Background: Esophageal varices are the porto-systemic channels that connect the portal and systemic venous circulation preferentially located in the sub mucosa of lower esophagus. They are the most important complication of portal hypertension.UGI scopy is very costly and not available in the peripheral rural areas. Many studies had been conducted for possible way of determining varices by means by using low cost and non-invasive parameters to investigate for varices for the replacement of endoscopy. Aim of the study: To prospectively evaluate the validity of platelet count to spleen diameter ratio by comparing it with other noninvasive parameters that can be used to screen for the presence of esophageal varices to reduce the burden of endoscopy.Materials and methods: The study was a prospective observational study. The study was conducted over a period of two years from May 2016 to August 2018. It was conducted at Inpatient and outpatient Department of Medicine of D. Y. Patil Medical College and Hospital, Kolhapur, Maharashtra, India. Registration of patients was from May 2016 to August 2018. They were registered and admitted under Medicine Department according to inclusion and exclusion criteria. The sample size selected was 100 patients. Results: Based on Conn’s Grading, the grading of the varices in study population was done. Grade I varices predominated (28 %), followed by Grade II varices (25 %). Varices were absent in 40 % of the patients. AUROC curve was 0.88 (CI- 0.80-0.95, p value <0.01). From ROC (Figure) obtained threshold value of 111 with sensitivity and specificity 88.3 and 85 respectively. ROC curve and the cut off value for spleen diameter was≥111mm. Area under the curve for ROC curve was 0.85. We have used cut off value 909 for Platelet Count Spleen Diameter Ratio, with this cut off value obtained sensitivity and specificity 81.67% and 82.50% respectively and PPV and NPV of 87.50% and 75% respectively.Conclusion: From our study we conclude that platelet count and spleen diameter ratio' is useful denominator to predict the presence of higher grades of varices. Hence it can identify the subset of patients who require endoscopy for the prophylactic management of esophageal varices. Therefore reduces the burden on the endoscopy units, avoiding unnecessary screening endoscopies as well. It may reduce the cost of management of bleeding varices.
Key words: Esophageal varices, porto-systemic channels, endoscopies.
Received: 15 December 2018 Revised: 27 December 2018 Accepted: 28 December 2018
Corresponding author: Dr. Ashwin Mankoskar, Postgraduate student, Department of General Medicine, D.Y. Patil Medical College, Kohlapur, Maharashtra, India
This article may be cited as: Wagh V, Mankoskar A. Platelet Count Spleen Diameter Ratio for non invasive Diagnosis of Esophageal Varices. J Adv Med Dent Scie Res 2019;7(1):136-141