الفهرس 
AcknowledgementsOnly 14 pages are availabe for public view
 |  | from | 96 |  |  |
| | | from | 96 | | |
Abstract
Gastro esophageal varices are present in approximately 50% of patients with liver cirrhosis. The aim of this study was to evaluate liver stiffness measurement (LSM), Fib-4, and APRI Score as noninvasive predictors of esophageal varices (EV) in comparison to EGD.
Methods
This prospective study included 100 patients with HCV-related liver cirrhosis. All patients underwent routine laboratory tests, transient elastograhy (TE) and esophagogastroduodenoscopy. FIB-4, APRI Score was calculated. The diagnostic performance of these methods was assessed using sensitivity, specificity, positive predictive value, negative predictive value, accuracy and receiver operating characteristic curves.
Results
All predictors (LSM, FIB-4, APRI Score) demonstrated statistically significant correlation with the presence and the grade of EV. TE could diagnose EV at a cutoff value of >29.2kPa. Fib-4 and APRI Score could diagnose EV at cutoff values of >2.09 and >0.48, respectively. For prediction of large varices (F2,F3), LSM showed accuracy of (95.2%) with a cutoff of >40.4kPa and AUROC of 0.98. Its sensitivity was 92.9%, specificity 97.5%, PPV 96.3% and NPV 95.1%. The diagnostic accuracies of FIB-4 and APRI Score was 100%, 87.7% respectively, at cutoffs of >4.59, >0.98respectively. For diagnosis of large esophageal varices, adding TE to each of the other diagnostic indices (serum fibrosis scores) increased their sensitivities with little decrease in their specificities.
Conclusion:
• Non-invasive methods, and specifically elastography, have provided alternatives for the surveillance of certain cirrhotic populations and there is evidence to support the Baveno VI guidelines and to avoid screening EGD in large groups of cirrhotic patients. However, this is an area that could still benefit from further research. Ideally, EGD in the future will be reserved mainly for therapeutic purposes; although this appeared unrealistic a few years ago, advances in technology and more prospective studies could make it feasible.
• This study suggests that cirrhotics with a high APRI score, FIB 4 and low serum albumin level show significant association with the presence and size of esophageal varices.
Recommendation:
Although upper gastrointestinal endoscopy is the gold standard for diagnosis of esophageal varices size, grading and risk of bleeding in newly diagnosed patients with liver cirrhosis.LSM,FIB-4 and APRI score can be used as non-invasive predictor for the presence and size of esophageal varices.
We recommend to do upper endoscopy as soon as possible for patients with liver cirrhosis if LSM> 29.2 kpa,FIB-4>2.09 and APRI score >0.48.