A Study on Non-Endoscopic Predictors of Esophageal Varices in Patients With Chronic Liver Disease - A Prospective Study

Abstract

Background: Esophageal varices are a serious consequence of portal hypertension in patients with liver diseases. Non-invasive markers of esophageal varices helps to reduce unnecessary endoscopies in patients with cirrhosis. Aims and Objectives: To evaluate various clinical, biochemical and ultrasonographic parameters in predicting the presence of large esophageal varices. Materials and Methods: Ninety-four in-hospital patients with chronic liver disease were studied. Detailed history and physical examination was done as per pre-fixed performa. Relavant haematological, biochemical and radiological investigations were done to confirm chronic liver disease and to record spleen diameter, portal vein diameter and ascites. Screening for esophageal varices was done by upper GI endoscopy. The severity of liver cirrhosis was judged by the Child Pugh score. Results: The prevalence of large esophageal varices was found to be 45(47.9%). 69 (73.4%) of the participants were male and 25(26.6%) were female with mean age 45 years. Alcohol was the most common etiology found. Ascites, hepatic encephalopathy, Child-Turcotte-Pugh score, low platelet count, serum bilirubin, PT/INR, spleen diameter and portal vein size were found statistically significant (p value<0.001) in univariate analysis in predicting the presence of large esophageal varices. However on multivariate analysis, low platelet count, splenomegaly and portal vein diameter found to have independent predictive value (p value<0.001). Conclusion: Low platelet count, splenomegaly and increased portal vein diameter were found to be the independent predictors of large esophageal varices in chronic liver disease patients. Hence using these noninvasive predictors for the detection of esophageal varices seems to be more cost effective than the “scope all strategy”. This may help reduce the cost and discomfort for patients and the burden on endoscopy units.