Non-invasive ultrasound-based diagnosis and staging of esophageal varices in liver cirrhosis. A systematic review of the literature published in the third Millenium

Endoscopic surveilance of esophageal varices in patients with liver cirrhosis is expensive for the health system and uncomfortable for the patients. Recently, non-invasive ultrasound-based parameters seem to offer valuable informations about the status of esophaeal varices and thus challenge the need for repetitive endoscopic monitoring.We have performed a systematic review of the literature published in PubMed from January 2000 until March 2012 over the role of ultrasound-based parameters on the evaluation of esophageal varices in patients with liver cirrhosis.Eleven papers studied the role of gray-scale and Doppler ultrasound and two further studies analyzed the relationship between liver stiffness and staging of esophageal varices. The parameters that proved to be valuable for diagnosis of esophageal varices and reached statistcal significance were: diameter of the spleen > 15 cm, congestion index of the portal vein > 0.154 cm x sec, portal hipertensive index > 2.08, liver stiffness > 43.97kPa, portal vein diameter > 13 mm, renal artery resistance index >/= 0.7 and development of new porto-systemic collaterals. Other parameters such as: pattern of hepatic venous waveforms or flow parameters of the hepatic or splenic veins did not reach statistical significance.Altough esophagogastroduodenoscopy remains the golden standard, there are some ultrasound-based parameters which, used within complex algorithms, may represent a viable alternative for the diagnosis and surveilance of esophageal varices in patients with liver cirrhosis.