Esophageal varices on computed tomography and subsequent variceal hemorrhage
- 344 Downloads
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.
Key words:Portal hypertension Variceal hemorrhage CT Cirrhosis
This work was supported by the American Society for Gastrointestinal Endoscopy Endoscopic Research Award (MS) and from the National Institute of Diabetes and Digestive and Kidney Diseases (K24 DK080941, JI). The funding agencies did not have any role in the design, interpretation, or preparation of the manuscript.
All authors do not have any actual or potential conflict of interest including any financial, personal, or other relationships that could inappropriately influence this work.