Evaluation of Non-invasive Marker of Esophageal Varices in Cirrhosis of Liver

Introduction: Esophageal varices develop as a consequence of portal hypertension (PHT) in patients with chronic liver disease. Hence, screening of all cirrhotic patients with upper gastrointestinal endoscopy to detect the presence of significant esophageal varices implies a number of unnecessary endoscopies and has its limitation where such facilities are not available, especially in the rural part of country.

Method: Patients with either sex, aged between 18 and 60 years with diagnosis of cirrhosis were studied. Detailed history, physical examination along with relevant investigations were recorded and upper gastrointestinal endoscopy was done within 2-3 days of investigation. Esophageal varices were graded as I-IV, using the Paquet grading system and patients were classified dichotomously either as having large esophageal varices (LEV) group A (Grade III-IV) and no varices group B (grade I-II).

Result: A total of 50 patients with cirrhosis of liver were recruited in the study. Among hematological markers, only low platelet count was significantly associated with the presence of LEV ( value <0.05). None of the biochemical markers were found to be significantly associated with LEV. All the ultrasonographic parameters, i.e. spleen size, splenic vein size, portal vein size, and the presence of portosystemic collaterals were found to be significantly associated with the presence of LEV ( value <0.05).

Conclusion: Though upper gastrointestinal endoscopy remains the gold standard for the diagnosis of esophageal varices in cirrhotic patients,those patients at high risk of having LEV can be screened by using clinical, hematological, biochemical, and radiological markers.