Noninvasive Prediction Of Esophageal Varices Research Articles

A study of non-invasive predictors of esophageal varices in patients with cirrhosis of liver – A cross-sectional study

Background: Current guidelines advise that patients diagnosed with liver cirrhosis undergo screening through upper gastrointestinal endoscopy to detect esophageal varices (EV). Prophylactic measures should be taken for those with large varices on diagnosis and during follow-up. However, this poses a dual challenge, both social and medical, as the number of cirrhotic patients rises while the availability of endoscopy units remains limited. Aims and Objectives: In this study, we aim to evaluate the diagnostic accuracy of the non-invasive predictors such as spleen size, platelet count (PC), and PC/spleen diameter (PC/SD) ratio for the diagnosis of EV. Materials and Methods: This hospital-based prospective observational study was done in the SDM College of Medical Sciences and Hospital, Dharwad, among 50 patients with cirrhosis of liver. Results: Among the 50 patients studied males pre-dominated the study with 80%. Out of the study population, 70% of the patients had varices. For a cutoff point of PC/SD ratio 916, the sensitivity was 71.42% and specificity was 93.3%. For a cutoff value of PC of 1.32 lakhs, the sensitivity was 71.42%, and the specificity was 73.3%. For a cutoff value of the longest SD of 12.40 cm, the sensitivity was 94.30%, and specificity was 33.3%. Conclusion: These non-invasive predictors can be useful screening tools for the diagnosis of EV. These can be effective for the initiation of prophylactic treatment when the endoscopy facility is not available.

Assessment of Sensitivity of Fib-4, Lok Score and Platelet Count / Spleen Diameter Ratio as Non-Invasive Indicator of Esophageal Varices in Egyptian Patients with Chronic Hepatitis C virus (HCV) Infection

Abstract Background The development of esophageal varices is one of the major complications of portal hypertension, which is considered a main complication of liver cirrhosis.Variceal bleeding occurs in 20–40% of cirrhotic patients with esophageal varices and The use of endoscopic prophylactic band ligation and non-selective beta blockers can decrease the risk of esophageal bleeding by 50%, so the current guidelines recommend screening all liver cirrhosis patients by endoscopy. Aim of the Work Assessment of sensitivity of fib-4, lok score and platelet count / spleen diameter ratio as non-invasive indicator of oesphageal varices in egyptian patients with chronic hepatitis c virus (hcv) infection. Patients and Methods This study will include 100 egyptian patients selected from internal medicine and hepatology outpatient clinics and inpatient wards at matria teaching hospital. Results Plt count/spleen diameter ratio, plt count and spleen diameter demonstrated a high statistically significant correlation with the presence and grade of esophageal varices. as according to sensitivity and specificity test the most accurate screening test for diagnosis of esophageal varicose is PLT/SD ratio as AUC (87.4%), also it is a good negative test as specificity (86.7%) with cutoff value (1026.7), but for suspect a case most sensitive test is PLT count as sensitivity (93.3%) with cutoff value (120.5). these tests followed by spleen diameter with accuracy (78.2%), and the least test is right lobe/ albumin ratio which cannot depend on it in diagnosis of esophageal varices as its accuracy is (52.2%),sensitivity 66.7% and specificity 48.3%. Conclusion The use of plt count/spleen diameter ratio, plt count and spleen diameter, especially the platelet count/spleen diameter ratio, can help physicians as noninvasive predictors of esophageal varices to restrict the use of endoscopic screening only to patients presenting a high probability of esophageal varices. This is especially useful in clinical settings where resources are limited and endoscopic facilities are not present in all areas.While rt liver lobe/albumin ratio can not be used as a non invasive predictor of esophageal varices.

The Utility of the Platelet-Albumin-Bilirubin Score as a Non-invasive Predictor of Esophageal Varices and Variceal Hemorrhage in Patients With Liver Cirrhosis Compared to Child-Turcotte-Pugh and Model of End-Stage Liver Disease-Sodium Scores.

Introduction Research on non-invasive tools for detecting gastro-esophageal varices is underway. We investigated the Platelet-Albumin-Bilirubin (PALBI) score in comparison with the Child-Turcotte-Pugh (CTP) and MELD-Na (MELD-Na) scores in patients with liver cirrhosis. Methods Three hundred and twenty-threepatients with liver cirrhosis were studied. The PALBI, CTP and MELD-Na scores were calculated and analyzed for gastroesophageal varices and their characteristics using SPSS version 26 (IBM Corp., Armonk, NY, USA). Results Two hundred and sixty-four patients had esophageal varices and 102 presented with variceal hemorrhage. Mean PALBI, CTP and MELD-Na scores were significantly higher for patients with varices versus without varices (p < 0.05). Unlike the mean MELD-Na score, the mean PALBI and CTP scores were significantly higher in patients with large high-risk varices as compared to patients with small low-risk varices (p < 0.05). The mean CTP scores were significantly higher in patients with variceal hemorrhage than those without hemorrhage (p < 0.05), while the difference between mean PALBI and MELD-Na was insignificant, in this regard. The PALBI score had better sensitivity than the CTP and MELD-Na scores in indicating the presence of varices but was similar to the CTP score in predicting high-risk varices. Conclusion The PALBI score proves to have good utility and efficiency in predicting varices in comparison to CTP and MELD-Na scores. It can determine high-risk stigmata of variceal hemorrhage with similar performance as the CTP Score.

Platelet Count to Prothrombin Time: A Noninvasive Predictor of Esophageal Varices in Patients With Chronic Liver Disease.

Introduction Esophageal variceal bleeding is a potentially deadly consequence of portal hypertension in patients with cirrhosis. Although upper gastrointestinal endoscopy is still the preferred method for identifying esophageal varices (EV), the present study measured the platelet count to prothrombin time (PLT/PT) ratio for the assessment of portal hypertension and subsequent diagnosis of EVs in patients with chronic liver disease (CLD). Methods This was an observationalcomparative study conducted in the outpatient department of Patel Hospital, Karachi, Pakistan, using a non-probability consecutive sampling technique. Ethical approval was obtained from the Patel Hospital ethical review committee (PH/IRB/2022/028). An independent sample t-test was used for parametric data, whereas the Mann-Whitney U test was used for non-parametric data. The chi-square test was used to compare the categorical data of patients with and without EV. Receiver operating characteristic (ROC) analysis was performed to evaluate the cutoff values for the PLT/PT ratio, sensitivity, specificity, and area under the curve (AUC). Results The study involved 105 patients with and without EV. Among them, 38 (63.3%) males and 22 (36.7%) females had EV, whereas 30 (66.7%) males and 15 (33.3%) females did not. The platelet (PLT) count was also significantly lower in patients with EV (87.6 ± 59.8) than in those without (176.6 ± 87.7) (p < 0.001). The PLT/PT ratio was significantly lower in patients with EV (median: 5.04, IQR: 3.12-9.21) compared to those without (median: 14.57, IQR: 8.08-20.58) (p < 0.001). The sensitivity and specificity of the PLT/PT ratio for identifying EVs were 97.80% and 83.30%, respectively. Conclusion We found a significantly lower PLT/PT ratio in cases with EV than those without EV. After defining an optimal cutoff, PLT/PT had a high sensitivity in identifying cases with EVs in CLD. Therefore, we conclude that in patients with CLD, the PLT/PT ratio is a noninvasive predictor for the presence of EV.

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.

Non-Invasive Prediction Models for Esophageal Varices and Red Signs in Patients With Hepatitis B Virus-Related Liver Cirrhosis.

Background: Red signs are closely related to esophageal variceal bleeding, and, despite improvements in therapy, the mortality rate remains high. We aimed to identify non-invasive predictors of esophageal varices and red signs in patients with hepatitis B virus-related liver cirrhosis. Methods: This retrospective study included 356 patients with hepatitis B virus-related liver cirrhosis after applying inclusion and exclusion criteria among 661 patients. All patients underwent endoscopy, ultrasonography, laboratory examinations, and computed tomography/magnetic resonance imaging. Univariate and multivariate logistic regression analysis were performed, and prediction models for esophageal varices and red signs were constructed. Results: Multivariate analysis revealed that spleen diameter, splenic vein diameter, and lymphocyte ratio were independent risk factors for esophageal varices and red signs. On this basis, we proposed two models: i) a spleen diameter-splenic vein diameter-lymphocyte ratio-esophageal varices prediction model (SSL-EV model); and ii) a spleen diameter-splenic vein diameter-lymphocyte ratio-red sign prediction model (SSL-RS model). The areas under the receiver operating characteristic curve for the two prediction models were 0.843 and 0.783, respectively. With a cutoff value of 1.55, the first prediction model had 81.3% sensitivity and 76.1% specificity for esophageal varices prediction. With a cutoff value of −0.20, the second prediction model had 72.1% sensitivity and 70.7% specificity for the prediction of red signs. Conclusions: We proposed a new statistical model, the spleen diameter-splenic vein diameter-lymphocyte ratio-red sign prediction model (SSL-RS model), to predict the presence of red signs non-invasively. Combined with the spleen diameter-splenic vein diameter-lymphocyte ratio-esophageal varices prediction model (SSL-EV model), these non-invasive prediction models will be helpful in guiding clinical decision-making and preventing the occurrence of esophageal variceal bleeding.

Spleen stiffness-spleen size-to-platelet ratio risk score as noninvasive predictors of esophageal varices in patients with hepatitis B virus-related cirrhosis.

This study was conducted to evaluate the predictive value of spleen stiffness-spleen size-to-platelet ratio risk score (SSPS) as a noninvasive predictor of esophageal varices (EVs) and to compare it with others.In this retrospective study, from April 2017 to October 2018, a total of 65 patients with hepatitis B virus-related cirrhosis who underwent the liver and spleen stiffness (LS, and SS) measurements by 2 dimensional-shear wave elastography and endoscopic evaluation for EVs were enrolled. Liver stiffness-spleen size-to-platelet ratio risk score (LSPS) and SSPS were calculated. The prognostic values were assessed by the area under the receiver operating characteristic curve (AUC).Twenty-six patients had no EV on endoscopy. Among 39 patients who had EVs, 12 patients had high risk EVs. The AUCs of the LS value, SS value, LSPS, and SSPS for predicting EVs were 0.72, 0.77, 0.80, and 0.85, respectively. The AUCs of the LS value, SS value, LSPS, and SSPS for predicting high-risk EVs were 0.55, 0.78, 0.67, and 0.80, respectively. SSPS had the highest specificity, at 96.15%, for predicting EVs.SSPS may be beneficial to exclude from having EVs and it is expected that the frequency of performing endoscopies for screening EVs can be reduced.

Spleen stiffness measurement based on shear-wave elastography for noninvasive assessment of esophageal varices in liver cirrhosis cases

Background and aim Several laboratory tests and procedures have been considered as noninvasive prediction of esophageal varices (OV). This study assessed the usefulness of shear-wave elastography in splenic stiffness measurement (SSM) as a noninvasive assessment for OV prediction. Patients and methods This study was performed on 100 cases in Sohag Cardiology and Gastroenterology 1Center who were categorized into three groups: group A: (n=40) included liver cirrhosis of any cause proved clinically, laboratory, and by ultrasound; group B: (n=30) included chronic hepatitis of any cause; and group C: (n=30) included nonhepatic cases attending the hospital with gastrointestinal tract complaints. All cases have been subjected to full history taking and clinical examination before classification, complete blood count, alanine aminotransferase, aspartate transaminase, serum albumin, coagulation profile and serum bilirubin, hepatitis C virus antibody (HCV Ab) and hepatitis B surface antigen (HB Ag), abdominal ultrasonography, SSM by shear-wave elastography, and upper endoscopy for diagnosing of OV. Results As regards to abdominal ultrasound and upper endoscopy, significant differences were noted between three groups regarding spleen, spleen diameter, SSM, ascites, and OV (as 27.5 and 65% cases in group I had ascites and OV versus no cases in groups II and III as P&lt;0.001). As regards to spleen diameter and SSM, significant increase was noted in group A than B and C, but insignificant differences were noted among groups B and C. As regards to OV grades in group A, there were five cases with grade I, nine cases with grade II, five cases with grade III, and seven cases with grade IV. Considerable positive correlations were noted among OV grades and acoustic radiation force impulse elastography (r=0.904, P &lt;0.001). Conclusion SSM by shear-wave elastography is a useful noninvasive parameter for detection of OV presence and grading in cases of liver cirrhosis.

Non-Invasive Predictors of Esophageal Varices in Patients with Cirrhosis of Liver- A Prospective Study

Background: Liver disease particularly chronic liver disease is one of the major public health problem, accounting for significant morbidity and mortality worldwide. Among the different complications, gastro-esophageal variceal bleeding is the deadliest complications of advanced liver disease and have been described in 50% of patients with liver cirrhosis. Aim: To identify the non-invasive predictors of esophageal varices in patients with cirrhosis of liver, so as to reduce number of unnecessary endoscopies. Methods: Ninety two patients with cirrhosis of liver irrespective of etiology were analysed prospectively from October 2019 to March 2020. Appropriate clinical, biochemical and ultrasonographic parameters were selected as variables to compare with esophageal varices. The data were assessed by univariate and multivariate analysis. Results: Univariate analysis of the studied parameters showed that decreased platelet count, albumin levels and platelet count/splenic diameter ratio and increased bilirubin levels, prothrombin time, splenic size, portal vein size were significantly associated with the presence of esophageal varices and their values correlated with increasing size of varices. On multivariate analysis of variables, the independent predictors for the presence of varices were platelet count/splenic size &lt;1433.1, splenic size&gt;115.75 mm. Conclusion: Platelet count/splenic size&lt;1433.1, Splenic size&gt;115.75 mm are independent noninvasive predictors of esophageal varices in patients with cirrhosis of liver

Multimodal Ultrasound Model Based on the Left Gastric Vein in B-Viral Cirrhosis: Noninvasive Prediction of Esophageal Varices.

OBJECTIVES:To establish and verify a simple noninvasive model based on the left gastric vein (LGV) to predict the grade of esophageal varices (EV) and high-risk EV (HEV), to facilitate clinical follow-up and timely treatment.METHODS:We enrolled 320 patients with B-viral cirrhosis. All patients underwent endoscopy, laboratory tests, liver and spleen stiffness (SS), and ultrasonography. HEV were analyzed using the χ2 test/t test and logistic regression in the univariate and multivariate analyses, respectively. EV grades were analyzed using the variance/rank-sum test and logistic regression. A prediction model was derived from the multivariate predictors.RESULTS:In the training set, multivariate analysis showed that the independent factors of different EV grades were SS, LGV diameter, and platelet count (PLT). We developed the LGV diameter-SS to PLT ratio index (LSPI) and LGV diameter/PLT models without SS. The area under the receiver operating characteristic curve of the LSPI for diagnosis of small EV, medium EV, large EV, and HEV was 0.897, 0.899, 0.853, and 0.954, respectively, and that of the LGV/PLT was 0.882, 0.890, 0.837, and 0.942, respectively. For the diagnosis of HEV, the negative predictive value was 94.07% when LSPI < 19.8 and the positive predictive value was 91.49% when LSPI > 23.0. The negative predictive value was 95.92% when LGV/PLT < 5.15, and the positive predictive value was 86.27% when LGV/PLT > 7.40. The predicted values showed similar accuracy in the validation set.DISCUSSION:Under appropriate conditions, the LSPI was an accurate method to detect the grade of EV and HEV. Alternatively, the LGV/PLT may also be useful in diagnosing the varices when condition limited.

Assessment of Right Liver Lobe Size / Serum Albumin Ratio as a New Non-Invasive Predictor for the Presence of Oesophageal Varices in Egyptian Patients with HCV Related Liver Cirrhosis

Background: Oesophageal varices are the most critical porto-systemic shunts that develop secondary to portal hypertension, which is considered the main complication of liver cirrhosis. Many studies recommend the screening of all cirrhotic patients by endoscopy, but repeated endoscopic examinations are unpleasant for patients and have a high- cost impact and burden on endoscopic units. Objective: This study aimed to evaluate the accuracy of using the right liver lobe size/serum albumin ratio as a non-invasive predictor of esophageal varices in patients with HCV-related liver cirrhosis. Patients Methods: This prospective study included 30 patients with liver cirrhosis and 30 patients who underwent upper gastrointestinal endoscopy for any causes other than liver cirrhosis. All studied subjects underwent a detailed history and clinical examination, biochemical workup, upper gastrointestinal endoscopy, and abdominal ultrasound. The right liver lobe/serum albumin ratio was calculated for all patients. Results: There was a statistically significant difference between the control and the study subgroups as regards the Right lobe of the Liver/Albumin ratio (p-value 0.007). The diagnostic accuracy of the Right lobe of the Liver/Albumin ratio was assessed using the ROC curve which revealed a sensitivity of 86.67% and specificity of 73.33% at cut-off value >3.88, with an acceptable discriminative accuracy of 79.9%. Conclusion: The use of Right liver lobe/serum albumin ratio can help physicians by restricting the use of endoscopic screening only to patients presenting a high probability of esophageal varices. This is especially useful in clinical settings where resources are limited, and endoscopic facilities are not present in all areas.

Assessment of Right Liver Lobe Size / Serum Albumin Ratio as a New Non-Invasive Predictor for the Presence of Oesophageal Varices in Egyptian Patients with HCV Related Liver Cirrhosis

Background: Oesophageal varices are the most critical porto-systemic shunts that develop secondary to portal hypertension, which is considered the main complication of liver cirrhosis. Many studies recommend the screening of all cirrhotic patients by endoscopy, but repeated endoscopic examinations are unpleasant for patients and have a high- cost impact and burden on endoscopic units. Objective: This study aimed to evaluate the accuracy of using the right liver lobe size/serum albumin ratio as a non-invasive predictor of esophageal varices in patients with HCV-related liver cirrhosis. Patients Methods: This prospective study included 30 patients with liver cirrhosis and 30 patients who underwent upper gastrointestinal endoscopy for any causes other than liver cirrhosis. All studied subjects underwent a detailed history and clinical examination, biochemical workup, upper gastrointestinal endoscopy, and abdominal ultrasound. The right liver lobe/serum albumin ratio was calculated for all patients. Results: There was a statistically significant difference between the control and the study subgroups as regards the Right lobe of the Liver/Albumin ratio (p-value 0.007). The diagnostic accuracy of the Right lobe of the Liver/Albumin ratio was assessed using the ROC curve which revealed a sensitivity of 86.67% and specificity of 73.33% at cut-off value >3.88, with an acceptable discriminative accuracy of 79.9%. Conclusion: The use of Right liver lobe/serum albumin ratio can help physicians by restricting the use of endoscopic screening only to patients presenting a high probability of esophageal varices. This is especially useful in clinical settings where resources are limited, and endoscopic facilities are not present in all areas.

Poor performance of noninvasive predictors of esophageal varices during primary prophylaxis surveillance in biliary atresia

ObjectiveOur objective was to analyze performance of noninvasive markers for significant esophageal varices in relation to outcomes of endoscopic surveillance and primary prophylaxis in biliary atresia (BA). MethodsThis was a prospective follow-up study of a national cohort of BA patients born between 1989 and 2017, including 72 consecutive patients who underwent variceal surveillance endoscopies. The risk for developing significant varices (grade ≥ 2) and variceal bleeding was compared between successful (postoperative total bilirubin ≤34 μmol/L) and failed portoenterostomy (PE) patients. AUROC analyses and Wilcoxon signed ranks test were used to assess accuracy of noninvasive measures to predict the presence of significant varices after successful PE. ResultsIn total, 72 patients underwent 471 endoscopies during 427 follow-up years. Among 45 successful PE patients (63%), varices appeared later [at median age 1.6 (0.7–14) vs. 0.8 (0.4–1.9) years] and bled less often [7% vs. 41%, p < 0.001 for both] than after failed PE. Liver biochemistry, stiffness, and predictive scores showed poor accuracy for the presence of significant varices. After failed PE, lowered plasma albumin concentration predicted varices with an AUROC of 0.69 (95% CI 0.52–0.85, p = 0.030). After successful PE the varices prediction rule with AUROC 0.72 (95% CI 0.64–0.79) was the most accurate predictor. Individual predictors showed no meaningful changes between the two consecutive endoscopies leading to discovery of varices. ConclusionAccurate targeting of endoscopies based on noninvasive predictors remains difficult during primary variceal prophylaxis protocol in BA. The differing prognoses after successful and failed PE should be considered in variceal surveillance and future studies. Type of studyDiagnostic/prognosis study. Level of evidenceLevel II.

Insulin resistance as a noninvasive predictor of esophageal varices in hepatitis C virus cirrhotic patients

Objectives The aim was to evaluate sensitivity and specificity of insulin resistance (IR) as a noninvasive predictor of esophageal varices (EV) in hepatitis C virus (HCV) cirrhotic patients. Background Variceal bleeding due to portal hypertension is associated with a high probability of circulatory dysfunction and even death. However, routine endoscopy is an invasive maneuver which consumes effort, time, and money. IR was studied as an early noninvasive predictor of EV. Patients and methods Eighty cirrhotic patients were included in this prospective case–control study and 20 nondiabetic nonhepatic patients served as the control group. Patients were recruited from the Gastrointestinal Endoscopy Unit of Tropical Medicine Department, Menoufia University Hospitals from January 2017 to March 2018. IR was calculated by the homeostasis model assessment (HOMA-IR)=fasting insulin (μU/ml)×fasting glucose (mmol/l)/22.5. Results HOMA-IR showed a high statistically significant correlation with the presence and grade of EV in HCV cirrhotic patients (P Conclusion IR estimated by HOMA-IR can provide sensitive information for determination of the presence and grade of EV in HCV cirrhotic patients regardless of their Child–Turcotte–Pugh classification.

Role of shear wave elastography of liver and spleen “as non-invasive method” in prediction of oesophgeal varices in Egyptian patients with liver cirrhosis.

ABSTRACT BACKGROUND: Upper gastrointestinal endoscopy (UGIE) screening for esophageal varices (EVs) is expensive for the health care system and invasive for the patients. Elastography has been recently used for prediction of liver cirrhosis and its complications. OBJECTIVE: To identify the reliability of liver stiffness (LS) and spleen stiffness (SS) using point shear wave elastography(PSWE) as noninvasive predictors of EVs. METHODS: Sixty patients divided into two groups (cirrhotics without EVs (30 patients) and cirrhotics with EVs (30 patients)) were subjected to: Demographic, clinical, laboratory tests, abdominal ultrasound and LS and SS measured by shear wave elastography (PSWE), and finally UGIE.60 healthy control subjects were also included in the study. RESULTS: There was highly significant increase of liver , spleen stiffness, and liver stiffness ᵡ splenic size/platelet count(LSPS) in group with EVs in comparison to group without EVs and control group, and in patients group with cirrhosis without EVs in comparison to control. Also there was significant increase of spleen stiffness in cases with large EVs than in those with mild and moderate EVs while there was no significant difference as regard liver stiffness.CONCLUSION: LS and SS are reliable predictive tools for EVs. These results could be used to reduce the need for routine upper gastrointestinal endoscopy screening. Keywords: Noninvasive, PSWE, Liver Stiffness, Spleen Stiffness, esophageal varices

Non-Invasive Predictors of Esophageal Varices in Alcoholic Chronic Liver Disease

Background: Alcohol is widely consumed socially accepted recreational beverage, that is toxic and affects directly or indirectly almost every organ. Spectrum of alcoholic liver disease ranges from fatty liver to cirrhosis. One of the complications of the later spectrum is portal hypertension, around 50% develops varices and bleeding depends on the size of the varices. Predicting varices without endoscopic is difficult but few non-invasive parameters are available.&#x0D; Materials and Methods: It was a prospective cross-sectional study done in Nobel Medical College Teaching Hospital, Biratnagar, Nepal from September 2018 to August 2019. Approval was acquired from Institutional Review Committee. Patients with chronic ethanol ingestion and features suggestive of chronic liver disease clinically and investigation wise were enrolled in the study. History, physical examinations along with platelet count, prothrombin time was taken and ultrasonography abdomen and upper gastrointestinal endoscopy was done to see the splenic diameter, and varices.&#x0D; Results: Esophageal varices were present in 53%. Mean platelet count with variceswas 122566 ± 36024.8 /mm3, splenic diameter was 133.1 ± 21.3 mm, prothrombintime (PT) time was 19.3 ± 5.0 sec andratio of platelet per spleen diameter was 930.2 ± 259.4 /mm3/mm.Platelet count &lt; 163500/mm3 has sensitivity and specificity 83.0% and 83.0% respectively. Ratio of platelet per splenic diameter ratio cutoff 1293.7 has 88.7% sensitivity and 85.1% specificity for predicting varices.&#x0D; Conclusion: In chronic alcoholic liver disease patients low platelet count, increased splenicdiameter, low platelet per splenic diameter ratio are useful in predicting presence of esophageal varices.

Acoustic radiation forced impulse-based splenic prediction model using data mining for the noninvasive prediction of esophageal varices in hepatitis C virus advanced fibrosis.

Esophageal varices (EV) are serious complications of hepatitis C virus (HCV) cirrhosis. Endoscopic screening is expensive, invasive, and uncomfortable. Accordingly, noninvasive methods are mandatory to avoid unnecessary endoscopy. Acoustic radiation forced impulse (ARFI) imaging using point shear wave elastography as demonstrated with virtual touch quantification is a possible noninvasive EV predictor. We aimed to validate the reliability of liver stiffness (LS) and spleen stiffness (SS) by an ARFI-based study together with other noninvasive parameters for EV prediction in HCV patients. Also, we aimed to evaluate the diagnostic performance of a new simple prediction model (incorporating SS) using data mining analysis. This cross-sectional study included 200 HCV patients with advanced fibrosis. Labs, endoscopic, ultrasonographic, LS, and SS data were collected. Their accuracy in diagnosing EV was assessed and a data mining analysis was carried out. Ninety patients (22/46% of F3/F4 patients) had EV (39/30/18/3 patients had grade I/II/III/IV, respectively). LS and SS by ARFI showed high significance in differentiating not only patients with/without EV (P = 0.000 for both) but also correlated with the grading of varices (R = 0.31 and 0.45, respectively; P = 0.000 for both). Spleen longitudinal diameter (SD), splenic vein diameter (SVD), platelets to spleen diameter ratio, LOK index, and FIB-4 score were the best ultrasonographic and biochemical predictors for the prediction of EV [area under receiver operating characteristic (AUROC) 0.79, 0.76, 0.76, 0.74, and 0.71, respectively]. SS (using ARFI) had better diagnostic performance than LS for the prediction of EV (AUROC = 0.76 and 0.70, respectively). The diagnostic performance increased using data mining to construct a simple prediction model: high probability for EV if [(SD cm) × 0.17 + (SVD mm) × 0.06 + (SS) × 0.97] more than 6.35 with AUROC 0.85. SS by ARFI represents a reliable noninvasive tool for the prediction of EV in HCV patients, especially when incorporated into a new data mining-based prediction model.

Evaluation of the Sabadell noninvasive hepatitis C-related cirrhosis early detection index and right lobe diameter to albumin ratio in the prediction of presence of varices in Egyptian cirrhotic patients

IntroductionPortal hypertension in cirrhosis results from progressive fibrotic remodeling of the liver, which increases the resistance to hepatic sinusoidal blood flow. Increased portal venous pressure causes esophageal and gastric varices, which contribute substantially to cirrhosis-related morbidity and mortality. The gold standard in the diagnosis of varices is esophagogastroduodenoscopy, but identification of noninvasive predictors of esophageal varices (OVs) will allow upper gastrointestinal tract endoscopy to be carried out only in a selected group of patients. Different noninvasive parameters including clinical, laboratory, and sonographic predictors are an alternative approach to perform selective screening endoscopy only in patients at high risk.ObjectiveOur objective is to evaluate whether the noninvasive hepatitis C-related cirrhosis early detection (NIHCED) score and the right lobe diameter to albumin ratio can predict the presence of OVs in a group of Egyptian cirrhotic patients.Patients and methodsSeventy-five patients with liver cirrhosis were enrolled in the study depending on the clinical evidence of stigmata of chronic liver disease (e.g. jaundice, ascites, palmar erythema, spider naevi, etc.) and ultrasonographic features of liver cirrhosis (e.g. coarse echo texture, shrunken liver, etc.).ResultsAccording to the esophagogastroduodenoscopy results, the patients were categorized into two groups: those with OVs (47 patients, 63%) and those without OVs (28 patients, 37%).Receiver operating characteristic curve analysis of the NIHCED score was applied to both groups with a cutoff score of more than 45. The estimation cohort study had a sensitivity of 70%, specificity of 78%, and diagnostic accuracy of 74% with an area under the receiver operating characteristic curve of 0.77 (95% confidence interval, 0.66–0.86).Receiver operating characteristic curve analysis of the right lobe diameter to albumin ratio was applied to both groups with a cutoff score of more than 2.80. The estimation cohort study had a sensitivity of 80%, specificity of 53%, and diagnostic accuracy of 67% with an area under the receiver operating characteristic curve of 0.67 (95% confidence interval, 0.55–0.77).ConclusionThe NIHCED score and right lobe diameter to albumin ratio are simple noninvasive predictors of the presence of varices in Egyptian patients with liver cirrhosis.

Mo1532 – The Utility of Radiographic Evidence of Portosystemic Collateral Vessels to Improve the Baveno Vi Consensus Recommendations in the Non-Invasive Prediction of Esophageal Varices

Mo1532 – The Utility of Radiographic Evidence of Portosystemic Collateral Vessels to Improve the Baveno Vi Consensus Recommendations in the Non-Invasive Prediction of Esophageal Varices

Measurement of liver and spleen stiffness by acoustic radiation force impulse elastography for noninvasive detection of esophageal varices in Egyptian cirrhotic patients

Introduction and aimScreening for esophageal varices (EVs) is recommended in patients with cirrhosis. Recent studies have focused on noninvasive prediction of EVs. The aim of the study was to evaluate the accuracy of liver stiffness (LS) and spleen stiffness (SS) measured by acoustic radiation force impulse (ARFI) elastography for noninvasive detection of EVs in Egyptian cirrhotic patients.Patients and methodsIn this prospective study, we performed ARFI elastography to measure LS and SS on 30 patients with cirrhosis undergoing endoscopic screening for EVs and on 15 healthy volunteers (controls). The diagnostic utility of LS and SS for identifying the presence of EVs was compared.ResultsPatients with EVs showed higher LS and SS values than patients without varices. The diagnostic performance of LS for the detection of varices at a cutoff value of more than 2.47 showed a sensitivity, specificity, positive predictive value, negative predictive value, and diagnostic accuracy of 73.3, 66.7, 68.7, 71.4, and 71.3%, respectively. Regarding SS, at a cutoff value of more than 3.02, the sensitivity, specificity, positive predictive value, negative predictive value, and diagnostic accuracy were 93.3, 73.3, 77.8, 91.7, and 87.6%, respectively.ConclusionSS measured using ARFI imaging is superior to LS with excellent diagnostic performance for predicting EVs and may be used as a noninvasive screening tool for the detection of EVs.