title: Non-invasive ultrasound-based diagnosis and staging of esophageal varices in liver cirrhosis. A systematic review of the literature published in the third millenium.
abstract: BACKGROUND
  Endoscopic surveilance of esophageal varices in patients with liver cirrhosis is expensive for the health system and uncomfortable for the patients. Recently, non-invasive ultrasound-based parameters seem to offer valuable informations about the status of esophaeal varices and thus challenge the need for repetitive endoscopic monitoring.
  
  
  METHODS
  We have performed a systematic review of the literature published in PubMed from January 2000 until March 2012 over the role of ultrasound-based parameters on the evaluation of esophageal varices in patients with liver cirrhosis.
  
  
  RESULTS
  Eleven papers studied the role of gray-scale and Doppler ultrasound and two further studies analyzed the relationship between liver stiffness and staging of esophageal varices. The parameters that proved to be valuable for diagnosis of esophageal varices and reached statistcal significance were: diameter of the spleen > 15 cm, congestion index of the portal vein > 0.154 cm x sec, portal hipertensive index > 2.08, liver stiffness > 43.97kPa, portal vein diameter > 13 mm, renal artery resistance index >/= 0.7 and development of new porto-systemic collaterals. Other parameters such as: pattern of hepatic venous waveforms or flow parameters of the hepatic or splenic veins did not reach statistical significance.
  
  
  CONCLUSIONS
  Altough esophagogastroduodenoscopy remains the golden standard, there are some ultrasound-based parameters which, used within complex algorithms, may represent a viable alternative for the diagnosis and surveilance of esophageal varices in patients with liver cirrhosis.
authors.affiliation: 1st Medical Clinic, Gastroenterology Department, "Iuliu Hațieganu" University of Medicine and Pharmacy, Cluj-Napoca, Romania. abintintan@yahoo.com
authors.forename: Adriana
authors.initials: A
authors.lastname: Binţinţan
authors.forename: Romeo Ioan
authors.initials: RI
authors.lastname: Chira
authors.forename: Petru Adrian
authors.initials: PA
authors.lastname: Mircea
mesh_terms: D015984:Causality; D015897:Comorbidity; D054459:Elasticity Imaging Techniques / Q000706:statistics & numerical data*; D004932:Esophageal and Gastric Varices / Q000000981:diagnostic imaging* / Q000453:epidemiology*; D006801:Humans; D008103:Liver Cirrhosis / Q000000981:diagnostic imaging* / Q000453:epidemiology*; D015995:Prevalence; D015203:Reproducibility of Results; D018570:Risk Assessment; D012680:Sensitivity and Specificity