Prediction Of Esophageal Varices Research Articles

Liver Elastography as a Predictor of Esophageal Varices in Patients With Cirrhosis.

IntroductionLiver cirrhosis is an advanced consequence of a long-standing liver disease that can lead to portal hypertension which subsequently can manifest as life-threatening variceal bleeding. The present study aimed to determine liver stiffness by shear wave elastography (SWE) to predict esophageal varices (EV) in patients with chronic liver diseases.MethodologyA prospective observational study was performed at the Department of Hepatogastroenterology, Sindh Institute of Urology and Transplantation, Karachi between November 2020 and July 2021. Individuals aged between 18 and 50 years, irrespective of gender, with diagnosed chronic liver disease >6 months were eligible to partake in the study. Patients with concomitant renal failure, severe ascites, severe life-threatening co-morbidities including congestive heart failure NYHA-III and IV, acute asthmatic attack, and recent myocardial infarction (MI) were excluded from the study. SWE was determined in all patients to measure liver stiffness. Esophagogastroduodenoscopy (EGD) was performed to visualize the esophageal varices. All findings were recorded. A 2 × 2 table was applied to determine the sensitivity, specificity, positive, and diagnostic accuracy for SWE by taking endoscopy as the definitive test.ResultsA total of 204 patients were included in the study. Mean age of 40.37 ± 15.20 years was observed. The mean liver size of patients was 12.38 ± 2.06 cm and the mean liver stiffness of patients was 19.97 ± 8.6. The sensitivity and specificity of liver elastography were 44.90% and 51.90%, respectively. Furthermore, the positive and negative predictive values were 53.00% and 99.39%, respectively. The diagnostic accuracy of the test was 51.86%.ConclusionEven though the diagnostic gold standard for the detection of varices is EGD, liver elastography provides a less invasive procedure to assess for varices in patients with cirrhotic liver disease. The present study concluded that liver elastography is a non-invasive and indirect valuable tool to predict the presence of esophageal varices with sensitivity and specificity of 44.90% and 51.90%, respectively.

Reliability of Plasma Von Willebrand Factor Antigen in Prediction of Oesophageal Varices in Pediatric and Adolescent Patients with Portal Hypertension

Abstract Background Ruptured oesophageal varices (OVs) is a major cause of mortality in Portal hypertension (PHT) patients, It has been a great issue of interest and research to screen and early detect OVs via oesophageal varices non-invasive methods. Objective The aim of this study was to assess the reliability of measuring plasma von willibrand factor antigen (VWF-Ag) for prediction of the occurrence of oesophageal varices in patients with portal hypertension. Subjects & Methods This was a prospective cross-sectional study, done on 47 children with portal hypertension. The children were recruited from Pediatrics Hepatology clinic, Ain Shams University. Patient’s data was collected including age, sex, etiology and duration of PHT, along with medical treatment. Also an upper GIT endoscope, abdominal doppler ultrasound, and laboratory tests including measuring of plasma VWF-Ag were done to each patient. Then the children were divided based on their endoscopic findings into two groups; variceal group which included 37 patients, and a nonvariceal group which included 10 patients Results: The results of our study revealed an elevated plasma VWF-Ag in patients with oesophageal varices, whilst normal levels of plasma VWF-Ag in the non-variceal patients. In addition, there was a direct positive correlation between increased plasma VWF-Ag and the degree of oesophageal varices. Conclusion Since the plasma VWF-Ag level correlates with the presence and degree of OVs, it can be used as a noninvasive indicator of the presence and degree of OVs, However, further studies using larger sample might be needed to support this.

P-35 NONINVASIVE PREDICTORS OF ESOPHAGEAL VARICES IN PATIENTS WITH HEPATOSPLENIC SCHISTOSOMIASIS MANSONI: MULTICENTER STUDY

No previous study have evaluated transient elastography (TE) for predicting esophageal varices (EV) in hepatosplenic schistosomiasis (HSS). To investigate noninvasive methods of predicting EV in patients with HSS mansoni. Cross-sectional multicentric study included 51 patients with HSS. Patients underwent ultrasonography-dopplerfluxometry, upper endoscopy, complete blood cell count and TE (Fibroscan®) for liver and spleen stiffness measurement (LSM and SSM). Noninvasive scores previously established for cirrhotic population were studied: platelet count to spleen diameter ratio (PSR), LSM-spleen diameter to platelet ratio score (LSPS) and varices risk score (VRS). We proposed a version of LSPS and VRS by replacing LSM with SSM and named them SSPS and modified-VRS, respectively. EV was detected in 42 (82.4%) subjects. Individuals with EV presented higher SSM (73.5 vs 36.3 Kpa, p=0.001), splenic vein diameter (10.8 vs 8.0 mm, p=0.017), SSPS (18.7 vs 6.7, p=0.003) and modified-VRS (4.0 vs 1.4, p=0.013), besides lower PSR (332 vs 542, p=0.038), than those without EV. SSPS was independently associated with EV presence (OR=1.19, 95%CI 1.03-1.37, p=0.020) after multivariate analysis. In a model excluding noninvasive scores, SSM was independently associated with EV diagnosis (OR=1.09, 95%CI 1.03-1.16, p=0.004). AUROC was 0.856 (95%CI 0.752-0.961, p=0.001) for SSM and 0.816 (95%CI 0.699-0.932, p=0.003) for SSPS (p=0.551). Spleen-related variables were predictors of EV: SSM, splenic vein diameter, SSPS, modified-VRS and PSR. Multivariate models indicated that SSM and SSPS are useful tools for predicting EV in non-cirrhotic portal hypertension by HSS and may be used in clinical practice.

Role of Serum Ascites Albumin Gradient (SAAG) and Portal Vein Congestion Index as Non-‎Invasive Methods for Prediction of Esophageal Varices in Cirrhotic Patients ‎

Background and aim: Majority of cirrhotic patients develop varices, the rate of variceal bleeding is 10-30% yearly with ‎death rate from bleeding is 17-57%. esophagogastroduodenoscopy (EGD) is an invasive and ‎unpleasant technique carrying rare but serious complications. We aimed to investigate the serum ‎ascites albumin gradient (SAAG) and portal vein congestion index (PCI) as non-invasive methods ‎for prediction of esophageal varices (EV) in patients with liver cirrhosis‎. Patients and Methods: ‎‎125 cirrhotic patients with ascites and no past history of EGD were included. Patients were ‎grouped into; Group I: 38 cirrhotic patients without EV. Group II: 87 cirrhotic patients with EV. ‎Patients were subjected to full clinical evaluation, calculation of SAAG, abdominal ultrasound ‎with a duplex study and measurement of PCI, and Esophagogastroduodenoscopy for detection and ‎grading of esophageal varices‎ ‎.‎ Results: Cirrhotic patients with EV had higher SAAG values (1.85 ‎‏±‏‎ 0.24 gm/dl) than cirrhotic patients ‎without EV (1.27 ‎‏±‏‎ 0.15 gm/dl). Additionally, cirrhotic patients with EV showed a higher PCI ‎than those without (0.16 ± 0.02 and 0.12 ± 0.01 respectively). For prediction of EV in cirrhotic ‎patients, SAAG had AUC 0.986 (p 1.4 with sensitivity 97.70% and ‎specificity 89.47% and portal congestion index, AUC was 0.974 (p 0.135 had ‎sensitivity 90.80% and specificity 94.74%‎‎‎. Conclusion: SAAG could be used as a non-invasive predictor for the presence of EV in cirrhotic patients along ‎with SAAG cutoff >1.4 requiring clinical attention. Combination of SAAG and PCI had a high ‎ability to predict esophageal varices in cirrhotic patients with AUC 1.000‎‎‎‎‎.

Hepatosplenic shear wave elastography for prediction of esophageal varices in cirrhosis: a promising future?

Hepatosplenic shear wave elastography for prediction of esophageal varices in cirrhosis: a promising future?

Prediction of Esophageal Varices Based on Serum-Ascites Albumin Gradient in Cirrhotic Patients

Background: Ascites and esophageal varices (EV) are the most common complications of portal hypertension, with an incidence of approximately 50%. Since effective preventive modalities have been established for variceal hemorrhage, early detection of EV is critical for primary prevention of bleeding. Serum-ascites albumin gradient (SAAG) can be considered an indirect parameter for the detection of EV and is useful in regions where there is a shortage of human and material resources to perform upper gastrointestinal endoscopy (UGE). The aim was to evaluate the role of serum-ascites albumin gradient (SAAG) in the prediction of esophageal varices (EV) in cirrhotic patients with ascites. Methods: All cirrhotic patients with ascites, identified by ultrasonography, who underwent measurement of SAAG, were included in this study. All patients underwent upper gastrointestinal endoscopy (UGE) for assessment of the presence and size of EV. Results: The study included 80 cirrhotic patients with ascites. The main causes of cirrhosis were alcohol intake (37.5%), hepatitis B virus (25.0%), and hepatitis C virus (15.0%). Patients with SAAG values > 1.75 g/dL demonstrated EV with a sensitivity and specificity of 78.4% and 83.3%, respectively. SAAG values > 1.8 g/dL were associated with the risk of large EV with AUC of 0.856, sensitivity of 88.24%, and specificity of 50.79%. The correlation coefficient (r) between SAAG and EV was 0.429, which was statistically significant (p < 0.001). Conclusions: Cirrhotic patients with SAAG values ≥ 1.8 have a higher risk of large EV. In particular, those with values > 1.9 who have higher possibility of bleeding must undergo upper GI endoscopy.

Evaluation of Liver Stiffness-Spleen Size-to-Platelet Count Ratio Score as a ‎Risk Score for the Prediction of Oesophageal Varices in Compensated ‎Cirrhotic Patients

Background and study aims: The prevalence of gastro-esophageal varices (GOVs) in cirrhotic patients ranges from 40-80%.The most serious complication of cirrhosis is variceal hemorrhage since it has a mortality rate of 17-57%. Endoscopy is the standard test to detect GOVs. This study aimed at the evaluation of liver stiffness (LS)-spleen size-to-platelet count ratio score (LSPS) as a risk score for the prediction of esophageal varices (OVs) in patients with compensated liver cirrhosis. Patients and Method: ‎This study included 51 patients with compensated cirrhosis. Screening ‎upper endoscopy was done for the detection of OVs. They were also ‎evaluated by transient elastography and laboratory tests, then divided ‎according to the presence or absence of OVs. We compared both groups based on ‎LSPS and platelet count splenic diameter ratio (PSR)‎.‎ Results: the LSPS ratio has sensitivity 87.88% and specificity 88.89% for prediction of ‎OVs. Regarding Platelet count /Splenic diameter ratio the cut off value for ‎the prediction of OV was 909.09 with sensitivity 87.9% and specificity ‎‎88.9%‎‎‎. Conclusion: PSR and LSPS provided good diagnostic tool for the prediction of ‎esophageal varices in compensated cirrhotic patients.

Diagnostic accuracy of liver and spleen stiffness measured by fibroscan® in the prediction of esophageal varices in HCV-related cirrhosis patients treated with oral antivirals

The aim of this study was to investigate the accuracy of liver and spleen stiffness measurement by transient elastography for the prediction of gastroesophageal varices in patients with HCV-associated cirrhosis treated with new direct-acting antiviral agents. This cross-sectional observational study included patients with compensated HCV-related cirrhosis and sustained virological response after direct-acting antiviral therapy. Patients underwent liver and spleen stiffness measurement, abdominal ultrasound and oesophago-gastroduodenoscopy. Clinical and laboratory data and non-invasive markers such as the liver stiffness–spleen diameter to platelet ratio score, variceal risk index and platelet count to spleen diameter ratio were analyzed. Ninety-seven consecutive patients were included. Liver stiffness measurement (12.2 vs 16; p = 0.02), spleen stiffness measurement (39.4 vs 46.05; p = 0.04), liver stiffness–spleen diameter to platelet ratio score (1.21 vs 2.02; p = 0.008), platelet count to spleen diameter ratio (1102.19 vs 829.7; p = 0.04) and variceal risk index (−3.4 vs −1.02; p = 0.01) showed significant differences between patients without/with gastroesophageal varices. The best cut-off value to discard the presence of gastroesophageal varices was 12.3 kPa for liver stiffness measurement and 27 kPa for spleen stiffness measurement. However, diagnostic accuracy was moderate (AUROC: 0.671 and 0.624 respectively). Combining different non-invasive parameters did not significantly improve the overall performance. Liver and spleen stiffness measurement showed suboptimal results for non-invasive assessment of gastroesophageal varices in HCV cirrhotic patients treated with direct-acting antiviral agents. Our results suggest that non-invasive methods cannot substitute standard procedures for predicting gastroesophageal varices in this population. El objetivo de este estudio fue evaluar la rigidez hepática y esplénica medidas con Fibroscan® para la predicción de várices esofágicas (VE), en pacientes con cirrosis hepática por VHC tratados con antivirales orales. Estudio observacional y transversal que incluyó pacientes con cirrosis hepática por VHC compensada y respuesta virológica sostenida tras tratamiento. Se recogieron datos clínico-analíticos, ecográficos y endoscópicos y marcadores no invasivos como el Fibroscan® hepático y esplénico, el modelo predictivo « Liver stiffness-spleen diameter to platelet ratio score » (LSPS), el « Varices Risk Index » (VRI) y el índice n° plaquetas/diámetro mayor del bazo. Se incluyeron 97 pacientes consecutivos. Los valores del Fibroscan® hepático (12,2 vs. 16; p = 0,02), esplénico (39,4 vs. 46,05; p = 0,04), LSPS (1,21 vs. 2,02; p = 0,008), índice n.° plaquetas/diámetro mayor del bazo (1.102,19 vs. 829,7; p = 0,04) y VRI (-3,4 vs. -1,02; p = 0,01) mostraron diferencias significativas entre pacientes sin/con VE. El mejor punto de corte del fibroscán hepático y esplénico para descartar la presencia de várices fue 12,3 y 27 kPas, respectivamente, con precisión diagnóstica moderada (AUROC: 0,671 y 0,624, respectivamente). La combinación de los parámetros no invasivos no mejoró el rendimiento global de estas pruebas. Los valores del Fibroscan® hepático y esplénico mostraron resultados subóptimos para la evaluación no invasiva de VE en pacientes cirróticos por VHC tratados con antivirales orales. Nuestros resultados sugieren que estas pruebas no pueden sustituir a los procedimientos estándar para predecir la presencia de várices en esta subpoblación.

Serum Soluble CD163 as a Predictor of Esophageal Varices and Variceal Bleeding in Cirrhotic Patients

ABSTRACT Background: Bleeding of esophageal varices (OV) is also bearing elevated mortality in patients with liver cirrhosis (LC). The best standard diagnostic investigation for OV is upper gastrointestinal (GI) endoscopy. Patients and endoscopic units alike are burdened by the endoscopic screening of all patients with liver cirrhosis. The use of non-invasive OV detection reduces the need for endoscopic screening. Objective: The aim of the current work was to test serum soluble CD 163(sCD163) as a predictor of the presence, and grade of OV and as non-invasive indicator of having severe variceal bleeding. Patients and Methods: This cross-sectional study included a total of 70 cirrhotic patients, attending at the Hepatology and Gastroenterology Unit, Department of Internal Medicine, Benha University Hospital, Egypt. To detect OV, all patients underwent upper GI endoscopy, and serum sCD163 levels were assessed using an ELISA technique. Results: Patients with OV had a higher mean value of sCD163 levels (8.71±8.42 ng/ml) than patients without OV (2.89±1.02 ng/ml), however this was not statistically significant (P=0.13). sCD163 level was significantly higher in large OV group (10.75±9.26 ng/ml) than small OV group (3.75±0.92 ng/ml), (P=0.001). The rate of significant variceal bleeding is closely linked to serum higher sCD163 levels more than (4.63 ng/ml). Conclusion: It could be concluded that serum sCD163 could be a non-invasive indicator of the presence of OV in cirrhotic patients. It may also be used for the prediction of the size of OV and the probability of severe variceal bleeding.

Non‐invasive Predictors of Esophageal Varices With a High Risk of Bleeding in Pediatric Cirrhotic Patients

To evaluate non-invasive predictive factors of varices with a high risk of bleeding in pediatric cirrhotic patients. This retrospective, cross-sectional study included data from 158 children with cirrhosis, median age of 5.38 years (interquartile [IQ] 2.08-11.52 years), and no history of upper gastrointestinal bleeding. Patients underwent an endoscopy to screen for esophageal varices. Varices with a high risk of bleeding were defined as those with a medium to large caliber, presence of red spots, or the presence of gastric varices and identified as high-risk varices (HRV). Laboratory and clinical factors were evaluated as possible predictors of HRV. HRV were detected in 30 children (19%) after the first endoscopy. In the multivariate analysis, only the risk score (RS), as described by Park et al, and the aspartate aminotransferase-to-platelet ratio index (APRi) were predictive of HRV. The best non-invasive predictor of HRV was the RS with an area under the receiver operating characteristic curve of 0.764. When used a cut-off point of -1.2, the sensitivity of the RS was 90% and specificity was 53%. The use of RS or APRi correctly identified 96% of children with HRV. The described predictors allow the correct identification of patients with HRV. The association of RS >-1.2 or APRi >1.4 has a good sensitivity to identify HRV and to prevent unnecessary endoscopy in about one-third of children with no HRV.

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English

Noninvasive scores for the prediction of esophageal varices and risk stratification in patients with cirrhosis.

The primary purpose of variceal screening in patients with cirrhosis is to detect gastroesophageal varices at high risk of hemorrhage and implement preventative intervention(s). It was previously recommended that all patients with cirrhosis undergo initial and periodic longitudinal variceal screening via upper endoscopy. However, there has been growing interest and methods to identify patients with cirrhosis who may not have clinically significant portal hypertension and therefore be unlikely to have varices requiring intervention or benefit from upper endoscopy. Because the population of patients with compensated advanced chronic liver disease continues to grow, it is neither beneficial nor cost-effective to perform endoscopic variceal screening in all patients. Therefore, there is ongoing research into the development of methods to non-invasively risk stratify patients with cirrhosis for the presence of high-risk esophageal varices and effectively limit the population that undergoes endoscopic variceal screening. This is particularly important and timely in light of increasing healthcare reform and barriers to healthcare. In this review, we discuss and compare, with respect to test characteristics and clinical applicability, the available methods used to non-invasively predict the presence of esophageal varices.

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.

Novel markers of endothelial dysfunction in hepatitis C virus-related cirrhosis: More than a mere prediction of esophageal varices.

BACKGROUNDHepatitis C virus (HCV) infection may affect lipid metabolism by enhancing the circulating levels of inflammatory cytokines, together with its impact on endothelial function. AIMTo evaluate the potential correlation of changes in lipid profile, carotid intima-media thickness (CIMT), and ankle-brachial index with the severity of fibrosis, grades of esophageal varices (EVs), and fibrosis indices.METHODSThe study included 240 subjects who were divided into 3 groups; group 1 (n = 90, HCV-related cirrhotic patients with EVs), group 2 (n = 90, HCV-related cirrhotic patients without EVs), and group 3 (n = 60, served as the healthy control group). All patients underwent routine laboratory tests, including a lipid profile assay. Low-density lipoproteins (LDL)/platelet count and platelet/splenic diameter ratios were calculated. Abdominal ultrasonography, CIMT by carotid Doppler, bedside ankle-brachial index (ABI), liver stiffness measurement, and upper gastrointestinal endoscopy were performed.RESULTSMultivariate logistic regression revealed that very-low-density lipoprotein (VLDL) (β = 0.988, odds ratio 2.5, P = 0.001), LDL/platelet count ratio (β = 1.178, odds ratio 3.24, P = 0.001), CIMT (β = 1.37, odds ratio 3.9, P = 0.001), and ABI (β = 2.3, odds ratio 5.9, P = 0.001) were the key variables associated with significant fibrosis, EVs and endothelial dysfunction. CIMT and LDL/platelet count ratio were predictive of advanced fibrosis and EVs at cutoff values of 1.1 mm and 1 mm, respectively, with an area under the curve (AUC) of 0.966 and 0.960 (P = 0.001), while VLDL and ABI at a cutoff of 16.5 mg/dL and 0.94 were predictive of advanced fibrosis and EVs with an AUC of 0.891 and 0.823, respectively (P = 0.001).CONCLUSIONCIMT, ABI, VLDL, LDL/platelet count ratio are good non-invasive predictors of advanced fibrosis, presence of EVs, and endothelial dysfunction in liver cirrhosis.

Diagnostic accuracy of liver and spleen stiffness measured by fibroscan® in the prediction of esophageal varices in HCV-related cirrhosis patients treated with oral antivirals

IntroductionThe aim of this study was to investigate the accuracy of liver and spleen stiffness measurement by transient elastography for the prediction of gastroesophageal varices in patients with HCV-associated cirrhosis treated with new direct-acting antiviral agents. Patients and methodsThis cross-sectional observational study included patients with compensated HCV-related cirrhosis and sustained virological response after direct-acting antiviral therapy. Patients underwent liver and spleen stiffness measurement, abdominal ultrasound and oesophago-gastroduodenoscopy. Clinical and laboratory data and non-invasive markers such as the liver stiffness–spleen diameter to platelet ratio score, variceal risk index and platelet count to spleen diameter ratio were analyzed. ResultsNinety-seven consecutive patients were included. Liver stiffness measurement (12.2 vs 16; p=0.02), spleen stiffness measurement (39.4 vs 46.05; p=0.04), liver stiffness–spleen diameter to platelet ratio score (1.21 vs 2.02; p=0.008), platelet count to spleen diameter ratio (1102.19 vs 829.7; p=0.04) and variceal risk index (−3.4 vs −1.02; p=0.01) showed significant differences between patients without/with gastroesophageal varices. The best cut-off value to discard the presence of gastroesophageal varices was 12.3kPa for liver stiffness measurement and 27kPa for spleen stiffness measurement. However, diagnostic accuracy was moderate (AUROC: 0.671 and 0.624 respectively). Combining different non-invasive parameters did not significantly improve the overall performance. DiscussionLiver and spleen stiffness measurement showed suboptimal results for non-invasive assessment of gastroesophageal varices in HCV cirrhotic patients treated with direct-acting antiviral agents. Our results suggest that non-invasive methods cannot substitute standard procedures for predicting gastroesophageal varices in this population.

Prediction of esophageal varices by spleen stiffness in patients with cirrhosis

BackgroundEsophageal varices are mainly caused by portal hypertension and are a common complication of chronic liver disease (CLD). In this study, we investigated the diagnostic relationship between liver stiffness (LS) and spleen stiffness (SS) measurement using elastography and their association with esophageal varices in cirrhotic patients. MethodsOne hundred twenty-five consecutive patients with liver cirrhosis were enrolled in this study between Sep 2017 and Aug 2019. All patients underwent upper gastrointestinal endoscopy to evaluate the presence and severity of esophageal varices. SS and LS measurements were performed for all liver and spleen elastography. ResultsAspartate aminotransferase (AST), alanine aminotransferase (ALT), Platelet and AST-to-platelet ratio (APRI) levels were not significantly different between the two groups (p > 0.05). No significant difference was observed for LS in the two groups (p-value = 0.826). SS was significantly different in the two groups of patients with esophageal varices and those without l varices (p-value = 0.004). The area under the SS and LS receiver operating characteristic (ROC) curves in predicting esophageal varices were 0.66 and 0.51, respectively. ConclusionAlthough there was a significant positive correlation between the measurement of SS and LS (p-value <0.001), SS was not significantly associated with the measurement of esophageal varices (EV). SS is a relatively good predictor for EV.

Diagnostic value of spleen stiffness by magnetic resonance elastography for prediction of esophageal varices in cirrhotic patients.

To evaluate the diagnostic value of spleen stiffness (SS) via magnetic resonance elastography (MRE) in predicting esophageal varices. From January 2016 to September 2018, we retrospectively reviewed 263 patients with esophagogastroduodenoscopy (EGD) records and available spleen and liver stiffness (LS) values from MRE. Clinical information including the underlying diseases, endoscopic grade of esophageal varices (EV) and laboratory data were collected from electronic medical records. In cirrhotic patients, MRE-SS was higher in those with EV than in those without. MRE-SS also showed significant association with EV in the multivariate analysis, whereas MRE-LS did not. The diagnostic performance of MRE-SS for EV in cirrhotic patients was demonstrated by the area under curve of 0.853 (cut-off value: 9.53kPa, P < 0.001), 84.4% sensitivity and 73.7% specificity. For prediction of EV in cirrhotic patients, MRE-SS is a useful non-invasive tool and it demonstrates better diagnostic performance than MRE-LS does.

Portal venous hemodynamics as predictors for the development and grades of esophageal varices in Post‐HCV cirrhotic patients: An Egyptian center study

AbstractThere is no consensus regarding the precise predictive role of portal vein hemodynamics for the prediction of esophageal varices. We performed the current prospective work to assess the diagnostic ability of portal vein hemodynamics for the prediction and grading of esophageal varices. The present work is a prospective one performed in the period from April 2014 till September 2017. Two hundred patients with HCV‐related cirrhosis with esophageal varices were enrolled in the present work as case group (group I). In addition, 100 cirrhotic cases, with no esophageal varices, were included in the work as control arm (group II). Doppler ultrasound (US) and upper endoscopy were performed to all patients. Case group were further subdivided according grades of esophageal varices into four grades. These grades were correlated to splenic size, portal vein velocity, portal vein caliber, and hepatic artery resistivity index. Cases in group I had significantly larger spleen &amp; portal vein diameter and higher hepatic artery resistivity index than cases in group II (P &lt; .001). The portal vein caliber had the highest diagnostic performance for the detection of esophageal varices with cut‐off values of ≥12.5 mm (sensitivity = 99% and specificity = 94%). Patients with grade IV varices had significantly elevated values of splenic diameter, portal vein caliber, and hepatic artery resistivity index; and lower portal vein velocity than other patients with lower grades (P &lt; .001). The same findings were observed with other esophageal varices grades. In conclusion, non‐invasive portal hemodynamic parameters are good indicators for the prediction and severity of esophageal varices.

Color Doppler Ultrasound in Portal Hypertension: A Closer Look at Left Gastric Vein Hemodynamics.

Portal hypertension is one of the most important causes of morbidity and mortality in cirrhotic patients. A color Doppler evaluation of the left gastric vein (LGV) has proven utility in the prediction of esophageal varices and variceal bleeding in patients with portal hypertension. The purpose of this review is to discuss the ultrasound evaluation, imaging findings, and clinical application of Doppler ultrasound in the assessment of the LGV. Knowledge of the color Doppler technique and imaging findings of the LGV may help clinicians improve the monitoring of portal hypertension and predict patients with a high risk of esophageal varices.

A Novel Score to Predict Esophageal Varices in Patients with Compensated Advanced Chronic Liver Disease

Several criteria have been described to noninvasively predict the presence of high-risk esophageal varices in patients with compensated advanced chronic liver disease (cACLD). However, a recent study showed that treatment with β blockers could increase decompensation-free survival in patients with clinically significant portal hypertension, thereby making it important to predict the presence of any esophageal varices. We aimed to develop a simple scoring system to predict any esophageal varices. We retrospectively reviewed patients who had vibration-controlled transient elastography (VCTE) at Cook County Hospital, Chicago, USA. Patients with cACLD and liver stiffness measurement (LSM) ≥ 10kPa with esophagogastroduodenoscopy performed within one year of VCTE were analyzed. We generated a novel score to predict esophageal varices, using the beta coefficient of predictive variables. The score was validated in an external cohort at the University of Iowa Hospital, USA. There were 372 patients in the development cohort and 200 patients in the validation cohort. LSM, platelet count, and albumin were identified as predictors of esophageal varices and were included for generating the Cook County score as "platelet count * - 0.0155872 + VCTE score * 0.0387052 + albumin * - 0.8549209." The area under receiver operating curve for our score was 0.86 for any varices and 0.85 for high risk varices and avoided more endoscopies than the expanded Baveno VI criteria while maintaining a very low miss rate (negative predictive value > 99%). We propose a new, highly accurate, and easy-to-use scoring system to predict the presence of not only high-risk but any esophageal varices in patients with cACLD.