Prediction of oesophagogastric varices in patients with liver cirrhosis

Abstract

Background : All patients with liver cirrhosis are recommended for evaluation of oesophagogastric varices (EGV) regularly. This prospective study was designed to develop a predictive model for EGV in cirrhotic patients. Methods : Ninety‐two patients were recruited. From all patients studied, the size of palpable spleen, liver chemistry value, platelet count, prothrombin time, diameter of main portal vein and splenic length as assessed by ultrasonography were determined. Upper endoscopy was performed. Oesophageal varices (EV) and gastric varices (GV) were graded (EV, grade 1–4; GV, grade 1–3). In the predictive model, the EGV was classified into two grades (low, grade 1–2 EV or grade 1 GV; high, grade 3–4 EV or grade 2–3 GV). Results : There were 53 patients with EGV and 39 patients without EGV as determined by endoscopy. Patients with EGV had a significantly higher degree of ascites and hepatic encephalopathy, lower platelet count and longer splenic length than those without EGV. Low platelet count and presence of ascites were the significant independent predictors for high‐grade EGV (concordance rate 0.83). The optimal critical value for the platelet count was 150 × 10 9/L. Of patients without thrombocytopenia and ascites, 37% had low‐grade EGV but none had high‐grade EGV, whereas 38 and 35% of patients with thrombocytopenia or ascites had low and high‐grade EGV, respectively. Therefore, this predictive model for high‐grade varices had a positive and negative predictive value of 35 and 100%, respectively. Conclusion : Endoscopic screening for EGV was not necessary until thrombocytopenia or ascites occurred.

Study of Portal Vein Diameter and Spleen Size by Ultrasonography and Their Association with Gastro-esophageal Varices

“…Ng et al, 14 found a mean PVD of 10.5 ± 2.6 mm among patients without esophageal varices and mean PVD of 11.5 ± 2.4 mm among patients with varices. The average PVD was 11.78 ± 1.58 mm in non-variceal group and 14.05 ± 2.26 mm in variceal group( p <0.01) by Shanker et al 15 The best cutoff of PVD for prediction of esophageal varices for our study population was >12.25 mm (Sensitivity = 92.72%, Specificity = 90%).…”

Portal hemodynamics as predictors of high risk esophageal varices in cirrhotic patients

“…It may be explained according to the issue that palpable spleen as well as LEV may both be related to the presence of a higher portal pressure. Different factors found to be important for this purpose included splenomegaly [23][24][25][26][27][28] , thrombocytopenia [23][24][25][26][27][28][29][30] , ascites [25,27] , hepatic encephalopathy [25] , serum albumin concentration [30] , serum bilirubin levels [30] , and Child-Pugh score [27,28] . Thus, the results of our study are consistent with those of the previously published data.…”

Noninvasive assessment of portal hypertension in patients with alcoholic cirrhosis

“…The gold standard in the diagnosis of varices is esophagogastroduodenoscopy (18), but it is an invasive and costly diagnostic procedure. Therefore, several studies (1,15,(19)(20)(21)(22)(23)(24)(25)(26) have addressed the issue of identifying patients with varices by noninvasive or minimally invasive means, with the aim of avoiding endoscopy in those at low risk of having varices. Platelet count and spleen size were the most frequently explored noninvasive parameters.…”