Portal venous hemodynamics as predictors for the development and grades of esophageal varices in Post‐HCV cirrhotic patients: An Egyptian center study

There is no consensus regarding the precise predictive role of portal vein hemodynamics for the prediction of esophageal varices. We performed the current prospective work to assess the diagnostic ability of portal vein hemodynamics for the prediction and grading of esophageal varices. The present work is a prospective one performed in the period from April 2014 till September 2017. Two hundred patients with HCV‐related cirrhosis with esophageal varices were enrolled in the present work as case group (group I). In addition, 100 cirrhotic cases, with no esophageal varices, were included in the work as control arm (group II). Doppler ultrasound (US) and upper endoscopy were performed to all patients. Case group were further subdivided according grades of esophageal varices into four grades. These grades were correlated to splenic size, portal vein velocity, portal vein caliber, and hepatic artery resistivity index. Cases in group I had significantly larger spleen & portal vein diameter and higher hepatic artery resistivity index than cases in group II ( P  < .001). The portal vein caliber had the highest diagnostic performance for the detection of esophageal varices with cut‐off values of ≥12.5 mm (sensitivity = 99% and specificity = 94%). Patients with grade IV varices had significantly elevated values of splenic diameter, portal vein caliber, and hepatic artery resistivity index; and lower portal vein velocity than other patients with lower grades ( P  < .001). The same findings were observed with other esophageal varices grades. In conclusion, non‐invasive portal hemodynamic parameters are good indicators for the prediction and severity of esophageal varices.