Abstract
Background and aim: Majority of cirrhotic patients develop varices, the rate of variceal bleeding is 10-30% yearly with death rate from bleeding is 17-57%. esophagogastroduodenoscopy (EGD) is an invasive and unpleasant technique carrying rare but serious complications. We aimed to investigate the serum ascites albumin gradient (SAAG) and portal vein congestion index (PCI) as non-invasive methods for prediction of esophageal varices (EV) in patients with liver cirrhosis. Patients and Methods: 125 cirrhotic patients with ascites and no past history of EGD were included. Patients were grouped into; Group I: 38 cirrhotic patients without EV. Group II: 87 cirrhotic patients with EV. Patients were subjected to full clinical evaluation, calculation of SAAG, abdominal ultrasound with a duplex study and measurement of PCI, and Esophagogastroduodenoscopy for detection and grading of esophageal varices . Results: Cirrhotic patients with EV had higher SAAG values (1.85 ± 0.24 gm/dl) than cirrhotic patients without EV (1.27 ± 0.15 gm/dl). Additionally, cirrhotic patients with EV showed a higher PCI than those without (0.16 ± 0.02 and 0.12 ± 0.01 respectively). For prediction of EV in cirrhotic patients, SAAG had AUC 0.986 (p 1.4 with sensitivity 97.70% and specificity 89.47% and portal congestion index, AUC was 0.974 (p 0.135 had sensitivity 90.80% and specificity 94.74%. Conclusion: SAAG could be used as a non-invasive predictor for the presence of EV in cirrhotic patients along with SAAG cutoff >1.4 requiring clinical attention. Combination of SAAG and PCI had a high ability to predict esophageal varices in cirrhotic patients with AUC 1.000.
Highlights
Liver cirrhosis is considered to be a histologic entity that is characterized by the presence of fibrous septae that surround the regenerative nodules of the hepatocytes
Group II; cirrhotic patients with esophageal varices displayed a higher prevalence of hepatic encephalopathy jaundice, and L.L oedema than cirrhotic patients without esophageal varices
Child Pugh score was significantly different between the two groups (p = 00.014) where in cirrhotic patients with esophageal varices, Child Pugh score C represents 63.2% of Group II compared to 39.5% in cirrhotic patients without esophageal varices
Summary
Liver cirrhosis is considered to be a histologic entity that is characterized by the presence of fibrous septae that surround the regenerative nodules of the hepatocytes. The occurrence of portal hypertension is almost universal, irrespective of the etiology of liver cirrhosis. As the portal pressure overrides a certain threshold, it leads to the development of varices [2]. Hepatic venous pressure gradient (HVPG) is the gold standard method accepted for estimating the severity of portal hypertension [3]. In spite of the advantages of HVPG as safety, and feasibility of the technique, it is invasive and minor complications (
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