EUS in cirrhotic patients with and without prior variceal hemorrhage in comparison with noncirrhotic control subjects

Background: Endoscopic ultrasound (EUS) was used to evaluate cirrhotic pati ents with and without prior variceal hemorrhage. The findings were compared with those of EUS in noncirrhotic control subjects to determine EUS featur es indicative of cirrhosis and of a risk for variceal hemorrhage. Methods: Patients with cirrhosis undergoing indicated endoscopic screening for varices or surveillance after endoscopic therapy for variceal hemorrhag e were studied and compared with healthy noncirrhotic control patients unde rgoing EUS for benign conditions. Results: Sixty-six cirrhotic patients (31 with prior hemorrhage) and 32 con trol patients were studied. Nonhemorrhage cirrhotic patients had more sever e liver disease by Child's class (p = 0.02) and less beta-adrenergic blocke r usage (p < 0.0001). Paraesophageal varices were detected in 97% of cirrho tic patients and 3% of control patients (p < 0.001) and were a more sensiti ve predictor of cirrhosis than varices at endoscopy (74%, p < 0.0001). Azyg os vein and thoracic duct diameters, and gastric mucosa and submucosa thick ness were greater for cirrhotic than control patients (p < 0.001). More hem orrhage patients had large (5 mm or greater) paraesophageal varices (odds r atio 3.1: 95% CI [1.1,8.3]; p < 0.05) and paragastric varices (odds ratio 3 .7: 95% CI [1.3, 10.2]; p = 0.01). Paraesophageal varix size correlated wit h ascites (p = 0.03) and, for nonhemorrhage patients, with Child's class (p < 0.01). Conclusions: Paraesophageal and paragastric varices correlate with the pres ence and severity of liver disease and portal hypertension. These data supp ort the hypothesis that large paraesophageal and paragastric varices (5 mm or greater) may be risk factors for variceal hemorrhage, an observation tha t merits further prospective study. Cirrhosis causes dilation of the azygos vein and thoracic duct and thickening of gastric mucose and submucosa.