Endoscopic, ultrasonographic, and US-Doppler parameters as indicators of variceal bleeding in patients with schistosomiasis

Bleeding from esophagogastric varices is a potentially deadly complication in patients with hepatosplenic schistosomiasis. The aim of this study is to establish indicators of variceal bleeding. We studied 40 patients with com pensated hepatosplenic schistosomiasis and varices, analyzing four endoscop ic (variceal size, red color signs, fundic var-ices, and congestive gastrop athy), nine ultrasonographic (right and left hepatic lobe size, periportal and gallbladder wall thickness, portal and splenic veins diameter, spleen l ongitudinal axis and volume, and presence of collateral circulation), and f ive US-Doppler parameters (portal and splenic veins velocity and flaw and p ortal vein congestion index). Patients were divided in two groups according to previous history of variceal bleeding. The group with bleeding episodes was again divided in two groups: with and without treatment, namely endosc opic sclerotherapy. All endoscopic parameters and two ultrasonographic (per iportal thickness and portal vein diameter) were statistically different be tween the groups with and without previous bleeding. The likelihood index, adopted to determine the best parameters related to previous bleeding showe d that the most important combinations are: gastropathy and red signs follo wed by portal vein diameter and variceal size. In conclusion, although awar e of the limits of the statistical analysis due to the small number of pati ents, our results demonstrated that endoscopic and US parameters (isolated or combined) can identify patients with a high risk of variceal bleeding, a llowing physicians to optimize prophylactic therapy.