Role of portal color Doppler ultrasonography as noninvasive predictive tool for esophageal varices in cirrhotic patients

Abstract

Background Esophageal varices (EV) is the most common apprehensive complication of portal hypertension in patients with cirrhotic liver. Guidelines recommend Upper gastro-intestinal endoscopic screening for EV in patients with newly diagnosed chronic cirrhosis (Imperiale et al. in Hepatology 45(4):870–878, 2007). Yet, it is invasive, time consuming and costly. To avoid unnecessary endoscopy, some studies have suggested Doppler ultrasound examination as simple, and noninvasive tool in prediction and assessment of severity of EV (Agha et al. in Dig Dis Sci 54(3):654–660, 2009). Our study was to assess the role of different Doppler indices of portal vein, hepatic and splenic arteries as a noninvasive tool for prediction of esophageal varices in cirrhotic patients. Results This prospective case control study was conducted on 100 cirrhotic liver patients and 100 of healthy volunteers as control group. Patients were subjected to clinical examination, upper gastrointestinal tract endoscopy, abdominal ultrasonography with duplex Doppler evaluation of different portal Doppler hemodynamic indices were done for each patient. The results revealed that portal vein diameter, hepatic artery pulsatility index, portal hypertensive index, portal vein flow velocity, portal congestion index have high sensitivity for prediction of EV. However, Splenic artery resistance index, hepatic artery resistance index HARI, liver vascular index and platelet count/spleen diameter have less sensitivity for prediction of EV. Conclusion Measuring the portal hemodynamic indices can help physicians as noninvasive predictors of EV in cirrhotic patients to restrict the need for unnecessary endoscopic screening especially when endoscopic facilities are limited.

Platelet Count/Spleen Diameter Ratio as a Non-invasive Parameter in the Prediction of Esophageal Varices in Patients with Liver Cirrhosis

“…These results were in agreement with [38] who reported that; ascites were significantly increased in cases with varices when compared to cases without varices (p 0.008), and spleen size was significantly higher in cases with varices than those without (p 0.001).…”

“…In the present study, a significant stepwise progressive decrease in PC/SD ratio was recorded through the increasing grades of esophageal varices mean ± SD (882.59±390.43) (603.33±266.99) (503.76± 190.80) (439.69±22.51) for grade I, II, III and IV respectively (p 0.002), (AUROC= 0.688, 0.764, 0.795, 0.849) with a cut-off value of (784.37, 640.27, 597.50, 462.00) in grade I, II, III and IV respectively. These results agreed with [38] who found that the mean ±SD of PC/SD ratio was(725.6 ± 273.5) (567.9 ± 280.2) (347.8 ± 162.6) (293.8 ± 91.8) in grades I, II, III and IV respectively as well (p 0.001).…”