Esophageal Varices In Cirrhotic Patients Research Articles

High Blood Ammonia Level Is a Predictor of Medium and Large Size Esophageal Varices In Cirrhotic Patients

Background: The development of esophageal varices (EV) and rupture of them are the most serious complications of portal hypertension. Upper gastrointestinal endoscopy is the gold standard for diagnosis of EV but it is a costly and troublesome invasive procedure. To find a non-invasive method for detection of size of EV and to predict the bleeding risk is appealing and would decrease the indications cost and discomfort of upper GI endoscopy. The aim of the study is to evaluate high blood ammonia level is a predictor of medium and large size of esophageal varices in Cirrhotic patients. Methods: This was an observational Cross-sectional study conducted on 40 cirrhotic patients in Department of Gastroenterology, BSMMU using a pre-designed data collection sheet. Information about clinical profile, laboratory parameters- blood ammonia, serum bilirubin, serum albumin, prothrombin time, and ultrasonography of abdomen, endoscopy upper GIT was collected and recorded. The collected data was analyzed by computer with the help of SPSS version 22. Statistical analysis was done by using appropriate statistical tool like Chi-square test, Student’s t- test. P value < 0.05 was considered as significant. Diagnostic efficacy of blood ammonia was calculated by using a value. Results: A total of 40 patients with cirrhosis. Mean age of cirrhotic patients were 47.47±12.98 years. Mean blood ammonia of small size EV of cirrhotic patients was 73.70±32.11 (μmol/L) and medium and large size EV was 118.3±38.37 (μmol/L) (P< .001). At the level of 78.5 (μmol/L), sensitivity and specificity of blood ammonia was 95% and 65% respectively in detection of size of EV. Conclusion: Blood ammonia estimation could be a good tool for identifying individuals with medium and large size esophageal who will need to undergo endoscopy more frequently. Bangladesh J Medicine 2024; 35: 167-172

Significance of AST to ALT Ratio in Predicting Esophageal Varices in Cirrhotic Patients taking Esophagogastroduodenoscopy as Gold Standard

Significance of AST to ALT Ratio in Predicting Esophageal Varices in Cirrhotic Patients taking Esophagogastroduodenoscopy as Gold Standard

Cardiac Dysfunction and Its Relation to Degree of Esophageal Varices in Cirrhotic Patients

Cardiac Dysfunction and Its Relation to Degree of Esophageal Varices in Cirrhotic Patients

Platelet Count/Spleen Diameter Ratio as a Non-Invasive Predictor of Esophageal Varices in Cirrhotic Patients: A Single-Center Experience

(1) Background: The current study examined the correlations between platelet count (PC), spleen diameter (SD), and their ratio to establish a non-invasive technique for predicting the presence of oesophageal varices in cirrhotic patients. (2) Methods: The current study was an observational study conducted in the Gastroenterology Department at IMS and SUM Hospital from November 2019 to November 2021. Consecutive cirrhotic patients without a history of gastrointestinal bleeding were enrolled in the study, and the esophageal varices were assessed. The patients underwent the necessary tests, including upper gastrointestinal endoscopy, liver function testing, abdominal ultrasonography, and full hemograms. All these parameters were analyzed statistically through SPSS version 23, and p ≤ 0.05 was considered statistically significant. (3) Results: There were significant differences between cases with and without esophageal varices in the following parameters: PC, SD and their ratio, hemoglobin, and ALT level. The PC/SD ratio of ≤ 1400 was associated with a sensitivity of 90.9%, specificity of 80.8%, and a positive predictive value of 82.56% in predicting the presence of oesophageal varices, as per receiver operating curve (ROC) analysis in our study. (4) Conclusions: Esophageal varices can be predicted non-invasively using the platelet count, spleen diameter, and PC/SD ratio.

Evaluation of serum kallistatin level as a predictor of esophageal varices in cirrhotic patients

Evaluation of serum kallistatin level as a predictor of esophageal varices in cirrhotic patients

Assessment of Right Lobe Size/Serum Albumin Ratio as a Non-Invasive Marker for Esophageal Varices in HCV Patients

Abstract Background Viral hepatitis was estimated to be the 7th leading cause of mortality globally. HCVassociated disease is one of the leading causes of HCC and the main indications for liver transplantation. Approximately 71 million people are chronically infected worldwide, with a total global HCV prevalence estimated at 2.5%. Egypt has the highest world prevalence of hepatitis C virus (HCV) infection, which is associated with substantial disease and economic burden. Chronic HCV infection can result in hepatic fibrosis, cirrhosis, HCC and death. One of the major complications of cirrhosis is gastroesophageal varices, the incidence of which ranges from 35% to 80%). Current guidelines recommend that all cirrhotic patients should undergo screening endoscopy at diagnosis to identify patients with varices at high risk of bleeding who will benefit from primary prophylaxis. Noninvasive identification of patients at highest risk for esophageal varices would limit investigation to those most likely to benefit. Aim of the Work The aim of our study is to determine the predictive value of noninvasive parameters (Rt. lobe diameter/ serum albumin ratio) in the prediction of esophageal varices. Patients and Methods It is a cross-sectional study carried on 100 patients collected from the Hepatology outpatient clinics and from Hepatology and Gastroenterology unit, Internal medicine department at Ain Shams University Hospital over 6-month period, with inclusion and exclusion criteria aiming at the elimination of other factors that might affect the study results. All patients were divided into 3 groups: 30 patients with Child-Pugh A, 30 patients with Child-Pugh B, and 40 patients with Child-Pugh C. patients were subjected to the following: Clinical assessment: including; Full medical history and clinical examination, laboratory investigations: (AST, ALT, Bilirubin, Albumin, INR, Alpha feto-protein, CBC), abdominal ultrasonography and doppler ultrasonography: performed after overnight fasting and the patient in supine position with emphasis on the liver right lobe diameter (cm), splenic bi-polar diameter (long axis) (cm), ascites, presence of periportal thickening, portal vein diameter (mm) and patency, upper GI endoscopy. Results Our study showed that regarding platelet count, INR, serum albumin, Liver size, liver size / serum albumin ratio there was a significant difference among esophageal varices grades. Liver size / serum albumin ratio had non-significant diagnostic performance in differentiating esophageal varices grade-I from grade-0, had significant moderate diagnostic performance in differentiating other esophageal varices grades from each other. Liver size / serum albumin ratio cutoff points had high specificity & PPV but low sensitivity& NPV in differentiating grade-I from grade-0, had high sensitivity& NPV but moderate specificity & PPV in differentiating other grades from each other. Conclusion Our study showed that there was significant moderate agreement between endoscopy and liver size / serum albumin ratio regarding esophageal varices grades. Our study stresses on the use of some of the non-invasive parameters in predicting the grade of esophageal varices in cirrhotic patients without submitting them to the invasive, time consuming and expensive procedure of endoscopy.

Gallbladder Wall Thickening as a Non-Invasive Screening Parameter for Esophageal Varices Compared to Upper GI Endoscopy

Abstract Background Variceal hemorrhage is considered a life threatening complication of esophageal varices (EV).The main cause of esophageal varices is liver Cirrhosis and subsequent Portal hypertension. Current Guidelines recommend screening via Upper GI Endoscopy which is an invasive procedure which has its own hazards, complications and disadvantages. Gallbladder wall thickening is an early finding in patients with liver cirrhosis that occurs even before other manifestations of portal hypertension. In this study, the utility and efficiency of sonographic measurement of gallbladder wall thickness will be analyzed as a non-invasive screening alternative for upper endoscopy for assessment of EV. Objective To assess possibility of using the Gallbladder wall thickness as a non invasive screening parameter for esophageal varices in cirrhotic patients. Patients and Methods 150 patients were enrolled in this study. The laboratory tests, sonographic and endoscopy findings of 150 CLD patients to assess their correlation to esophageal varices. The Patients were classified into two groups according to the presence of varices and ascites into EV Group of 75 cirrhotic patients with esophageal varices regardless of ascites, and Non EV: Group of 75 patients with chronic liver disease and no ascites on sonography as a control group. The esophageal varices group were further subclassified into 3 groups according to the grade of varices present. Patients with grade I varices were assigned to Group (EV 1). Patients with grade II varices (EV 2). Patients with grade III varices were included in (EV 3) group. Results On Comparison of the lab finding, Sonography, and Child score of the EV and Non EV group, it was found a statistical significance in most variables. On using the multi variate assessment, the following parameters were significant as independent predictors for varices being, platelet count, AFP, Liver Span, and GBWT. The platelet levels seem to be of statistical significance with a mean of 109 with an interquartile range of 79 to 146 in the EV group. while the Non EV group, the median is 195 with IQR from 178 to 234. Alpha feto protein shows statistical significance with a median of 4.5 with IQR of 2.7 to 6.7 in the EV group, and median of 2.1 with an IQR of 1.5 to 4.9 in the Non EV group. The mean liver span in the EV group is 127.56 ± 16.19 with values ranging from 84 to 175. While the mean liver span in the Non EV group in 146.88 ± 14.47 with values ranging from 114 to 184.The mean spleen diameter in the EV group was 161.18±20.73 with values ranging from 118 to 213. The mean splenic diameter in the Non EV group is 141.84±12.34 with measurements ranging from 114 to 167. AUROC curve was drawn with a best cutoff value at 3.8 mm with AUC of 0.810 showing a sensitivity of 76%, specificity at 76 %, PPV at 76 % and NPV of 76%. At a cut off value of 4 mm sensitivity was at 62% specificity 81.3%, PPV 77% and a NPV 68%. PC/ SD was assessed with AUROC with a cutoff of 1006.29 with AUC of 0.879 with a sensitivity of 76%, specificity of 96 %, PPV of 95% and NPV of 80%.Noteworthy that GBWT showed statistical significance between grades of varices with a P-value of 0.003 and mean thickness in EV1, EV2, and EV 3 as follows 4.04 ± 0.8, 4.46 ± 0.68, and 5.27 ± 1.75. Conclusion GBWT seems to be a good predictor of varices which could be used as a screening modality for varices.

Diagnostic Accuracy of Portal Vein Flow Velocity for Esophageal Varices in Cirrhotic Patients.

Background Variceal bleeding is a life-threatening complication of cirrhosis. Traditionally, endoscopy has been utilized as a preferred modality for the detection and grading of esophageal varices. However, endoscopy is an invasive procedure and may not be readily available in resource-limited settings. To overcome this limitation, various non-invasive tests, including Doppler ultrasonography (DUS) with portal vein (PV) velocity measurement, have been investigated to predict the presence of esophageal varices (EV). This study aimed to evaluate the potential utility of portal vein flow velocity (PVFV) as a non-invasive alternative to endoscopic screening for predicting the presence of esophageal varices among cirrhotic patients. Methodology This validation cross-sectional study was carried out at the Department of Gastroenterology and Hepatology, Pakistan Kidney and Liver Institute & Research Centre (PKLI&RC), Lahore, Pakistan from June 8, 2022, to March 8, 2023. Cirrhotic patients were enrolled based on clinical, laboratory, and radiological assessments. Doppler ultrasonography was performed to measure portal vein flow velocity along other relevant indices. Subsequently, all patients underwent endoscopic evaluation to screen and grade the esophageal varices. Univariate and multivariate logistic regression analyses were performed to identify significant clinical predictors of EV based on the results of the independent sample t-tests or Mann-Whitney U tests. Receiver operating characteristic (ROC) curves were employed to determine the optimal cut-off value for portal vein flow velocity (PVFV). Sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV), and diagnostic accuracy were calculated based on the identified cut-off value. A p-value ≤ 0.05 was considered statistically significant. Results A cohort of 137 cirrhotic patients was enrolled. The study population consisted of 92 males (67.2%) and 45 females (32.8%). Endoscopic screening confirmed the presence of esophageal varices in 81 patients (59.91%). A multivariate analysis revealed that aspartate aminotransferase to platelet ratio index (APRI) (p=0.008) and portal vein flow velocity (p=0.001) were significant factors associated with esophageal varices and were used for receiver operating characteristic (ROC) analysis. The area under the curve (AUC) for PVFV was 0.981, and for APRI, it was 0.711. At a cut-off value of 18 cm/sec for PVFV, the sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV), and diagnostic accuracy for esophageal varices were found to be 93.83%, 92.86%, 95%, 91.23%, and 93.43%, respectively. Conclusion Measurement of portal vein flow velocity using Doppler ultrasonography (DUS) is a reliable screening method for predicting the presence of esophageal varices (EV) in patients with liver cirrhosis. DUS offers several advantages, including its non-invasive nature, cost-effectiveness, and widespread availability, making it a recommended approach due to its high diagnostic accuracy.

Prediction of esophageal varices and risk of bleeding in liver cirrhosis by aspartate aminotransferase to-platelet ratio index and fibrosis-4 index

Background: Liver cirrhosis is the end-stage for chronic liver disease. During the course of cirrhosis repeated endoscopy is recommended. As this intervention is expensive and often poorly accepted by patients who may refuse further follow up, there is a need for non-invasive methods to predicts the progression of portal hypertension as well as the presence and size of esophageal varices. This study was aimed to assess the value of aspartate aminotransferase (AST)-to-platelet ratio index (APRI) and fibrosis-4 index (FIB-4) for predicting esophageal varices in cirrhotic patients. Objectives of the study were: prediction of esophageal varices and risk of bleeding in liver cirrhosis by APRI, and prediction of esophageal varices and risk of bleeding in liver cirrhosis by FIB-4. Methods: It was a single centre, observational study in 100 patients of chronic liver disease. Patients were included in the study after applying inclusion and exclusion criteria. Complete blood count (CBC), liver function test (LFT), kidney function test (KFT), SE, viral marker, ultrasonography (USG) whole abdomen, and upper gastrointestinal endoscopy (UGIE) was done for all patients. Child-Pugh-Turcotte (CTP) score was calculated for every patient. Results: The APRI and FIB-4 shows moderate diagnostic accuracy in predicting the presence of esophageal varices and variceal bleed. Conclusions: In conclusion, the APRI and FIB-4 shows moderate diagnostic accuracy in predicting the presence of esophageal varices and variceal bleed. They help in starting prophylactic therapy earlier to prevent the bleeding and other complications of varices. Although endoscopy remains the primary modality for diagnosis of esophageal varices but these non-invasive parameters can also play an effective role in conjunction with endoscopy in predicting the presence of esophageal varices.

PREDICTION OF ESOPHAGEAL VARICES BASED ON SERUM-ASCITES ALBUMIN GRADIENT (SAAG) IN CIRRHOTIC PATIENTS

1.Introduction Cirrhosis is the end stage of chronic liver disease. Ascites and esophageal varices (EVs) are the most common complications of portal hypertension (PHT), with an incidence of approximately 50% [1]. Since effective preventive modalities have been established for variceal haemorrhage, early detection of EVs is critical for primary prevention of bleeding. Upper gastrointestinal endoscopy (UGE) remains the gold standard for screening [2,3]. However, many studies have been conducted to predict PHT and EV with a diverse rate of accuracy. All patients with cirrhosis should undergo UGE screening to identify those at high risk of bleeding and who may benet from primary prophylaxis, since EVs are an independent predictive factor and an early complication of cirrhosis. The test should also be repeated during the follow-up of patients with cirrhosis without EVs, who are at risk of bleeding, with or without decompensation [1]. Though UGiscopy is the gold standard to screen patients for variceal development; but has has many drawbacks such as being relatively expensive, invasive, and restrictive [4]. Such a screening test should be simple, rapid, reproducible, and inexpensive [5–7]. The serum ascites albumin gradient (SAAG) is a minimally invasive method that is precise and has been described in the classication of ascitic uid(AF) based on the presence or absence of PHT [8]. Many Studies have been performed to identify non-invasive parameters for the prediction of EVs in patients newly diagnosed with cirrhosis [5]. SAAG can be considered an indirect parameter for the detection of EVs and is useful in regions where there are limitations to perform UGE. The aim of our study was to evaluate the role of SAAG in the prediction of EVs in cirrhotic patients with ascites.

Evaluation of right liver lobe size to serum albumin concentration ratio in predicting the presence of esophageal varices in cirrhotic patients taking endoscopy as gold standard

Background: Cirrhosis with its complication is a major health concern in Pakistan. Endoscopy is an invasive and expensive modality for screening for esophageal varices which is one of the most common complication of liver cirrhosis. Research is being conducted to explore non-invasive markers that can replace this invasive technique. We aimed to evaluate the predictive value of the ratio of the size of the right lobe of liver to serum albumin concentration in prediction of the presence of esophageal varices.
 Methods: It was a cross-sectional study conducted at the Medicine Department, Ghurki Trust Teaching Hospital, Lahore from January 4 till July 31. The study included 297 patients of all the genders, aged 20-70 years, diagnosed cases of liver cirrhosis for at least 6 months and having suspected esophageal varices on right liver lobe size to serum albumin ratio >4.1. All the patients were subjected to upper GI endoscopy to confirm predicted varices. Data was analyzed using SPSS 23.0. PPV of the ratio was calculated. Post-stratification chi square was used to find association (p value <0.05 as significant).
 Results: The patients had a mean age of 51.5 ± 9.2 years with 180 (60.6%) male and 117 (39.4%) female patients. Diagnosis of esophageal varices was confirmed in 225 (75.8%) patients on endoscopy. There were 225 true positive and 72 false positive cases. Positive predictive value was 75.8%.
 Conclusion: The positive predictive value of the ratio of the size of the right liver lobe to serum albumin was statistically significant in predicting the presence of esophageal varices on upper GI endoscopy. These findings were not dependent on the patient's age, BMI, gender, duration of disease or serum bilirubin level.
 
 Cirrhosis, Esophageal Varices, Right Liver Lobe Diameter to Serum Albumin Ratio

Sonographic gallbladder wall thickness measurement and the prediction of esophageal varices among cirrhotics.

Acute variceal bleeding in patients with liver cirrhosis and portal hypertension (PHT) is the most serious emergency complication among those patients and could have catastrophic ‎outcomes if not timely managed. ‎Early screening by esophago-gastro-duodenoscopy (EGD) for the presence of esophageal varices (EVs) is ‎‎currently recommended by the practice guidelines for all cirrhotic patients. Meanwhile, EGD is not readily accepted or preferred by many patients. The literature is rich in ‎studies to investigate and validate ‎ non-invasive markers of EVs prediction aiming at reducing the unneeded endoscopic procedures. Gallbladder (GB) wall thickness (GBWT) ‎measurement has been found promising in many published research ‎articles. We aim to highlight the validity of sonographic GBWT measurement in the ‎prediction of EVs based on the available evidence.‎ We searched databases including Cochrane library, PubMed, Web of Science and many others for relevant articles. GBWT is associated with the presence of EVs in cirrhotic patients with PHT of different etiologies. The cut-off of GBWT that can predict the presence of EVs varied in the literature and ranges from 3.1 mm to 4.35 mm with variable sensitivities of 46%-90.9% and lower cut-offs in viral cirrhosis compared to non-viral, however GBWT > 4 mm in many studies is associated with acceptable sensitivity up to 90%. Furthermore, a relation was also noticed with the degree of varices and portal hypertensive gastropathy. Among cirrhotics, GBWT > 3.5 mm predicts the presence of advanced (grade III-IV) EVs with a sensitivity of 45%, the sensitivity increased to 92% when a cut-off ≥ 3.95 mm was used in another cohort. Analysis of these results should carefully be revised in the context of ascites, hypoalbuminemia and other intrinsic GB diseases among cirrhotic patients. The sensitivity for prediction of EVs improved upon combining GBWT measurement with other non-invasive predictors, e.g., platelets/GBWT.

Evaluation of Liver Stiffness Measurement by Means of 2D-SWE for the Diagnosis of Esophageal Varices.

Portal hypertension (PH) and esophageal varices (EVs) are a matter of extensive research. According to current Baveno VII guidelines, in patients with compensated advanced chronic liver disease (cACLD), liver stiffness measurement (LSM) < 15 kPa and PLT count > 150 × 109/L, upper endoscopy (UE) is not mandatory, and the emphasis should be set on non-invasive methods for evaluation of clinically significant portal hypertension (CSPH). The aim of this study is to establish whether liver stiffness (LS) measured by 2D-SWE could be used as a predictor for the presence and severity of EVs in cirrhotic patients. In total, 86 patients of whom 32 with compensated liver cirrhosis (cLC) and 54 with decompensated liver cirrhosis (dLC) were examined in the Gastroenterology clinic of University hospital "Kaspela", Plovdiv, Bulgaria. Each patient underwent LS assessment by 2D-SWE and EVs grading by UE. EVs were detected in 47 (54.7%) patients, 23 (49%) of them were stage 4-high-risk EVs (HREV). The cut-off value for LS that differentiates HREV from the rest was set at 2.49 m/s with 100% sensitivity and 100% specificity (AUC 1.000, CI 0.925). Conclusions: 2D-SWE can be used as a non-invasive method in the assessment of only high-grade esophageal varices. For the other grades, upper endoscopy remains the method of choice.

Combined Platelets & Albumin-Bilirubin Grade (PALBI) Score and Albumin-Bilirubin Score (ALBI) as a Non-invasive Markers for Prediction of Oesophageal Varices in Cirrhotic Patients

Combined Platelets & Albumin-Bilirubin Grade (PALBI) Score and Albumin-Bilirubin Score (ALBI) as a Non-invasive Markers for Prediction of Oesophageal Varices in Cirrhotic Patients

Correlation of Platelet Count with Grading of Esophageal Varices in Cirrhotic Patients

Background/Aims: Cirrhosis represents a late stage of progressive hepatic fibrosis and is generally considered to be irreversible in its advanced stages. Esophageal varix is a complication of liver cirrhosis and is the consequence of portal hypertension. The aim of this study was to determine the correlation between the severity of thrombocytopenia and the presenting of esophageal varices (EVs) in cirrhotic patient. Patients and Methods: This study was a retrospective, descriptive, analytic and monocentric study, which was carried out at Gastroenterology Department, Khmer Soviet Friendship Hospital, Phnom Penh, Cambodia. It was conducted from 1st September 2020 to 31st January 2021. All patients were diagnosed as liver cirrhosis by clinic, biology and ultrasound. Patients’ data were noted in standardized questionnaire with information such as age, sex, address, laboratory result, and the result of endoscopic finding. All data were registered into a data set and then analyzed by SPSS program version 23. Results: 1445 patients were enrolled for gastroscopy. Only 303 patients (21%) were suggested for variceal screening after the exclusions. Male was predominant with sex ratio F/M (1/2.03). Patients’ age varied between 21 and 80 years old, with the mean age of 55 ± 11 years old. 199 patients (66%) were found with EVs, while EVs grade 1 and 2 without red signs were predominated, accounting to 22.8% and 19.5% respectively. The majority of the patients with platelet count between 50 - 99 giga/l had EVs vs platelet count > 150 giga/l had no EVs (p < 0.0001). The cut-off level of platelet with EVs was 123 giga/l with 75% sensitivity and 65% specificity and with large varices was 105 giga/l with 70% sensitivity and 63% specificity. Conclusion: Thrombocytopenia is a non-invasive parameter with high accuracy for the prediction of EVs in cirrhosis. The severity of thrombocytopenia increased as the grading of EVs increased. Thus, it can assist in triaging cirrhotic patients for endoscopy to identify EVs.

Platelet Count/Spleen Diameter Ratio as a Non-invasive Parameter in the Prediction of Esophageal Varices in Patients with Liver Cirrhosis

Background: Esophagogastroduodenoscopy (EGD) is the gold standard for detecting oesophageal varices (OVs) in cirrhotic patients. However, due to the possible limitations of EGD, there has been much interest in the use of non-invasive techniques for this purpose. This study aimed to evaluate the use of platelet count/ spleen diameter ratio (PC/SD) in the prediction of the presence and grading of OVs in cirrhotic patients.&#x0D; Methods: One hundred cirrhotic patients were included in this cross-sectional study and subjected to EGD after informed consent. Either absence or the grade of OVs if existent was correlated with values of the PC/SD ratio. Univariate and multivariate analyses of data and areas under the receiver operating characteristic curve (AUC) were used.&#x0D; Results: The PC/SD ratio was a good indicator in predicting the development of OVs (AUC of 0.897) with cut-off values of (987.28). Also, it correlated well with grades of oesophageal varices, a significant stepwise progressive decrease in PC/SD ratio was recorded through the grades of oesophageal varices as follows: Mean ± SD (882.59±390.43) (603.33±266.99) (503.76±190.80) (439.69±22.51) for grades I, II, III and IV respectively (p &lt;0.002),(AUC=0.688, 0.764, 0.795, 0.849) with a cut-off value of (784.37, 640.27, 597.50, 462.00) in grades I, II, III and IV respectively.&#x0D; Conclusion: The PC/SD ratio could be considered a non-invasive method of choice for screening OVs, sparing EGD for patients in need of intervention.

Correlation of spleen stiffness measured by Acoustic Radiation Force Impulse Imaging (ARFI) with Hepatic Venous Pressure Gradient (HVPG) in the prediction of esophageal varices (EVs) grades in cirrhotic patients

Background: measurement of spleen stiffness (SS) by ARFI may predict the presence of EVs. Aim: To assess the correlation of SS measured by ARFI as noninvasive assessment with HVPG in the prediction of presence and grades of EVs in cirrhotic patients. Methods: 30 patients with post HCV liver cirrhosis who underwent biochemical tests, abdominal ultrasound (US) , Doppler , Upper gastrointestinal endoscopy (UGE), liver stiffness (LS) and spleen stiffness (SS) measurements using ARFI elastography and HVPG. Results: statistically significant difference was found between EVs presence and grades in relation to HVPG. In contrary no statistically significant difference was found between EVs presence and grades in relation to SS. Conclusion: HVPG had good significant positive correlation with presence and grades of EVs. There was no significant correlation between non-invasive parameters including the SS and LS (by ARFI) and presence or grades of EVs. There was no significant correlation between HVPG and SS and LS (by ARFI).

Combined Albumin-Bilirubin Grade and Platelets (ALBI-PLT) Score and Albumin-Bilirubin Score (ALBI) as Simple Noninvasive Laboratory Markers for Prediction of Esophageal Varices in Cirrhotic Patients

Combined Albumin-Bilirubin Grade and Platelets (ALBI-PLT) Score and Albumin-Bilirubin Score (ALBI) as Simple Noninvasive Laboratory Markers for Prediction of Esophageal Varices in Cirrhotic Patients

Non-invasive evaluation of esophageal varices in patients with liver cirrhosis using low-dose splenic perfusion CT

PurposeTo assess the value of splenic hemodynamic parameters measured using low-dose perfusion CT in the noninvasive evaluation of esophageal varices (EV) in patients with liver cirrhosis. MethodsWe retrospectively studied 43 cirrhotic patients with EV, which were divided into mild (EV1), moderate (EV2) and severe (EV3) groups. 14 patients with normal liver function and no EV were selected as the control group. All patients underwent low-dose splenic perfusion CT and radiation dose were recorded. Spleen perfusion parameters, including blood volume (BV), blood flow (BF) and permeability surface (PS), were obtained. The volume of the spleen (V-S) was measured. The total blood volume of the spleen (BV-S) was obtained using the product of V-S and BV. The measurement differences among the four groups were analyzed using ANOVA with Welch correction. Least Significant Difference (LSD) was used for the multiple comparison. P < 0.05 was considered statistically significant. ResultsThere were statistically significant differences in BV, BF, PS, V-S, and BV-S among different groups (p < 0.05). PS, V-S, and BV-S were higher, and BV and BF were lower in the study groups than those in the control group. There was a statistically significant difference between EV2 and EV1 groups, and EV2 and EV3 groups in BV and BF. The average dose-length product (DLP) was 1286.41 ± 261.15 mGy*cm, and the effective radiation dose（Deff）was 19.30 ± 3.92 mSv. ConclusionThe splenic perfusion parameters obtained in the low-dose splenic perfusion CT could be used to noninvasively evaluate the degrees of EV in cirrhotic patients.

Role of Liver and Spleen Stiffness in Predicting the Degree and Bleeding Risk of Esophageal Varices in Cirrhotic Patients

Role of Liver and Spleen Stiffness in Predicting the Degree and Bleeding Risk of Esophageal Varices in Cirrhotic Patients