PURPOSE: Endoscopy is recommended to screen for esophageal varices in patients with cirrhosis. The objective of this study was to identify features on abdominal CT imaging associated variceal hemorrhage (VH). METHODS: A case-control study was performed among patients with cirrhosis who had a CT scan. Consecutive patients who experienced VH were included as cases, and patients without VH served as controls. Two radiologists recorded the maximal esophageal varix diameter in addition to other measures of portal hypertension at CT. RESULTS: The most powerful CT parameter associated with VH was the esophageal varix diameter (5.8 vs. 2.7 mm, p < 0.001; adjusted OR 1.84 per mm, p = 0.009). 63% of individuals with VH had a maximal varix diameter ≥5 mm compared to 7.5% of cirrhotic patients without VH (p < 0.001). In contrast, the proportion of individuals whose largest varix was <3 mm was 7.4% among VH cases compared to 54.7% among controls (p = 0.001). The varix diameter powerfully discriminated those with and without VH (C-statistic 0.84). CONCLUSIONS: A large esophageal varix diameter is strongly associated with subsequent VH. A threshold of <3 and ≥5 mm appears to identify patients with cirrhosis at low and high risk for hemorrhage.
PURPOSE: Endoscopy is recommended to screen for esophageal varices in patients with cirrhosis. The objective of this study was to identify features on abdominal CT imaging associated variceal hemorrhage (VH). METHODS: A case-control study was performed among patients with cirrhosis who had a CT scan. Consecutive patients who experienced VH were included as cases, and patients without VH served as controls. Two radiologists recorded the maximal esophageal varix diameter in addition to other measures of portal hypertension at CT. RESULTS: The most powerful CT parameter associated with VH was the esophageal varix diameter (5.8 vs. 2.7 mm, p < 0.001; adjusted OR 1.84 per mm, p = 0.009). 63% of individuals with VH had a maximal varix diameter ≥5 mm compared to 7.5% of cirrhotic patients without VH (p < 0.001). In contrast, the proportion of individuals whose largest varix was <3 mm was 7.4% among VH cases compared to 54.7% among controls (p = 0.001). The varix diameter powerfully discriminated those with and without VH (C-statistic 0.84). CONCLUSIONS: A large esophageal varix diameter is strongly associated with subsequent VH. A threshold of <3 and ≥5 mm appears to identify patients with cirrhosis at low and high risk for hemorrhage.
Authors: Glenn M Eisen; Todd H Baron; Jason A Dominitz; Douglas O Faigel; Jay L Goldstein; John F Johanson; J Shawn Mallery; Hareth M Raddawi; John J Vargo; J Patrick Waring; Robert D Fanelli; Jo Wheeler-Harbough Journal: Gastrointest Endosc Date: 2002-06 Impact factor: 9.427
Authors: P S Kamath; R H Wiesner; M Malinchoc; W Kremers; T M Therneau; C L Kosberg; G D'Amico; E R Dickson; W R Kim Journal: Hepatology Date: 2001-02 Impact factor: 17.425
Authors: Roberto de Franchis; Glenn M Eisen; Loren Laine; Inaki Fernandez-Urien; Juan Manuel Herrerias; Russell D Brown; Laurel Fisher; Hugo E Vargas; John Vargo; Julie Thompson; Rami Eliakim Journal: Hepatology Date: 2008-05 Impact factor: 17.425
Authors: Roman E Perri; Michael V Chiorean; Jeff L Fidler; Joel G Fletcher; Jayant A Talwalkar; Linda Stadheim; Nilay D Shah; Patrick S Kamath Journal: Hepatology Date: 2008-05 Impact factor: 17.425
Authors: M G Lapalus; E Ben Soussan; M Gaudric; J C Saurin; P N D'Halluin; O Favre; B Filoche; F Cholet; A de Leusse; M Antonietti; J L Gaudin; P Sogni; D Heresbach; T Ponchon; J Dumortier Journal: Am J Gastroenterol Date: 2009-03-31 Impact factor: 10.864