Transabdominal US Evaluation of Esophageal Varices: as a Prospective Screening Test.

Baek,  Seung Yon; Lee,  Sun Wha

Journal of Korean Society of Medical Ultrasound 2001;20(1): 29-35.

Seung Yon Baek, Sun Wha Lee

Department of Radiology, College of Medicine, Ewha Womans University.

Published online: March 1, 2001.

ABSTRACT

PURPOSE: To evaluate the efficacy of transabdominal ultrasonography to diagnose esophageal varices and to predict the grade of varices as a screening test for cirrhotic patients. MATERIALS and METHODS : Transabdominal ultrasonography was performed in 41 cirrhotic patients to evaluate esophageal varices prospectively. We measured thickness of the anterior distal esophageal wall three times and calculated the mean thickness. We evaluated the pattern of the wall (smooth or irregular), the presence of Doppler signal flow, the pattern and direction and velocity of Doppler signal flow in the esophageal wall. We considered the mean thickness of the esophageal wall in 44 patients without liver diseases to normal control. The endoscopic grade (grade 1 to 4) of esophageal varices was considered as a gold standard. We analyzed the statistical difference between groups of esophageal varices and the normal control group using ANOVA and multiple comparison method and t-test. RESULTS: Mean thickness of the normal and variceal group was 2.7 +/- 0.7mm and 5.2 +/- 1.8mm with statistical difference (p<0.001). Mean thickness between the normal group and each of the three grades of variceal group was statistically different (p<0.001) respectively. Mean thickness of grade I (N=19), grade II (N=10) and grade III and above (N=12) was 4.2 +/- 1.2mm, 4.9 +/- 1.1mm, 7.0 +/- 1.8mm respectively and for higher grades, the esophageal wall became thicker. There was statistical difference of mean thickness between grade I and grade III and above, grade II and grade III and above (p<0.001) and no difference between grade I and grade II (p=0.40). The pattern of the esophageal wall was irregular in 17(41%) patients and the presence of Doppler signal flow was found in 8(20%) patients. If the diagnostic criteria of mean thickness to diagnose varices was 3.5mm, accuracy, sensitivity, specificity, positive predictive value and negative predictive value was 85.9%,82.9%, 88.6%, 87.2%, 84.8% respectively. CONCLUSION: Transabdominal ultrasonography is an efficient prospective screening test to diagnose varices and to predict the grade of varices.

Keywords: Esophagus, US; Esophagus, varices