Non-invasive diagnosis of esophageal varices in chronic liver diseases

Background/Aims: The primary prevention of bleeding from esophageal varices is a major therapeutic issue requiring early screening of esophageal varic es, Our aim was to study the diagnostic accuracy of non-endoscopic means fo r the diagnosis of esophageal varices, Methods: Sixty-three clinical, biochemical, endoscopic and Doppler ultrasou nd variables were prospectively recorded in 207 consecutive patients with c hronic liver disease. Diagnostic accuracy was evaluated by discriminant ana lysis, first globally using all variables with diagnostic accuracy greater than or equal to 65% in univariate analysis, then by stepwise regression. Results: A) whole group (n=207), 1) diagnosis of esophageal varices: diagno stic accuracy was globally 81%, and 81% with 1 variable: irregular liver su rface at ultrasound, 2) Diagnosis of large esophageal varices (grades 2+3): diagnostic accuracy was globally 80%, and 79% with 2 variables: prothrombi n index, gamma-globulin's. B) patients with cirrhosis (n=116), 1) diagnosis of esophageal varices: diagnostic accuracy was globally 71%, and 72% with 2 variables: platelet count, prothrombin index, 2) diagnosis of large esoph ageal varices (grades 2+3): diagnostic accuracy was globally 71%, and 72% w ith 3 variables: platelet count, prothrombin index, spider naevi, The ROC c urve showed that the best threshold for the diagnostic accuracy of platelet count was 160 Gn providing a sensitivity of 80% and a specificity of 58%, Platelet count greater than or equal to 260 Gn has a negative predictive va lue greater than or equal to 91%. Conclusions: Using a few non-endoscopic criteria, esophageal varices can be correctly diagnosed in 81% of patients with chronic liver disease and in 7 1% of patients with cirrhosis, These results show that the non-invasive scr eening of patients who are candidates for the primary prevention of varicea l bleeding is possible, but should be improved before being used in a clini cal setting.