Study Of Portal Vein Doppler Indices and Other Noninvasive Markers as Predictors of Esophageal Varices in Cirrhotic Patients

Abstract

Background: Portal hypertension commonly accompanies liver cirrhosis.  The development of esophageal varices (EV) is one of the major complications of portal hypertension.  Guidelines recommend that all cirrhotic patients should be screened for the presence of EV when liver cirrhosis is diagnosed.

Objectives: To evaluate portal hypertension parameters in liver cirrhosis by using Doppler ultrasound and other non-invasive parameters in predicting esophageal varices and to correlate portal hypertension parameters in predicting esophageal varices and upper GI bleed from esophageal varices.

Materials and Methods: 99 Cirrhotic patients were enrolled in our study based on their clinical presentation, Child-Pugh status, co-morbid conditions, baseline blood parameters, liver function test, etiology and endoscopic grading of varices were noted. All patients will be subjected to Doppler evaluation of portal system and other indices like Liver vascular index, congestion index, portal hypertensive index and presence of porto-systemic collaterals also noted. Platelet/spleen ratio, AST/platelet ratio were calculated.

Results: The most common aetiology of cirrhosis in this part of country is Alcohol related liver disease (29%), followed by cryptogenic and Hepatitis B related liver disease (28% & 21% respectively). Non-invasive parameters like Platelet count (114578 in patients without varices vs. 78113 in patients with large varices, P=0.049), Prothrombin time (16.53±4.3 vs. 18.18±4.5, P=0.030), Platelet count/spleen diameter ratio (957 vs. 627, P=0.011) predicted the presence of large esophageal varices. Among the Colour Doppler Ultrasound study parameters, the Portal vein mean velocity (15.44±4.63 vs. 11.91±3.97, P=0.019), Liver vascular index (14.38±5.56 vs. 9.38±4.01, P=0.001), Spleen size>16.2 cm (13.34±4.20 vs.16.29±3.42, P=0.05) predicted the presence of large esophageal varices, increasing the risk for upper gastrointestinal bleeding.

Conclusion:

Results of our study indicate that non-invasive tools like platelet count, prothrombin time, platelet/spleen diameter ratio, spleen size >16.2 cm, and Doppler parameters like portal vein velocity, liver vascular index are predictors of presence of large esophageal varices.