Detection of Risky Esophageal Varices by Two-Dimensional Ultrasound: When to Perform Endoscopy

Abstract

ObjectiveEsophageal varices are a consequence of portal hypertension in cirrhotic patients. Current guidelines recommend that all cirrhotic patients undergo screening endoscopy at diagnosis to identify patients with varices at high risk of bleeding who will benefit from primary prophylaxis. This practice increases costs, involves a degree of invasiveness and discomfort and places a heavy burden on endoscopy units. several studies have evaluated possible noninvasive predictors of esophageal varices, but most of these studies remain controversial. MethodsThe intra-abdominal portion of the esophagus in 673 patients who presented with liver cirrhosis and portal hypertension was examined using standard 2-dimensional (2D) ultrasound. A direct relationship between the degree of varices observed on upper endoscopy and the intra-abdominal esophageal wall thickness was detected using 2D ultrasound. ResultsThe mean thicknesses of the esophageal wall were 3.7±0.5mm (mean±standard deviation) in normal individuals, 7.3±3.3mm in those with esophageal varices and 8.65±1.98mm in those with risky esophageal varices. The overall accuracy of 2D ultrasound was 95%. ConclusionsThe intra-abdominal esophagus should be observed during abdominal ultrasound examination in patients with liver cirrhosis. Two-dimensional ultrasound can play an important role in screening for esophageal varices.