EVALUATION OF A NEW ENDOSCOPIC INDEX TO PREDICT FIRST BLEEDING FROM THE UPPER GASTROINTESTINAL-TRACT IN PATIENTS WITH CIRRHOSIS

The aim of this study was to prospectively evaluate the usefulness of the Italian Liver Cirrhosis Project (ILCP) classification of esophagea l varices, together with the gastric features of portal hypertension, in predicting the first upper gastrointestinal bleeding: in cirrhosis, The efficiency of these endoscopic parameters in predicting bleeding was also compared with the efficiency of the North Italian Endoscopic Club (NIEC) index, Three hundred forty-four cirrhotic patients with es ophageal varices but without any previous bleeding were enrolled in th e study, The following endoscopic parameters of esophageal varices wer e recorded: location, size, occupancy, blue tone, and red color signs, Gastric varices were graded as absent or present, while congestive ga stropathy was considered as absent, mild to moderate, or severe, All p atients were followed until the first upper gastrointestinal bleeding and/or death, or for at least 24 months, No patient received any treat ment to prevent bleeding, Sixty-five patients bled from the upper gast rointestinal tract during the study, Univariate analysis showed that a ll endoscopic parameters were predictors of bleeding, According to mul tivariate analysis (Cox's model), size, gastric varices and congestive gastropathy were the only independent predictors of bleeding, and the following prognostic index (PI) was developed: PI = (size x 0.0395) (congestive gastropathy x 0.878) + (gastric varices x 0.705), This in dex, which was validated using a split-sample technique, and which app ears to be superior to the NIEC index in predicting bleeding, may be u seful in decision making for primary prophylaxis.