Portal vein Doppler: a tool for non-invasive prediction of esophageal varices in cirrhosis.

Abstract

Esophageal varices (EV), a major complication of liver cirrhosis, can lead to life threatening gastrointestinal (GI) bleeding. Esophagogastroduodenoscopy (EGD) is the gold standard for diagnosis and management of esophageal varices. However, it is not always available in resource-constrained settings.This study was aimed at evaluating portal vein indices (PVI) using Doppler on ultrasound abdomen, which is more widely available, as tools to predict the presence of EV. A total of 50 adult patients with cirrhosis were included in the study. All subjects underwent a percutaneous liver biopsy, abdominal ultrasound and EGD along with other tests as part of the work up for cirrhosis. The portal vein indices that were studied included hepatic congestion index (HCI), portal vein diameter (PVD) and portal vein velocity (PVV). Their sensitivity, specificity and predictive values were calculated using EGD as a gold standard. Association of PVD, PVV and HCI with presence of EV was statistically significant (p-value <0.01). PVV had the highest sensitivity 84% (95% CI 66.45%- 94.10%) for detecting the presence of EV. PVD and HCI had the highest specificity of 55% (95% CI 0.31-0.77) and the highest negative predictive value of 38%(95% CI 0.24-0.52). Positive predictive value was highest PVV at 76%. (95% CI 0.61-0.86). In resources- constricted settings where EGD is not available, PVI (PVV, PVD and HCI) on ultrasound abdomen can be used as non-invasive parameters to predict the presence of EV. Although EGD remains the gold standard for the diagnosis and management of EV, when this is not possible due to scarcity of resources, PVV may be used a tool to triage patients for referral for an EGD as it has the highest sensitivity of 84% (95% CI 66.45%-94.10%) and positive predictive value of 76% (95% CI 61.51%-86.47%) amongst the PVI studied for detecting the presence of EV.