Esophageal varices on computed tomography and subsequent variceal hemorrhage
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Endoscopy is recommended to screen for esophageal varices in patients with cirrhosis. The objective of this study was to identify features on abdominal CT imaging associated variceal hemorrhage (VH).
A case–control study was performed among patients with cirrhosis who had a CT scan. Consecutive patients who experienced VH were included as cases, and patients without VH served as controls. Two radiologists recorded the maximal esophageal varix diameter in addition to other measures of portal hypertension at CT.
The most powerful CT parameter associated with VH was the esophageal varix diameter (5.8 vs. 2.7 mm, p < 0.001; adjusted OR 1.84 per mm, p = 0.009). 63% of individuals with VH had a maximal varix diameter ≥5 mm compared to 7.5% of cirrhotic patients without VH (p < 0.001). In contrast, the proportion of individuals whose largest varix was <3 mm was 7.4% among VH cases compared to 54.7% among controls (p = 0.001). The varix diameter powerfully discriminated those with and without VH (C-statistic 0.84).
A large esophageal varix diameter is strongly associated with subsequent VH. A threshold of <3 and ≥5 mm appears to identify patients with cirrhosis at low and high risk for hemorrhage.
- Esophageal varices on computed tomography and subsequent variceal hemorrhage
Volume 39, Issue 2 , pp 251-256
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- Online ISSN
- Springer US
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- Portal hypertension
- Variceal hemorrhage
- Industry Sectors
- Author Affiliations
- 1. Division of Gastroenterology, Department of Medicine, University of California, San Francisco, 1001 Potrero Avenue, San Francisco, CA, 94110, USA
- 2. Department of Radiology and Biomedical Imaging, University of California, San Francisco, San Francisco, CA, USA
- 3. Department of Radiology, University of Colorado Hospital, Aurora, CO, USA
- 4. Department of Epidemiology and Biostatistics, University of California, San Francisco, San Francisco, CA, USA
- 5. Division of Gastroenterology and Hepatology, Department of Medicine, San Francisco Veterans Affairs Medical Center, San Francisco, CA, USA
- 6. Division of Gastroenterology and Hepatology, Department of Medicine, University of Washington, Seattle, WA, USA