Adriana Bintintan1, Romeo Ioan Chira2, Vasile Virgil Bintintan3, Georgiana Anca Nagy2, Maria Roberta Manzat-Saplacan2, Monica Lupsor-Platon4, Horia Stefanescu5, Maria Magdalena Duma6, Simona Doina Valean7, Petru Adrian Mircea7. 1. 1st Medical Clinic, Gastroenterology Department, Emergency Clinical County Hospital,"Iuliu Hatieganu" University of Medicine and Pharmacy, Cluj-Napoca, Romania. E-mail:abintintan@yahoo.com. 2. 1st Medical Clinic, Gastroenterology Department, Emergency Clinical County Hospital,"Iuliu Hatieganu" University of Medicine and Pharmacy, Cluj-Napoca, Romania. 3. 1st Surgical Department, Emergency Clinical County Hospital, "Iuliu Hatieganu" University of Medicine and Pharmacy, Cluj-Napoca, Romania. 4. Medical Imaging Department, "Prof. Dr. Octavian Fodor" Regional Institute of Gastroenterology and Hepatology, "Iuliu Hatieganu" University of Medicine and Pharmacy, Cluj-Napoca, Romania. 5. Hepatology Department, "Prof. Dr. Octavian Fodor" Regional Institute of Gastroenterology and Hepatology, "Iuliu Hațieganu" University of Medicine and Pharmacy, Cluj-Napoca, Romania. 6. Radiology Department, Emergency Clinical County Hospital, "Iuliu Hatieganu" University of Medicine and Pharmacy, Cluj-Napoca, Romania. 7. 1st Medical Clinic, Gastroenterology Department, Emergency Clinical County Hospital, "Iuliu Hatieganu" University of Medicine and Pharmacy, Cluj-Napoca, Romania.
Abstract
AIMS: Non-invasive methods are required to diagnose presence and grading of esophageal varices in patients with hepatic cirrhosis and in this respect we have evaluated the role of transient elastography and abdominal ultrasound parameters. MATERIAL AND METHODS: Cirrhotic patients were prospectively evaluated by transient elastography and Doppler ultrasound for diagnosis of presence and grading of esophageal varices, the results being compared with the findings of the esophagogastroduodenoscopy. RESULTS: Sixty patients with hepatic cirrhosis were analysed. The parameters that reached statistical significance for diagnosis of esophageal varices were: liver stiffness (LSM) > 15 kPa, hemodynamic liver index (PVr1) >/= 0.66, portal vascular resistance (PVR) > 17.66 and splenoportal index (SPI) > 4.77. The only parameter that reached statistical power for the diagnosis of large esophageal varices was LSM at a cut-off value of 28.8 kPa. CONCLUSIONS: Assessment of LSM in patients with liver cirrhosis can predict both the presence of esophageal varices and of large esophageal varices. The PVr1, PVR and SPI Doppler indexes can be used to diagnose the presence of esophageal varices but have no role in the prediction of large esophageal varices. Further studies are required to confirm these results and offer a stronger clinical significance.
AIMS: Non-invasive methods are required to diagnose presence and grading of esophageal varices in patients with hepatic cirrhosis and in this respect we have evaluated the role of transient elastography and abdominal ultrasound parameters. MATERIAL AND METHODS: Cirrhotic patients were prospectively evaluated by transient elastography and Doppler ultrasound for diagnosis of presence and grading of esophageal varices, the results being compared with the findings of the esophagogastroduodenoscopy. RESULTS: Sixty patients with hepatic cirrhosis were analysed. The parameters that reached statistical significance for diagnosis of esophageal varices were: liver stiffness (LSM) > 15 kPa, hemodynamic liver index (PVr1) >/= 0.66, portal vascular resistance (PVR) > 17.66 and splenoportal index (SPI) > 4.77. The only parameter that reached statistical power for the diagnosis of large esophageal varices was LSM at a cut-off value of 28.8 kPa. CONCLUSIONS: Assessment of LSM in patients with liver cirrhosis can predict both the presence of esophageal varices and of large esophageal varices. The PVr1, PVR and SPI Doppler indexes can be used to diagnose the presence of esophageal varices but have no role in the prediction of large esophageal varices. Further studies are required to confirm these results and offer a stronger clinical significance.