Gall bladder wall thickening as non-invasive screening parameter for esophageal varices – a comparative endoscopic – sonographic study

Abstract

BackgroundThe mortality due to hemorrhage of esophageal varices (EV) is still high. The predominant cause for EV is liver cirrhosis, which has a high prevalence in Western Europe. Therefore, non-invasive screening markers for the presence of EV are of interest. Here, we aim to investigate whether non-inflammatory gall bladder wall thickening (GBWT) may serve as predictor for the presence of EV in comparison and combination with other non-invasive clinical and laboratory parameters.MethodsOne hundred ninety four patients were retrospectively enrolled in the study. Abdominal ultrasound, upper endoscopy and blood tests were evaluated. GBWT, spleen size and the presence of ascites were evaluated by ultrasound. Platelet count and Child-Pugh-score were also recorded. The study population was categorized in two groups: 122 patients without esophageal varices (non EV) compared to 72 patients with EV were analyzed by uni-and multivariate analysis.ResultsIn the EV group 46% showed a non-inflammatory GBWT of ≥4 mm, compared to 12% in the non-EV group (p < 0.01). GBWT was significantly higher in EV patients compared to the non-EV group (mean: 4.4 mm vs. 2.8 mm, p < 0.0001), and multivariate analysis confirmed GBWT as independent predictor for EV (p < 0.04). The platelets/GBWT ratio (cut-off > 46.2) had a sensitivity and specificity of 78 and 86%, PPV 76% and NPV of 87%, and ROC analysis calculated the AUC of 0.864 (CI 0.809–0.919).ConclusionsGBWT occurs significantly more often in patients with EV. However, because of the low sensitivity, combination with other non-invasive parameters such as platelet count is recommended.

Accuracy of noninvasive tests in the prediction of portal hypertensive gastropathy in Egyptian patients with cirrhosis

“…In our study, INR was significantly increased in group A. This was in line with Tsaknakis et al 19 . and Nashaat et al ., 4 who showed that INR was significantly higher with EV.…”

“…In our study, portal vein diameter, spleen size, right lobe liver diameter, GBWT, and Child–Pugh score were significantly increased in group A, and platelets/GBWT was significantly decreased in group A. This was in line with Tsaknakis et al ., 19 who demonstrated that Child–Pugh Score, GBWT, spleen diameter, and portal vein diameter were significantly higher in the EV group. Moreover, Ahmed et al 18 .…”

“…In our study, platelet/GBWT predicted PHG significantly at a cut‐off of <40, with a sensitivity of 68%, specificity of 78%, PPV of 75.6%, NPV of 70.9%, AUC of 0.861, and P < 0.001. This was in the same line as Tsaknakis et al ., 19 who demonstrated that platelet/GBWT predicted EV significantly at a cut‐off of > 46.2, with 78% sensitivity, 86% specificity, 76% PPV, 87% NPV, and an AUC of 0.864.…”

“…Due to the impairment in venous drainage, GBWT increases as an effect of PHTN 17 . This was in line with Tsaknakis et al ., 19 who showed that GBWT significantly predicted EV at a cut‐off of ≥4 mm, with 46% sensitivity, 89% specificity, 70% PPV, and 73% NPV.…”

“…showed that lower serum albumin and platelet were independent predictors of PHG. Tsaknakis et al ., 19 González‐Ojeda et al ., 20 Esmat et al ., 21 and Nashaat et al 4 . also showed that platelet was significantly decreased in the esophageal varices (EV) group.…”