Noninvasive Prediction of Esophageal Varices Grade (Size) in Sudanese Patients with Periportal Fibrosis

Abstract

Endoscopy is an effective tool for variceal grading, but it is costly, invasive, and not always at hand. The study aimed to assess platelets count and ultrasonographic parameters of portal hypertension as predictors of esophageal grade. This, cross-sectional hospital based study conducted among100 patients with Schistosomal portal hypertension at Ibn Sina Teaching Hospital, Khartoum, Sudan during the period from November 2011 – August 2012. Patients with liver cirrhosis, previous treatment for esophageal varices or on β blockers were not included. Information collected were: socio-demographic data, history of and onset of variceal bleeding, ascites, SchistosomaMansoni Score (SMS), the spleen size, liver span, portal and splenic veins diameter, variceal grade, and platelets count. The ethical committee of the Sudan Medical Specialization Board approved the research and the Statistical Package for Social Sciences (SPSS, version 20, New York) was used for data analysis. Participants (76% males), Mean age (43.9 ± 14 years), liver span, spleen size below the costal margin, and portal vein diameter were, 10.34± 2.01, 6 ± 3.9, and 1.5 cm ± 0.27 cm respectively. Platelets count, SMS, the extent of periportal fibrosis, and portal vein diameter were significant predictors of esophageal grade,(P-value <0.05), while spleen size, portal vein diameter, platelets/spleen index were not. The study concluded that, non-invasive assessment of ultrasonographic parameters (ShistosomaMansoni Score, portal vein diameter, degree of periportal fibrosis) and platelets count could aid the detection of patients with large esophageal varies for the implementation of the needed intervention. The limitation was the small sample size.