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Is non-invasive diagnosis of esophageal varices in patients with compensated hepatic cirrhosis possible by duplex Doppler ultrasonography?

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Abstract

Background and Aim

Esophageal varices are present in 30 % to 40 % of patients in compensated cirrhosis (Child-Pugh class A) and in 60 % to 85 % of patients in decompensated cirrhosis (Child-Pugh classes B and C). It is important to identify patients with compensated cirrhosis at risk for esophageal varix development. We evaluated the accuracy of a duplex Doppler ultrasonographic index for predicting the presence or absence of esophageal varices in patients with compensated hepatic cirrhosis (Child-Pugh class A) by using endoscopy as the reference standard.

Methods

Fifty-six enrolled patients underwent duplex Doppler ultrasonography followed by screening endoscopy. Mean portal vein velocity (PVV), splenic index (SI), splenoportal index (SPI), hepatic and splenic arterial resistive, and pulsatility indices (hepatic artery resistive index [HARI], hepatic artery pulsatility index [HAPI], splenic artery resistive index [SARI], splenic artery pulsatility index [SAPI]) were recorded. Univariate logistic regression analysis was followed by receiver operating characteristic (ROC) curve construction for the indices that were significant.

Results

The indices HARI, HAPI, SARI, SAPI were not helpful (p > 0.05). Mean PVV, SI, and SPI were all predictive of the presence of esophageal varices (p < 0.05) and SPI was found to be the most accurate parameter. Of the various cut-off levels of SPI evaluated, a cut-off value of SPI at 5.0, offered the highest diagnostic accuracy (88 %). For the 28 patients with SPI <5.0, the absence of esophageal varices in 27 of them could be correctly diagnosed using only SPI without invasive screening endoscopy, with high negative predictive value (96 %) and sensitivity (96 %). Of the remaining 28 patients with SPI ≥5.0, presence of esophageal varices could be similarly correctly diagnosed in 22 of them by using SPI without screening endoscopy, with high positive predictive value (79 %) and specificity (82 %).

Conclusion

The SPI was accurate in predicting the presence or absence of esophageal varices in patients with compensated cirrhosis.

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Authors and Affiliations

  1. Military Hospital Tiruvananthapuram, Pangode, Tiruvananthapuram, 695 006, India

    Ritwik Chakrabarti

  2. Indian Field Hospital Level II, UN Mission in South Sudan (UNMISS), C/O 56 APO, Malakal, Sudan

    Debraj Sen

  3. 92 Base Hospital, c/o 56 APO, Srinagar, India

    Vikram Khanna

Authors
  1. Ritwik Chakrabarti
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  2. Debraj Sen
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  3. Vikram Khanna
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Corresponding author

Correspondence to Debraj Sen.

Ethics declarations

This cross-sectional study was conducted at a tertiary care center from September 2014 to July 2015 after approval of the institutional ethics committee. A total of 56 consecutive patients with newly diagnosed compensated cirrhosis (Child-Pugh A) were enrolled after obtaining informed written consent.

Conflict of interest

RC, DS, and VK declare that they have no competing interests.

Ethics statement

The study was performed in a manner to conform with the Helsinki Declaration of 1975, as revised in 2000 and 2008 concerning Human and Animal Rights and the authors followed the policy concerning Informed Consent as shown on Springer.com.

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Chakrabarti, R., Sen, D. & Khanna, V. Is non-invasive diagnosis of esophageal varices in patients with compensated hepatic cirrhosis possible by duplex Doppler ultrasonography?. Indian J Gastroenterol 35, 60–66 (2016). https://doi.org/10.1007/s12664-016-0630-7

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  • DOI: https://doi.org/10.1007/s12664-016-0630-7

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