Portal Hypertension and Esophageal Varices in Cystic Fibrosis: Unreliability of Echo-Doppler Flowmetry

Abstract

To investigate the role of echo-Doppler flowmetry in evaluating patients with cystic fibrosis and portal hypertension at risk of esophageal varices, we studied 26 subjects divided in 3 groups: 9 with portal hypertension and esophageal varices, 8 with chronic liver disease without varices, and 9 without chronic liver disease. Spleen size, diameter, blood velocity, and flow rate of portal, splenic, and superior mesenteric veins were recorded. In patients without chronic liver disease Doppler measurements were repeated on 2 different days to assess intraobserver variability. Significant differences among the three groups were found for mean values of spleen size and diameters of portal, splenic, and superior mesenteric veins. Nevertheless, a considerable overlapping of individual data was observed. No differences were observed in mean hemodynamic measurements, except for blood velocity in portal vein and flow rate in splenic vein. The intraobserver variability for repeated Doppler measurements was clinically unacceptable for most of the variables studied. Echo-Doppler assessment of splanchnic flow seems to be an unreliable tool in the management of cystic fibrosis patients with portal hypertension at risk of esophageal varices.

Noninvasive predictors of large varices in patients hospitalized with gastroesophageal variceal hemorrhage

“…While many studies have documented good predictive value of nonendoscopic variables for the presence or absence of varices, there is limited data regarding variables that could reliably and nonendoscopically predict the presence of large varices in decompensated patients. In our study, we considered only simple, commonly available, reproducible parameters, as we believe that other features that had previously been identified as noninvasive predictors of EV were less reproducible in clinical practice [27], were subject to interobserver variability [28], or were assessed in different ways even within the same study. Our study has demonstrated that platelet count \91,000, palpable splenomegaly, splenic size of 158 mm, hemodynamic instability, cirrhosis with hepatocellular carcinoma, and a previous history of GEVH are indicators of LV.…”

Platelet count/spleen diameter ratio: proposal and validation of a non-invasive parameter to predict the presence of oesophageal varices in patients with liver cirrhosis

“…15 In general, most identified decreased platelet count and splenomegaly as non-invasive predictors of the presence of OV. In our study, we considered only simple, commonly available, reproducible parameters as we believe that other features that had previously been identified as non-invasive predictors of OV were less reproducible in clinical practice, 35 were subject to interobserver variability, 36 or were assessed in different ways even within the same study. Moreover, we introduced a new parameter (that is, the platelet count/spleen diameter ratio).…”

Derivation of a Clinical Prediction Rule for the Noninvasive Diagnosis of Varices in Children

“…The rule could be used to identify children most likely to have varices, thereby avoiding EGD in children who do not have varices. We considered only simple, commonly available, reproducible variables because we believe that the other previously reported noninvasive predictors of esophageal varices were less reproducible in clinical practice (28) and were subject to interobserver variability (29). We measured spleen length using ultrasonography which is an easily obtainable, noninvasive, and reproducible test (30,31).…”