ABSTRACT
Background: Liver cirrhosis is a pathologic condition characterized by fibrosis of the liver parenchyma and evidence of regenerative activity, resulting in portal hypertension. Portal hypertension plays a crucial role in the transition from the pre-clinical to the clinical phase of the disease. Bleeding from ruptured esophagogastric varices is the most severe complication of cirrhosis and is the cause of death in about one third of cirrhotic patients. Cirrhotic patients frequently undergo screening endoscopy for the presence of varices. These recommendations imply a considerable burden of endoscopies and related costs
Objective: the aim of the study was to determine the predictive value of noninvasive parameters [Rt. lobe diameter/ serum albumin ratio] in the prediction of esophageal varices
Subjects and Methods: This study was done on 120 patients divided into four groups: Group A: includes 30 cirrhotic patients with esophageal varices [OVs] grade I to II. Group B: includes 30 cirrhotic patients with OVs grade III to IV. Group C: includes 30 cirrhotic patients without OVs. Group D: includes 30 none cirrhotic patients presented for esophagogastroduodenoscopy [EGD] screening because of other etiologic factors that are not associated with liver cirrhosis. All participants were subjected to clinical examination; laboratory investigations [CBC, Liver function tests including serum albumin concentration, prothrombin time and concentration, modified Child-Pugh score and abdominal ultrasonography [studying the right lobe and left lobe diameter, the presence of periportal thickening, the splenic longest axis and the presence of ascites and Portal vein diameter, Right liver lobe diameter/albumin ratio were calculated for all patients]. Upper endoscopy was done for detection and grading of esophageal varices
Results: This study revealed that The predictors that showed statistically significantly associated with the presence of varices were increased right lobe diameter/Albumin ratio, shrunken Rt. hepatic lobe, splenomegaly, thrombocytopenia, and the more advanced liver disease [according to child class scoring of the patients], the more likely the presence of varices
Conclusion: Right lobe diameter/Albumin ratio is good predictor for the presence and grading of esophageal varices
ABSTRACT
To assess the feasibility of trans-abdominal, fast three-dimensional, colour-coded ultrasound [3D CDUS] in the evaluation of gastric mass lesions compared to video endoscopy [VE] as the reference standard method. The study was conducted according to the guidelines of the local ethics committee. Informed consent was obtained from each patient. Sixty-three patients [34 males, 29 females; ages ranging from 21 to 72 years; mean 48.3 years] with VE-proven gastric mass lesions, from a population with gastric disorders, were included in this study. VE parameters and histopathology results remained blinded to the investigator. Fast 3D CDUS was performed on all patients and results interpreted. Finally, we reviewed the imaging results for each patient and compared them with previously obtained video recordings from VE and confirmed by histopathology. Compared to VE results, 61 out of 63 mass lesions were effectively diagnosed using 3D CDUS. In the remaining two cases [3.2%], a study of the gastric wall produced no conclusive findings. Our results showed an accuracy of 100% in benign gastric mass lesions, 95% in the evaluation of malignant involvement and an overall accuracy of 96.8%. Malignant stenotic segments and staging of malignant masses, which is mandatory if surgical intervention is planned, can be demonstrated by employing 3D CDUS. Fast 3D CDUS imaging is an easy, office-based, non-invasive method that has been shown to be effective for the evaluation of gastric mass lesions. Theoretically, it can also be used as a preliminary test in patient selection for endoscopy