Abstract
Objective
This study aims to assess esophageal varices (EV) by noninvasive parameters in patients with liver cirrhosis.
Background
The current guidelines recommend the screening of all cirrhotic patients by endoscopy for EV, but repeated endoscopic examinations are unpleasant for patients and have a high cost impact and burden on endoscopic units. Therefore, there is a particular need for noninvasive predictors of EV.
Patients and methods
A total of 120 cirrhotic patients were enrolled in this study and were divided into three groups: 40 cirrhotic patients with EV and a history of upper gastrointestinal bleeding, 40 cirrhotic patients with EV without a history of upper gastrointestinal bleeding, and 40 cirrhotic patients without EV. All patients in the study were subjected to an assessment of history, clinical examination, routine laboratory investigation, abdominal ultrasound, and upper gastrointestinal endoscopy.
Results
Serum albumin at cut-off less than 3.65 g/dl, platelet count at cut-off less than 99 000/mm3, platelet count/spleen diameter ratio (PC/SD) at cut-off less than 919.6, aspartate aminotransferase-to-platelet ratio index at cut-off greater than 1.14, spleen longitudinal diameter at cut-off more than 140.5 mm, portal vein diameter at cut-off more than 15.2 mm, and prothrombin time at cut-off more than 15.1s are significant in the prediction of EV. North Italian Endoscopy Club Index at cut-off more than 25.4, platelet count at cut-off less than 74 000/mm3, and PC/SD at cut-off 851.6 are significant in the prediction of variceal bleeding risk.
Conclusion
Serum albumin, platelet count, PC/SD ratio, aspartate aminotransferase-to-platelet ratio index, spleen longitudinal diameter, portal vein diameter, prothrombin time, and Child score can provide information that can help in the prediction of the presence of EVs in patients with liver cirrhosis. North Italian Endoscopy Club Index, platelet count, and PC/SD ratio can provide information that can help in the prediction of variceal bleeding risk in patients with liver cirrhosis.
References
Garcia-Tsao G, Sanyal AJ, Grace ND, Carey W. and the Practice Guidelines Committee of the Americal Association for the Study of Liver Diseases, the Practice Parameters Committee of the American College of Gastroenterology: prevention and management of gastroesophageal varices and variceal hemorrhage in cirrhosis. Hepatology 2007; 46:922–938.
Ling SC, Walters T, McKiernan PJ, Schwarz KB, Garcia-Tsao G, Shneider BL. Primary prophylaxis of variceal hemorrhage in children with portal hypertension: a framework for future research. J Pediatr Gastroenterol Nutr 2011; 52:254–261.
Lyles T, Elliott A, Rockey DC. A risk scoring system to predict in hospital mortality in patients with cirrhosis presenting with upper gastrointestinal bleeding. J Clin Gastroenterol 2014; 48:712–720.
Garcia-Tsao G, Friedman S, Iredale J, Pinzani M. Now there are many (stages) where before there was one: in search of a pathophysiological classification of cirrhosis. Hepatology 2010; 51:1445–1449.
Entwisle C, Younossi MM. Q: How often should patients with hepatitis C be screened for esophageal varices?. Cleve Clin J Med 2006; 73:758–759.
Child CG, Turcotte JG. Surgery and portal hypertension. In: Child CG, eds. In the liver and portal hypertension. Philadelphia, PA: Saunders 1964. pp. 50–64.
Kamath PS, Kim WR. The model for end-stage liver disease (MELD). Hepatology 2007; 45:797–805.
Brocchi E, Caletti G, Brambilla G, Mantia LL, Lupinacci G, Pisano G, et al. North Italian Endoscopic Club for the Study and Treatment of Esophageal Varices. Prediction of the first variceal hemorrhage in patients with cirrhosis of the liver and esophageal varices. N Engl J Med 1988; 319:983–989.
Sterling RK, Lissen E, Clumeck N, Sola R, Correa MC, Montaner J, et al. Clinical Investigators: development of a simple noninvasive index to predict significant fibrosis in patients with HIV/HCV coinfection. Hepatology 2006; 43:1317–1325.
Joel J, Heidelbaugh XX, Bruderly M. Cirrhosis and chronic liver failure part 1. diagnosis and evaluation. Am Fam Physician 2006; 74:756–762.
Mohammad KT, Mohammad HS, Farhang S, Jalilvand M. Portal hemodynamics as predictors of high risk esophageal varices in cirrhotic patients. World J Gastroenterol 2008; 14:1898–1912.
Silva G. New serum markers for predicting oesophageal varices: is it areality? J Gastroenterol Hepatol 2013; 28:112–121.
De Franchis R. Non-invasive (and minimally invasive) diagnosis of oesophagealvarices. J Hepatol 2008; 49:520–527.
Berzigotti A, Seijo S, Reverter E, Bosch J. Assessing portal hypertension in liver diseases. Expert Rev Gastroenterol Hepatol 2013; 7:141–155.
Shehata M, AboAlia LA, El-Shafey K, El-Hossary M. A comparative study of Duplex Doppler ultrasound and blood indices as noninvasive predictors of oesophageal varices in cirrhotic patients. Tanta Med J 2014; 42:83–91.
Galal G, Ghweil A, Muhammad EM, Yousef LM. Clinical utility of simple fibrosis markers in prediction of oesophageal varices in chronic hepatitis C patients with advanced cirrhosis. Med J Cairo Univ 2012; 80:85–93.
El Naggar AA, Gomaa MS, Fawzy MM. Non endoscopic predictors of large esophageal varices. Egypt J Intern Med 2012; 24:97–99.
Said HE, Elsayed EY, Ameen A, Abd Elal H. Cytopenia as a predictor of oesophageal varices in patients with liver cirrhosis. Rep Opin 2010; 2:35–41.
Schepis F, Camma C, Niceforo D, Magnano A, Pallio S, Cinquegrani M, et al. Which patients with cirrhosis should undergo endoscopic screening for esophageal varices detection? Hepatology 2001; 33:333–338.
Madhotra R, Mlcahy H, Willner I, Reuben A. Prediction of esophageal varices in patients with cirrhosis. J Clin Gastroenterol 2002; 34:81–85.
Umar A, Qazi F, Abdul Sattar R, Umar B. Non-invasive parameters for the detection of variceal bleed in patients of liver cirrhosis, an experience of a tertiary care hospital in Pakistan. Asian J Med Sci 2014; 6:61–66.
Benedeto-Stojanov A, Nagorni A, Bjelaković G, Milanović J, Stojanov D. Predictive factors of bleeding from esophageal varices in patients with liver cirrhosis. Med Biol 2006; 13:164–167.
Limquiaco J, Daez E, Gloria V, Domingo EO, Banez VP, Zano FM. Clinical predictors of bleeding from esophageal varices: a retrospective study. Phil J Gastroenterol 2006; 2:103–111.
Agha A, Anwar E, Bashir K, Savarino V, Giannini EG. External validation of the platelet count/spleen diameter ratio for the diagnosis of esophageal varices in hepatitis C virus-related cirrhosis. Dig Dis Sci 2009; 54:654–660.
Sheta EA, Yosef M, Abd Elsalam M, Mohammed RE, Ismail A, EL-Kalla F, et al. Non invasive diagnosis of esophageal varices: can it replace screening endoscopy? Int J Curr Microbiol App Sci 2016; 5:701–715.
Giannini E, Botta F, Borro P, Risso D, Romagnoli P, Fasoli A, et al. Platelet count/spleen diameter ratio: proposal and validation of a non-invasive parameter to predict with liver cirrhosis the presence of esophageal varices in patients with liver cirrhosis. Gut 2003; 52:1200–1205.
El hady HA, Hammam AA, Elnimr SA, Osha A. Evaluation of some non invasive predictors for presence of esophageal varices in patients with compensated HCV positive cirrhosis. Int J Sci Res 2016; 5:461–469.
De Mattos AZ, de Mattos AA, Daros LF, Musskopf AI. Aspartate aminotransferase-to-platelet ratio index (APRI) for the non-invasive prediction of esophageal varices. Ann Hepatol 2013; 12:810–814.
Hassan EA, Abd El-Rehim AS, Sayed ZA, Kholef EF, Hareedy MA, El-Aal RF. Non-invasive parameters of oesophageal varices diagnosis: which sensitive and applicable; a pilot study. J Liver 2015; 4:182.
Thomopoulos K, Labropoulou K, Mimidis K. Non-invasive predictors of the presence of large esophageal varices in patients with cirrhosis. Dig Liver Dis 2003; 35:473–478.
Esmat S, Omarn D, Rashid L. Can we consider the right hepatic lobe size/ albumin ratio a noninvasive predictor of oesophageal varices in hepatitis C virus-related liver cirrhotic Egyptian patients?. Eur J Intern Med 2012; 23:267–272.
Nashaat EH, Abd-Elaziz H, Sabry M, Ibrahim AA. Non-endoscopic predictors of oesophageal varices and portal hypertensive gastropathy. Nat Sci 2010; 8:43–50.
Hong WD, Zhu QH, Huang ZM, Chen X, Jiang Z, Xu S, et al. Predictors of oesophageal varices in patients with HBV-related cirrhosis: a retrospective study. BMC Gastroenterol 2009; 9:11–56.
Arulprakash S, Chitra S, Muthukumaran K, Rangachari B, Thangavelu P, Subbarayanet J. Non-invasive prediction of large oesophageal varices in chronic liver disease patients. Saudi J Gastroenterol 2010; 16:38–42.
Yosry A, Fouad R, Abdel Bary M, Hamdy S, Mahmoud M, Khairy M. Non invasive prediction of varices in egyptian cirrhotic patients. Med J Cairo Univ 2009; 77:343–349.
Tafarel JR, Tolentino LH, Correa LM, Bonilha DR, Piauilino P, Martins FP, et al. Prediction of oesophageal varices in hepatic cirrhosis by noninvasive markers. Eur J Gastroenterol Hepatol 2011; 23:754–758.
Zaman A, Becker T, Lapidus J, Benner K. Risk factors for the presence of varices in cirrhotic patients without a history of variceal hemorrhage. Arch Intern Med 2011; 161:2564–2570.
Hong WD, Dong L, Jiang Z, Zhu Q, Jin S. Prediction of large esophageal varices in cirrhotic patients using classification and regression tree analysis. Clinics 2011; 66:119–124.
Merkel C, Zoli M, Siringo S, van Buuren H, Magalotti D, Angeli P, et al. Prognostic Indicators of Risk for First Variceal Bleeding in Cirrhosis: A Multicenter Study in 711 Patients to Validate and Improve the North Italian Endoscopic Club (NIEC) Index. Am J Gastroenterol 2000; 95:2916–2920.
Moodley J, Lopez R, Carey W. Compliance with practice guidelines and risk of a first esophageal variceal hemorrhage in patients with cirrhosis. Clin Gastroenterol Hepatol 2010; 8:703–708.
Author information
Authors and Affiliations
Corresponding author
Additional information
This is an open access journal, and articles are distributed under the terms of the Creative Commons Attribution-NonCommercial-ShareAlike 4.0 License, which allows others to remix, tweak, and build upon the work non-commercially, as long as appropriate credit is given and the new creations are licensed under the identical terms.
Rights and permissions
This article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. The images or other third party material in this article are included in the article's Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article's Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit http://creativecommons.org/licenses/by/4.0/.
About this article
Cite this article
Elatty, E.A.A., Elshayeb, E.I., Badr, M.H. et al. Noninvasive parameters for assessment of esophageal varices. Egypt J Intern Med 31, 536–543 (2019). https://doi.org/10.4103/ejim.ejim_25_19
Received:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.4103/ejim.ejim_25_19
Keywords
- liver cirrhosis
- noninvasive parameters
- varices