Association of Portal Vein Indices with Upper Gastrointestinal Endoscopic Findings in Patients with Cirrhosis of Liver OC08-OC10
Dr. Ajay Kandpal,
Flat 601, Tower 9, North Town, Stephenson Road, Perambur,
Chennai, Tamil Nadu, India.
Introduction: Upper Gastrointestinal (UGI) bleed is major cause of mortality and admissions in cirrhotics. Timely initiation of prophylaxis reduces the burden of disease. Few endoscopists at periphery are compelled to look at other options to identify at risk patients. This study explores Portal Vein Diameter (PVD) as an option while taking clues and corrections from past studies.
Aim: To identify any association between increase in portal pressure with appearance of oesophageal varices.
Materials and Methods: This was an observational cross-sectional study on 75 patients of cirrhosis of liver, from November 2018 to June 2019. Baseline characteristics were noted and assessment of the severity of disease was done. Endoscopy and Portal Vein (PV) Doppler was performed in same time frame. Analysis of Variance (ANOVA) and unpaired t-tests were used for analysis of the collected data. A p-value <0.05 was considered significant in both the tests.
Results: Grade of varices was found to have a direct relationship with portal diameter and a statistically significant inverse relationship with Portal Venous flow Velocity (PVV) (p-value 0.037). Total 28 patients had active bleed or history of UGI bleed and showed higher mean portal diameter and lower average portal velocity compared to patients without any history of variceal bleeding. A statistically significant relation was found between diameter of Portal Vein (PV) and Child-Turcotte-Pugh (CTP) grade from A to C. Patients with grade C had on an average, the biggest portal diameter and lowest PVV. Patients with Model for End-Stage Liver Disease (MELD) scores values higher than 14 and had higher mean PV diameter and a lower mean PVV. Also, hepato-fugal flow was recorded with advanced cirrhosis.
Conclusion: In advanced cirrhosis, the PV Doppler can be thought of as a substitute to endoscopy in starting primary medical prophylaxis, though more extensive study is needed to arrive at a definitive conclusion.