Portal vein flow velocity as a possible fast noninvasive screening tool for esophageal varices in cirrhotic patients
Background and Aim Esophagogastroduodenoscopy (EGD) is the gold standard tool in both screening/diagnosis and management of varices in cirrhotic patients; however, its invasive nature may be uncomfortable to some patients, and in addition, it may be unavailable in some centers that cannot afford it....
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| Published in: | JGH open Vol. 4; no. 4; pp. 589 - 594 |
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| Main Authors: | , , , |
| Format: | Journal Article |
| Language: | English |
| Published: |
Melbourne
Wiley Publishing Asia Pty Ltd
01-08-2020
John Wiley & Sons, Inc Wiley |
| Subjects: | |
| Online Access: | Get full text |
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| Summary: | Background and Aim
Esophagogastroduodenoscopy (EGD) is the gold standard tool in both screening/diagnosis and management of varices in cirrhotic patients; however, its invasive nature may be uncomfortable to some patients, and in addition, it may be unavailable in some centers that cannot afford it. Therefore, to decrease the economic and physical burden on patients, multiple noninvasive clinical, laboratory, and radiological parameters are evaluated as triage screening predictors of varices before patients' referral to endoscopy. In this respect, we tried to evaluate the validity of portal vein velocity (PVV) as a noninvasive screening tool of esophageal varices (EV).
Methods
One hundred thirty‐five cirrhotic patients were consecutively enrolled in this cross‐sectional study. All patients were evaluated independently and blindly by EGD as the gold standard and then by Doppler ultrasound on portal vein (PV).
Results
Univariate regression showed significant coefficients for PVV, platelet (PLT), albumin, bilirubin, international normalized ratio (INR), portal vein diameter, and ascites; however, multivariable regression showed significant coefficients only for PVV, PLT, and albumin; (P = 0.000, 0.000, and 0.006, respectively). Area under the receiver operating characteristic curve (AUROC), sensitivity, specificity, LR+, and LR− values were then calculated and validated using bootstrap analysis. PVV was more accurate than other evaluated parameters (AUROC: 0.927 and P = 0.000). The most accurate rule out cutoff value for PVV was ≥19 cm/s with the sensitivity of 97% and LR− of 0.05.
Conclusion
PVV may be useful as a noninvasive triage test for selection of the high‐risk cirrhotic patients who should be referred to and could benefit from EGD. We could highlight using PVV to rule out EV at a cutoff value ≥19 cm/s, reserving EGD only for patients with the PVV value <19 cm/s.
Esophagogastroduodenoscopy (EGD) is the gold standard tool in both screening/diagnosis and management of varices in cirrhotic patients, however, its invasive nature may be uncomfortable to some patients, and in addition, it may be unavailable in some centers with low economic conditions. Solving these obstacles, we tried to evaluate the validity of portal vein velocity as a non‐invasive triage screening tool of esophageal varices before patients' referral to endoscopy so as to decrease the economic and physical burden on patients. We found that portal vein velocity may be useful as a non‐invasive triage test for selection of the high risk cirrhotic patients who should be referred to and could benefit from EGD. |
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| Bibliography: | ObjectType-Article-1 SourceType-Scholarly Journals-1 ObjectType-Feature-2 content type line 23 Declaration of conflict of interest: None of the authors have declared any conflict of interest. |
| ISSN: | 2397-9070 2397-9070 |
| DOI: | 10.1002/jgh3.12301 |