Non-Invasive Predictors of Gastro-Oesophageal Varices

Abstract

Introduction: The worldwide accepted tool for screening and monitoring gastro-oesophageal varices
 in patients with liver cirrhosis is upper gastrointestinal endoscopy. Endoscopy needs clinical expertise
 and has got its own procedure related complications. Repeated endoscopies may be expensive and
 patients tend to develop poor compliance. This study was undertaken to establish the role of noninvasive
 parameters in predicting gastro-esophageal varices.
 Methods: Two hundred patients with clinical features, laboratory and sonological findings
 suggestive of cirrhosis of liver and endoscopic evidence of portal hypertension were included in the
 study. Blood parameters like serum albumin, international normalized ratio (INR), platelets count
 and ultrasonography assessments of portal vein diameter and spleen size were compared with
 presence of gastro-oesophageal varices.
 Results: At cutoff point of 2.55g/dl, serum albumin had high specificity of 99% whereas platelets
 count <1,44,000/mm3 had 87.9% sensitivity for presence of oesophageal varices. Sensitivities of
 92.72% and 94.5% while specificities of 90% and 75% were detected for presence of oesophageal
 varices when the cutoff values for portal vein diameter and spleen size were 12.25 mm and 13.9 cm
 respectively.
 Conclusions: Measurements of serum albumin, platelets count, portal vein diameter and spleen size
 by ultrasonography can be recommended as a non-invasive predictor for gastro-oesophageal varices
 in cirrhosis of liver. All these non-invasive parameters could be useful to patients with liver cirrhosis
 with portal hypertension in predicting presence of varices as well as in long-term clinical monitoring
 and management.
 Keywords: cirrhosis of liver; endoscopy; gastro-oesophageal varices; non-invasive predictors.

Non-Invasive Predictors of Esophageal Varices in Alcoholic Chronic Liver Disease

“…Of 100 patients studied in the study 76 (76%) were male, similar male predominance of 77%, 69.3% and 86.1% was observed in studies carried out by Bhattarai S et al [12] Mandal L et al [13] and Sharma SK et al [14] respectively. Median age of study population was 52 years which reported similar 54 years as in the study carried out by Bhattrai et al [12] whereas the age was higher in the other above studies 40 and 45 years respectively. Oesophageal varices were detected in 53% of the patients, in contrary higher number of varices were detected in other studies carried out by Bhattrai et al [12] and Mandal L et al [13] [12].…”

“…Median age of study population was 52 years which reported similar 54 years as in the study carried out by Bhattrai et al [12] whereas the age was higher in the other above studies 40 and 45 years respectively. Oesophageal varices were detected in 53% of the patients, in contrary higher number of varices were detected in other studies carried out by Bhattrai et al [12] and Mandal L et al [13] [12]. Another study by Mandal et al [13] also had lower platelet count with varices111000± 2840/cumm whereas platelet count was 215000 ± 5500/cumm without varices, which was higher then above studies.…”

“…Average splenic diameter of 133.1 ± 21.3mm was observed in patients with varices, whereas 106.1 ± 19.7mm in without varices. In the study by Bhattrai et al [12] average spleen size with varices was 155.0± 0.10mm and without varices was 126.6± 21.5mm. Mandal et al [13] study found that average spleen size for patients with varices as 149.9 ± 19.2mm and without varices as 131.3± 11.0mm.…”

“…Similarly, Thomopoulos et al [16] mentioned platelet count of <118000/cumm to be a good indicator for presence of varices with sensitivity of 95% and specicity of 73%. In Bhattrai et al [12] study sensitivity of 87.9 % and specicity of 41.7% for cutoff platelets count of <144000/cumm was observed. Though lower platelet count had higher sensitivity in predicting varices but lacked specicity.…”

The magnitude and correlates of esophageal Varices among newly diagnosed cirrhotic patients undergoing screening fibre optic endoscope before incident bleeding in North-Western Tanzania; a cross-sectional study

“…These findings are similar to those reported by Jamil et al with sensitivity of 51.25% (95%CI: 39.8–62.6) and specificity of 65.71% (95%CI: 53.4–76.7) with comparable AUC: 0.591, and a lower cutoff point of 12 mm [37]. High predictive values of the PVD for varices was reported in Nepal at a cutoff point of 12.25 mm (sensitivity: 92.72%; specificity: 90%) [38].…”