الفهرس 
anatomyOnly 14 pages are availabe for public view
 |  | from | 154 |  |  |
| | | from | 154 | | |
Abstract
Oesophageal varices are the most common clinical manifestations of portal hypertension (PH) in patients with liver cirrhosis. Varices are present in (30%-40%) of patients in compensated cirrhosis and in (60%-80%) of patients with decompensated cirrhosis. Bleeding from OV is the most clinically relevant complication of cirrhosis and carries a high risk of morbidity and mortality.
Recent studies; AASLD and Baveno IV Consensus Conference on PH recommended that, all cirrhotic patients should be screened for presence of OV on cirrhosis diagnosis, to be repeated every 2-3 years in compensated cirrhosis and annually in decompensated cirrhosis. A generalized screening program of periodical upper endoscopy in chronic liver disease patients will increase socioeconomic and medical load, because of the rising number of such patients, in addition to low compliance. Therefore, there is a particular need for a non-invasive predictor for OV presence to ease the medical and socioeconomic burden of the disease. Various studies evaluated the rule of non- invasive markers in diagnosis of OV, but available data in Egypt are limited.
This study was conducted to evaluate the accuracy of both ultrasound indices and blood indices (liver profile ,CBC ) as non-invasive predictors of oesophageal varices in chronic liver disease patients using simple parameters depending on hematological, biochemical and radiological data.
One hundred chronic liver disease patients without past history of previous variceal bleeding, previous endoscopic treatment for OV
as band ligation or sclerotherapy or surgical intervention for PH. Patients on (B-blockers, patients with hepatocellular carcinoma, portal or splenic vein thrombosis, or active infection were excluded from the study. The patients included in this study were divided into two groups according to upper GI endoscopy :- Group 1: non variceal group (18 chronic liver disease patients ) Group 2: variceal group (82 chronic liver disease patients ) The variceal group further subdivided into four subgroups according to Comar and Sanyal (grade I ,II ,III, IV ). All participants in the study were subjected to the following: 1 .Full history taking and clinical assessment. 2. Routine laboratory investigations (as CBC, liver profile). 3. Child-Pugh score-classification. 4. Abdominal ultrasonography: evaluating liver and spleen size stressing on PVD . 5. Upper endoscopy. By evaluation of the studied parameters, as predictors for OV we reported that the significant parameters were as follow:
1-Splenic size at cutoff >13 cm is significant in prediction of O.V. with sensitivity 87.7 ,specificity 83.3 ,PPV 95.9 and NPV 60 .
2-Platelet count at a cutoff <123000 is significant in prediction of O.V. with sensitivity 57.3 specificity 83.3 ,PPV 94.0 and NPV 30.0.
3- Portal vein diameter at a cutoff >12 mm is significant in prediction of O.V. with sensitivity 76.50 ,specificity 88.9 ,PPV 96.9 and NPV 45.7.
4-Serum albumin level at a cutoff < 3.2 gm/dl is significant in prediction of O.V. with sensitivity 73.20 ,specificity 77.80 ,PPV 93.80 and NPV 38.9 .
5- Prothrombin time at a cutoff >13.29 sec. was significant in prediction of O.V. with sensitivity 84.1 ,specificity 72.2 ,PPV 93.2 and NPV 50.0.
6- Child- Pugh score was significant in prediction of O.V. with advanced score .
Then by multivariate regression analysis of the significant parameters we reported that :-
*Splenic size is the most significant Parameter in prediction of O.V.
P-value 0.022) .
Patients with splenomegaly were at 1.56 risk for the presence of O.V. .
*Splenomegaly was followed secondly by thrombocytopenia in prediction of O.V. (P-value 0.031).
Patients with thrombocytopenia were at 1.45 risk for the presence of O.V.
*Child-Pugh score came thirdly in prediction of O.V. (P-value 0.042).
Patients with advanced Child-Pugh score were at 1.364 risk for the presence of O.V.
Then we calculated a score from the most significant parameters for
highly prediction of O.V. (O.V. prediction score –OVPS )
OVPS >2 had sensitivity 79.3 ,specificity 83.3 ,PPV 95.6 and accuracy
87.6 in prediction of O.V. .
It was suggested that according to these non invasive predictors for O.V. ; endoscopy could be considered or risterectd as a confirmatory technique for such group of patients ,with suspected need for prophylactic O.V. band ligation.
All, to prevent a first bleeding which carries high morbidity and mortality.