Portal Vein Doppler: A Tool for Non-Invasive Prediction of Esophageal Varices in Cirrhosis

Shastri, Minal; Kulkarni, Sujay; Patell, Rushad; Jasdanwala, Sarfaraz

doi:10.7860/jcdr/2014/8571.4589

Cited by 9 publications

(9 citation statements)

References 29 publications

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“…This parameter represents the ratio between the cross-sectional area (cm 2 ) and the blood flow velocity (cm/sec) of the PV: CIx = (pP2/4)/PV mean, where P is the PV diameter and PV mean represents the mean portal flow velocity [ 83 ]. Although the first results were promising for the detection of varices, large varices [ 84 ] and red spots [ 85 ], other studies failed to confirm these results [ 86 ] or demonstrated better predictive values for other indices, such as PV velocity [ 87 ].…”

Section: Resultsmentioning

confidence: 99%

Νon-invasive screening for esophageal varices in patients with liver cirrhosis

Karatzas¹,

Konstantakis

Αγγελετοπούλου³

et al. 2018

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Esophageal varices are one of the main complications of liver cirrhosis. Upper gastrointestinal endoscopy is the gold standard for the detection of esophageal varices. Many less invasive methods for screening of varices have been investigated and the most recent Baveno VI guidelines suggest that endoscopy is not necessary in patients with liver stiffness <20 kPa and platelets >150,000/μL. A critical review of the literature was performed concerning non-invasive or minimally invasive methods of screening for esophageal varices. Liver and spleen elastography, imaging methods including computed tomography, magnetic resonance imaging and ultrasound, laboratory tests and capsule endoscopy are discussed. The accuracy of each method, and its advantages and limitations compared to endoscopy are analyzed. There are data to support the Baveno VI guidelines, but there is still a lack of large prospective studies and low specificity has been reported for the liver stiffness and platelet count combination. Spleen elastography has shown promising results, as there are data to support its superiority to liver elastography, but it needs further assessment. Computed tomography has shown high diagnostic accuracy and can be part of the diagnostic work up of cirrhotic patients in the future, including screening for varices.

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Section: Resultsmentioning

confidence: 99%

Νon-invasive screening for esophageal varices in patients with liver cirrhosis

Karatzas¹,

Konstantakis

Αγγελετοπούλου³

et al. 2018

aog

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“…A sample size of 64 was calculated using the sensitivity formula with a confidence level of 90%, a level of significance of 10%, the sensitivity of the test being 96% 7 and a reasonable estimate of key proportions to be measured in the study was 16% 2 .…”

Section: Methodsmentioning

confidence: 99%

“…Portal vein velocity (PVV) has high sensitivity and a positive predictive value (PPV) for esophageal varices formation in cirrhosis. PVV with a rule-out cutoff value greater than 19 cm/s has 96% sensitivity for screening of esophageal varices 7 .…”

Section: Introductionmentioning

confidence: 99%

Measurement of portal vein indices and splenic index by ultrasound and their association with gastroesophageal varices in cirrhosis of liver

Katwal,

Ansari,

Suwal

et al. 2023

Annals of Medicine &Amp; Surgery

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Background and Objectives: Esophageal and gastric fundic varices are common in liver cirrhosis patients. Ultrasound with the Doppler study assesses liver cirrhosis severity, measuring portal vein and splenic indices’ association with gastroesophageal varices. Methodology: This study was conducted on 64 subjects with sonographic features of chronic liver disease who were referred for routine follow-up scans. Portal vein diameter, average velocity, splenic index, congestion index (CI), and portal vein area and velocity were measured. Result: Subjects with gastroesophageal varices had significantly larger portal vein diameters (14.7±1.64 mm) compared to those without varices (12.05±1.26 mm) (P<0.05). Conversely, subjects without varices exhibited a higher portal vein velocity of (17.9±0.6 cm/s) than with varices (13.91±2.01 cm/s) (P=0.0005). The splenic index was higher in subjects with varices (1120±494 cm3) than those without varices (419 cm3) (P<0.05). The CI was also higher in subjects with varices. Portal vein velocity showed the highest sensitivity (94%) with a cutoff of 19 cm/s, while the CI had the highest diagnostic accuracy (93.75%) with a cutoff of 0.10 cm xsec. The splenic index demonstrated a sensitivity of 92.85% and diagnostic accuracy of 92.18% with a cutoff of 480 cm3. The splenic index followed by the CI is found to be a better predictor of esophageal varices (area under the curve of 96.8 and 96%, respectively). Conclusion: Ultrasonographic assessment of the portal vein and spleen is a reliable, noninvasive method for predicting gastroesophageal varices in liver cirrhosis. The splenic index and CI have high diagnostic accuracy.

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“…One parameter associated with EV is the PV velocity [16][17][18]. Unfortunately, the association seemed not strong enough and even showed insignificant in some studies, especially on SEV [18][19][20].…”

Section: Introductionmentioning

confidence: 99%

A Novel Splenic Vein Flow Volume to the Portal Vein Flow Velocity Index as a Predictor for the Degree of Esophageal Varices in Liver Cirrhosis Patients

Wicaksono

Matondang

Silman

et al. 2022

Case Rep Gastroenterol

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Bleeding esophageal varices (EV) have the highest mortality rate from all complications of liver cirrhosis (LC). Several Doppler ultrasound (DUS) studies have been done on the splenic or portal vein (PV) to evaluate the hemodynamic of the esophageal vein. Our study focused on finding a better index using the ratio from two parameters correlated with EV, splenic vein flow volume (SFV), and PV flow velocity. In this study, 28 patients with LC were evaluated using DUS to compare the SFV to PV flow velocity/speed (Sv/Ps) index and other measured DUS parameters with the EV degree. Afterward, the receiver operating characteristic (ROC) curve analysis was performed on statistically significant DUS parameters. Mean Sv/Ps index value in the group of nonvarices was 9.89 ± 3.56; 19.50 ± 5.56 in the small esophageal varices (SEV) and 74.12 ± 29.37 in the large esophageal varices (LEV) group with <i>p</i> < 0.001. ROC curve analysis generated an optimal cutoff point of 16.5 (90% sensitivity and 100% specificity) to predict the presence of EV and the cutoff point of 46.7 (100% sensitivity and specificity) to predict the presence of LEV. In conclusion, the Sv/Ps index measured using DUS can be used as a noninvasive method to predict the presence of EV, especially in predicting LEV.

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Portal Vein Doppler: A Tool for Non-Invasive Prediction of Esophageal Varices in Cirrhosis

Cited by 9 publications

References 29 publications

Νon-invasive screening for esophageal varices in patients with liver cirrhosis

Νon-invasive screening for esophageal varices in patients with liver cirrhosis

Measurement of portal vein indices and splenic index by ultrasound and their association with gastroesophageal varices in cirrhosis of liver

A Novel Splenic Vein Flow Volume to the Portal Vein Flow Velocity Index as a Predictor for the Degree of Esophageal Varices in Liver Cirrhosis Patients

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