الفهرس 
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Abstract
Several studies have examined how to identify patients with varices using non-invasive or minimally invasive methods to avoid endoscopy in patients with a low risk of varices. The aim of the present study was to assess the role of different portal hemodynamic indices with duplex doppler ultrasonography and to compare between them as noninvasive tool for prediction of esophageal varices in cirrhotic patients.
This case control study included 100 cirrhotic patients and 100 healthy controls. Cirrhotic patients were selected from 670 patients attending the outpatient and \ or inpatient department of Tropical Medicine, Menoufia University Hospital in the period between October 2017 to August 2019.500 patients excluded due to presence of exclusion criteria.
The studied groups were classified into two groups:
group 1: 100 cirrhotic patients.
group 2: 100 of healthy volunteers as a control group.
group 1 patients were classified into two subgroups after upper GI endoscopy.
• Group1A: 67 Cirrhotic patients with esophageal varices.
• Group1B: 33 Cirrhotic patients without esophageal varices.
Patients was classified according to Child–Pugh score using 5 parameters (ascites, albumin, bilirubin, prothrombin time in seconds and hepatic encephalopathy) into Child A, Child B and Child C.
The following exclusion criteria were applied: History of active GIT bleeding, portal vein thrombosis, any surgery for portal hypertension (TIPS), splenectomy, hepatocellular carcinoma, severe medical condition (end stage renal, congestive heart failure or severe respiratory syndrome)] and prior to use of beta blockers.
All studied patients underwent a detailed history, clinical examination, laboratory workup, pelvi abdominal ultrasound with color duplex doppler used for measurement of different portal hemodynamic indices. Upper gastrointestinal endoscopy.
Statistical analysis of the presenting data revealed these results:
• Our data showed that, the main etiology of cirrhosis was HCV (74%) and there was high statistical significant difference between group 1A and group 1B as regarding child classification.
• Clinical findings of the studied groups showed that, there was statistical significant difference between group 1A and group 1B as regarding pallor, jaundice, lower limb edema, hepatic encephalopathy, ascites, liver enlargment and spleen enlargement.
• Laboratory data of the studied groups showed that, there was high statistical significant difference between group 1A and group 1B as regarding hemoglobin level, platelet count and all liver function tests apart from AST and ALT.
• Pelvi abdominal ultrasound findings of studied groups showed that, there was statistical significant difference between group 1A and group 1B as regarding, liver echogenicity, spleen size, splenic collaterals and ascites.
• Comparison of portal hemodynamic indices between cirrhotic group and control group revealed that, there was high statistical significant difference between cirrhotic group and control group as regarding all measured portal hemodynamic indices apart from PVD and LVI.
• Comparison of different predictors in relation to presence of esophageal varices revealed that, there was high statistical significant difference between group 1A and group 1B as regarding PC/SD ratio and all measured portal hemodynamic indices.
• Comparison of different predictors in relation to the grade of esophageal varices revealed that, there was no statistical significant difference between the measured portal hemodynamic indices and the grade of EV except PC/SD ratio and PVD.
• Comparison of different predictors in relation to presence of gastric varices revealed that, there was statistical significant difference between the measured portal hemodynamic indices and prescence of gastric varices except PCI, HAPI and SARI.
• Comparison of different predictors in relation to the grade of PHG revealed that, there was statistical significant difference between the measured portal hemodynamic indices and the grade of PHG except PVFV, HAPI and SARI.
• Comparison of different predictors in relation to Child classification revealed that, there was statistical significant difference between all measured portal hemodynamic indices and Child classification except HAPI.
• Comparison between different measured portal hemodynamic indices revealed that, PVD, HAPI, PHI, PVFV and PCI have high sensitivity (94.03%, 94.01% , 92.43%, 89.55% and 89.35%) respectively for prediction of EV at cut off values of (10.4, 1.3, 1.48, 15.2 and 0.1) respectively. However, SARI, HARI, LVI and PC/SD ratio have less sensitivity (77.61%, 76.12%,74.63% and 61.19%) respectively for prediction of EV at cut off values of (0.72, 0.71, 9.4 and 604) respectively.
from this study, we concluded that;
• Measuring portal hemodynamic indices with high sensitivity (PVD, HAPI, PHI, PVFV and PCI) can help physicians as noninvasive predictors of EV in cirrhotic patients to restrict the need for unnecessary endoscopic screening.
• PC/SD ratio and PVD can help physicians to grade esophageal varices.
• PC/SD ratio, PVD, HARI, PHI and LVI can help physicians as noninvasive predictors of gastric varices and for grading of PHG.
from this study, we recommend that;
• At cutoff points of portal hemodynamic indices with high sensitivity PVD, HAPI, PHI, PVFV and PCI (10.4, 1.3, 1.48, 15.2 and 0.1) respectively the beginning of upper endoscopic screening is suggested to be done especially for patients with compensated cirrhosis to restrict the need for unnecessary endoscopic screening.
• Portal hemodynamic indices measurement is suggested to be added in routine ultrasound of cirrhotic patients and is recommended to be done before screening UGIE as they are easy, noninvasive, significant and low cost predictors of esophageal varices.
• Additional studies are required in a larger number of cirrhotic patients of different etiologies and different grades of Child classification for validation of portal hemodynamic indices as noninvasive predictors of esophageal varices.
• Additional studies are necessary to determine universal best cut off values that can be recommended for the noninvasive diagnosis of eosophageal varices in these patients.