Ultrasound Prediction of Esophageal Variceal Bleeding Risk

Background and Rationale:

Esophageal variceal bleeding is a life-threatening complication of portal hypertension in patients with chronic liver disease. While upper gastrointestinal endoscopy remains the gold standard for diagnosing and grading esophageal varices, it is an invasive procedure. Recent studies demonstrate that non-invasive parameters, specifically ultrasonographic measurements like portal vein diameter and splenic size, have emerged as independent predictors of variceal presence and bleeding risk. Despite these findings, there is limited data from Egyptian populations, particularly from Upper Egypt. This study aims to assess the diagnostic accuracy of these measurements and establish optimal cutoff values for non-invasive parameters in this population.

Study Design and Setting:

This is a prospective cross-sectional observational study conducted at the Department of Tropical Medicine and Gastroenterology and the Department of Diagnostic Radiology at AL-Rajhi University Hospital, Assiut University, Egypt. The study aims to recruit 165 adult patients with liver cirrhosis.

Study Procedures:

All enrolled participants will undergo the following assessments:

Clinical and Laboratory Assessment: Participants will undergo comprehensive history taking and physical examinations, alongside the calculation of Child-Pugh and Model for End-Stage Liver Disease (MELD) scores. Blood samples will be evaluated for complete blood count (focusing on platelets), liver and renal function tests, and prothrombin time/INR.

Abdominal Ultrasound: A high-resolution ultrasound using a 3.5-5 MHz convex transducer will be performed to measure the longest craniocaudal splenic diameter, splenic width and thickness, and portal vein diameter at the porta hepatis. Additional assessments include splenic vein diameter, ascites, liver echotexture, and the calculation of the platelet count/spleen diameter ratio.

Upper Gastrointestinal Endoscopy: Within 48-72 hours of the ultrasound, an endoscopy will be performed. Investigators will grade the varices (Grade I-III), assess for red color signs (indicating high bleeding risk), and document any gastric varices or portal hypertensive gastropathy.

Inclusion criteria

• Adult patients (age ≥18 years) with chronic liver disease and clinical/laboratory/radiological evidence of liver cirrhosis
• Both compensated and decompensated cirrhosis (Child-Pugh classes A, B, and C)
• Patients scheduled for upper gastrointestinal endoscopy
• Patients who provide informed consent

Exclusion criteria

• Previous history of endoscopic variceal band ligation or sclerotherapy
• Prior surgical portosystemic shunt procedures or transjugular intrahepatic portosystemic shunt (TIPS)
• Hepatocellular carcinoma with portal vein thrombosis
• Previous splenectomy
• Patients receiving beta-blockers for variceal bleeding prophylaxis
• Poor quality ultrasound images due to obesity or ascites
• Refusal to participate in the study