Timing of the first variceal hemorrhage in cirrhotic patients: Prospective evaluation of doppler flowmetry, endoscopy and clinical parameters

✍ Scribed by Sebastiano Siringo; Professor Luigi Bolondi; Stefano Gaiani; Soccorsa Sofia; Gianni Zironi; Alessandra Rigamonti; Giulio Di Febo; Mario Miglioli; Giancarlo Cavalli; Luigi Barbara

• Book ID: 102849876
• Publisher: John Wiley and Sons
• Year: 1994
• Tongue: English
• Weight: 795 KB
• Volume: 20
• Category: Article
• ISSN: 0270-9139
• DOI: 10.1002/hep.1840200111

✦ Synopsis

We followed 87 cirrhotic patients with esophageal varices and without previous hemorrhage for a mean period of 24 mo to prospectively evaluate the occurrence of variceal bleeding within (early) or after (late) 6 mo from entry and the contribution of portal Doppler ultrasound parameters to the prediction of early and late hemorrhage. Clinical, biochemical, endoscopic and portal Doppler ultrasound parameters were recorded at entry. Variceal bleeding occurred in 22 patients (25.3%). Nine (40.9%) bled within the first 6 mo. Cox regression analysis identified variceal size, cherry-red spots, serum bilirubin and congestion index of the portal vein (the ratio of portal vein [crosssectional area] and portal blood flow velocity) as the only independent predictors of first variceal hemorrhage. Discriminant analysis was used to find the prognostic index cut off points to identify patients who bled within 6 mo (prognostic group 1) or after 6 mo (prognostic group 2) or remained free of bleeding (prognostic group 3). The cumulative proportion of patients correctly classified was 73% in prognostic group 1,479k in prognostic group 2 and more than 80% in prognostic group 3. The addition of Doppler ultrasound flowmetry to clinical, biochemical and endoscopic parameter only improved the classification of patients with early bleeding. (HEPATOLOGY 1994;20: 66-73.) Approximately 25% to 30% of cirrhotic patients with esophageal varices and without previous variceal hemorrhage will bleed from ruptured varices and 70% of them will do so within the first 2 yr of follow-up (1). However, studies evaluating risk factors for the first variceal hemorrhage have not assessed the timing of variceal bleeding during this period (2-4). Our experience suggests that the risk of bleeding within the first 2 yr is not constant but tends to decrease after an initial