만성 간질환에서 식도 정맥류 존재의 비침습 예측 인자로서 도플러 초음파와 혈액검사의 가치 = The Value of Doppler-ultrasonography and Laboratory Tests as Non-invasive Predictors of the Presence of Esophageal Varices in Patients with Chronic Liver Disease

다국어 초록 (Multilingual Abstract)

Background/Aims: Upper gastrointestinal endoscopy is usually recommended for the evaluation of esophageal varices in patients with liver cirrhosis. However, the prevalence of varices is extremely variable. We performed this study to determine the predictive values for esophageal varices and to select eligible patients for screening endoscopy. Methods: Fifty-two patients were enrolled in this study. Laboratory tests including liver biochemistry and complete blood count along with ultrasonography with Doppler measurements and endoscopy were performed. Results: Esophageal varices were present in 25 patients (48%). Variables associated with the presence of esophageal varices on univariate analysis were serum albumin, total bilirubin, prothrombin time and platelet count (p＜0.05). Significant variables in ultrasonography with Doppler measurement were diameter of spleen (13.04±2.1 ㎝ vs. 10.39±1.6 ㎝, p＜0.001), peak velocity of portal vein (30.2±7.5 ㎝/sec vs. 36.1±8.0 ㎝/sec, p＜0.01) and portal vein diameter (1.26±0.28 ㎝ vs. 1.13±0.18 ㎝, p＜0.05). On multivariate analysis, independent variables were platelet count (odds ratio (OR) 0.922; 95% confidence interval (CI), 0.86-0.99), diameter of spleen (OR 5.4; 95% CI, 1.63-17.88) and platelet count/spleen diameter ratio (OR 1.007; 95% CI, 1.01-1.02). The optimal critical value for the diameter of spleen was 11 ㎝. The sensitivity and specificity with this value were 84% and 63%, respectively. Conclusions: Doppler measurement was not helpful in distinguishing the presence of varices. However, clinical tests including biochemistry and ultrasonography would be useful in selecting eligible patients for screening endoscopy. Endoscopic screening for esophageal varices is recommended in cirrhotic patients with splenomegaly. (Korean J Gastroenterol 2006;48:180-187)

참고문헌 (Reference)

• 1 "Which patients with cirrhosis should undergo endoscopic screening for esophageal varices detection?" 33 : 333-338, 2001
• 2 "Upper digestive bleeding in cirrhosis" 38 : 599-612, 2003
• 3 "Ultrasonography in the diagnosis of portal hypertension:diminished response of portal vessels to respiration" 142 : 167-172, 1982
• 4 "Ultrasonographic findings with bleeding and nonbleeding esophageal varices" 83 : 58-63, 1988
• 5 "The hepatic venous pressure gradient" 39 : 280-282, 2004
• 6 "The general rules for recording endoscopic findings on esophageal varices" 10 : 84-87, 1980
• 7 "Prevalence and predictors of esophageal varices in patients with primary sclerosing cholangitis" 39 : 204-210, 2004
• 8 "Predictors of large esophageal varices in patients with cirrhosis" 94 : 3285-3291, 1999
• 9 "Predictive value of ultrasonography in the screening of non-ascitic cirrhotic patients with large varices" 5 : 189-192, 1986
• 10 "Prediction of esophageal varices in patients with liver cirrhosis" 14 : 785-790, 1999
• 11 "Prediction of esophageal varices in patients with cirrhosis" 34 : 81-85, 2002
• 12 "Platelet count/spleen diameter ratio" 52 : 1200-1205, 2003
• 13 "Pharmacologic treatment of portal hypertension" 19 : 475-505, 1999
• 14 "Pathophysiology of portal hypertension" 11 : 203-219, 1997
• 15 "Noninvasive markers of esophageal varices" 39 : 30-34, 2004
• 16 "Natural history of portal hypertension" 1 : 31-44, 1997
• 17 "Is doppler ultrasonography useful in assessing risk of variceal bleeding?" 36 : 515-521, 2000
• 18 "Increased cerebrovascular resistance in liver cirrhosis and ascites" 5 : 33-42, 1999
• 19 "Incidence and natural history of small esophageal varices in cirrhotic patients" 38 : 266-272, 2003
• 20 "Improved patient survival after acute variceal bleeding" 98 : 653-659, 2003
• 21 "Hyperdynamic circulation in portal-hypertensive rat model a primary factor for maintenance of chronic portal hypertension" 52-57,
• 22 "Gastroesophageal endoscopic features in cirrhosis and relationship to hepatic dysfunction" 156-62, gastroenterology1990
• 23 "Evaluation and follow-up of patients with portal hypertension and oesophageal varices" 33 : 643-646, 2001
• 24 "Doppler study of mesen-teric, hepatic, and portal circulation in alcoholic cirrhosis" 28 : 932-936, 1998
• 25 "Diagnosis of portal hypertension" Blackwell Science 36-64, 2000
• 26 "Cost-effectiveness of screening, surveillence, and primary prophylaxis strategies for esophageal varices" 97 : 2441-2452, 2002
• 27 "Comparison of doppler ultrasonography and hepatic venous pressure gradient in assessing portal hypertension in liver cirrhosis" 8 : 264-270, 2002
• 28 "Clinical predictors of large varices in cirrhotic patients" 47 : 78-, 1998
• 29 "Aspects of natural history of gastrointestinal bleeding in cirrhosis and the effect of prednisone" 81 : 944-952, 1981
• 30 "A meta-analysis of endoscopic variceal ligation for primary prophylaxis of esophageal variceal bleeding" 33 : 802-807, 2001