Gallbladder Wall Thickness as a Non-Invasive Marker for Esophageal Varices: A Systematic Review and Meta-Analysis

Background: The early detection of esophageal varices (EV) is important in patients with chronic liver disease (CLD). Non-invasive diagnostic markers are preferred to avoid the cost and potential complications associated with endoscopy. The gallbladder venous blood is drained via small veins which terminate in the portal venous circulation. Therefore, the gallbladder wall thickness (GBWT) can be affected by portal hypertension. We con-ducted the present study to evaluate the diagnostic and predictive utility of ultrasound GBWT measurement in patients with EV. Methods: We searched PubMed, Scopus, Web of Science and Embase for relevant studies up to March 15, 2022, using the keywords "varix", "varices", and "gallbladder" to search the databases by title and abstract. Our meta-analysis was performed using the "meta" package of R software version 4.1.0 and meta-disc for diagnostic test accuracy (DTA). Results: We included 12 studies in our review (N = 1343 partici-pants). The gallbladder thickness was significantly larger in patients with EV compared with the control group (MD = 1.86 mm; 95% CI, 1.36-2.36). The DTA analysis and summary ROC plot showed an AUC of 86% and Q* = 0.80. The pooled sensitivity was 73% and the specificity was 86% Conclusions: Our analysis shows that GBWT measurement is a promising predictor of esophageal varices in chronic liver disease patients. ( J CLIN EXP HEPATOL 2023;13:509-517)