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P37 Platelet count and spleen size: avoidance of screening endoscopy for varices in patients with hepatitis C cirrhosis


Introduction Many patients with liver cirrhosis, screened for oesophageal varices (OV) are found to have either no or insignificant varices, resulting in unnecessary procedures and financial burden. We had previously shown that the non-invasive parameters of platelet count and spleen size, measured by transabdominal ultrasound, were highly sensitive for the prediction of OV in patients with hepatitis C cirrhosis.

Aim To determine in a subsequent cohort of patients with hepatitis C cirrhosis whether such a clinical tool was accurate in determining which patients require endoscopic screening.

Method 246 outpatients with biopsy-proven hepatitis C cirrhosis over a 3-year period were studied retrospectively. Endoscopy should have been performed, according to our protocol, if any of the following parameters were met: platelet count <100×109/l, spleen size _14 cm or specific ultrasound findings indicative of portal hypertension (recanalised paraumbilical vein, ascites, splenic hilar varices).

Results Of 246 patients, 98 patients underwent upper GI endoscopy, 76 of whom met criteria (78%). Of 148 patients who did not undergo endoscopy, 63 met criteria (43%). Endoscopic findings are summarised in the Abstract P37 table 1 below.

Abstract P37 Table 1

Endoscopic findings

Conclusion Using simple non-invasive criteria, screening endoscopy could be avoided in around 44% of patients with hepatitis C cirrhosis. Treatable varices would not be missed in this group.

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