A comparative study between three noninvasive predictors of oesophageal varices in post hepatitis C virus liver cirrhosis in Egypt

Background and aim : The prevention of variceal bleeding is very important. The current guide lines recommend screening of all cirrhotic patients by endoscopy, to identify patients at risk of bleeding in whom prophylactic treatment should be started. Repeated endoscopic examinations are unpleasant for patients, and carry a high cost impact and burden on endoscopic units, while only 50% of cirrhotic patients have esophageal varices, 30% of whom have large varices. The aim of this study is to evaluate prospectively the spleen size, platelet count and platelet count/spleen diameter ratio as noninvasive predictors of oesophageal varices in post hepatitis C virus liver cirrhosis in Egypt. Patients and methods : One hundred patients with post hepatitis C virus liver cirrhosis were included in the study. All studied sub- jects underwent a detailed history taking, clinical examination, biochemical workup, upper gastrointestinal endoscopy and abdominal ultrasound. The platelet count to spleen diameter ratio was calculated. Results : All the 3 predictors showed high statistically significant correlation with the presence, size and the grade of oesophageal varices (P < 0.01). Among the 3 noninvasive predictors the platelet count/spleen diameter ratio gave the highest accuracy (94%) at a cut-off value of 1326.58 followed by the spleen size (89%) at a cut-off value of 131.5 mm and lastly the platelet count (84%) at a cut-of value of 131000/mm3. Conclusion : The use of the three studied predictors in this study can help the physicians to restrict endoscopy to those who are highly suspected to have oesophageal varices. (Acta gastroenterol. belg., 2011, 74, 497-502).