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The Egyptian Journal of Internal Medicine
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Noninvasive parameters for assessment of esophageal varices

The Egyptian Journal of Internal Medicine volume 31, pages 536–543 (2019)Cite this article

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

  1. 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.

    Article  CAS  Google Scholar 

  2. 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.

    Article  Google Scholar 

  3. 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.

    Article  Google Scholar 

  4. 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.

    Article  Google Scholar 

  5. 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.

    Article  Google Scholar 

  6. 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.

    Google Scholar 

  7. Kamath PS, Kim WR. The model for end-stage liver disease (MELD). Hepatology 2007; 45:797–805.

    Article  Google Scholar 

  8. 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.

    Google Scholar 

  9. 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.

    Article  CAS  Google Scholar 

  10. Joel J, Heidelbaugh XX, Bruderly M. Cirrhosis and chronic liver failure part 1. diagnosis and evaluation. Am Fam Physician 2006; 74:756–762.

    Google Scholar 

  11. 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.

    Article  Google Scholar 

  12. Silva G. New serum markers for predicting oesophageal varices: is it areality? J Gastroenterol Hepatol 2013; 28:112–121.

    Article  Google Scholar 

  13. De Franchis R. Non-invasive (and minimally invasive) diagnosis of oesophagealvarices. J Hepatol 2008; 49:520–527.

    Article  Google Scholar 

  14. Berzigotti A, Seijo S, Reverter E, Bosch J. Assessing portal hypertension in liver diseases. Expert Rev Gastroenterol Hepatol 2013; 7:141–155.

    Article  CAS  Google Scholar 

  15. 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.

    Article  Google Scholar 

  16. 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.

    Google Scholar 

  17. El Naggar AA, Gomaa MS, Fawzy MM. Non endoscopic predictors of large esophageal varices. Egypt J Intern Med 2012; 24:97–99.

    Google Scholar 

  18. 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.

    Google Scholar 

  19. 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.

    Article  CAS  Google Scholar 

  20. Madhotra R, Mlcahy H, Willner I, Reuben A. Prediction of esophageal varices in patients with cirrhosis. J Clin Gastroenterol 2002; 34:81–85.

    Article  CAS  Google Scholar 

  21. 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.

    Article  Google Scholar 

  22. 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.

    Google Scholar 

  23. 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.

    Google Scholar 

  24. 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.

    Article  Google Scholar 

  25. 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.

    Article  CAS  Google Scholar 

  26. 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.

    Article  CAS  Google Scholar 

  27. 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.

    Google Scholar 

  28. 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.

    Article  Google Scholar 

  29. 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.

    Article  Google Scholar 

  30. 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.

    Article  CAS  Google Scholar 

  31. 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.

    Article  Google Scholar 

  32. 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.

    Google Scholar 

  33. 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.

    Article  Google Scholar 

  34. 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.

    Article  Google Scholar 

  35. 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.

    Google Scholar 

  36. 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.

    Article  Google Scholar 

  37. 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.

    Article  Google Scholar 

  38. 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.

    Article  Google Scholar 

  39. 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.

    Article  Google Scholar 

  40. 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.

    Article  Google Scholar 

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Author information

Authors and Affiliations

  1. Department of Internal Medicine, Faculty of Medicine, Menoufia University, Shebeen El-Kom, 32511, Egypt

    Ehab A. A. Elatty, Elsayed I. Elshayeb MD & Mohammed H. Badr

  2. Department of Radiodiagnosis, Faculty of Medicine, Menoufia University, Shebeen El-Kom, Egypt

    Waleed A. E. Mousa

  3. Elmahalla Hepatology Educational Hospital, Egypt

    Mohammed F. El Mansory

Authors
  1. Ehab A. A. Elatty
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  2. Elsayed I. Elshayeb MD
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  3. Mohammed H. Badr
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  4. Waleed A. E. Mousa
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  5. Mohammed F. El Mansory
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Correspondence to Elsayed I. Elshayeb MD.

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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

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  • DOI: https://doi.org/10.4103/ejim.ejim_25_19

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