ABSTRACT
Screening all cirrhotic patients by endoscopy for detection of varices is not cost-effective as the number of patients increases by time and half of them still would not have developed varices 10 years after being diagnosed with cirrhosis. Therefore, this study aimed to evaluate hepatic haemodynamic Doppler parameters in predicting the presence of oesophageal varices [OVs] in cirrhotic patients for better selection of those actually needed for screening endoscopy. Eighty-one patients with liver cirrhosis, 32 females and 49 males, with a mean age of 50.7 +/- 11.7 years were recruited for the study. They included 61 patients with OVs and 20 patients without varices. The diagnosis of liver cirrhosis was based on clinical history, examination, and investigations. Liver function and kidney function tests and complete blood count [CBC] were performed for all patients. All patients underwent abdominal ultrasound [US], upper endoscopy, and hepatic Doppler US examination. The portal vein velocity [PVV] and liver vascular index [LVI] showed statistically significantly lower values in patients with OVs than those without OVs [p value = 0.02 and 0.000, respectively]. The congestion index [CI] of the portal vein, the portal hypertension index [PHI], and the splenoportal index [SPI] showed statistically significantly higher values in patients with OVs than those without OVs [p value = 0.006, 0.001, and 0.001, respectively]. CI and SPI were the best parameters that could predict the presence of OVs with high sensitivity, specificity, and diagnostic accuracy when cutoff values were set at >0.069 and 3.57, respectively [area under the curve = 0.864 and 0.894, respectively]. The CI of the portal vein and SPI are good predictors for the presence of OVs in cirrhotic patients, and could be used noninvasively to decrease the burden on the upper endoscopy unit by proper selection of those who are candidates for screening endoscopy
ABSTRACT
Variceal bleeding is a severe complication in patients with portal hypertension. Early rebleeding occurs frequently in the first few weeks after band ligation, and the mortality associated with each bleeding episode ranges from 30% to 50%. Our aims were to study the rate of early rebleeding oesophageal varices after band ligation in the Sohag University Hospital, Egypt, and to assess different clinical, biochemical, ultrasonographic, and endoscopic parameters that may predict the risk factors of rebleeding. In the period from December 2011 to December 2012, we performed endoscopic variceal ligation [EVL] for 146 cirrhotic patients [105 male and 41 female] with a mean age of 51.77 +/- 10.47 years; the patients were divided into rebleeding and non-rebleeding groups. Complete history taking, clinical examination, laboratory investigations, abdominal ultrasound [US], and upper gastrointestinal [GI] endoscopy were performed for all patients. The incidence of early rebleeding after EVL was 20.54%, and it was significantly associated with male gender [p = 0.013], older age [p = 0.009], infection with spontaneous bacterial peritonitis [SBP] [p < 0.0007], reduced liver size [p = 0.017], a coarser echo pattern [p = 0.03], the presence of hepatic focal lesions [p < 0.001], splenomegaly [p = 0.02], the presence of portosystemic collaterals [p = 0.006], a low haemoglobin [HB] level [p < 0.0001], prothrombin concentration [p = 0.017], high aspartate aminotransferase [AST] level [p = 0.01], Child-Pugh B and C [p = 0.02, 0.003], large oesophageal varices F3 in the two endoscopies [p = 0.002; p < 0.0001], varices extending to the superior third Ls [p < 0.001], and the presence of massive red colour signs [RC+++] [p < 0.0001]. By multivariate analysis, SBP and low HB level were found to be independent predictors of rebleeding. The following conclusions were drawn from this study: [1] The incidence of rebleeding after EVL in our centre is about 20%. [2] Early rebleeding after EVL is affected by many clinical, laboratory, ultrasonographic, and endoscopic parameters. The most prominent of them are SBP, splenomegaly, the presence of collaterals, anaemia, more decompensated cirrhosis, and the presence of large varices with red signs. [3] SBP and low HB level were found to be independent predictors of rebleeding