Non-invasive ultrasound-based diagnosis and staging of esophageal varices in liver cirrhosis. A systematic review of the literature published in the third Millenium

Abstract

Altough esophagogastroduodenoscopy remains the golden standard, there are some ultrasound-based parameters which, used within complex algorithms, may represent a viable alternative for the diagnosis and surveilance of esophageal varices in patients with liver cirrhosis.

Usefulness of Contrast-Enhanced Ultrasonography for Predicting Esophageal Varices in Patients with Hepatitis B Virus (HBV)-Related Cirrhosis

“…Although spleen length and portal vein diameter are easy to measure, a systematic review showed that they are not accurate enough to predict EV [28]. Laboratory tests are correlated with the grade of EV, but are not sufficient [29].…”

“…Moreover, these methods can be affected by factors unrelated to the liver [1]. Doppler indexes have been used to diagnose EV for many years, but the results are unsatisfactory even today [28]. Liver stiffness measured by transient elastography showed a good correlation with the severity of EV, and this approach is simple and reproducible.…”

Early evaluation of response to sorafenib for hepatocellular carcinoma by duplex Doppler ultrasonography

“…'s original method . However, it is generally accepted that the congestion index is now measured by a circle using an automatic measurement system . This resistance reflects portal resistance, which was evaluated by hepatic vein catheterization .…”

Ultrasound based techniques and transient elastography may not be precise methods for the detection of esophageal varices in liver cirrhosis

“…In an interesting systematic review published in Medical Ultrasound, Bintintan et al concluded that some ultrasound parameters including diameter of the spleen > 15 cm, congestion index of the portal vein > 0.154 cm×sec, portal hypertensive index > 2.08, liver stiffness > 43.97kPa, portal vein diameter > 13 mm, renal artery resistance index ≥ 0.7 are useful markers of esophageal varices [1]. The study is well written but some points should be considered.…”