Abstract
It is currently recommended that all patients with liver cirrhosis undergo upper gastrointestinal endoscopy (UGIE) to identify those who have esophageal varices (EV) that carry a high risk of bleeding and may benefit from prophylactic measures. In the future, this social and medical burden will increase due to the greater number of patients with chronic liver disease and their improved survival. The aim of this study was to assess the value of Doppler sonography for the prediction/screening of EV)in cirrhotic patients. In this twoyear prospective study, 50 patients with liver cirrhosis, referred to Al-Zahra hospital, were enrolled. Patients underwent detailed clinical examination, biochemistry tests (hematology, liver function tests), Gray-scale ultrasonography and Doppler sonography of hepatoportal system. Degree of esophageal varices was assessed at UGIE; Paquet's grades 0 – III were classified as group A (0-I; No or Mild EV) and group B (II-III; Moderate to severe EV). Three portal hemodynamic indices including liver vascular index, portal hypertension index, and congestive index was also measured. Degree of esophageal varices was assessed at UGIE. The relationship between the presence and degree of EVs with Doppler results were evaluated. Among 50 consecutive cirrhotic patients (41 males and 9 female, with mean age of 52.1(±16.2) year) were enrolled. 19 (38%) patients were placed in group A (No or mild EV), while 31(62%) had endoscopic evidences of moderate to severe esophageal varices (group B). Our study showed that among three portal hemodynamic indices we studied, only portal hypertension index has statistically significant correlation with degree of EVs confirmed by UGIE (P=0.029). Doppler ROC area under the curve was not significant but was near to be (AUC=0.64). Our data indicate that Doppler sonographic evaluations have no highly accurate predicting value for the presence of EV and its severity in patients with cirrhosis. However, we think Doppler study can be helpful for further investigation and finding more established and unchangeable information.
Highlights
Our study showed that been shown to be predictive of the severity of temic stent shunt placement, and clear signs among three portal hemodynamic indices we esophageal varices or risks of variceal bleeding of portal hypertension
The value of the prediction rule were estimated for rc indices by means of a receiver operating characteristic (ROC) curve and the area under the e curve (AUC) was reported for independent prem dictors. om Results group B grade had no significant relationship with conwere meaningfully more than patients in gestion index and liver vascular index group A(P=
Clinical tests including biobleeding in first 2-year after first detection.[23] chemistry and ultrasonography would be use- Appendix. It seems that recognizing patients with ele- ful in selecting eligible patients for screening vated risk of bleeding for on time interven- endoscopy.[30]
Summary
Esophageal varix (EV) is a common major complication in patients with cirrhosis, with an estimated prevalence about 35-80%1 and an annual incidence of approximately 5 % for EV formation in patients with liver cirrhosis.[2,3] The presence of varices correlates with the congestive index.
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