Screening of Esophageal Varices by Noninvasive Means in Chronic Liver Disease.

Mohammad A Rahim,Abu S Abdullah,Satyajit K Saha,Ferdaus Ahammed,Syed A Foez,Enayet Hossain

doi:10.5005/jp-journals-10018-1252

Abstract

IntroductionNoninvasive assessment of esophageal varices (EV) decreases the medical and financial burden related to screening and helps in the management of patients with chronic liver diseases (CLDs). In this study, our aim was to assess the utility of the platelet count/spleen diameter index for the noninvasive evaluation of EV.Materials and methodsIn this cross-sectional observational study, a total of 100 CLD patients underwent screening endoscopy for EV in Medicine and Gastroenterology Department, Sylhet MAG Osmani Medical College Hospital, Sylhet, Bangladesh. Platelet count/spleen diameter ratio was assessed in all patients and its diagnostic implication was calculated.ResultsUpper gastrointestinal endoscopy revealed that 45 (45.0%) patients had medium EV followed by 27 (27.0%) that had small EV and 19 (19.0%) patients had large EV. Receiver operator characteristic (ROC) curve was constructed using platelet count/spleen index, which gave a cut-off value of >905. The validity of platelet count/spleen index evaluation of CLD was: Sensitivity 92.3%, specificity 66.7%, accuracy 90.0%, positive predictive value (PPV) and negative predictive value (NPV) were 96.6 and 46.2% respectively. True positive was 84 cases, false positive 3 cases, false negative 7 cases, and true negative 6 cases. If we consider cut-off value as 909 in the evaluation of EV in CLD, then true positive was 85 cases, false positive 3 cases, false negative 6 cases, and true negative 6 cases. From this, by calculation, sensitivity was 93.4%, specificity 66.7%, accuracy 91%, PPV 96.6%, and NPV 50%.ConclusionThe platelet count/spleen index may be proposed to be a safe and reliable mean of screening of EV in CLD patients; however, case-control study would be required to validate this.How to cite this article: Hossain E, Ahammed F, Saha SK, Foez SA, Rahim MA, Noor-e-Alam SM, Abdullah AS. Screening of Esophageal Varices by Noninvasive Means in Chronic Liver Disease. Euroasian J Hepato-Gastroenterol 2018;8(1):18-22.

Highlights

Noninvasive assessment of esophageal varices (EV) decreases the medical and financial burden related to screening and helps in the management of patients with chronic liver diseases (CLDs)
Endoscopic screening for EV is currently recommended in all patients at the time of diagnosis of cirrhosis.[3]
The etiology of CLD was hepatitis B virus (HBV) in 45% of patients and etiology could not be ascertained in 38% patients

Summary

Introduction

Noninvasive assessment of esophageal varices (EV) decreases the medical and financial burden related to screening and helps in the management of patients with chronic liver diseases (CLDs). Lack of facilities, and poverty, underdeveloped countries suffer more It follows as an indolent course and eventually patients develop the complications of liver decompensation characterized by variceal bleeding from portal hypertension, ascites, hepatorenal syndrome, hepatic encephalopathy, and spontaneous bacterial peritonitis.[1] Esophageal varices are generally the most common clinical manifestation of portal hypertension, and ruptured varices are the deadliest complication of portal hypertension.[2] Varices usually form when portal pressure exceeds 10 mm Hg and bleeds when it exceeds 12 mm Hg. Endoscopic screening for EV is currently recommended in all patients at the time of diagnosis of cirrhosis.[3] As far as patients with no varices at screening endoscopy are concerned, surveillance should be performed every 2 years on patients with stable liver function and every year on those who show abnormal liver function. Endoscopy should be repeated every year when screening endoscopy reveals small varices.[4]

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