Hepatic Doppler Ultrasound in Assessment of the Severity of Esophagel Varices in Cirrhotic Patients

Background/ Endoscopy is the gold-standard technique for the assessment of acutely hemorrhagic esophageal varices in patients with hepatic cirrhosis. The objective of this study is to determine the value of different hepatic vasculature Doppler ultrasonography and their flow characteristics for non-invasive assessment of esophageal varices.Patients and Fifty-five (31 male, 24 female) consecutive patients with a mean±SD age of 55±16 (range: 20-88) years, with biopsy-proven hepatic cirrhosis were prospectively studied using Doppler ultrasonography. All of these patients were also examined endoscopically and by echocardiography. None of patients had clinical or echocardiographic signs of right heart failure, tricuspid valve regurgitation or previous history of therapeutic interventions on varices. An ordinal logistic regression (OLR) model was used for determining the adjusted associations between sizes of esophageal varices and hepatic hemodynamic determinants. There was a significant correlation between the size of esophageal varices and maximum portal vein velocity, which was lower in patients with varices (p = 0.04). Other parameters though not statistically significant, were of clinical importance. Those included portal vein mean velocity (p = 0.08), hepatic artery volume flow (p = 0.06) and hepatic venous waveform pattern (p = 0.15). OLR model did not show any significant adjusted associations between these parameters and the size of esophageal varices. The maximum portal vein velocity and to a lesser extent, hepatic artery volume flow were superior to Doppler ultrasonographic spectral waveform pattern of hepatic vein in differentiating patients with esophageal varices from those with no varices. None of hepatic vasculature Doppler measurements had a significant role in predicting the size of esophageal varices, nonetheless.