Validation of Gall bladder wall thickness as a non-invasive marker for the prediction of esophageal varices in cirrhotic patients with portal hypertension.

Objective: To validate the gall bladder wall thickness as a non-invasive marker for the prediction of esophageal varices (EV) in cirrhotic patients with portal hypertension. Study Design: Cross-sectional study. Setting: Department of Gastroenterology, Liaquat National Hospital, Karachi, Pakistan. Period: January 2024 to June 2024. Methods: Patients of age 18 years, of any gender diagnosed with cirrhosis and were endoscopy naïve with no previous history of intervention for varices were included. After an overnight fast, the gall bladder (GB) thickness was measured twice at two distinct places, and an average value was determined. Results: Total 210 patients were enrolled into the study with mean age of 56.3 ± 11.8 years. Majority were males (57.1%). Patients had comorbidity of hypertension (17.1%) and diabetes (16.2%). Median gall bladder thick was 2.3 (IQR=1.2-2.9) cm. AUC for GB to predict EV was found to be 0.983 (95% CI: 0.96-1, p<0.001) which shows excellent predictive ability of GB thickness. The optimal cut-off value of GB thickness was found to be ≥1.95 cm. On multivariable regression analysis, increasing gall bladder thickness was found to be associated with higher odds of esophageal varices. Conclusion: The present demonstrated that GB thickness is a promising parameter with excellent predictive ability for prediction of EV among cirrhotic patients with portal hypertension, which should be included in part of routine evaluation in such cohort of patients for timely detection of EV.