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World J Gastrointest Endosc. Dec 16, 2023; 15(12): 681-689
Published online Dec 16, 2023. doi: 10.4253/wjge.v15.i12.681
The role of computed tomography for the prediction of esophageal variceal bleeding: Current status and future perspectives
Alberto Martino, Lucio Amitrano, Marianna Guardascione, Marco Di Serafino, Raffaele Bennato, Rossana Martino, Annalisa de Leone, Luigi Orsini, Luigia Romano, Giovanni Lombardi
Alberto Martino, Lucio Amitrano, Marianna Guardascione, Raffaele Bennato, Rossana Martino, Annalisa de Leone, Luigi Orsini, Giovanni Lombardi, Department of Gastroenterology and Digestive Endoscopy, AORN “Antonio Cardarelli”, Napoli 80131, Italy
Marco Di Serafino, Luigia Romano, Department of General and Emergency Radiology, AORN “Antonio Cardarelli”, Napoli 80131, Italy
Author contributions: Martino A, Amitrano L, Guardascione M and Di Serafino M designed research and wrote, edited and finalized the text; Martino A, Amitrano L, Guardascione M, Di Serafino M, Bennato R, Martino R and de Leone A performed literature search and analyzed the data; Orsini L, Romano L and Lombardi G reviewed the paper for important intellectual content.
Conflict-of-interest statement: No conflict of interest to declare.
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: https://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Alberto Martino, MD, Staff Physician, Department of Gastroenterology and Digestive Endoscopy, AORN “Antonio Cardarelli”, Via Antonio Cardarelli, 9, Napoli 80131, Italy. alberto.martino@aocardarelli.it
Received: September 27, 2023
Peer-review started: September 27, 2023
First decision: November 1, 2023
Revised: November 13, 2023
Accepted: November 27, 2023
Article in press: November 27, 2023
Published online: December 16, 2023
Abstract

Esophageal variceal bleeding (EVB) is one of the most common and severe complications related to portal hypertension (PH). Despite marked advances in its management during the last three decades, EVB is still associated with significant morbidity and mortality. The risk of first EVB is related to the severity of both PH and liver disease, and to the size and endoscopic appearance of esophageal varices. Indeed, hepatic venous pressure gradient (HVPG) and esophagogastroduodenoscopy (EGD) are currently recognized as the “gold standard” and the diagnostic reference standard for the prediction of EVB, respectively. However, HVPG is an invasive, expensive, and technically complex procedure, not widely available in clinical practice, whereas EGD is mainly limited by its invasive nature. In this scenario, computed tomography (CT) has been recently proposed as a promising modality for the non-invasive prediction of EVB. Although CT is only a diagnostic modality, thus being not capable of supplanting EGD or HVPG in providing therapeutic and physiological data, it could potentially assist liver disease scores, HVPG, and EGD in a more effective prediction of EVB. However, to date, evidence concerning the role of CT in this setting is still lacking. Our review aimed to summarize and discuss the current evidence concerning the role of CT in predicting the risk of EVB.

Keywords: Esophageal variceal bleeding, Variceal upper gastrointestinal bleeding, Portal hypertension, Computed tomography, Computed tomography angiography

Core Tip: Esophagogastroduodenoscopy is currently considered the diagnostic reference standard for the prediction of esophageal variceal bleeding (EVB) among cirrhotic patients. Recently, computed tomography (CT) has emerged as a promising tool for the non-invasive prediction of EVB. Nevertheless, to date, evidence concerning the role of CT in this setting is still lacking. Thus, our study aimed to review the current evidence regarding the role of CT in the prediction of EVB.