Egyptian revalidation of non-invasive parameters for predicting esophageal varices in cirrhotic patients: A retrospective study

Mohamed El-Kassas; Wafaa Elakel; Mohamed Alboraie; Reem Ezzat; Sara Abdelhakam; Mohamed Hassany; Zainab Ali-Eldin; Ahmed F Sherief; Ayman Yosry; Magdy El-Serafy; Manal Hamdy El-Sayed; Imam Waked; Wahid Doss; Gamal Esmat; Egyptian National Committee for Control of Viral Hepatitis

doi:10.1016/j.ajg.2022.04.003

Egyptian revalidation of non-invasive parameters for predicting esophageal varices in cirrhotic patients: A retrospective study

Arab J Gastroenterol. 2022 May;23(2):120-124. doi: 10.1016/j.ajg.2022.04.003. Epub 2022 Apr 23.

Authors

Affiliations

¹ Endemic Medicine Department, Faculty of Medicine, Helwan University, Cairo, Egypt; National Committee for Control of Viral Hepatitis, Egypt.
² National Committee for Control of Viral Hepatitis, Egypt; Endemic Medicine and Hepatology Department, Faculty of Medicine, Cairo University, Cairo, Egypt.
³ National Committee for Control of Viral Hepatitis, Egypt; Department of Internal Medicine, Al-Azhar University, Cairo, Egypt.
⁴ Internal Medicine Department, Assiut University, Assiut, Egypt.
⁵ Tropical Medicine Department, Faculty of Medicine, Ain Shams University, Cairo, Egypt.
⁶ National Committee for Control of Viral Hepatitis, Egypt; National Hepatology & Tropical Medicine Research Institute, Cairo, Egypt.
⁷ Internal Medicine Department, Faculty of Medicine, Ain Shams University, Egypt.
⁸ National Committee for Control of Viral Hepatitis, Egypt; Pediatrics Department, Hematology-Oncology Division, Faculty of Medicine, Ain-Shams University, Cairo, Egypt.
⁹ National Committee for Control of Viral Hepatitis, Egypt; National Liver Institute, Menofia, Egypt.

PMID: 35473688
DOI: 10.1016/j.ajg.2022.04.003

Abstract

Background and study aims: In resource-limited countries, non-invasive tests for assessing liver fibrosis are a potential alternative to costly endoscopic screening for esophageal varices. We aimed to validate several non-invasive parameters for predicting the presence of varices.

Patients and methods: Between September 2006 and August 2017, a total of 46,014 patients who underwent upper gastrointestinal endoscopy as one of the perquisites for receiving hepatitis C virus (HCV) therapy were enrolled and divided into group I (without varices) and group II (with varices). Non-invasive parameters of fibrosis, namely Lok index, Bonacini score, liver stiffness, FIB-4, Baveno, and extended Baveno criteria, were validated.

Results: Lok index, Bonacini score, liver stiffness, and FIB-4 had areas under the receiver operating characteristic curve (AUCs) of >0.6 (all P < 0.01 for the null hypothesis that the AUC was 0.5) for determination of the presence/absence of varices, with cutoff values of 0.80, 6.5, 21.9 kPa, and 2.94, and sensitivities of 74%, 74%, 66%, and 83%, respectively. The expanded Baveno VI criteria performed better than the Baveno VI criteria (spared endoscopy rate 81% versus 63%).

Conclusion: The use of non-invasive methods is of limited value in predicting esophageal varices. The limited accuracy of ≤60% may delay the use of appropriate primary prophylaxis against variceal bleeding in a large proportion of cirrhotic patients.

Keywords: Baveno guidelines; Cirrhosis; Esophageal varices; Non-invasive parameter; Portal hypertension.

MeSH terms

Egypt
Elasticity Imaging Techniques* / methods
Endoscopy, Gastrointestinal
Esophageal and Gastric Varices* / diagnosis
Esophageal and Gastric Varices* / etiology
Gastrointestinal Hemorrhage / diagnosis
Gastrointestinal Hemorrhage / etiology
Humans
Liver Cirrhosis / complications
Liver Cirrhosis / diagnosis
Platelet Count
Retrospective Studies
Varicose Veins*