Which patients with cirrhosis should undergo endoscopic screening for esophageal varices detection?

Our aims were to develop a noninvasive predictive tool to identify cirrhoti c patients with esophageal varices and to evaluate whether portal Doppler u ltrasonographic parameters may improve the value of other predictors. One h undred forty-three consecutive compensated cirrhotic patients underwent upp er gastrointestinal endoscopy, Fourteen clinical, biochemical, ultrasonogra phic, and Doppler ultrasonographic parameters of each patient were also rec orded. Esophageal varices were detected in 63 of the 143 patients examined (44%; 95% confidence interval [CI] 36.2-52.6). Medium and large esophageal varices were observed in 28 subjects (44%; 95% CI 31.4-58.4), Using stepwis e logistic regression, presence of esophageal varices was independently pre dicted by prothrombin activity less than 70% (odds ratio [OR]: 5.83; 95% CI : 2.6-12.8), ultrasonographic portal vein diameter greater than 13 mm (OR: 2.92; 95% CI: 1.3-6.4), and platelet count less than 100 x 10(9)/L(OR: 2.83 ; 95% CI: 1.27-6,28), Variables included in the model were used to generate a simple incremental rule to evaluate each individual patient. The discrim inating ability of the prediction rule was relevant (area under the curve: 0.80) and did not change by replacing ultrasonographic portal vein diameter with congestion index of portal vein. We concluded that compensated cirrho tic patients should be screened by upper gastrointestinal endoscopy when pr othrombin activity less than 70%, platelet count less than 100 x 109/L, and ultra- sonographic portal vein diameter greater than13 mm are observed, wh ereas those without any of these predictors should not undergo endoscopy, T he contribution provided by portal Doppler ultrasonographic parameters does not appear of practical utility.