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Esophageal varices on computed tomography and subsequent variceal hemorrhage

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Abstract

Purpose

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).

Methods

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.

Results

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).

Conclusions

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.

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Funding

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.

Disclosure

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.

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Authors and Affiliations

  1. Division of Gastroenterology, Department of Medicine, University of California, San Francisco, 1001 Potrero Avenue, San Francisco, CA, 94110, USA

    Ma Somsouk

  2. Department of Radiology and Biomedical Imaging, University of California, San Francisco, San Francisco, CA, USA

    Katherine To’o, Benjamin M. Yeh, Judy Yee & Rizwan Aslam

  3. Department of Radiology, University of Colorado Hospital, Aurora, CO, USA

    Mujtaba Ali

  4. Department of Epidemiology and Biostatistics, University of California, San Francisco, San Francisco, CA, USA

    Eric Vittinghoff

  5. Division of Gastroenterology and Hepatology, Department of Medicine, San Francisco Veterans Affairs Medical Center, San Francisco, CA, USA

    Alex Monto

  6. Division of Gastroenterology and Hepatology, Department of Medicine, University of Washington, Seattle, WA, USA

    John M. Inadomi

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  1. Ma Somsouk
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  2. Katherine To’o
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  3. Mujtaba Ali
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  4. Eric Vittinghoff
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  5. Benjamin M. Yeh
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  6. Judy Yee
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  7. Alex Monto
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  8. John M. Inadomi
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  9. Rizwan Aslam
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Corresponding author

Correspondence to Ma Somsouk.

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Somsouk, M., To’o, K., Ali, M. et al. Esophageal varices on computed tomography and subsequent variceal hemorrhage. Abdom Imaging 39, 251–256 (2014). https://doi.org/10.1007/s00261-013-0057-x

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