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News

Noninvasive diagnosis of esophageal varices

The platelet count/spleen diameter ratio can be used in cirrhotic screening endoscopy for esophageal varices, finds this month's American Journal of Gastroenterology.

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Noninvasive assessment of esophageal varices may improve the management of patients with cirrhosis.

It may decrease both the medical and financial burden related to screening.

Dr Edoardo Giannini and colleagues from Italy prospectively validated the use of the platelet count/spleen diameter ratio for the noninvasive diagnosis of esophageal varices.

A total of 218 cirrhotic patients underwent screening endoscopy for esophageal varices.

The research team assessed platelet count/spleen diameter ratio in all patients, and calculated its diagnostic accuracy.

On the basis of previous results, a platelet count/spleen diameter ratio cutoff of 909 was applied to this population.

The diagnostic accuracy of the platelet count/spleen diameter ratio was further evaluated for both severity and etiology of disease subgroups.

The researchers found that the prevalence of esophageal varices was 54%.

The platelet count/spleen diameter ratio was accurate in 86%
American Journal of Gastroenterology

The platelet count/spleen diameter ratio had 86% diagnostic accuracy for esophageal varices.

The team noted that this significantly greater as compared with either accuracy of platelet count alone, or spleen diameter alone.

The researchers observed that the 909 cutoff had 92% sensitivity, and 67% specificity.

The research team found that the cutoff value also gave a 77% positive predictive value, and a 87% negative predictive value.

The positive likelihood ratio was 2.8, and the negative likelihood ratio for the diagnosis of esophageal varices was 0.1.

The team noted that accuracy of the platelet count/spleen diameter ratio was maintained for both severity and etiology of disease subgroups.

Dr Giannini's team concludes, “The platelet count/spleen diameter ratio may be proposed as a safe and reproducible means to improve the management of cirrhotic patients who should undergo screening endoscopy for esophageal varices.”

Am J Gastroenterol 2006: 101(11): 2511
13 November 2006

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