scholarly journals Study of Portal Vein Diameter and Spleen Size by Ultrasonography and Their Association with Gastro-esophageal Varices

2017 ◽  
Vol 4 (2) ◽  
pp. 6-14
Author(s):  
Subash Bhattarai ◽  
M Gyawali ◽  
KR Dewan ◽  
G Shrestha ◽  
BS Patowary ◽  
...  
Keyword(s):  
Portal Vein ◽  
Esophageal Varices ◽  
Spleen Size ◽  
Cutoff Value ◽  
Non Invasive ◽  
Vein Diameter ◽  
Cirrhotic Patients ◽  
Positive Correlations ◽  
Cirrhosis Of Liver

 Introduction: Upper Gastro-intestinal endoscopy is considered the best screening tool for varices in cirrhotic patients. It is still an expensive, invasive tool, has poor compliance and not routinely available in every hospitals in Nepal. This study was undertaken to establish the role of portal vein diameter and spleen size by ultrasonography in predicting gastro-esophageal varices.Method: One hundred and fifty patients with clinical features, laboratory and sonological findings suggestive of cirrhosis of liver and endoscopic evidence of portal hypertension were included in the study. Ultrasonography assessments of portal vein diameter and spleen size alongside endoscopy for detection of varices were done.Result: Average portal vein diameter of patients without gastro-esophageal varices was 10.800 ± 1.1402 mm, while it was 13.731 ± 1.061mm in patients with varices(p<0.001). Average spleen size of patients without varices was 12.67 ± 2.35 cm and with varices was 15.367 ± 1.210 cm (p < 0.001). There was 92.72 % sensitivity and 90 % specificity for prediction for presence of esophageal varices when the cutoff value for portal vein diameter was 12.25 mm. There was 94.5 % sensitivity and 75 % specificity for prediction for presence of esophageal varices when the cutoff value for spleen size was 13.9 cm.Conclusion: Ultrasonography of portal vein diameter and spleen size is a reliable non invasive tool in predicting the presence of gastro-esophageal varices in patients with liver cirrhosis. With increase in portal vein diameter and spleen size, risk of formation of gastro-esophageal varices also increases and positive correlations exist between them. Nepalese Journal of Radiology, VOL 4 No. 2 ISSUE 7 July-December, 2014: 6-14 

scholarly journals Correlation of portal vein diameter with the presence of oesophageal varices in chronic liver disease: a prospective study

2018 ◽  
Vol 5 (4) ◽  
pp. 859 ◽  
Author(s):  
Suraj Uppalapati ◽  
Lokesh S.
Keyword(s):  
Portal Vein ◽  
Esophageal Varices ◽  
Previous History ◽  
Oesophageal Varices ◽  
Upper Gastrointestinal Endoscopy ◽  
Non Invasive ◽  
Upper Gi ◽  
Vein Diameter ◽  
Cirrhosis Of Liver ◽  
A Prospective Study

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.

scholarly journals Non-Invasive Predictors of Gastro-Oesophageal Varices

2017 ◽  
Vol 56 (207) ◽  
pp. 298-303 ◽  
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.

scholarly journals Role of portal color Doppler ultrasonography as noninvasive predictive tool for esophageal varices in cirrhotic patients

2022 ◽  
Vol 53 (1) ◽  
Author(s):  
Mohamed Alaa ELdin Nouh ◽  
Mohamed Kamel Abd-Elmageed ◽  
Amany Abas Mohamed Amer ◽  
Moamena Said ELhamouly
Keyword(s):  
Portal Vein ◽  
Hepatic Artery ◽  
Esophageal Varices ◽  
Resistance Index ◽  
Cirrhotic Liver ◽  
Control Group ◽  
Predictive Tool ◽  
Endoscopic Screening ◽  
Cirrhotic Patients

Abstract Background Esophageal varices (EV) is the most common apprehensive complication of portal hypertension in patients with cirrhotic liver. Guidelines recommend Upper gastro-intestinal endoscopic screening for EV in patients with newly diagnosed chronic cirrhosis (Imperiale et al. in Hepatology 45(4):870–878, 2007). Yet, it is invasive, time consuming and costly. To avoid unnecessary endoscopy, some studies have suggested Doppler ultrasound examination as simple, and noninvasive tool in prediction and assessment of severity of EV (Agha et al. in Dig Dis Sci 54(3):654–660, 2009). Our study was to assess the role of different Doppler indices of portal vein, hepatic and splenic arteries as a noninvasive tool for prediction of esophageal varices in cirrhotic patients. Results This prospective case control study was conducted on 100 cirrhotic liver patients and 100 of healthy volunteers as control group. Patients were subjected to clinical examination, upper gastrointestinal tract endoscopy, abdominal ultrasonography with duplex Doppler evaluation of different portal Doppler hemodynamic indices were done for each patient. The results revealed that portal vein diameter, hepatic artery pulsatility index, portal hypertensive index, portal vein flow velocity, portal congestion index have high sensitivity for prediction of EV. However, Splenic artery resistance index, hepatic artery resistance index HARI, liver vascular index and platelet count/spleen diameter have less sensitivity for prediction of EV. Conclusion Measuring the portal hemodynamic indices can help physicians as noninvasive predictors of EV in cirrhotic patients to restrict the need for unnecessary endoscopic screening especially when endoscopic facilities are limited.

scholarly journals Value of hepatic elastography and Doppler indexes for predictions of esophageal varices in liver cirrhosis

2015 ◽  
Vol 17 (1) ◽  
pp. 5 ◽  
Author(s):  
Adriana Bintintan ◽  
Romeo Ioan Chira ◽  
Vasile Virgil Bintintan ◽  
Georgiana Nagy ◽  
Roberta Maria Manzat-Saplacan ◽  
...  
Keyword(s):  
Liver Cirrhosis ◽  
Esophageal Varices ◽  
Statistical Power ◽  
Transient Elastography ◽  
Liver Stiffness ◽  
Abdominal Ultrasound ◽  
Non Invasive ◽  
Cirrhotic Patients ◽  
Ultrasound Parameters

Aims: Non-invasive methods are required to diagnose presence and grading of esophageal varices in patients with he- patic cirrhosis and in this respect we have evaluated the role of transient elastography and abdominal ultrasound parameters. Material and methods: Cirrhotic patients were prospectively evaluated by transient elastography and Doppler ultrasound for diagnosis of presence and grading of esophageal varices, the results being compared with the findings of the esophagogas- troduodenoscopy. Results: Sixty patients with hepatic cirrhosis were analysed. The parameters that reached statistical signifi- cance for diagnosis of esophageal varices were: liver stiffness (LSM) > 15 kPa, hemodynamic liver index (PVr1) ≥ 0.66, portal vascular resistance (PVR) > 17.66 and splenoportal index (SPI) > 4.77. The only parameter that reached statistical power for the diagnosis of large esophageal varices was LSM at a cut-off value of 28.8 kPa. Conclusions: Assessment of LSM in patients with liver cirrhosis can predict both the presence of esophageal varices and of large esophageal varices. The PVr1, PVR and SPI Doppler indexes can be used to diagnose the presence of esophageal varices but have no role in the prediction of large esophageal varices. Further studies are required to confirm these results and offer a stronger clinical significance.

scholarly journals Significance of Non-Invasive Markers as Predictor of Esophageal Varices in Liver Cirrhosis

2017 ◽  
Vol 56 (208) ◽  
pp. 412-6 ◽  
Author(s):  
Dipendra Khadka ◽  
Sushil Prajapati ◽  
Sudhamshu KC ◽  
Jeetendra Kaji Shrestha ◽  
Niyanta Karki ◽  
...  
Keyword(s):  
Liver Cirrhosis ◽  
Platelet Count ◽  
Esophageal Varices ◽  
Complete Blood Count ◽  
Clinical Expertise ◽  
Spleen Size ◽  
Cross Sectional ◽  
Cutoff Value ◽  
Non Invasive ◽  
Pugh Class

Introduction: Upper gastro-intestinal endoscopy remains the gold standard for screening for esophageal varices but it has its own limitations. It is an invasive, expensive and uncomfortable procedure and needs clinical expertise. Accordingly, this study was conducted to establish the role of non-invasive markers for prediction of esophageal varices in liver cirrhosis. Methods: A hospital based descriptive cross-sectional study was carried out in Liver unit of National Academy of Medical Sciences, Bir Hospital, from October 2016 to September 2017. Complete blood count, liver function test, liver ultrasound and upper gastro-intestinal endoscopy were done for all patients to detect esophageal varices and to correlate with different non-invasive markers. Results: Total 191 patients of liver cirrhosis were studied after exclusion. Platelet count of 92082.00±43435.83/mm3 and spleen size of 144.21±10.71 mm was found to be good predictors of presence of EV (P≤0.001). Significant association between Child-Turcotte-Pugh class and presence of varices was observed (P≤0.001). AST/ALT ratio with cutoff value of 1.415 showed sensitivity of 82.4% and specificity of 36.4%. APRI at a cutoff value of 1.3 showed a sensitivity of 83.2% and specificity of 50%. Conclusions: Platelet count, spleen size and Child-Turcotte-Pugh class are good predictors of presence of esophageal varices in patients with liver cirrhosis. AST/ALT ratio and APRI score are not good substitutes for upper gastro-intestinal endoscopy.   Keywords:  esophageal varices; liver cirrhosis; non-invasive markers; portal hypertension; upper gastro-intestinal.

scholarly journals Evaluation of the Gallbladder Wall Thickening as a Non-invasive Predictor of Esophageal Varices in Cirrhotic Patients

2021 ◽  
pp. 1-9
Author(s):  
Nora M. Shehata ◽  
Alsiagy A. AbdelAziz ◽  
Medhat Abd El-Megid ◽  
Yasser M. Hafez
Keyword(s):  
Gall Bladder ◽  
Portal Vein ◽  
Wall Thickness ◽  
Esophageal Varices ◽  
Bladder Wall ◽  
Wall Thickening ◽  
P Value ◽  
Bladder Wall Thickness ◽  
Non Invasive ◽  
Cirrhotic Patients

Background: Liver cirrhosis represent the end stage of fibrosis that destroy normal liver parenchyma and leads to serious complication as portal hypertension which result in esophageal varices (EV), EV bleeding leads to high mortality, so repeated upper endoscopy needed to control bleeding which is invasive procedure and of high risk of hazards as infection. Our Study Aimed: to evaluate the Gallbladder Wall Thickening (GBWT) as a non-invasive predictor of Esophageal Varices (EV) in cirrhotic patients. Methods: In this cross sectional study, we tested 120 cirrhotic patients at gastroenterology and hepatology unit, internal medicine department, Tanta university hospitals. They were divided into 60 cirrhotic patients with EV and 60 cirrhotic patients without EV. All patients were subjected to history taking,  physical examination, investigation (complete blood count, liver function tests, viral markers) ultrasound detecting (gall bladder wall thickness, portal vein diameter, portal vein flow velocity, portal cross sectional area and gall bladder fasting volume) upper gastrointestinal endoscopy to detect presence or absence of varices. Results: Significant correlation was observed between gall bladder wall thickness (GBWT) and portal hypertension, GBWT ranged from 2.5 to 7 mm in group 2 (cirrhotic patients with EV) and from 1.5 to 5 in group 1( cirrhotic patients without EV). There is significant difference between group 1 and group 2 as regard GBWT with (P value < 0.05), portal vein diameter (PVD) with (P value <0.05) and platelets counts with (P value <0.05). Conclusions: We recommend thatgall bladder wall thickness can be used as a non-invasive predictor of esophageal varices in cirrhotic patients.

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

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

scholarly journals Are non invasive predictors of esophageal varices reliable?

2019 ◽  
Vol 7 (2) ◽  
pp. 508
Author(s):  
Akshatha Savith ◽  
Sidhartha Naidu Bhumireddy
Keyword(s):  
Platelet Count ◽  
Portal Vein ◽  
Esophageal Varices ◽  
Cross Sectional Study ◽  
Sectional Study ◽  
Medical Sciences ◽  
Cross Sectional ◽  
Non Invasive ◽  
Vein Diameter ◽  
One Year

Background: One of the most serious complications of portal hypertension is the development of esophageal varices and variceal bleeding due to the rupture of varices. The purpose of the study was to assess the efficacy of various clinical and laboratory parameters in predicting the presence and severity of esophageal varices in cirrhotic patients.Methods: This is an observational cross-sectional study done in the department of medicine in Vydehi Institute of Medical Sciences, Bengaluru over a period of one year. Total of 76 patients above the age of 18years with the diagnosis of cirrhosis of any etiology were included. Multivariate Backward method was applied and Portal vein diameter, Platelet count, PT INR, FIB-4 score, APRI, AST/ALT ratio were included as predictors in the model.Results: No statistically significant correlation was found between platelet count, portal vein diameter, FIB 4 score, APRI, AST/ALT ratio and presence of esophageal varices.Conclusions: Present study showed that the non invasive markers such as platelet count, portal vein diameter, FIB 4 score, APRI and AST/ALT ratio are not reliable in predicting the presence of esophageal varices.

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