title: Role of portal haemodynamic parameters in prediction of oesophageal varices in cirrhotic patients.
abstract: OBJECTIVE
  Screening all cirrhotic patients by endoscopy for detection of varices is not cost-effective as the number of patients increases by time and half of them still would not have developed varices 10years after being diagnosed with cirrhosis. Therefore, this study aimed to evaluate hepatic haemodynamic Doppler parameters in predicting the presence of oesophageal varices (OVs) in cirrhotic patients for better selection of those actually needed for screening endoscopy.
  
  
  METHODS
  Eighty-one patients with liver cirrhosis, 32 females and 49 males, with a mean age of 50.7±11.7years were recruited for the study. They included 61 patients with OVs and 20 patients without varices. The diagnosis of liver cirrhosis was based on clinical history, examination, and investigations. Liver function and kidney function tests and complete blood count (CBC) were performed for all patients. All patients underwent abdominal ultrasound (US), upper endoscopy, and hepatic Doppler US examination.
  
  
  RESULTS
  The portal vein velocity (PVV) and liver vascular index (LVI) showed statistically significantly lower values in patients with OVs than those without OVs (p value=0.02 and 0.000, respectively). The congestion index (CI) of the portal vein, the portal hypertension index (PHI), and the splenoportal index (SPI) showed statistically significantly higher values in patients with OVs than those without OVs (p value=0.006, 0.001, and 0.001, respectively). CI and SPI were the best parameters that could predict the presence of OVs with high sensitivity, specificity, and diagnostic accuracy when cutoff values were set at >0.069 and 3.57, respectively (area under the curve=0.864 and 0.894, respectively).
  
  
  CONCLUSIONS
  The CI of the portal vein and SPI are good predictors for the presence of OVs in cirrhotic patients, and could be used noninvasively to decrease the burden on the upper endoscopy unit by proper selection of those who are candidates for screening endoscopy.
authors.affiliation: Department of Tropical Medicine and Gastroenterology, Qena Faculty of Medicine, South Valley University, Qena, Egypt.
authors.forename: Hasan S
authors.initials: HS
authors.lastname: Mahmoud
authors.affiliation: Department of Tropical Medicine and Gastroenterology, Assiut Faculty of Medicine, Assiut University, Assiut, Egypt.
authors.forename: Ehab F
authors.initials: EF
authors.lastname: Mostafa
authors.affiliation: Department of Tropical medicine and Gastroenterology, Sohag Faculty of Medicine, Sohag University, Egypt.
authors.forename: Mohammed A W
authors.initials: MA
authors.lastname: Mohammed
mesh_terms: D004932:Esophageal and Gastric Varices / Q000000981:diagnostic imaging / Q000209:etiology / Q000503:physiopathology*; D005260:Female; D006439:Hemodynamics / Q000502:physiology*; D006801:Humans; D008099:Liver / Q000098:blood supply / Q000000981:diagnostic imaging / Q000503:physiopathology; D008103:Liver Cirrhosis / Q000150:complications* / Q000000981:diagnostic imaging / Q000503:physiopathology; D008297:Male; D008875:Middle Aged; D011169:Portal Vein / Q000000981:diagnostic imaging / Q000503:physiopathology*; D011379:Prognosis; D018608:Ultrasonography, Doppler
keywords: Cirrhosis; Doppler US; Oesophageal varices; Portal hypertension