Esophageal varies is the most dreaded complications of cirrhosis of liver responsible for high mortality and morbidity in these patients. As per current guidelines these patients need to go periodic screening with upper Gi endoscopy to detect and institute prophylactic measures if needed.

However this poses a great burden on patients as well as on doctors in our setup. In this study we aim to identify any correlation between spleen size and presence of oesophageal varicesin cirrhosis of liver patients.

Methods: 50 patients with cirrhosis of liver with no history of Gi bleeding who were admitted in hospital from April 2018 to November 2018 were studied in this prospective observational study. Apart from history and physical examinations they were subjected to baseline investigations. Ultrasounography abdomen was used for spleen size and upper gastrointestinal endoscopy for varices.

Results: Out of 50 patients studied 46 (92%) were males and varices were present in 42 (84%).A cut off value of 100 mm of spleenic diameter on ultrasonography predicts the presence of varices with positive predictive value of 93.33%, p value of 0.027, sensitivity of 66.7% and specificity of 75%.

Conclusion: From our study we concluded that there is significant correlation between spleenic size and presence of oesophageal varices in cirrhosis of liver patients. This along with other non-invasive investigations can be used to avoid unnecessary GI endoscopies In cirrhosis of liver patients.

Keywords: Cirrhosis of liver, oesophageal varices, endoscopy, spleen size.

1. Gupta, TK, Chen L, Groszmann RJ. Pathophysiology of portal hypertension. Clin. Liver Dis. 1997; 1:1-12.
2. De Franchis R, Primignani M. Natural history of portal hypertension inpatients with cirrhosis. Clin. Liver Disease 2001; 5: 645-63.
3. Luketic VA, Sanyal AJ. Oesophageal varices. I clinical presentation, medical therapy and endoscopic therapy. Gastroenterology clinics of North America 2000: 29: 337-385.
4. Rigo GP, Merghi A, Chalen NJ, Mastronardi M, Codoluppi PL, Ferrari Aet al. A prospective study of the ability of the three endoscopic classification to predict hemorrhage from oesophageal varices. Gastro intest Endos. 1992; 38: 425-9.
5. The Northern Italian Endoscopic club for the study and treatment of oesophageal varices. Prediction of the first variceal hemorrhage in patients with cirrhosis of the liver and oesophageal varices: a prospective multicenter study. N. Engl. J. Med. 1988; 319: 983-9.
6. D'Amico G, Garcia-Isao G, Cales P. Diagnosis of portal hypertension; Howand When. Proceedings of the third Baveno International consensus workshop on definitions, methodology and therapeutic strategies. Oxford: Black well science 2001: 36-63.
7. D'Amico G, Pagliano L, Bosch J, The treatment of portal hypertension, a meta analysis review. Hepatology 1995: 22: 332-54.
8. Brenna MRS, Targowhik L, Gareti SD, Hetal AK, Ian MG. Endoscopic screening for oesophageal varices in cirrhosis. Is it ever cost effective? Hepatology 2003; 37: 366-77.
9. De Franchis R, Dell' Era A, Primignani M. Diagnosis and monitoring of portal hypertension. Dig Liver Dis. May 2008; 40(5):312-7.
10. Bruce R. Bacon. Cirrhosis and its complications. Chapter 308. Harrison’s principles of Internal Medicine 18th edition. McGraw-Hill. 2012.

Dr Suhail Hassan

Assistant Professor Dept. of General Medicine Teerthanker Mahaveer Medical College and Research centre Moradabad UP, India