Prediction of oesophagogastric varices in patients with liver cirrhosis

Background: All patients with liver cirrhosis are recommended for evaluatio n of oesophagogastric varices (EGV) regularly. This prospective study was d esigned to develop a predictive model for EGV in cirrhotic patients. Methods: Ninety-two patients were recruited. From all patients studied, the size of palpable spleen, liver chemistry value, platelet count, prothrombi n time, diameter of main portal vein and splenic length as assessed by ultr asonography were determined. Upper endoscopy was performed. Oesophageal var ices (EV) and gastric varices (GV) were graded (EV, grade 1-4; GV, grade 1- 3). In the predictive model, the EGV was classified into two grades (low, g rade 1-2 EV or grade I GV;high, grade 3-4 EV or grade 2-3 GV). Results: There were 53 patients with EGV and 39 patients without EGV as det ermined by endoscopy. Patients with EGV had a significantly higher degree o f ascites and hepatic encephalopathy, lower platelet count and longer splen ic length than those without EGV. Low platelet count and presence of ascite s were the significant independent predictors for high-grade EGV (concordan ce rate 0.83). The optimal critical value for the platelet count was 150 x 10(9)/L. Of patients without thrombocytopenia and ascites, 37% had low-grad e EGV but none had high-grade EGV, whereas 38 and 35% of patients with thro mbocytopenia or ascites had low and high-grade EGV, respectively. Therefore , this predictive model for high-grade varices had a positive and negative predictive value of 35 and 100%, respectively. Conclusion: Endoscopic screening for EGV was not necessary until thrombocyt openia or ascites occurred. (C) 1999 Blackwell Science Asia Pty Ltd.