The Splenic Size (Antero-Posterior Diameter) & Portal Vein Diameter as Noninvasive Tool: For Identification Size of Oesophageal Varices in Cirrhosis of Liver

Background: Guidelines recommends upper gastrointestinal endoscopy for all the patients with cirrhosis of liver to rule out portal hypertension. Many patients may not be willing to undergo this unpleasant procedure or resources may not be available. In this study, authors aim to identify the effectiveness of portal vein size as a non-invasive predictor of esophageal varices.Methods: In this prospective observational study of 30 patients, patients with liver cirrhosis without a previous history of upper GI bleeding were included between November 2012 and October 2014. Relevant clinical parameters were assessed which included physical examination, complete hemogram, biochemical workup, upper GI endoscopy and ultrasonographic measurement of portal vein diameter.Results: Out of the study population 70% of the patients had Oesophageal varices. Ultrasonography abdomen showed portal vein dilatation(>13mm) in 66.6% cases. The mean portal vein diameter in our study group was 13.1mm and majority of patients had portal vein between 13-13.9 mm (43.3%). A cut-off point of more than 13 mm had strong significant relationship (p<0.01) with presence of esophageal varices (sensitivity of 100%, specificity of 90% and positive predictive value of 95.24%). Higher grades of esophageal varices exists with larger portal vein size.Conclusions: From present study, authors conclude that portal vein size and its dilatation detected ultrasonographically can determine the presence of esophageal varices and can hence identify the subset of patients who require endoscopy for the prophylactic management of variceal bleeding. Therefore, reduce the burden on the endoscopy units, avoiding unnecessary screening endoscopies. Apart from being non-invasive, portal vein diameter is a relatively inexpensive and easily reproducible parameter.

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Role of Ultrasonography in Predicting Gastro-oesophageal Varices in Patients with Liver Cirrhosis

Journal of College of Medical Sciences-Nepal ◽

10.3126/jcmsn.v17i1.33325 ◽

2021 ◽

Vol 17 (1) ◽

pp. 10-15

Author(s):

Merina Gyawali ◽

Ramesh Raj Acharya

Keyword(s):

Liver Cirrhosis ◽

Portal Vein ◽

Portal System ◽

Oesophageal Varices ◽

Spleen Size ◽

Cross Sectional ◽

Non Invasive ◽

The Social ◽

Vein Diameter ◽

Splenic Size

IntroductionUpper Gastrointestinal endoscopy is considered the best screening tool in detecting gastroesophagealvarices in patients with cirrhosis. Ultrasonography of the abdomen can be used forassessment of liver and portal system. This research was undertaken to demonstrate that theportal vein diameter and splenic size by ultrasonography can be used as a non-invasive predictorof gastro-esophageal varices. MethodsA cross-sectional hospital based study comprising of 290 consecutive patients with liver cirrhosiswere enrolled between November 2019 to November 2020. Clinical profile at admission andsonological splenic size and portal vein diameter were studied in all cirrhotic patients. Patientswere classified into 2 groups: one with presence of varices and second without varices. Data entrywas done in Statistical Packages for the Social Sciences version 20. ResultsThe mean age of subjects was 52±13.26 years with a range of 27 – 82 years of age (M:F=2:1). Thecommonest etiology of cirrhosis was chronic alcohol consumption. The prevalence of varices incirrhotics was 42.8%. Average portal vein diameter of patients without gastro-esophageal variceswas 11.12 ± 1.36 mm, while it was 12.81 ± 1.62 mm in patients with varices (p < 0.001). Averagespleen size in cirrhotics without varices was 12.44 ± 1.32 cm and with varices was 14.32 ± 2.42 cm.This difference was also statistically significant (p < 0.001). ConclusionsMeasurement of portal vein diameter and spleen size by ultrasonography can be recommendedas a non invasive predictor for gastro-oesophageal varices in patients with liver cirrhosis . Keywords: cirrhosis; portal vein diameter; spleen size; ultrasonography; gastro-oesophageal varices

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Non-Invasive Predictors of Gastro-Oesophageal Varices

Journal of Nepal Medical Association ◽

10.31729/jnma.3202 ◽

2017 ◽

Vol 56 (207) ◽

pp. 298-303 ◽

Cited By ~ 2

Author(s):

Subash Bhattarai ◽

Khus Raj Dewan ◽

Gaurav Shrestha ◽

Bhanumati Saikia Patowary

Keyword(s):

Liver Cirrhosis ◽

Portal Hypertension ◽

Portal Vein ◽

Serum Albumin ◽

Oesophageal Varices ◽

Upper Gastrointestinal Endoscopy ◽

Spleen Size ◽

Non Invasive ◽

Vein Diameter ◽

Cirrhosis Of Liver

Introduction: The worldwide accepted tool for screening and monitoring gastro-oesophageal varices in patients with liver cirrhosis is upper gastrointestinal endoscopy. Endoscopy needs clinical expertise and has got its own procedure related complications. Repeated endoscopies may be expensive and patients tend to develop poor compliance. This study was undertaken to establish the role of noninvasive parameters in predicting gastro-esophageal varices. Methods: Two hundred patients with clinical features, laboratory and sonological findings suggestive of cirrhosis of liver and endoscopic evidence of portal hypertension were included in the study. Blood parameters like serum albumin, international normalized ratio (INR), platelets count and ultrasonography assessments of portal vein diameter and spleen size were compared with presence of gastro-oesophageal varices. Results: At cutoff point of 2.55g/dl, serum albumin had high specificity of 99% whereas platelets count <1,44,000/mm3 had 87.9% sensitivity for presence of oesophageal varices. Sensitivities of 92.72% and 94.5% while specificities of 90% and 75% were detected for presence of oesophageal varices when the cutoff values for portal vein diameter and spleen size were 12.25 mm and 13.9 cm respectively. Conclusions: Measurements of serum albumin, platelets count, portal vein diameter and spleen size by ultrasonography can be recommended as a non-invasive predictor for gastro-oesophageal varices in cirrhosis of liver. All these non-invasive parameters could be useful to patients with liver cirrhosis with portal hypertension in predicting presence of varices as well as in long-term clinical monitoring and management. Keywords: cirrhosis of liver; endoscopy; gastro-oesophageal varices; non-invasive predictors.

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A Study of Association of Portal Vein Diameter And Splenic Size With Gastro-Oesophageal Varices in Liver Cirrhosis Patients

IOSR Journal of Dental and Medical Sciences ◽

10.9790/0853-150906125129 ◽

2016 ◽

Vol 15 (09) ◽

pp. 125-129

Author(s):

Dr. Ravi Shanker ◽

Dr. S. Banerjee ◽

Dr. Anshul ◽

Dr. Sujata Ganguly ◽

Dr. Saurav Bansal ◽

...

Keyword(s):

Liver Cirrhosis ◽

Portal Vein ◽

Oesophageal Varices ◽

Vein Diameter ◽

Splenic Size

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To Study the Association between Splenic Size and Grades of Oesophageal Varices in Patients of Cirrhosis of Liver with Portal Hypertension

Journal of Evolution of Medical and Dental Sciences ◽

10.14260/jemds/2020/220 ◽

2020 ◽

Vol 9 (13) ◽

pp. 1022-1025

Author(s):

Priyadarshi B. P ◽

Imran Kamal Khan ◽

Vinay Kumar ◽

Ashok Kumar Verma ◽

Tanu Midha ◽

...

Keyword(s):

Portal Hypertension ◽

Oesophageal Varices ◽

Cirrhosis Of Liver ◽

Splenic Size

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Study of the correlation of oesophageal varices with portal vein diameter and ratio of platelet count to splenic diameter and their comparative evaluation in liver cirrhosis

International Journal of Advances in Medicine ◽

10.18203/2349-3933.ijam20213245 ◽

2021 ◽

Vol 8 (9) ◽

pp. 1405

Author(s):

Harpreet Singh ◽

Sidharth Sharma ◽

Gurminder Singh ◽

Dania Kaur

Keyword(s):

Liver Cirrhosis ◽

Platelet Count ◽

Portal Vein ◽

Comparative Evaluation ◽

Significant Negative Correlation ◽

Diameter Ratio ◽

Oesophageal Varices ◽

Non Invasive ◽

Vein Diameter ◽

The Mean

Background: The aim of the study was to determine the correlation of oesophageal varices (OV) with portal vein diameter and the platelet count to splenic diameter ratio and their comparative evaluation in patients of liver cirrhosis.Methods:The present study consisted of 50 patients diagnosed with liver cirrhosis. Necessary investigations were performed in all the patients including Upper gastrointestinal (GI) endoscopy. Platelet count/spleen diameter ratio, spleen diameter and portal vein diameter were calculated for all patients and the presence and grading of OV was then comparatively evaluated. The results were systematically recorded and statistically analysed.Results: The mean age of patients was 49.82±10.23 years. 78% of patients presented with OV. The portal vein diameter, platelet count, spleen diameter and platelet count/spleen diameter ratio were significantly increased in patients with OV than those without OV (p<0.0001). Highly significant positive correlation between portal vein diameter, spleen diameter and grading of OV was seen. Platelet count/spleen diameter ratio and platelet count was significantly decreased as the grade of OV increased in the patients. There was statistically, a highly significant negative correlation between them.Conclusions: The non-invasive parameters used to detect presence of OV in liver cirrhosis were portal vein diameter and platelet count/spleen diameter ratio. Though, both seemed to be effective in predicting OV, platelet count/spleen diameter ratio proved to be slightly more significant when compared to the other.

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CORRELATION OF PORTAL VEIN DIAMETER, SPLENOMEGALY AND THROMBOCYTOPAENIA WITH GASTRO-OESOPHAGEAL VARICES IN CIRRHOTIC PATIENTS

Journal of Evolution of Medical and Dental Sciences ◽

10.14260/jemds/2017/1260 ◽

2017 ◽

Vol 6 (83) ◽

pp. 5806-5810

Author(s):

Krishan Oberoi ◽

Upasana Upasana

Keyword(s):

Portal Vein ◽

Oesophageal Varices ◽

Vein Diameter ◽

Cirrhotic Patients

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Role of Colour Doppler in Evaluation of Hemodynamic Changes in Chronic Hepatitis C Infection

Annals of King Edward Medical University ◽

10.21649/akemu.v22i2.1296 ◽

2016 ◽

Vol 22 (2) ◽

Author(s):

Mahjabeen Masood ◽

Iqbal Hussain Dogar ◽

Mahesh Gautam ◽

Ghulam Rasul

Keyword(s):

Hepatitis C ◽

Portal Vein ◽

Tissue Level ◽

Study Patient ◽

Hepatitis C Infection ◽

Doppler Study ◽

Vein Diameter ◽

Liver Hemodynamics ◽

Splenic Size

Objective: The objective of this study is to determine the role of colour flow Doppler ultrasound examination for detection of change in liver hemodynamic in hepatitis C positive chronic liver disease.Materials and Methods: This study was conducted in Department of Radiology, Mayo Hospital Lahore from 2012 to 2013. Hundred diagnosed case of Hepatitis C by serology were included in this study. Patient were examined for liver and spleen size, texture and presence and absence of ascites before Doppler study. All the data were coded and analyzed using SPSS version 20.Results: Mean age of the patient was found to be 45.90 ± 12.71 years. The echotexture of liver was normal in 29 patients (29.0%), coarse with smooth margins in 48 patients (48.0%) and coarse with irregularSMO, Department of Radiology, Children Hospital, Lahoremargins in 23 patients (23.0%). Splenic size was enlarged (≥ 13 cm) in 63.0%. Portal vein diameter was enlarged in (≥ 13 mm) in 53.0%. Severity of ascites shows mild ascites in 24.0%, moderate in 24.0% and severe in 19.0% patients. Portal vein velocity shows abnormality (≥ 24cm/sec) in 63.0%. Hepatic vein waveform in 71.0% of patients was triphasic and non-triphasic in 29.0%.Conclusion: In conclusion alterations of liver hemodynamics resulting from inflammation at the tissue level are detectable in Doppler sonography.

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ESOPHAGEAL VARICES;

The Professional Medical Journal ◽

10.29309/tpmj/2013.20.05.1201 ◽

2013 ◽

Vol 20 (05) ◽

pp. 653-660

Author(s):

AHSAN AYUB

Keyword(s):

Platelet Count ◽

Portal Vein ◽

Esophageal Varices ◽

Clinical Laboratory ◽

Oesophageal Varices ◽

Upper Gastrointestinal Endoscopy ◽

High Morbidity ◽

Cross Sectional ◽

Need To Evaluate ◽

Vein Diameter

Bleeding from esophageal varices is associated with high morbidity and mortality. It is currently recommended that allpatients with liver cirrhosis undergo upper gastrointestinal endoscopy to identify those who have esophageal varices. This approachleads to unnecessary endoscopies. There is need to evaluate clinical, laboratory and imaging parameters that may predict the presence ofesophageal varices and help select patients for endoscopy. Objective: Identify hematological, biochemical and ultasonographicpredictors of oesophageal varices in patients of cirrhosis. Study design: Cross sectional Descriptive study. Setting: Department ofGeneral Medicine and Gastroenterology unit 1, Services Hospital, Lahore. Duration of study: 6 months (April 01, 2007 – September 30,2007). Sample size: Study was done on One hundred patients who had established cirrhosis with oesophageal varices. Results: Majority(77%) were male who had evidence of esophageal varices. Hematemesis was the presenting complaint in 75% of patients and majority(83%) had clinically palpable spleen. Esophageal varices were present in 75% of patents who had platelet count <100, 000. In patientswho had portal vein diameter of >20mm 41% had evidence of esophageal varices. Splenic measurement of >13cm was associated withmaximum number of cases of esophageal varices i.e 82%. Conclusion: It is concluded from the study that male gender, clinically palpablespleen, low platelet count, portal vein diameter and splenic measurement can be used as non invasive parameters to predict esophagealvarices reducing the need of unnecessary endoscopies.

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