Screening endoscopy has been recommended for cirrhotics to identify those patients with large varices and initiate medical prophylaxis. However only a minority of cirrhotics have large varices on endoscopy, and the cost/effectiveness of screening has been questioned. In a retrospective study of 52 patients we have reported that ascites increases the risk of finding large varices at endoscopy. We report our findings in a different group of 95 consecutive cirrhotics referred to our service for screening EGD. Materials: We reviewed the charts of 95 cirrhotic patients who consecutively had screening EGD to rule out varices. Data was collected for age, sex, WBC, hemoglobin, platelets, PT, albumin, bilirubin, ascites, splenomegaly and PSE documented by clinical history. The Child-Pugh class and score were calculated. Results: The mean age was 53.2 years with 58 males and 37 females. Thirty-two (34%) patients were Child Pugh class A, 46 patients (49%) were class B, and 16 patients (17%) were class C. The mean value of the collected data with their 95% confidence intervals were: WBC 5.85 (5.3-6.4), Hb 11.9 (11.5-12.4), PT 15 (14.3-15.6) seconds, pit count 121.9 (102.6-141.2), bilirubin 2.17 (1.6-2.7), albumin 2.99 (2.8-3.2). A total of 74 patients had imaging studies: ascites was present in 38 patients (40%), splenomegaly in 36 patients (37.9%), PSE was recorded in 7 patients (7.4%). Endoscopic esophageal varices were present in 81 of 95 patients (85.3%): grade I in 21 (22.1%), grade II in 26 (27.4%), grade III in 31 (32.6%), and grade IV in 3 (3.1%). Multiple regression analysis revealed statisticaly significant correlations between the size of the varix and Child-Pugh score value (p = 0.021) and ascites (p = 0.042). Conclusions: Higher Child-Pugh scores and the presence of ascites were significant predictors of large varices. Clinical variables may help predict which cirrhotic patients are more likely to benefit from screening endoscopy.
|Original language||English (US)|
|State||Published - Dec 1 1998|
ASJC Scopus subject areas
- Radiology Nuclear Medicine and imaging