation":[{"name":"CIC 1413 INSERM CHU Nantes France"},{"name":"Department of Gastroenterology IMAD CHU and UNIV Nantes Bretagne Loire University Nantes France"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Dominique","family":"Valla","sequence":"additional","affiliation":[{"name":"Liver Unit DHU UNITY Beaujon Hospital HUPNVS APHP INSERM UMR U1149 University Paris Diderot Clichy France"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Christophe","family":"Bureau","sequence":"additional","affiliation":[{"name":"Department of Hepato\u2010gastroenterology CHU Toulouse France"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Anne","family":"Olivier","sequence":"additional","affiliation":[{"name":"Department of Liver\u2010Gastroenterology University Hospital HIFIH Laboratory UNIV Angers Bretagne Loire University Angers France"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Fr\u00e9d\u00e9ric","family":"Oberti","sequence":"additional","affiliation":[{"name":"Department of Liver\u2010Gastroenterology University Hospital HIFIH Laboratory UNIV Angers Bretagne Loire University Angers France"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"J\u00e9r\u00f4me","family":"Boursier","sequence":"additional","affiliation":[{"name":"Department of Liver\u2010Gastroenterology University Hospital HIFIH Laboratory UNIV 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