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Cutaneous vascular spiders in cirrhotic patients: correlation with hemorrhage from esophageal varices
P G Foutch1, J A Sullivan, J A Gaines
1Gastroenterology Section, VA Medical Center, Phoenix, Arizona.
Insights
Cutaneous vascular spiders are nearly as common as esophageal varices in cirrhotic patients. The presence and characteristics of these spiders can help identify patients at higher risk for variceal bleeding.
Area of Science:
- Gastroenterology
- Dermatology
Background:
- Esophageal varices are a common complication of cirrhosis, posing a significant risk of hemorrhage.
- Cutaneous vascular spiders (CVS) are frequently observed in patients with liver disease, but their direct correlation with variceal bleeding risk is not fully established.
Purpose of the Study:
- To investigate the association between the presence and characteristics of cutaneous vascular spiders and the occurrence of esophageal variceal bleeding in cirrhotic patients.
- To determine if CVS can serve as a predictive marker for variceal hemorrhage.
Main Methods:
- Esophagoscopy was performed on 92 male cirrhotic patients to assess esophageal varices.
- A concurrent skin examination was conducted to evaluate the presence, size, and location of cutaneous vascular spiders.
- Patients were categorized into those who bled from varices within 10 days of evaluation and those who never bled.
Main Results:
- The incidence of spiders (90%) and varices (91%) was nearly identical in the study population.
- Patients with spiders had a significantly higher frequency of variceal bleeding (36%) compared to those without spiders (11%, p < 0.05).
- A higher number of spiders (>20), atypical locations, and larger size (>15 mm) were strongly associated with increased risk and severity of variceal bleeding (up to 80% bleeding risk with large spiders).
Conclusions:
- Cutaneous vascular spiders are a prevalent finding in cirrhotic patients and correlate strongly with the presence of esophageal varices.
- The spider profile, including number, location, and size, may serve as a valuable, non-invasive tool to identify cirrhotic patients at increased risk for variceal hemorrhage.
- Further research may establish the spider profile as a discriminating marker for selecting patients who could benefit from prophylactic therapy for esophageal varices.
Abstract:
Ninety-two consecutive male cirrhotic patients had esophagoscopy to determine the presence and size of varices, and a concomitant skin examination for assessment of cutaneous vascular spiders. Thirty-one subjects bled from varices within 10 days of the spider evaluation, and this group was compared to 61 individuals who never bled. Our results show that incidence of spiders (90%) and varices (91%) is nearly identical, that frequency of variceal bleeding is higher among subjects with spiders compared with those who lack these lesions (36% vs 11%, p less than 0.05), and that the spider profile may be useful to identify individuals who are at increased risk for variceal hemorrhage. Frequency of bleeding was 50% (p less than 0.01) when greater than 20 spiders were present and 63% (p less than 0.01) when multiple atypically located lesions were detected. Large spiders (greater than 15 mm) correlate best with large varices and have the strongest association with bleeding (80%, p = 0.0002). If evidence of benefit from prophylactic treatment of esophageal varices can be established, then elements of the spider profile may serve as a discriminating marker to assist in selection of appropriate patients for therapy.