Resum
Background: Endoscopy has been recommended for all patients with liver cirrhosis to detect varices, but it is expensive, invasive and uncomfortable. There is therefore, need to find non-endoscopic means to predict oesophageal varices.
Aim: To determine the sensitivity and specificity of platelet count, splenic size and portal vein diameter to predict oesophageal varices in patients with liver cirrhosis.
Methodology: Subjects were patients with liver cirrhosis and controls without liver disease aged 18 years and above. Platelet count was determined using Mindray BC-3000plus auto-analyzer. Portal vein diameter was measured at a point where it crosses the hepatic artery. Splenic length was measured through the hilum, as the distance between the dome and the tip. All the patients had upper gastrointestinal endoscopy. Varices were graded into I, II, III based on the Japanese classification of oesophageal varices.
Results: The patients comprised 59 (81%) males and 14 (19%) females, while controls comprised 29 (73%) males and 11 (27%) females. The mean±(S.D.) age of the patients and controls was 44±12.6 and 40± 13 years respectively. There was statistically significant difference in the means of platelet count and platelet count/splenic size between patients with large oesophageal varices and those with small or no varices (p=0.00), while no such difference in the means of splenic size, portal vein diameter and the presence/size or absence of varices. (p=0.06).
Conclusion: Platelet count has the best sensitivity and specificity among the three values in predicting both small and large varices in patients with liver cirrhosis.
Keywords: Non-Endoscopic Diagnosis, Oesophageal Varices, Liver Cirrhosis
Résumé
Contexte: L'endoscopie a été recommandée pour tous les patients atteints de cirrhose du foie pour détecter les varices,
mais c'est coûteux, invasive et inconfortable. Il est donc nécessaire de trouver des moyens non-endoscopiques pour
prédire les varices œsophagiques.
Objectif: Pour déterminer la sensibilité et la spécificité de la numération plaquettaire, la taille de la rate et le diamètre de la veine portale pour prédire les varices œsophagiques chez les patients atteints de cirrhose du foie.
Méthodologie: Les sujets étaient des patients atteints de cirrhose du foie et les contrôles sans maladie du foie âgés de 18 ans et plus. La numération plaquettaire a été déterminée en utilisant Mindray BC-3000plus auto-analyseur. Le diamètre de la veine portale a été mesuré à un point où elle croise l'artère hépatique. La taille de la rate a été mesurée parle hile, comme la distance entre le dôme et la pointe. Tous les patients ont eu une endoscopie gastro-intestinale supérieure. Les varicesont été classéesen I, II, III selon la base de classification japonaise des varicesœsophagiques.
Résultats: Les patients comprenaient 59 (81%) hommes et 14 (19%) femmes, tandis que les contrôles comprenaient 29 (73%) hommes et 11 (27%) femmes. L'âge moyen ± (ET) des patients et des contrôles étaient de 44 ± 12,6 et 40 ± 13 ans, respectivement. Il y avait une différence statistiquement significative dans les moyennes de numération plaquettaire et numération plaquettaire / taille de la rate entre les patients avec de grandes varices œsophagiques et ceux qui ont peu ou pas de varices (p = 0,00), tandis qu'aucune telle différence dans les moyennes de taille de la rate, le diamètre de la veine porte et la présence / taille ou absence des varices. (P = 0,06).
Conclusion: La numération plaquettaire a la meilleure sensibilité et spécificité parmi les trois valeurs pour prédire les petites et grandes varices chez les patients atteints de cirrhose du foie.
Mots-clés: DiagnostiqueNon-Endoscopique, Varices Œsophagiques, Cirrhose du foie
Correspondence: Dr. Adegboyega Akere, Department of Medicine, College of Medicine, University of Ibadan, Ibadan, Nigeria. E-mail: adeakere@yahoo.co.uk.
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