DOI: http://dx.doi.org/10.18203/2349-3933.ijam20213245

Study of the correlation of oesophageal varices with portal vein diameter and ratio of platelet count to splenic diameter and their comparative evaluation in liver cirrhosis

Harpreet Singh, Sidharth Sharma, Gurminder Singh, Dania Kaur

Abstract


Background: The aim of the study was to determine the correlation of oesophageal varices (OV) with portal vein diameter and the platelet count to splenic diameter ratio and their comparative evaluation in patients of liver cirrhosis.

Methods:The present study consisted of 50 patients diagnosed with liver cirrhosis. Necessary investigations were performed in all the patients including Upper gastrointestinal (GI) endoscopy. Platelet count/spleen diameter ratio, spleen diameter and portal vein diameter were calculated for all patients and the presence and grading of OV was then comparatively evaluated. The results were systematically recorded and statistically analysed.

Results: The mean age of patients was 49.82±10.23 years. 78% of patients presented with OV. The portal vein diameter, platelet count, spleen diameter and platelet count/spleen diameter ratio were significantly increased in patients with OV than those without OV (p<0.0001). Highly significant positive correlation between portal vein diameter, spleen diameter and grading of OV was seen. Platelet count/spleen diameter ratio and platelet count was significantly decreased as the grade of OV increased in the patients. There was statistically, a highly significant negative correlation between them.

Conclusions: The non-invasive parameters used to detect presence of OV in liver cirrhosis were portal vein diameter and platelet count/spleen diameter ratio. Though, both seemed to be effective in predicting OV, platelet count/spleen diameter ratio proved to be slightly more significant when compared to the other. 


Keywords


Oesophageal varices, Portal vein diameter, Platelet count, Spleen diameter and platelet count/spleen diameter ratio

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References


Garceau AJ, Chalmers TC. The Boston Inter-Hospital Liver Group. The natural history of cirrhosis: I. Survival with oesophageal varices. N Engl J Med. 1963;268:469-73.

Graham D, Smith JL. The course of patients after variceal hemorrhage. Gastroenterology. 1981;80;800-9.

Rigo GP, Merighi A, Chalen JN. A prospective study of the ability of three endoscopic classifications to predict hemorrhage from esophageal varices. Gastrointest Endosc. 1992;38:425-9.

Brocchi E, Caletti G, Brambilla G, La Mantia L, Lupinacci G, Pisano G, et al. Prediction of the first variceal hemorrhage in patients with cirrhosis of the liver and esophageal varices. A prospective multicenter study. N Engl J Med. 1988;319(15):983-9.

Vianna A, Hayes PC, Moscoso G, Driver M, Portmann B, Westaby D, et al. Normal venous circulation of the gastroesophageal junction: a route to understanding varices. Gastroenterology. 1987;93(4):876-89.

Garcia-Tsao G, Groszmann RJ, Fisher RL. Portal pressure, presence of gastroesophageal varices and variceal bleeding. Hepatology. 1985;5(3):419-24.

Gines P, Guevara M, Arroyo V, Rodes J. Hepatorenal syndrome. The Lancet. 2003;362(9398):1819-27.

Jensen DM. Endoscopic screening for varices in cirrhosis: findings, implications, and outcomes. Gastroenterology. 2002;122(6):1620-30.

Kapoor A, Dharel N, Sanyal AJ. Endoscopic Diagnosis and Therapy in Gastroesophageal Variceal Bleeding. Gastrointest Endosc Clin N Am. 2015;25(3):491-507.

Karatzas A, Konstantakis C, Aggeletopoulou I, Kalogeropoulou C, Thomopoulos K, Triantos C. Νon-invasive screening for esophageal varices in patients with liver cirrhosis. Ann Gastroenterol. 2018;31(3):305.

Abu El Makarem MA, Shatat ME, Shaker Y, Abdel Aleem AA, El Sherif AM, Moaty MA, et al. Platelet count/bipolar spleen diameter ratio for the prediction of oesophageal varices: The special Egyptian situation: Non invasive prediction of oesophageal varices. Hepatitis monthly. 2011;11(4):278-84.

Mohanty R, Mohapatra N, Malla A, Naik J, Mohanty B, Meher M, et al. Correlation of portal vein diameter and splenic size with oesophageal varices in cirrhosis of liver. Alcohol. 2017;36:72.

Chalasani N, Imperiale TF, Ismail A, Sood G, Carey M, Wilcox CM, et al. Predictors of large oesophageal varices in patients with cirrhosis. Am J Gastroenterol. 1999;94(11):3285-91.

Zaman A, Hapke R, Flora K, Rosen HR, Benner K. Factors predicting the presence of esophageal or gastric varices in patients with advanced liver disease. Am J Gastroenterol. 1999;94(11):3292-6.

Bhattarai S, Gyawali M, Dewan KR, Shrestha G, Patowary BS, Sharma P. Study of Portal Vein Diameter and Spleen Size by Ultrasonography and Their Association with Gastro-esophageal Varices. NJR. 2014;2(7):6-14.

Sreenath S, Saraswathy ST, Anoop VS. A study on noninvasive parameters as predictors of oesophageal varices in cirrhotic patients. J Evid Based Med Healthc. 2017;4(49):2985-91.

Savith A, Bhumireddy SN. Are non invasive predictors of esophageal varices reliable? Int J Res Med Sci. 2019;7:508-11.

Ng FH, Wong SY, Loo CK, Lam KM, Lai CW, Cheng CS. Prediction of oesophagogastric varices in patients with liver cirrhosis. J Gastroenterol Hepatol. 1999;14(8):785-90.

Schepis F, Cammà C, Niceforo D, Magnano A, Pallio S, Cinquegrani M, et al. Which patients with cirrhosis should undergo endoscopic screening for esophageal varices detection? Hepatol Baltim Md. 2001;33(2):333-8.

Shanker R, Banerjee S, Anshul GS, Bansal S, Uppal A. A study of association of portal vein diameter and splenic size with gastrooesophageal varices in liver cirrhosis patients. IOSR Journal of Dental and Medical Sciences. 2016;15(9):125-9.

Cherian JV, Deepak N, Ponnusamy RP, Somasundaram A, Jayanthi V. Non-invasive predictors of esophageal varices. Saudi journal of gastroenterology: official journal of the Saudi Gastroenterology Association. 2011;17(1):64.

Prihartini J, Lesmana LA, Manan C, Gani RA. Detection of esophageal varices in liver cirrhosis using non-invasive parameters. Portal. 2005;37(3).

Thomopoulos KC, Labropoulou-Karatza C, Mimidis KP, Katsakoulis EC, Iconomou G, Nikolopoulou VN. Non-invasive predictors of the presence of large oesophageal varices in patients with cirrhosis. Dig Liver Dis Off J Ital Soc Gastroenterol Ital Assoc Study Liver. 2003;35(7):473-8.

Giannini E, Botta F, Borro P, Risso D, Romagnoli P, Fasoli A, et al. Platelet count/spleen diameter ratio: proposal and validation of a non-invasive parameter to predict the presence of oesophageal varices in patients with liver cirrhosis. Gut. 2003;52(8):1200-5.

Legasto GMA, Sevilla J, Balay A, Tan JA, Cham LV, Vitug A, et al. Platelet count/spleen diameter ratio: a noninvasive parameter to predict the presence of esophageal varices. Phil J Gastroenterol. 2006;2:33-8.

Agha A, Anwar E, Bashir K, Savarino V, Giannini EG. External validation of the platelet count/spleen diameter ratio for the diagnosis of oesophageal varices in hepatitis C virus-related cirrhosis. Dig Dis Sci. 2009;54(3):654-60.

Baig WW, Nagaraja M, Varma M, Prabhu R. Platelet count to spleen diameter ratio for the diagnosis of oesophageal varices: Is it feasible? Can J Gastroenterol. 2008;22(10):825-8.