title: Esophageal varices on computed tomography and subsequent variceal hemorrhage.
abstract: OBJECTIVE
  Endoscopy is recommended to screen for esophageal varices in patients with cirrhosis. The objective of this study was to identify features on abdominal CT imaging associated variceal hemorrhage (VH).
  
  
  METHODS
  A case-control study was performed among patients with cirrhosis who had a CT scan. Consecutive patients who experienced VH were included as cases, and patients without VH served as controls. Two radiologists recorded the maximal esophageal varix diameter in addition to other measures of portal hypertension at CT.
  
  
  RESULTS
  The most powerful CT parameter associated with VH was the esophageal varix diameter (5.8 vs. 2.7 mm, p < 0.001; adjusted OR 1.84 per mm, p = 0.009). 63% of individuals with VH had a maximal varix diameter ≥5 mm compared to 7.5% of cirrhotic patients without VH (p < 0.001). In contrast, the proportion of individuals whose largest varix was <3 mm was 7.4% among VH cases compared to 54.7% among controls (p = 0.001). The varix diameter powerfully discriminated those with and without VH (C-statistic 0.84).
  
  
  CONCLUSIONS
  A large esophageal varix diameter is strongly associated with subsequent VH. A threshold of <3 and ≥5 mm appears to identify patients with cirrhosis at low and high risk for hemorrhage.
authors.affiliation: Division of Gastroenterology, Department of Medicine, University of California, San Francisco, 1001 Potrero Avenue, San Francisco, CA, 94110, USA, ma.somsouk@ucsf.edu.
authors.forename: Ma
authors.initials: M
authors.lastname: Somsouk
authors.forename: Katherine
authors.initials: K
authors.lastname: To'o
authors.forename: Mujtaba
authors.initials: M
authors.lastname: Ali
authors.forename: Eric
authors.initials: E
authors.lastname: Vittinghoff
authors.forename: Benjamin M
authors.initials: BM
authors.lastname: Yeh
authors.forename: Judy
authors.initials: J
authors.lastname: Yee
authors.forename: Alex
authors.initials: A
authors.lastname: Monto
authors.forename: John M
authors.initials: JM
authors.lastname: Inadomi
authors.forename: Rizwan
authors.initials: R
authors.lastname: Aslam
mesh_terms: D016022:Case-Control Studies; D003287:Contrast Media; D003973:Diatrizoate; D003974:Diatrizoate Meglumine; D004932:Esophageal and Gastric Varices / Q000000981:diagnostic imaging* / Q000209:etiology; D005260:Female; D006471:Gastrointestinal Hemorrhage / Q000000981:diagnostic imaging* / Q000209:etiology; D006801:Humans; D007472:Iohexol; D008103:Liver Cirrhosis / Q000150:complications / Q000000981:diagnostic imaging; D008297:Male; D008875:Middle Aged; D014057:Tomography, X-Ray Computed / Q000379:methods*
chemical_list: D003287:Contrast Media; D003973:Diatrizoate; D003974:Diatrizoate Meglumine; D007472:Iohexol