Mohammad Ali Abd Elrazek, Abd El razek Mohammad Ali1, Hamdy Mahfouz, Mohamed Afifi, Mohamed Nafady, Abd El wahhab Fathy, Khaled Abd El azeem, Khaled Amer, Ahmed El-shamy, Uryuhara Kenji, A Ammar Ghibah, Ammar Ghiba, Shymaa Bilasy, Nadia El-ansary, Mohamed Fakhry, Magdy Mansour. 1. Department of Tropical Medicine (AMA, HM, AEWF, KAE, MF), Al Azhar Faculty of Medicine, Asuit, Egypt; Department of Tropical Medicine (MA), Al Azhar Faculty of Medicine, Cairo, Egypt; Department of Radiology (MN), Al Azhar Faculty of Medicine, Asuit, Egypt; Department of Liver Transplantation (KA), International Medical Center (IMC), Cairo, Egypt; Division of Liver Diseases (AE-S), Mount Sinai School of Medicine, New York, New York; Department of Hepatobiliary (UK), Pancreatic Surgery, Kobe City Medical Center, Kobe, Japan; Informatics and Communications Department (AAG), Yarmouk University, Syria, and Tokoshima University, Tokoshima, Japan; Department of Biochemistry Faculty of Pharmacy (SB), Suez Canal University, Ismaelia, Egypt; Department of Tropical Medicine (NE-A), Ain Shams University, Cairo, Egypt; Department of Radiology (MM), Al Azhar Faculty of Medicine, Cairo, Egypt.
Abstract
OBJECTIVE: Esophageal varices are a consequence of portal hypertension in cirrhotic patients. Current guidelines recommend that all cirrhotic patients undergo screening endoscopy at diagnosis to identify patients with varices at high risk of bleeding who will benefit from primary prophylaxis. This practice increases costs, involves a degree of invasiveness and discomfort and places a heavy burden on endoscopy units. Several studies have evaluated possible noninvasive predictors of esophageal varices, but most of these studies remain controversial. METHODS: The intra-abdominal portion of the esophagus in 673 patients who presented with liver cirrhosis and portal hypertension was examined using standard 2-dimensional (2D) ultrasound. A direct relationship between the degree of varices observed on upper endoscopy and the intra-abdominal esophageal wall thickness was detected using 2D ultrasound. RESULTS: The mean thicknesses of the esophageal wall were 3.7 ± 0.5 mm (mean ± standard deviation) in normal individuals, 7.3 ± 3.3 mm in those with esophageal varices and 8.65 ± 1.98 mm in those with risky esophageal varices. The overall accuracy of 2D ultrasound was 95%. CONCLUSIONS: The intra-abdominal esophagus should be observed during abdominal ultrasound examination in patients with liver cirrhosis. Two-dimensional ultrasound can play an important role in screening for esophageal varices.
OBJECTIVE: Esophageal varices are a consequence of portal hypertension in cirrhotic patients. Current guidelines recommend that all cirrhotic patients undergo screening endoscopy at diagnosis to identify patients with varices at high risk of bleeding who will benefit from primary prophylaxis. This practice increases costs, involves a degree of invasiveness and discomfort and places a heavy burden on endoscopy units. Several studies have evaluated possible noninvasive predictors of esophageal varices, but most of these studies remain controversial. METHODS: The intra-abdominal portion of the esophagus in 673 patients who presented with liver cirrhosis and portal hypertension was examined using standard 2-dimensional (2D) ultrasound. A direct relationship between the degree of varices observed on upper endoscopy and the intra-abdominal esophageal wall thickness was detected using 2D ultrasound. RESULTS: The mean thicknesses of the esophageal wall were 3.7 ± 0.5 mm (mean ± standard deviation) in normal individuals, 7.3 ± 3.3 mm in those with esophageal varices and 8.65 ± 1.98 mm in those with risky esophageal varices. The overall accuracy of 2D ultrasound was 95%. CONCLUSIONS: The intra-abdominal esophagus should be observed during abdominal ultrasound examination in patients with liver cirrhosis. Two-dimensional ultrasound can play an important role in screening for esophageal varices.
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