title: Diagnostic accuracy of abdominal ultrasound in the screening of esophageal varices in patients with cirrhosis.
abstract: BACKGROUND
  Abdominal ultrasound (US) may provide data on the presence of esophageal varices in cirrhosis. We assess the diagnostic accuracy of this procedure.
  
  
  METHODS
  Retrospective recording of clinical data was carried out in cirrhotic patients who underwent abdominal US and upper gastrointestinal endoscopy. We compared patients with and without large varices and assessed the value of US in predicting the presence of these lesions as well as other significant variables.
  
  
  RESULTS
  Of the 353 patients included, 123 (35%) had esophageal varices. The presence of US signs of portal hypertension independently predicted the existence of esophageal varices with a sensitivity of 87.9%, a specificity of 34.9%, a positive predictive value of 40.6%, and a negative predictive value of 85.1%, which could increase to 91.5% if the patient presented plasma albumin and platelet concentrations above the mean values (3.1 g/dl and 122×10 cells/l, respectively). Plasma albumin and platelet concentrations were the two other variables with independent predictive capacity. Applying these selection criteria, up to 30% of screening endoscopies may not be necessary, and up to 43% in patients with compensated cirrhosis. In patients with decompensated cirrhosis, however, US does not have predictive capacity. The results obtained are comparable with those reported for transient elastography.
  
  
  CONCLUSIONS
  Abdominal US is a highly reliable technique for detecting patients with a low risk of presenting esophageal varices. Its use may avoid up to 43% of screening endoscopies in patients with compensated cirrhosis. The results obtained are similar to those observed using transient elastography.
authors.affiliation: aDigestive Diseases Service bInternal Medicine Service cIntensive Care Service dDiagnostic Imaging Service, Althaia Xarxa Hospitalaria i Universitària de Manresa, Universitat Internacional de Catalunya, Manresa, Spain.
authors.forename: Pau
authors.initials: P
authors.lastname: Sort
authors.forename: Magdalena
authors.initials: M
authors.lastname: Muelas
authors.forename: Alvaro
authors.initials: A
authors.lastname: Isava
authors.forename: Jordina
authors.initials: J
authors.lastname: Llaó
authors.forename: Francesc
authors.initials: F
authors.lastname: Porta
authors.forename: Ignasi
authors.initials: I
authors.lastname: Puig
authors.forename: Claudia
authors.initials: C
authors.lastname: Domínguez-Curell
authors.forename: Enrique
authors.initials: E
authors.lastname: Esteve
authors.forename: Carles
authors.initials: C
authors.lastname: Yanguas
authors.forename: Francesc
authors.initials: F
authors.lastname: Vida
mesh_terms: D015415:Biomarkers / Q000097:blood; D016099:Endoscopy, Gastrointestinal; D004932:Esophageal and Gastric Varices / Q000097:blood / Q000000981:diagnostic imaging* / Q000209:etiology; D005260:Female; D006801:Humans; D008103:Liver Cirrhosis / Q000097:blood / Q000150:complications / Q000000981:diagnostic imaging*; D008297:Male; D008875:Middle Aged; D011237:Predictive Value of Tests; D011379:Prognosis; D015203:Reproducibility of Results; D012189:Retrospective Studies; D018570:Risk Assessment; D012307:Risk Factors; D014463:Ultrasonography
chemical_list: D015415:Biomarkers