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Ultrasonographic predictors of esophageal varices

Roberta V de Alcantara1, Roberto M Yamada, Sílvia R Cardoso

  • 1*Department of Pediatrics, Hospital de Clínicas, UNICAMP, Campinas †Department of Medicine, Universidade Federal de São Carlos, São Carlos, São Paulo, Brazil.

Journal of Pediatric Gastroenterology and Nutrition
|August 15, 2013
PubMed

Insights

Ultrasonography can predict esophageal varices in children with liver disease. Splenorenal shunt and omental thickness indicate varices in chronic liver disease, while gallbladder varices and thickening predict them in extrahepatic portal venous obstruction.

Area of Science:

  • Pediatric Gastroenterology
  • Hepatology
  • Diagnostic Imaging

Background:

  • Esophageal varices (EVs) are a serious complication in children with chronic liver disease (CLD) and extrahepatic portal venous obstruction (EHPVO).
  • Early identification of EVs is crucial for timely intervention and management.
  • Ultrasonography offers a non-invasive method for assessing liver and portal vein abnormalities.

Purpose of the Study:

  • To identify ultrasonographic predictors of esophageal varices (EVs) in pediatric patients with CLD and EHPVO.
  • To correlate specific ultrasound findings with the presence and severity of EVs.

Main Methods:

  • A cohort of 53 pediatric patients (<20 years) with CLD or EHPVO, without prior bleeding or treatment, was evaluated.
  • Ultrasound parameters including splenorenal shunt (SS), gallbladder wall varices, gallbladder wall thickening (GT), and lesser omental thickness (LOT) were assessed.
  • Statistical analyses, including univariate and multivariate logistic regression, were performed to determine predictor significance.

Main Results:

  • Esophageal varices were present in 48.5% of CLD patients and 83.3% of EHPVO patients.
  • In CLD patients, SS and LOT were significant predictors of EVs (P=0.0329 and P=0.0151, respectively). A LOT of 5.3 mm was a key indicator.
  • In EHPVO patients, gallbladder varices and GT predicted EVs (P=0.0245 and P=0.0289). SS was an independent predictor of EVs in EHPVO (OR 15).
  • Portal hypertensive gastropathy (PHG) was more frequent in CLD patients with SS and greater LOT.

Conclusions:

  • Splenorenal shunt and increased lesser omental thickness are valuable ultrasonographic indicators for EVs in pediatric CLD.
  • Gallbladder varices and gallbladder wall thickening are significant predictors of EVs in pediatric EHPVO.
  • Ultrasonography can effectively identify children at risk for EVs and associated complications like PHG.
Abstract

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