Oesophagogastroduodenoscopy in patients with cirrhosis: Extending the range of detection beyond portal hypertension.
BACKGROUND
Oesophagogastroduodenoscopy is currently recommended for the screening of varices in cirrhosis. In addition to the assessment of varices, oesophagogastroduodenoscopy can detect conditions that, while unrelated to portal hypertension, may require treatment.


OBJECTIVE
We evaluated in a large cohort of cirrhotic patients the prevalence of upper digestive findings other than oesophagogastric varices, the associations between upper gastrointestinal findings, portal hypertension and features of cirrhosis, and the incidence of new lesions in the course of a surveillance program.


METHODS
Analysis of the records of 611 consecutive cirrhotic patients undergoing oesophagogastroduodenoscopy for screening and surveillance.


RESULTS
232 patients (38%) presented endoscopic lesions not related to portal hypertension: peptic diseases (n=193), proliferative diseases (n=27) and vascular diseases (n=12). In the screening group, 127 patients (39.4%) had pathologic lesions. At multivariate analysis, an association was found between peptic diseases and the absence of portal hypertensive gastropathy (RR 3.3; 95% CI 2.2-4.8); vascular diseases were associated with endoscopic signs of portal hypertension (p=0.01). During surveillance, 9/55 patients (16.3%) in the group without previous pathologic findings developed new lesions.


CONCLUSIONS
Oesophagogastroduodenoscopy in patients with cirrhosis undergoing endoscopy for screening diagnosed pathologic lesions unrelated to portal hypertension requiring a change in management in 39.4% of asymptomatic subjects.
De Lisi
Stefania
S
Di.Bi.M.I.S., University of Palermo, Italy. stefaniadelisi@gmail.com
Peralta
Sergio
S
Arini
Andrea
A
Simone
Fabio
F
Craxì
Antonio
A
D000230:Adenocarcinoma / Q000150:complications* / Q000453:epidemiology / Q000473:pathology; D000368:Aged; D004381:Duodenal Ulcer / Q000150:complications / Q000453:epidemiology; D016145:Endoscopy, Digestive System; D004932:Esophageal and Gastric Varices / Q000453:epidemiology / Q000209:etiology* / Q000473:pathology; D005260:Female; D005756:Gastritis / Q000150:complications / Q000453:epidemiology; D016481:Helicobacter Infections / Q000150:complications* / Q000453:epidemiology; D016480:Helicobacter pylori; D006801:Humans; D006975:Hypertension, Portal / Q000150:complications*; D008103:Liver Cirrhosis / Q000150:complications*; D008297:Male; D008679:Metaplasia / Q000150:complications / Q000453:epidemiology; D008875:Middle Aged; D011127:Polyps / Q000150:complications / Q000453:epidemiology; D015995:Prevalence; D013274:Stomach Neoplasms / Q000150:complications* / Q000453:epidemiology / Q000473:pathology; D013276:Stomach Ulcer / Q000150:complications / Q000453:epidemiology; D014652:Vascular Diseases / Q000150:complications / Q000453:epidemiology