Doppler surrogate endoscopy for screening esophageal varices in patients with cirrhosis

Prediction of Esophageal Varices in Viral Hepatitis C Cirrhosis: Performance of Combined Ultrasonography and Clinical Predictors

Objectives

This study is aimed at evaluating the diagnostic performance of clinical predictors and the Doppler ultrasonography in predicting esophageal varices (EV) in patients with hepatitis C-related cirrhosis and exploring the practical predictors of EV.

Methods

We conducted a prospective study from July 2020 to January 2021, enrolling 65 patients with mild hepatitis C-related cirrhosis. We obtained clinical data and performed grayscale and the Doppler ultrasound to explore the predictors of EV. Esophagogastroduodenoscopy (EGD) was performed as the reference test by the gastroenterologist within a week.

Results

The prevalence of EV in the study was 41.5%. Multivariable regression analysis revealed that gender (female, OR = 4.04, p = 0.02), platelet count (<150000 per ml, OR = 3.13, p = 0.09), splenic length (>11 cm, OR = 3.64, p = 0.02), and absent right hepatic vein (RHV) triphasicity (OR = 3.15, p = 0.03) were significant predictors of EV. However, the diagnostic accuracy indices for isolated predictors were not good (AUROC = 0.63-0.66). A combination of these four predictors increases the diagnostic accuracy in predicting the presence of EV (AUROC = 0.80, 95% CI 0.69-0.91). Furthermore, the Doppler assessment of the right hepatic vein waveform showed good reproducibility (κ = 0.76).

Conclusion

Combining clinical and Doppler ultrasound features can be used as a screening test for predicting the presence of EV in patients with hepatitis C-related cirrhosis. The practical predictors identified in this study could serve as an alternative to invasive EGD in EV diagnosis. Further studies are needed to explore the diagnostic accuracy of additional noninvasive predictors, such as elastography, to improve EV screening.

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. 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.

Can Ultrasound Findings be a Good Predictor of Sperm Parameters in Patients With Varicocele? A Cross-Sectional Study

BACKGROUND

Varicocele, one of the most common causes of sperm abnormalities in men, is the dilation of the testicular vein (the pampiniform venous plexus) by more than 2 mm. Ultrasonography is the primary imaging procedure for varicocele diagnosis. The venous diameter is evaluated using B-mode sonography, and venous reflux is assessed using color Doppler sonography.

OBJECTIVES

In this study, we investigated the association of ultrasound findings with sperm parameters in patients with varicocele.

METHODS

Ninety-nine patients with clinically diagnosed varicocele were included in this study, which was performed at a university imaging center. Patients were evaluated for pampiniform venous plexus diameter, venous reflux, and testicular size on both sides. Semen analysis was performed for all patients. The ultrasonography parameters and semen analysis data were compared to assess the correlations between the results.

RESULTS

The semen analysis parameters, including semen volume and sperm morphology, count, and motility, significant correlations with the diameter of the varicocele vein but were not correlated with testes size. In addition, the patients with reflux of longer than 1 s and those with reflux of less than 1 s had significant differences in sperm parameters and varicocele size.

CONCLUSIONS

Our study showed that ultrasonography findings can be a good predictor of sperm parameters in patients with varicocele.

Portal vein Doppler: a tool for non-invasive prediction of esophageal varices in cirrhosis

BACKGROUND AND OBJECTIVES

Esophageal varices (EV), a major complication of liver cirrhosis, can lead to life threatening gastrointestinal (GI) bleeding. Esophagogastroduodenoscopy (EGD) is the gold standard for diagnosis and management of esophageal varices. However, it is not always available in resource-constrained settings.This study was aimed at evaluating portal vein indices (PVI) using Doppler on ultrasound abdomen, which is more widely available, as tools to predict the presence of EV.

METHODS

A total of 50 adult patients with cirrhosis were included in the study. All subjects underwent a percutaneous liver biopsy, abdominal ultrasound and EGD along with other tests as part of the work up for cirrhosis. The portal vein indices that were studied included hepatic congestion index (HCI), portal vein diameter (PVD) and portal vein velocity (PVV). Their sensitivity, specificity and predictive values were calculated using EGD as a gold standard.

RESULTS

Association of PVD, PVV and HCI with presence of EV was statistically significant (p-value <0.01). PVV had the highest sensitivity 84% (95% CI 66.45%- 94.10%) for detecting the presence of EV. PVD and HCI had the highest specificity of 55% (95% CI 0.31-0.77) and the highest negative predictive value of 38%(95% CI 0.24-0.52). Positive predictive value was highest PVV at 76%. (95% CI 0.61-0.86).

CONCLUSION

In resources- constricted settings where EGD is not available, PVI (PVV, PVD and HCI) on ultrasound abdomen can be used as non-invasive parameters to predict the presence of EV. Although EGD remains the gold standard for the diagnosis and management of EV, when this is not possible due to scarcity of resources, PVV may be used a tool to triage patients for referral for an EGD as it has the highest sensitivity of 84% (95% CI 66.45%-94.10%) and positive predictive value of 76% (95% CI 61.51%-86.47%) amongst the PVI studied for detecting the presence of EV.