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

The aim of this study was to identify possible clinical,biochemical or instrumental markers which can predict in anon-invasive manner the presence of EV. One hundred andfifty-eight consecutive liver cirrhotic patients seen at our outpatientclinic were included in this study. The diagnosis of LCwas 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 splancnicvessels and the main parameters of liver function were tested.Liver cirrhosis was mostly correlated to hepatitis C virus andmost patients were class A according to Child.At EGE, EV w e re absent in 41 patients, grade 1 in 86patients, while 22 and 9 patients presented varices grade 2 and3, re s p e c t i v e l y. When patients were divided according to thepresence/absence of varices, statistically significant differencesre 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 atunivariate analysis showed a statistically significant associa -tion with the presence of varices only for number ofplatelet/longitudinal spleen diameter ratio (p<0.0001) and forprothrombin activity values (p<0.03).When patients were divided into two groups, without andwith varices grade 1, and with varices grade 2 and 3, severalparameters resulted significant at univariate analysis, butamong these, at multivariate analysis, only the platelet countand platelet count/spleen diameter ratio were confirmed to beassociated to diagnosis of severe EV, p<0.03 and p<0.001,respectively.In conclusion our data agree with those of the literatureabout the absence of reliable non invasive predictors of EV inc i rrhotic patients, being platelet count and plateletcount/spleen diameter ratio the best one, but not yet sufficientto avoid a lot of useless EGE in cirrhotic patients.