Detection Of Esophageal Varices Research Articles

Esophageal Varices Detection and Bleeding Risk Assessment with Artificial Intelligence: A Systematic Review

Esophageal Varices Detection and Bleeding Risk Assessment with Artificial Intelligence: A Systematic Review

Evaluating aspartate–platelet ratio index: A potential non-invasive tool for liver cirrhosis and esophageal varices detection

Background: The global health challenge posed by liver cirrhosis, notably its progression to complications such as esophageal varices, necessitates advancements in diagnostic techniques. Aims and Objectives: This study probes the aspartate–platelet ratio index (APRI) capability, a non-invasive diagnostic approach, in effectively managing liver cirrhosis and foreseeing the development of esophageal varices. Materials and Methods: The research at MES Medical College in Perinthalmanna included a cohort of 114 ultrasonographically diagnosed liver cirrhosis patients. Utilizing established formulae, the APRI score was computed and juxtaposed with the incidence and gravity of esophageal varices, ascertained through endoscopic examinations. The analysis encompassed receiver operating characteristic (ROC) curve evaluation alongside descriptive and inferential statistical methodologies. Results: Within the participant group, the average age was 59.35 years, with males constituting 64.04% of the sample. Notably, 83.33% of the subjects were found to have esophageal varices varying in severity. The APRI score’s predictive capability was moderate (ROC curve area=0.655), indicating limitations in its sole use for diagnosing esophageal varices. Conclusion: While user-friendly and non-intrusive, the APRI score exhibits limited effectiveness in the specific diagnosis of liver cirrhosis and in forecasting the emergence of esophageal varices. Its utility, primarily in signaling liver fibrosis, does not extend robustly as an independent diagnostic tool in clinical scenarios. This study underscores an urgent need for extended research to affirm APRI’s accuracy in diverse liver disease stages and anticipate associated complications.

Diagnostic accuracy of triphasic CT scan abdomen in the diagnosis of distal esophageal varices taking endoscopic findings as gold standard.

Objective: To determine the diagnostic accuracy of multidetector computed tomography in detection of esophageal varices in patients with hrpatic cirrhosis. Study Design: Cross Sectional study. Setting: Department of Diagnostic Radiology, Kot Khawaja Saeed Teaching Hospital, Lahore. Period: January, 2021 to July, 2021. Material & Methods: Two hundred seventy five patients diagnosed with liver cirrhosis were included in our study. Multidetector CT of the abdomen was performed using multislice CT and the findings were recorded. The cases underwent endoscopy within the subsequent 8 weeks. The results of MDCT were compared with endoscopy findings, which were taken as gold standard. Results: We found 190 true-positives, 80 true-negatives, 03 false-negatives, and 02 false-positive results. MDCT demonstrated a sensitivity of 98.4%, a specificity of 97.6%, PPV of 99.0%, NPV of 96.4%, and an accuracy of 98.1%. Extra-esophageal findings on MDCT included other porto-systemic collaterals and hepatocellular carcinoma. Conclusion: MDCT is an effective modality for diagnosis of esophageal varices and can be used as a screening test for varices. CT also permits evaluation of extra-luminal pathology that impacts management.

Accuracy of Multi-Detector Computed Tomography in Detection of Esophageal Varices in Chronic Liver Disease

Background: Patients with chronic liver disease should undergo screening endoscopy, but this approach places a heavy burden upon endoscopy units along with other limitations. The aim of this study was to determine the diagnostic accuracy of multi-detector computed tomography scan in detecting esophageal varices taking endoscopy as gold standard.Material and Methods: This cross-sectional study was done from 1st Jan 2018 to 31st Dec 2018 at Department of Radiology, PIMS Hospital Islamabad. A total of 180 patients of both gender with chronic liver disease for at least 12 months were included in this study with an age range of 25-65 years. Patients with active gastrointestinal hemorrhage, hypersensitivity to iodinated contrast agent, chronic renal failure, claustrophobic and pregnant females were excluded. All the patients underwent endoscopy and computed tomography of lower chest and the upper abdomen before and after intravenous contrast administration. Multi detector computed tomography (MDCT) scan findings for esophageal varices were compared with endoscopy findings.Results: In MDCT positive patients (n=102), 98 were true positive and 04 were false positive. Among 78 MDCT negative patients, 07 were false negative, whereas 71 were true negative. Overall sensitivity and specificity were 93.33%, and 94.67% respectively. The positive and negative predictive values were 96.08% and 91.03% respectively, while diagnostic accuracy of MDCT in detecting esophageal varices in chronic liver disease patients was 93.89%, taking endoscopy as gold standard.Conclusions: Multi-detector computed tomography scan is a highly sensitive and accurate non-invasive modality for detecting esophageal varices in chronic liver disease patients.Key words: Accuracy, Chronic liver disease, Esophageal varices, Multi-detector computed tomography

Predictive and Prognostic Value of Von Willebrand Factor in Patients with Cirrhosis and Esophageal Varices

Background and study aim: Von Willebrand factor (vWF) is released by activated endothelial cells and plays a crucial role in the development of portal hypertension. vWF levels correlate with liver function and venous hepatic pressure gradient (VHPG) and independently predict clinical outcome. The aim was to evaluate serum vWF levels as a predictor for esophageal varices and prognosis in patients with liver cirrhosis. Patients and Methods: Sixty two patients with liver cirrhosis, divided into two groups according to presence (group I) or absence (group II) of varices were included, In addition, twenty healthy persons served as control group (group III). All patients were submitted to full history taking, clinical examination, laboratory investigations and abdominal ultrasonography. The severity of liver disease was estimated by Modified Child-Pugh and Model for End Stage Liver Disease (MELD) scores. All patients were underwent upper gastrointestinal endoscopy and vWF assay. Results: vWF values were significantly higher in group I (p1=0.001), than controls (p2=0.000), but no significant difference between group II and control group (p3= 0.59). Receiver operating characteristics (ROC) curve analysis of vWF revealed that, vWF at cutoff value of 173.8 µg/ml; the sensitivity for detection of esophageal varices was 80.8%, specificity 76.0%, positive predictive value (PPV) was 93.9%, negative predictive value (NPV) was 55.6%; area under the curve was 86.6.There was significant positive correlation between vWF and Child, MELD, esophageal varices grade and severity of portal hypertensive gastropathy. Conclusion: vWF is a good predictor for development of esophageal varices and correlated well with prognosis in patients with cirrhosis.

Diagnostic Accuracy of Multidetector Computed Tomography in Detection of Esophageal Varices.

ObjectiveTo determine the diagnostic accuracy of multidetector computed tomography (MDCT) in the detection of esophageal varices by taking endoscopy as the reference standard.Materials and methodsThis was a cross-sectional prospective study conducted at the Department of Radiology, Aga Khan University Hospital, (AKUH) Karachi, for the duration of 12 months from August 1, 2014 to July 31, 2015. One hundred ninety-six patients with a suspicion of chronic liver disease/cirrhosis undergoing 64 slice MDCT were enrolled in our study and underwent computed tomography (CT) scanning in the Department of Radiology at AKUH. Biphasic CT was performed with images obtained during the hepatic arterial phase (30-second delay) and the portal venous phase (65-second delay) after the intravenous (IV) injection of 120 mL of nonionic contrast material at a rate of 3.5 mL/s. The presence of esophageal varices was evaluated on MDCT with endoscopy as gold standard. The sensitivity, specificity, negative predictive value and positive predictive value, and accuracy of MDCT were assessed against the gold standard.ResultsOur results yielded an MDCT sensitivity of 98.96%, specificity of 100%, positive predictive value (PPV) of 100%, negative predictive value (NPV) of 66.67%, and diagnostic accuracy of 98.97% for esophageal varices in chronic liver disease (CLD) patients.ConclusionThe rate of detection of esophageal varices in patients with chronic liver disease on MDCT in our country is comparable to the international data and we advocate that MDCT should be used as a screening tool in patients with chronic liver disease to exclude esophageal varices.

Advances in noninvasive detection of esophageal varices in primary biliary cirrhosis

Primary biliary cirrhosis as autoimmune liver disease, due to conventional screening in recent years, the popularity of anti-mitochondrial antibodies to the number of patients with early primary biliary cirrhosis showed an upward trend. The development of esophageal varices is an important indicator of poor prognosis of primary biliary cirrhosis. The current assessment of esophageal variceal gold standard is endoscopy, but it is invasive examination, such as non-invasive examination to assess whether patients with esophageal varices, the selective endoscopy of the patient, can significantly reduce the patient's pain and the economic burden. In recent years, clinical studies have been carried out or carried out with non-invasive detection of patients with primary biliary cirrhosis complicated by esophageal varices. Key words: Liver cirrhosis, biliary/CO/DI; Blood glucose/CO/DI; Review

Blood Ammonia level : Is it a Clue for the Presence of Oesophageal Varices in Cirrhotic Patients ?

Background and study aim: Endoscopic screening of all patients with liver cirrhosis add major burden to endoscopic units. Non-invasive detection of Oesophageal varices (OV) help to reduce the necessity of endoscopic screening.The aim of this work is to assess the diagnostic utility of blood ammonia level (BAL) as noninvasive predictor for presence of OV and evaluate its correlation with variceal size in cirrhotic patients. Patients and Methods: This prospective cross sectional study was conducted upon 100 cirrhotic patients who attended Hepatology, Gastroenterology and Infectious diseases department, Benha University Hospital. Fasting blood ammonia was measured and upper gastrointestinal endoscopy was done for all patients. Patients were divided according to presence of OV into two groups: Group I : included 30 patients with liver cirrhosis without OV. Group II: included 70 patients with liver cirrhosis with OV who were subdivided into four subgroups: Group IIa:included 11 patients with grade I O.V. Group IIb: included 21 patients with grade II O.V. Group IIc: included 15 patients with grade III O.V. Group IId: included 23 patients with grade IV O.V. Results: The study showed that there was a highly significant increase in the mean values of BAL in cirrhotic patients with varices in comparison to those without varices. Also the study showed highly significant increase in the mean values of BAL in patients with large OV (grade III,IV) in comparison to patients with small and medium sized varices (grade I,II). By multivariate analysis, the presence of O.V. was independently associated with increased blood ammonia levels. Conclusion: Blood ammonia level could be a non invasive predictor for the presence of OV and could be clinically useful, as it correlated with the size of OV.

Measurement of Splenic Stiffness as a Predictor of Oesophageal Varices in Patients with Liver Cirrhosis in Zagazig University Hospitals

Background and study aim: Portal hypertension (PH) is a frequent complication of cirrhosis, contributing to the development of ascites, esophageal varices (EV) and hepatic encephalopathy. The best available methodology for the assessment of PH is measurement of the hepatic vein pressure gradient (HVPG). However, the performance of HVPG is limited to highly specialized centers and requires extensive experience Predicting the presence, grading and follow up of esophageal varices by non-invasive means might increase compliance and would permit to restrict the performance of endoscopy to those patients with a high probability of having varices. Patients and Methods: This study included 117 individuals divided into two groups. Group I: included 39 normal individuals as a control group for splenic stiffness measurement. Group II: included 78 cirrhotic patients. All patients of group II were subjected to upper GIT endoscopy and according to the results this group was subdivided into patients with no varices (IIa) and patients with esophageal varices (IIb). All patients underwent clinical assessment, routine laboratory evaluation, BMI, splenic and liver stiffness measurement, upper GIT endoscopy. Splenic stiffness measurement repeated for patients who had varices after 6 months of pharmaco medical treatment. Results: Splenic stiffness was found to be higher in cirrhotic group than control group, splenic stiffness measurement was found to be higher in patients who had varices than no varices in cirrhotic patients, cut off of SSM for the presence of varices ≥39.5 kpa had AUROC 0.999, sensitivity 97.7%, specificity 96.9%, PPV 97.8% and NPV while LSM showed cut off value for presence of varices >22.5 kpa had AUROC 0.641 sensitivity 84.44%, specificity 60.61%, PPV 74.5% and NPV 74.1%. PSR showed cut of ≤657.7 had AUROC 0.855 sensitivity 95.56%, specificity 78.79%, PPV 86% and NPV 92.9%. APRI showed cut off >2.7 had AUROC 0.657 sensitivity 57.78, specificity 93.94%, PPV 92.9% and NPV 62%. There was highly significant difference in median SS in patients with large varices versus small varices (49.6vs 71.58 kpa with p<.0001).SSM is not a useful tool for follow up of varices after pharmacological treatment with non selective beta-blockers (p=0.014). Conclusion: Fibroscan is a sensitive and reliable method for detection of esophageal varices. Splenic stiffness showed the best performance on detection of eosophageal varices, when compared to other non invasive predictors, PSR came in the 2nd place. Splenic stiffness measurement can differentiate small and large varices

Short article: Noninvasive assessment of portal hypertension and detection of esophageal varices in cirrhosis: state-of-the-art.

Portal hypertension (PHT) is a major consequence of any chronic liver disease and it is the main cause of complications in patients with cirrhosis. Measurement of hepatic vein pressure gradient is considered the gold standard for PHT assessment, together with its diagnosis and prognosis relevance. Even though hepatic vein pressure gradient measurement is a safe procedure, it is still considered an invasive technique and not widely available. There is thus a need for noninvasive methods that can predict the progression of PHT as well as the presence and the risk of complications related to esophageal varices. This review aimed to discuss the noninvasive markers used in the assessment of PHT and detection of high-risk esophageal varices in patients with liver cirrhosis. We focus on the main biomarkers, particularly those used in the routine assessment of chronic liver disease, and the physical methods that use tissue elastography as a diagnosis tool.

PLATELET COUNT TO SPLEEN DIAMETER RATIO AND TO SPLEEN AREA RATIO AS PREDICTORS FOR ESOPHA-GEAL VARICES IN CHRONIC HEPATITIS C PATIENTS WITH LIVER CIRRHOSIS.

Endoscopic detection of esophageal varices (EV) especially the high risk esophageal varices (HREV) is recommended in cirrhotic patients. There are several studies about non-invasive markers to predict the presence of EV. The aim of this study was to evaluate platelet count to spleen diameter (P/D) ratio and platelet count to spleen area (P/A) ratio as predictors for EV and HREV in patients with liver cirrhosis. This prospective study included 100 cirrhotic patients without previous variceal hemorrhage or endoscopic intervesion. Biochemical, imaging and endoscopic findings were collected in all patients. Several parameters including P/D and P/A ratio were measured and their association with the presence of EV and HREV was tested. The results showed that only P/D and P/A ratios were found to be independent predictors for the presence of EV and HREV in multivariant analysis. For prediction of the EV formation in cirrhotic patients, P/D ratio at value < or =979.9 and P/A ratio of < or =20.6 had area under the curve (AUC) 0.922 and 0.975 respectively with sensitivity 100%, specificity 30% for P/D ratio and sensitivity 100%, specificity 75% for P/A ratio. For prediction of the HREV formation, P/D ratio at value < or = 587.9 and P/A ratio of 513.7 had AUC 0.867 and 0.991 respectively with sensitivity 100%, specificity 50% for P/D ratio and sensitivity 100%, specificity 88% for P/A ratio.

Non-Invasive Parameters of Oesophageal Varices Diagnosis: Which Sensitive and Applicable; A Pilot Study

Background: Oesophageal varices (OV) have the greatest clinical impact. Upper endoscopy is the gold standard for OV diagnosis, despite its own limitations. Non-invasive detection of OV promises to decrease the necessity of endoscopic screening. Objectives: To assess blood ammonia level, spleen longitudinal (SLD), portal vein (PVD), splenic vein (SVD) diameters, platelets count and platelets/SLD ratio to evaluate their predictive accuracy as non-invasive indicators for the presence of OV and their correlation with variceal size. Patients and methods: This was a prospective study. Sixty cirrhotic patients were screened using upper endoscopy (for the presence and size of OV) and abdominal ultrasonography (for measurement of PVD, SVD, SLD). Fasting blood ammonia level, platelets / SLD ratio were measured. Results: Blood ammonia, PVD, SVD and SLD were significantly higher in patients with OV than those without (P < 0.001 for all). Using area under receiver operating characteristic curve (AUC), these parameters were good predictors for the presence of OV where, PVD had the highest AUC (I.00) followed by blood ammonia (AUC 0.99). Blood ammonia level correlated with variceal size (rho = 0.442, P = 0.002). Conclusion: Blood ammonia, PVD, SVD and SLD were good non-invasive predictors for OV presence with the superiority of PVD and ammonia. Blood ammonia level could be clinically useful, as it correlated with the size of OV so, pinpoint those patients requiring closer follow-up and endoscopic screening.

The Use of Three-Dimensional Reconstruction Software in Oesophageal Capsule Endoscopy: A Pilot Study from Edinburgh

Introduction : Oesophageal capsule endoscopy (OCE) is used in the detection of oesophageal varices (OVs). In such context, application of innovative 3-D reconstruction software may improve OCE accuracy. Methods : Fourteen OCE recordings were deconstructed to individual frames, 3-D reconstructed and re-stitched to 3-D videos. Six novice and 4 experienced reviewers read the OCE first in 2-D and then with 2-D / 3-D views. The consensus opinion of 3 hepatologists was used as reference standard (RS). Inter-observer agreement was checked with kappa (κ) statistics. When the RS for C2 (i.e. big OVs) was taken into account, the negative predictive value (NPV) of all reviewers for C2 OVs with 2-D and combined 2-D /3-D was calculated. Moreover, ROC curve analysis was performed. Results : The inter-observer agreement for the entire group, novices, experienced and experts with 2-D was 0.145, 0.118, 0.125 and 0.025, respectively. The inter- observer agreement for the entire group, novice, experienced and experts with 2-D / 3-D was 0.215, 0.104, 0.222 and 0.372, respectively. For C2 OVs, the NPV of 2-D and 2-D / 3-D review was 66.6% and 80%, respectively. Conclusion : In OCE, a 3-D reconstruction software leads to improved diagnostic agreement; furthermore, it improves significantly NPV of OCE for C2 varices.

CT esophagography: Non invasive screening and grading of esophageal varices in cirrhosis

PurposeTo evaluate the role of CT esophagography in the detection of esophageal varices (OV) and the differentiation of the varices at low risk and those at high risk of bleeding as compared to upper endoscopy. Patients and methodsThis study included 54 consecutive patients with liver cirrhosis. Patients with active or previous variceal bleeding, or with history of previous variceal ligation or injection were excluded. OV were best visualized on axial multidetector-CT (MD-CT) images in the post-contrast portal venous (PV) phase. No oral contrast media or air insufflation was used for esophageal lumen delineation. Four-point confidence scale (scores 1–4) was used to determine the grading of OV by CT scan: A diameter threshold of ⩾2mm was used for discrimination between high-risk (score 3 or 4) and low-risk varices (score 2). Score 1 indicated no varices. Upper endoscopy was the reference standard. ResultsThe patients with cirrhosis were 40 males (74%) and 14 females (26%). Their mean age was 56.84±7.52years. They were classified according to the CT findings into group I: 6 patients with no esophageal varices (11.1%), group II: 32 patients with low risk varices (59.3%), and group III: 16 patients with high risk varices (29.6%). The overall CT sensitivity for detection of OV was 96%, specificity 100%, positive predictive value 100% and negative predictive value 66.67%. The CT sensitivity for the high risk OV cases (100%) was higher than that for those with low risk OV (94.12%). There was no significant statistical difference in the distribution of age, sex and extra-esophageal CT findings between the low and high risk OV cases (P-value >0.05). ConclusionMD-CT esophagography is a good alternative non invasive diagnostic tool to conventional upper GI endoscopy for screening (high sensitivity) and grading of esophageal varices in cirrhosis. The diagnosis of other portal hypertension stigmata does not help in discrimination between the low risk and high risk varices. The use of abdominal triphasic CT scan as an initial full imaging method of cirrhosis is of higher cost-benefit than that of upper endoscopy for screening of esophageal varices.

Detection of Esophageal Varices Using CT and MRI

The development of esophageal varices in cirrhotic patients carries a significant risk of hemorrhage and associated morbidity/mortality. Universal endoscopic screening, however, is invasive and expensive. Conversely, cirrhotic patients often have imaging findings which suggest portal hypertension. The aim of this study was to evaluate the ability of CT and/or MRI to detect esophageal varices compared to EGD. Medical records from 2000 to 2007 were retrospectively reviewed. CT and/or MRI images were included if performed within 90 days of EGD. Two blinded, experienced radiologists were asked to review images for the presence of esophageal varices, as well as other findings associated with portal hypertension. Sensitivity, specificity, PPV and NPV were calculated using EGD findings as the gold standard. A total of 195 patients and 142 patients met criteria for CT and MRI, respectively. The sensitivity of CT to detect EGD varices was 58-89%, but increased to 65-100% when specifically looking at large endoscopic varices. Overall specificity was 68-82%, but increased to 97-100% when applying ≥4 mm varices criteria. CT was superior to MRI in the detection of endoscopic varices; the addition of other portal hypertension stigmata did not improve results. The exclusion of large endoscopic varices by CT, using standardized criteria, may obviate the need or frequency of EGD screening in select patient populations. Alternatively, CT findings highly suggestive of esophageal varices in cirrhotic patients may warrant further investigation and/or treatment. Further studies are needed to validate these findings.

ECE vs. EGD for Detection of Esophageal Varices

Esophagogastroduodenoscopy (EGD) is the gold standard for detecting esophageal varices, but this procedure is relatively invasive and is not always

M1123 The Accuracy and Safety of Esophageal Capsule Endoscopy for the Detection of Esophageal Varices: A Meta-Analysis

on assessing the extent of the enhancement pattern of tumors and therefore it has been difficult to clearly visualize the microvasculature in the tumors. The grade of visualization of eanhancement patterns and microvasculature with Sonazoid compared to Levovist was 43 with ‘excellent', 7 with ‘good', and 0 with ‘poor'. The diagnostic precision in using Sonazoid was better than that of Levovist in contrast to patjological diagnosis (the rate of improvement; 8%). Conclusion: CE-US is a low invasive diagnostic technique. The use of DI and MFI with Sonazoid, results in better visualization of the microvasculature inside tumors than Levovist. This study indicated that the new techniques led to improvements in diagnostic performance of biliary and pancreatic diseases than ever.

Diagnostic model of esophageal varices in alcoholic liver disease

Esophageal varices may cause life-threatening bleeding with attendant high hospital cost. Since effective preventive modalities for variceal hemorrhage have been established, early detection of esophageal varices is critical for prevention of bleeding. Currently, endoscopic screening is widely recommended to patients who have the diagnosis of cirrhosis. However, the diagnosis of cirrhosis relies on histological evaluations, which is costly and invasive, and endoscopic screening also burdens medical resources. Recent cost-effectiveness studies suggested that empiric prophylaxis with beta-blockers may be viable in comparison with endoscopic screening in patients with cirrhosis. However, this issue need to be also evaluated taking account of societal and patient perspectives and is not yet decided. An accurate non-invasive diagnostic model to predict the presence of esophageal varices may reduce unnecessary endoscopic procedures and prophylactic medication and improve cost-benefit of these approaches. Use of an accurate serum marker for severe hepatic fibrosis may also improve accuracy of non-invasive diagnostic models. Hyaluronic acid, a serum marker for severe hepatic fibrosis, has been reported to have a high diagnostic performance in assessing the severity of hepatic fibrosis in patients with alcoholic liver disease. In this issue, a non-invasive diagnostic model including hyaluronic acid was shown to have excellent performance in excluding the presence of medium to large esophageal varices in severe alcohol abusers. Based on current evidence, the strategy of using a non-invasive diagnostic model together with a serum marker for severe hepatic fibrosis may improve cost-benefit in the prevention of variceal hemorrhage among patients with alcoholic liver disease. The independent verification of such diagnostic models is needed.

Esophageal varices: evaluation with transabdominal US.

To prospectively evaluate the clinical usefulness of transabdominal ultrasound (US) in the detection of esophageal varices. Transabdominal US was performed in 47 patients (30 men, 17 women; age range, 18-75 years) with liver cirrhosis or idiopathic portal hypertension. The intraabdominal esophagus was demonstrated satisfactorily, and the findings were correlated with the presence of esophageal varices at endoscopy and angiography. The thickness of the anterior wall of the intraabdominal esophagus was measured and the irregularity of the wall surface documented. Blood flow signal in the esophageal wall also was evaluated with color Doppler and pulsed Doppler examinations. The mean thickness of the esophageal wall was 5.7 mm +/- 1.7 (standard deviation) in patients with esophageal varices and 3.6 mm +/- 0.96 in patients without varices. This difference was statistically significant (P < .001). Varices also caused irregular wall surfaces. Another specific finding was hepatofugal venous flow within the esophageal wall at Doppler examination. When an esophageal wall thickness of at least 5 mm or an irregular wall surface was used as a diagnostic criterion for esophageal varices, the sensitivity, specificity, and accuracy were 93%, 82%, and 89%, respectively. Transabdominal US can play a role in screening for esophageal varices. The intraabdominal esophagus should be observed during standard abdominal US in patients with chronic liver disease.

Detection and grading of oesophageal varices by fibre-optic endoscopy and barium swallow with and without Buscopan

Detection of oesophageal varices is important in the diagnosis of portal hypertension. We have, therefore, compared the results of fibre-optic endoscopy and barium swallow in 56 patients with chronic liver disease. Oesophageal varices were graded as small, moderate or gross by independent observers for each technique. In 12 patients varices were not detected by either method, and in six cases varices were detected by endoscopy when the barium swallow was negative. In 15 of the remaining 38 patients varices were found to be one grade larger at endoscopy than on barium swallow. Since it is possible that varices appear larger at endoscopy because of the Buscopan (hyoscine N-butyl bromide) used as a relaxant, we carried out barium examinations after Buscopan 20 mg i.v. in 23 of the patients. In eight cases varices were one grade larger after Buscopan than on the standard barium swallow, and in two were only detected after Buscopan had been given. Eight cases negative after Buscopan were also negative at endoscopy. Although emergency endoscopy has particular value in locating the site of bleeding in patients with portal hypertension and acute gastrointestinal haemorrhage, the results of the present study suggest that a barium meal with Buscopan is as accurate as endoscopy in the detection of oesophageal varices.