title: Detection of risky esophageal varices by two-dimensional ultrasound: when to perform endoscopy.
abstract: OBJECTIVE
  Esophageal varices are a consequence of portal hypertension in cirrhotic patients. Current guidelines recommend that all cirrhotic patients undergo screening endoscopy at diagnosis to identify patients with varices at high risk of bleeding who will benefit from primary prophylaxis. This practice increases costs, involves a degree of invasiveness and discomfort and places a heavy burden on endoscopy units. Several studies have evaluated possible noninvasive predictors of esophageal varices, but most of these studies remain controversial.
  
  
  METHODS
  The intra-abdominal portion of the esophagus in 673 patients who presented with liver cirrhosis and portal hypertension was examined using standard 2-dimensional (2D) ultrasound. A direct relationship between the degree of varices observed on upper endoscopy and the intra-abdominal esophageal wall thickness was detected using 2D ultrasound.
  
  
  RESULTS
  The mean thicknesses of the esophageal wall were 3.7 ± 0.5 mm (mean ± standard deviation) in normal individuals, 7.3 ± 3.3 mm in those with esophageal varices and 8.65 ± 1.98 mm in those with risky esophageal varices. The overall accuracy of 2D ultrasound was 95%.
  
  
  CONCLUSIONS
  The intra-abdominal esophagus should be observed during abdominal ultrasound examination in patients with liver cirrhosis. Two-dimensional ultrasound can play an important role in screening for esophageal varices.
authors.forename: Mohammad Ali
authors.initials: MA
authors.lastname: Abd Elrazek
authors.affiliation: Department of Tropical Medicine (AMA, HM, AEWF, KAE, MF), Al Azhar Faculty of Medicine, Asuit, Egypt; Department of Tropical Medicine (MA), Al Azhar Faculty of Medicine, Cairo, Egypt; Department of Radiology (MN), Al Azhar Faculty of Medicine, Asuit, Egypt; Department of Liver Transplantation (KA), International Medical Center (IMC), Cairo, Egypt; Division of Liver Diseases (AE-S), Mount Sinai School of Medicine, New York, New York; Department of Hepatobiliary (UK), Pancreatic Surgery, Kobe City Medical Center, Kobe, Japan; Informatics and Communications Department (AAG), Yarmouk University, Syria, and Tokoshima University, Tokoshima, Japan; Department of Biochemistry Faculty of Pharmacy (SB), Suez Canal University, Ismaelia, Egypt; Department of Tropical Medicine (NE-A), Ain Shams University, Cairo, Egypt; Department of Radiology (MM), Al Azhar Faculty of Medicine, Cairo, Egypt.
authors.forename: Abd El razek
authors.initials: Ael R
authors.lastname: Mohammad Ali
authors.forename: Hamdy
authors.initials: H
authors.lastname: Mahfouz
authors.forename: Mohamed
authors.initials: M
authors.lastname: Afifi
authors.forename: Mohamed
authors.initials: M
authors.lastname: Nafady
authors.forename: Abd El wahhab
authors.initials: Ael W
authors.lastname: Fathy
authors.forename: Khaled Abd
authors.initials: KA
authors.lastname: El azeem
authors.forename: Khaled
authors.initials: K
authors.lastname: Amer
authors.forename: Ahmed
authors.initials: A
authors.lastname: El-shamy
authors.forename: Uryuhara
authors.initials: U
authors.lastname: Kenji
authors.forename: A Ammar
authors.initials: AA
authors.lastname: Ghibah
authors.forename: Ammar
authors.initials: A
authors.lastname: Ghiba
authors.forename: Shymaa
authors.initials: S
authors.lastname: Bilasy
authors.forename: Nadia
authors.initials: N
authors.lastname: El-ansary
authors.forename: Mohamed
authors.initials: M
authors.lastname: Fakhry
authors.forename: Magdy
authors.initials: M
authors.lastname: Mansour
mesh_terms: D000293:Adolescent; D000328:Adult; D016099:Endoscopy, Gastrointestinal / Q000191:economics / Q000379:methods / Q000706:statistics & numerical data*; D004932:Esophageal and Gastric Varices / Q000175:diagnosis / Q000000981:diagnostic imaging* / Q000453:epidemiology*; D005260:Female; D006801:Humans; D006975:Hypertension, Portal / Q000150:complications; D015994:Incidence; D008103:Liver Cirrhosis / Q000150:complications; D008297:Male; D008403:Mass Screening / Q000379:methods*; D008875:Middle Aged; D011446:Prospective Studies; D012307:Risk Factors; D014463:Ultrasonography / Q000191:economics / Q000379:methods / Q000706:statistics & numerical data; D055815:Young Adult