Background: Variceal bleeding is a frequent and life-threatening complication of portal hypertension. The first episode of variceal bleeding is not only associated with a high mortality, but also with a high recurrence rate in those who survive. Therefore, many studies and randomized clinical trials have focused on different strategies aiming to prevent the first episode of variceal bleeding (primary prophylaxis). Aims: to identify clinical, biochemical, and ultrasonographic parameters which might non-invasily predict the presence of esophageal varices and to evaluate the reproducibility of different non-invasive parameters like P/S dimeter ratio, portal vein diameter, splenic diameter and platelet count cut off values in diagnosing the presence of varices. Methods: In the first part of this study we retrospectively included 284 patients referred to our unit in National Liver Institute, Menoufiya University. Non-invasive diagnostic parameters for the presence of varices which included portal vein diameter, splenic diameter, platelets count and P/S diameter ratio were analyzed. In the second part, we analyzed prospectively 83 patients for the smae non-invasive diagnostic parameters. Results: Among the 289 patients included in the 1st retrospective part who underwent upper endoscopy, overall 177 (61%) patients had endoscopic evidence of EV, 85 (29%) patients had both EV and GV and only 5(2%)patients had gastric patients, while 17 (6%) patients had gastric erosions. Different non invasive diagnostic parameters for dtection of varices were studied as shown in table (5): PV diameter was was 11.3571±2.22 for non-EV patients and 13.9125±3,55 for EV patients (p=0.006). Platelet count was 235,363.64±11420.88 for non-EV patients and 120,080.15±61,673.88 for EV patients (p<0.0001) with significantaly higher number in EV group. Splenic diameter count was 137.73±46.08 for non-EV patients and 175.43±34.07 for EV patients (p<0.0001) with significantaly higher number in EV group and finally, P/S diameter ratio was 1952.6405±1180.35 for non-EV patients and 738.2708±456.12 for EV patients (p<0.0001) with significantaly higher cut-off in non-EV group. In the 2nd part, 83 patients were prospectively studied; splenic diameter was ≥ 142.50 (sensitivity: 86.36%, specificity: 41.28%, +ve predictive value: 85.07% and -ve predictive value: 43.75%), platelet count was ≤ 183,500 (sensitivity: 92.42%, specificity: 29.41%, +ve predictive value: 83.56% and -ve predictive value: 50%) and P/S diameter ratio was ≤ 1313.9400 (sensitivity: 95.45%, specificity: 29.41%, +ve predictive value: 84% and -ve predictive value: 62.5%). P/S diameter ratio cut off was (≤ 1313) the only indepenent parameter for detection of esophageal varices but, not for predicting the presence or absence of gastric varices. Conclusions: Upper endoscopy is still the essential tool for diagnosing and directing management of variceal bleeding. The use of P/S diameter ratio cut off value is promising and might be benificial and an important substitute for endoscopy and cost effective. Future studies are needed to predict its role in diagnosing which patient will have attack of bleeding.
