A Study to Compare The Efficacy of Non-invasive Predictors of Esophageal Varices in Patients with Portal Hypertension

Abstract

Objective: To study the predictive power and compare the various noninvasive investigative
parameters for detection of esophageal varices in patients with Portal Hypertension as compared
to invasive parameter.
Methods: Fifty consecutive patients meeting the inclusion and exclusion criteria were enrolled in
the study. All patient were subjected to complete blood count, Liver function tests, total serum
proteins, albumin and globulin levels, coagulation profile (APTT, PT, INR)HbsAg, anti HCV
antibodies and abdominal ultrasonography to assess the spleen longitudinal diameter of spleen
and portal vein diameter and upper gastrointestinal endoscopic examination. Elastography was
determined using Fibroscan. Patients were assessed with Child Turcotte Pugh (CTP) score and
the esophageal varices were graded using Westaby's Classification.
Results: Predominant age group was 51-60 years. Males were the most common to present
with EV. Majority of patients were Hepatitis C antibodies positive and they were the most common
cause for PHT. 48% had severe thrombocytopenia of count less than twenty thousand. 56% had
spleen size of less than 130mm. 4% did not have EV, 26% had Grade-I varices, 34% had Grade-II
varices and 36% had Grade-III varices. Higher Fibroscan score is associated with larger varices.
(p-value -0.001). Low platelet count was seen in Grade-III varices. When the Right lobe diameter
albumin ratio was high the varices were also larger. Patients who had large grade-III varices also
had a low Platelet / spleen ratio with a mean of 190. (p-value -0.002)
Conclusions: Overall the non-invasive parameters had a significant ability to predict and
estimate grade of varices and severity of PHT