Prediction of esophageal varices in chronic liver disease patients by using fibroscan, spleen size and platelet count.

Patients with cirrhosis of liver according to current guidelines and recommendation need to undergo screening with an OGD scopy to detect esophageal varices and to institute prophylactic measures in patients with large esophageal varices at the time of diagnosis and during follow up. This poses social and medical burden due to the greater number of cirrhotic patients and lesser number of endoscopy units. In this study we aim to identify the non invasive predictors of esophageal varices particularly fibroscan, spleen size, platelet count and platelet count/ spleen diameter ratio. Methods In this observational study of 50 patients, newly diagnosed patients with chronic liver disease without a history of gastro intestinal bleeding were included between march 2014 and September 2014. Relevant clinical parameters were assessed which included physical examination, complete hemogram, biochemical work up, liver stiffness measurement using fibroscan , USG measurement of spleen long axis diameter, OGD scopy . platelet count/ spleen diameter ratio was calculated for all patients. Results Among the 50 patients studied males predominated the study with 86%. Out of the study population 88% of the patients had varices. For a cut off point of fibroscan value > 32 ,the sensitivity was 79.5% and specificity was 100% . A statistically significant correlation between fibroscan values and presence of varices was noted ( P ==0.001). for a cut off value of platelet count/ spleen diameter the sensitivity was 68.2% and statistical correlation was sgnifican( P = for the prediction of varices. CONCLUSION: From our study we conclude that fibroscan is a valuable tool in the prediction of presence of esophageal varices. But the cut off values differ from study to study which needs to be validated. A lower PC/SD ratio determine the presence of highgrades of varices. From all these parameters we could identify the subset of patients who require OGD scopy for the prophylactic management of esophageal varices. Therefore avoiding unnecessary endoscopy screenings and reducing the burden of endoscopy units. Apart from being non invasive these parameters are easily reproducible