Chalasani et al identified risk factors associated with large esophageal varices in a patient with cirrhosis. This can help identify patients who may benefit from endoscopy. The authors are from Indiana University, Emory University, and the University of Alabama.
Large esophageal varices are:
(1) in the lower third of the esophagus
(2) occupy a third of the lumen
(3) do not flatten with air insufflation
Patient selection: Patient with cirrhosis who are candidates for liver transplant
Parameters:
(1) platelet count
(2) splenomegaly
Parameter
Finding
Points
platelet count
>= 88,000 per µL
0
< 88,000 per µL
1
splenomegaly
absent
0
present
1
risk score =
= (points for platelet count) + (points for splenomegaly)
Interpretation:
• minimum score: 0
• maximum score: 2
• A person with a score >= 1 has a 28% chance of having large esophageal varices, as compared to 7% in those with a score of 0 (4 fold greater risk).
NOTE: Zaman et al also identified a platelet count < 88,000 per µL as a risk factor for esophageal or gastric varices.
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