Emara Mohamed H, Zaghloul Mariam, Amer Ibrahim F, Mahros Aya M, Ahmed Mohammed Hussien, Elkerdawy Mahmoud A, Elshenawy Eslam, Rasheda Abdelrahman M Ahmed, Zaher Tarik I, Haseeb Mona Talaat, Emara Emad Hassan, Elbatae Hassan
Department of Hepatology, Gastroenterology and Infectious Diseases, Kafrelsheikh University, Kafr-Elshikh 33516, Egypt.
Department of Internal Medicine, Gastroenterology Unit, Security Forces Hospital, Riyadh 11481, Saudi Arabia.
World J Hepatol. 2023 Feb 27;15(2):216-224. doi: 10.4254/wjh.v15.i2.216.
Acute variceal bleeding in patients with liver cirrhosis and portal hypertension (PHT) is the most serious emergency complication among those patients and could have catastrophic outcomes if not timely managed. Early screening by esophago-gastro-duodenoscopy (EGD) for the presence of esophageal varices (EVs) is currently recommended by the practice guidelines for all cirrhotic patients. Meanwhile, EGD is not readily accepted or preferred by many patients. The literature is rich in studies to investigate and validate non-invasive markers of EVs prediction aiming at reducing the unneeded endoscopic procedures. Gallbladder (GB) wall thickness (GBWT) measurement has been found promising in many published research articles. We aim to highlight the validity of sonographic GBWT measurement in the prediction of EVs based on the available evidence. We searched databases including Cochrane library, PubMed, Web of Science and many others for relevant articles. GBWT is associated with the presence of EVs in cirrhotic patients with PHT of different etiologies. The cut-off of GBWT that can predict the presence of EVs varied in the literature and ranges from 3.1 mm to 4.35 mm with variable sensitivities of 46%-90.9% and lower cut-offs in viral cirrhosis compared to non-viral, however GBWT > 4 mm in many studies is associated with acceptable sensitivity up to 90%. Furthermore, a relation was also noticed with the degree of varices and portal hypertensive gastropathy. Among cirrhotics, GBWT > 3.5 mm predicts the presence of advanced (grade III-IV) EVs with a sensitivity of 45%, the sensitivity increased to 92% when a cut-off ≥ 3.95 mm was used in another cohort. Analysis of these results should carefully be revised in the context of ascites, hypoalbuminemia and other intrinsic GB diseases among cirrhotic patients. The sensitivity for prediction of EVs improved upon combining GBWT measurement with other non-invasive predictors, platelets/GBWT.
肝硬化和门静脉高压（PHT）患者的急性静脉曲张出血是这些患者中最严重的紧急并发症，如果不及时处理可能会产生灾难性后果。目前，实践指南建议对所有肝硬化患者通过食管胃十二指肠镜检查（EGD）进行早期筛查，以确定是否存在食管静脉曲张（EVs）。然而，许多患者并不容易接受或更倾向于EGD检查。有大量文献研究旨在调查和验证EVs预测的非侵入性标志物，以减少不必要的内镜检查。许多已发表的研究文章发现，测量胆囊（GB）壁厚度（GBWT）很有前景。我们旨在根据现有证据强调超声测量GBWT在预测EVs方面的有效性。我们检索了包括Cochrane图书馆、PubMed、科学网等在内的数据库以查找相关文章。GBWT与不同病因的PHT肝硬化患者中EVs的存在相关。文献中能够预测EVs存在的GBWT临界值各不相同，范围在3.1毫米至4.35毫米之间，敏感性在46%至90.9%之间变化，与非病毒性肝硬化相比，病毒性肝硬化中的临界值更低，然而在许多研究中GBWT>4毫米与高达90%的可接受敏感性相关。此外，还注意到其与静脉曲张程度和门静脉高压性胃病之间的关系。在肝硬化患者中，GBWT>3.5毫米预测存在高级别（III-IV级）EVs的敏感性为45%，在另一组中当使用≥3.95毫米的临界值时，敏感性增加到92%。在肝硬化患者腹水、低白蛋白血症和其他内在胆囊疾病的背景下，应仔细修正对这些结果的分析。将GBWT测量与其他非侵入性预测指标（血小板/GBWT）相结合时，预测EVs的敏感性有所提高。
