Ascites predicts the presence of high grade varices by screening gastroscopy

Lavergne, Jean‐Maurice; Molina, Esther; Reddy, K. Rajender; Jeffers, Lennox; Leon, Roberto De; Nader, AK; Schiff, E.

doi:10.1016/s0016-5107(97)80648-7

Cited by 22 publications

(7 citation statements)

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“…It was previously suggested that ascites, 16,17 splenomegaly, 16,18 spleen thickness, 19 spider nevi, 20 low albumin 20 or cholinesterase levels, 19 and thrombocytopenia 16,20,[21][22][23][24] could serve as predictors of EV presence. However, these conclusions derive from studies published as abstracts or preliminary reports, either analyzing retrospective data, or performing only univariate comparison, or including end-stage patients.…”

Section: Discussionmentioning

confidence: 99%

“…On the basis of experience gathered from literature 11,12,14,[16][17][18][19][20][21][22][23][24][25] and from our preliminary evidence, we selected age, sex, platelet count (PLT c ), serum albumin, bilirubin and cholinesterase levels, prothrombin activity (PT p ), ascites, hepatic encephalopathy, ultrasonographic longitudinal spleen axis, P, PV max , PV mean , and CI x as candidate predictors of the endoscopic presence of EV. Variables found to be significant in the univariate analysis (P Ͻ .05) were included in a multivariate stepwise logistic regression model.…”

Section: Methodsmentioning

confidence: 99%

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Which Patients With Cirrhosis Should Undergo Endoscopic Screening for Esophageal Varices Detection?

2001

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SEE EDITORIAL ON PAGE 471Our aims were to develop a noninvasive predictive tool to identify cirrhotic patients with esophageal varices and to evaluate whether portal Doppler ultrasonographic parameters may improve the value of other predictors. One hundred forty-three consecutive compensated cirrhotic patients underwent upper gastrointestinal endoscopy. Fourteen clinical, biochemical, ultrasonographic, and Doppler ultrasonographic parameters of each patient were also recorded. Esophageal varices were detected in 63 of the 143 patients examined (44%; 95% confidence interval [CI] 36.2-52.6). Medium and large esophageal varices were observed in 28 subjects (44%; 95% CI 31.4-58.4). Using stepwise logistic regression, presence of esophageal varices was independently predicted by prothrombin activity less than 70% (odds ratio [OR]: 5.83; 95% CI: 2.6-12.8), ultrasonographic portal vein diameter greater than 13 mm (OR: 2.92; 95% CI: 1.3-6.4), and platelet count less than 100 ؋ 10 9 /L (OR: 2.83; 95% CI: 1.27-6.28). Variables included in the model were used to generate a simple incremental rule to evaluate each individual patient. The discriminating ability of the prediction rule was relevant (area under the curve: 0.80) and did not change by replacing ultrasonographic portal vein diameter with congestion index of portal vein. We concluded that compensated cirrhotic patients should be screened by upper gastrointestinal endoscopy when prothrombin activity less than 70%, platelet count less than 100 ؋ 10 9 /L, and ultrasonographic portal vein diameter greater than13 mm are observed, whereas those without any of these predictors should not undergo endoscopy Portal hypertension (PHT) is a common complication of hepatic cirrhosis. Cirrhotic patients with PHT develop esophageal varices (EV) and are at very high risk of variceal bleeding. 1 The available evidence shows that severity of liver dysfunction, size of varices, presence of red signs on varices, and a portal pressure greater than 12 mm Hg are the most reliable predictors for the first episode of variceal bleeding. 2,3 In particular, size of the varices has been identified as the principal endoscopic predictor for the first bleeding occurrence, although variceal hemorrhage is not confined to subjects with large varices. 4 The incidence of EV development is approximately 5% per year in patients with cirrhosis, 5,6 and the progression from small to large varices occurs in 10% to 20% of cases after 1 year. 7 In the 2 years following the first detection of EV, the risk of variceal bleeding ranges between 20% to 30% 5-7 and results in a mortality of 25% to 50% within a week of the first bleeding episode. 8 Therefore, portal hypertensive bleeding prevention remains at the forefront of long-term management of cirrhotic patients.In 1996, the AASLD single topic symposium on PHT recommended that Child's class A cirrhotics should be screened endoscopically for the presence of varices if and when there is clinical evidence of portal hypertension, e.g., a low platelet count (Ͻ140 ϫ ...

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Section: Discussionmentioning

confidence: 99%

Section: Methodsmentioning

confidence: 99%

Which Patients With Cirrhosis Should Undergo Endoscopic Screening for Esophageal Varices Detection?

2001

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“…Investigators have attempted to identify characteristics that noninvasively predict the presence of varices. These studies have shown that biochemical, clinical, and ultrasonographic parameters alone or together have good predictive power for noninvasively assessing the presence of EV [8][9][10][11][12][13][14][15][16][17][18][19][20][21][22][23][24]. Overall, the most common result of these studies was that parameters such as splenomegaly, thrombocytopenia, Childs score, ascites, portal flow patterns, and platelet count-splenic size ratio were predictors of the presence of EV.…”

Section: Introductionmentioning

confidence: 99%

Noninvasive predictors of large varices in patients hospitalized with gastroesophageal variceal hemorrhage

et al. 2007

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“…[10][11][12] Of these, only 9% to 36% of patients have been found to have varices that are large enough to warrant prophylactic b blocker use. [13][14][15] In light of the financial, social and medical resource burdens implicated by these recommendations, a number of attempts have been made to determine a noninvasive method of stratifying cirrhotic patients according to their risk of having varices. [15][16][17][18][19][20][21] Although most have focused on identifying positive predictors of varices, a recent effort has focused on identifying a subset of cirrhotic patients that are unlikely to have varices, and therefore unlikely to benefit from endoscopic screening.…”

mentioning

confidence: 99%

Utilization of Platelet Count Spleen Diameter Ratio in Predicting the Presence of Esophageal Varices in Patients With Cirrhosis

Schwarzenberger

Meyer

Golla

et al. 2010

Journal of Clinical Gastroenterology

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Ascites predicts the presence of high grade varices by screening gastroscopy

Cited by 22 publications

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Which Patients With Cirrhosis Should Undergo Endoscopic Screening for Esophageal Varices Detection?

Which Patients With Cirrhosis Should Undergo Endoscopic Screening for Esophageal Varices Detection?

Noninvasive predictors of large varices in patients hospitalized with gastroesophageal variceal hemorrhage

Utilization of Platelet Count Spleen Diameter Ratio in Predicting the Presence of Esophageal Varices in Patients With Cirrhosis

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