Predictors of large esophageal varices in patients with cirrhosis

OBJECTIVE: Recent guidelines recommend that all cirrhotics undergo screenin g upper endoscopy to identify those patients at risk for bleeding from vari ces. However, this practice may not be cost effective as large esophageal v arices are seen only in 9-36% of these patients. The aim of this study was to determine whether clinical variables were predictive of the presence of large esophageal varices. METHODS: This is a retrospective analysis of cirrhotics who had a screening upper endoscopy during an evaluation for liver transplantation at three di fferent centers and who had not previously bled from varices. A multivariat e model was derived on the combined cohort using logistic regression. Three hundred forty-six patients were eligible for the study. RESULTS: The prevalence of large esophageal varices was 20%. On multivariat e analysis, splenomegaly detected by computed tomographic scan (odds ratio: 4.3; 95% confidence interval: 1.6-11.5) or by physical examination (odds r atio: 2.0; 95% confidence interval: 1.1-3.8), and low plate let count were independent predictors of large esophageal varices. On the basis of these v ariables, cirrhotics were stratified into high- and low-risk groups for the presence of large esophageal varices. Patients with a platelet count of gr eater than or equal to,88,000/mm(3) (median value) and no splenomegaly by p hysical examination had a risk of large esophageal varices of 7.2%. Those w ith splenomegaly or platelet count <88,000/mm(3) had a risk of large esopha geal varices of 28% (p < 0.0001). CONCLUSIONS: Our data show that clinical predictors could be used to strati fy cirrhotic patients for the risk of large esophageal varices and such str atification could be used to improve the cost effectiveness of screening en doscopy. (C) 1999 by Am. Cell. of Gastroenterology.