Performance of Non-Invasive Liver Function Tests and Abdominal Ultrasound in the Prediction of Esophageal Varices

Aims Esophageal varices(EV) are a serious and life-threatening complication of portal hypertension(PHT). Their diagnosis is based on upper digestive endoscopy(UGIE) which is an invasive examination. Our objective was to evaluate the performance of thirteen non-invasive liver function tests and abdominal ultrasound (AU) in the EV prediction.

Methods We performed a retrospective analysis of data, between January 2010 and December 2019, of consecutive patients with chronic liver disease who underwent UGIE and UA within 3 months. Ultrasound signs of PTH were sought and the following scores were calculated: CHILD, MELD, MELD-Na, albumin-bilirubin grade(ALBI), platelet-albumin-bilirubin grade(PALBI), fibrosis-index based on 4factors(FIB-4), aspartate-aminotransferase-to-platelet ratio(APRI), Lok index, cirrhosis discriminant index(CDS), King’s score, Goteborg-University Cirrhosis Index(GUCI), age to platelet index and aspartate-aminotransferase to alanine-aminotransferase ratio(AAR).

Results A total of 219 patients were collected with a mean age of 61.2 ± 13.06 and a sex ratio of 1.64. Viral origin (65,2 %) and non-alcoholic steatohepatitis (21 %) were the predominant etiologies of chronic liver disease. One hundred and eighty-eight patients had EV (85.84 %): EV grade1 in 11.17 %; EV grade2 in 52.12 % and EV grade3 in 36.71 % of cases. Ultrasound signs of PTH were noted in 63.47 % of cases. The presence of ultrasound signs of PHT(p < 0,001), CHILD (p = 0,001), MELD (p = 0,015), ALBI (p = 0,002), FIB-4 (p = 0,001), CDS (p < 0,001) and age to platelet index (p < 0,001) were statistically correlated with the EV presence. CDS had the best area under the ROC curve (AUROC) in the EV prediction of EV (AUROC = 0.765; [95 %CI; 0,515-1,000]) followed by the presence of ultrasound signs of PHT (AUROC = 0,645; [95 %CI; 0,329-0,961]), age to platelet index (AUROC = 0,616; [95 %CI; 0,306-0,925] and FIB-4 (AUROC = 0,602; [95 % CI; 0,180-1,000]).

Conclusions In our series, abdominal ultrasound and CDS as a non-invasive liver function test seem to perform well in EV prediction. These tests don’t replace the UGIE, but could provide a better selection of patients requiring this invasive exploration.

Citation: Trad N, Ghanem M, Ben slimen B et al. eP50 PERFORMANCE OF NON-INVASIVE LIVER FUNCTION TESTS AND ABDOMINAL ULTRASOUND IN THE PREDICTION OF ESOPHAGEAL VARICES. Endoscopy 2021; 53: S113.

Publication History

Article published online:
19 March 2021