Non-invasive methods of predicting esophageal varices in patients with intrahepatic portal hypertension

Background: Esophageal variceal bleeding is a severe complication of portal hypertension. The standard diagnostic screening test and therapeutic procedure to confirm esophageal varices is endoscopy. However because esophagogastroduodenoscopy is invasive, we studied the effectiveness of various noninvasive parameters in predicting the presence of esophageal varices.
Methods: The patients studied were either newly diagnosed as liver cirrhosis or were previously diagnosed with liver cirrhosis and were on follow up. The Non-invasive parameters that were used either in retrospective or prospective way for prediction of esophageal varices in our study were:AST, ALT Ratio (AST/ALT),Platelet count,APRI score, Splenic size (AP Diameter),Portal vein diameter,FIB -4 Score,LOK Score and Platelet/Splenic(AP)Diameter.
Results: A total of 144 patients were enrolled prospectively as well as retrospectively for a period of 2 years. Majority of our patients were males in age group of 40- 60 yrs and the most familiar etiology was Nonalcoholic fatty liver. Among the noninvasive predictors, the sensitive predictors to foretell the presence esophageal varices were platelet count, portal vein diameter, splenomegaly, High APRI, FIB4, and LOK Scores with sensitivity and specificity of around 85% and 80%.
Conclusion: Platelet count, Platelet/ Splenic ratio, and various fibrosis scores can be helpful in identifying cirrhotic patients with high risk of esophageal varices and higher chances of bleeding vis–a-vis higher mortality.