Diagnostica non invasiva delle varici esofagee nei pazienti con cirrosi epatica: dati ecografici vs dati endoscopici

Abstract

The aim of this study was to identify possible clinical, biochemical or instrumental markers which can predict in a non-invasive manner the presence of EV. One hundred and fifty-eight consecutive liver cirrhotic patients seen at our outpatient clinic were included in this study. The diagnosis of LC was done on liver biopsy findings or based on instru m e n t a l , clinical and serological data. Patients underwent EGE, ultra - sound of the upper abdomen, Doppler of the main splancnic vessels and the main parameters of liver function were tested. Liver cirrhosis was mostly correlated to hepatitis C virus and most patients were class A according to Child. At EGE, EV w e re absent in 41 patients, grade 1 in 86 patients, while 22 and 9 patients presented varices grade 2 and 3, re s p e c t i v e l y. When patients were divided according to the presence/absence of varices, statistically significant differences re g a rding pro t h rombin activity values (p<0.002), platelet (p<0.0001) and WBC count (p<0.002), portal vein dimensions (p<0.003), albumin levels (p<0.02), n° of platelet/spleen dia - meter ratio (p<0.0001) and n° of WBC/spleen diameter ratio (p<0.0001), were found. Multiple logistic regression of parameters significant at univariate analysis showed a statistically significant associa - tion with the presence of varices only for number of platelet/longitudinal spleen diameter ratio (p<0.0001) and for prothrombin activity values (p<0.03). When patients were divided into two groups, without and with varices grade 1, and with varices grade 2 and 3, several parameters resulted significant at univariate analysis, but among these, at multivariate analysis, only the platelet count and platelet count/spleen diameter ratio were confirmed to be associated to diagnosis of severe EV, p<0.03 and p<0.001, respectively. In conclusion our data agree with those of the literature about the absence of reliable non invasive predictors of EV in c i rrhotic patients, being platelet count and platelet count/spleen diameter ratio the best one, but not yet sufficient to avoid a lot of useless EGE in cirrhotic patients.