Diagnostic Accuracy of Portal Vein Flow Velocity & Hepatic Veins Waveform Morphology in Comparison to Upper GI Endoscopy for Esophageal Varices in Cirrhotic Patients

Background: Variceal bleeding is a life-threatening complication of cirrhosis that necessitates urgent detection then management to significantly decrease morbidity & mortality. This study aimed to compare reliability of measuring portal vein flow velocity (PVFV) & hepatic vein waveform morphology (HVWM) with upper GI endoscopy (UGIE) results in the detection & grading of esophageal varices (EV) in cirrhotic patients. Methods: This cross-sectional study was conducted on fifty cirrhotic patients who underwent history taking, clinical examination, laboratory investigations,Child-Pugh-Turcotte, Doppler ultrasound (DUS) assessment followed by UGIE. Results: Patients with EV exhibited significantly larger PV diameter and significantly lower median PVFV as opposed to those without varices. Additionally, monophasic-biphasic HVWM predominated among patients with varices , whereas triphasic morphology was more common in those without varices. ROC curve analysis was done for PVFV to predict the presence of EV suggesting excellent ability to predict it. The best cutoff was ≤16 cm/sec, at which sensitivity, specificity, positive predictive value, and negative predictive value were 70.6%, 87.5%, 92.3%, and 58.3%, respectively. HVWM demonstrated a sensitivity of 55.9% and a specificity of 87.5% for predicting the presence of EV. The positive predictive value was 90.5%, while the negative predictive value was 48.3%. Conclusion: DUS offers a promising, non-invasive tool to assess hemodynamic changes associated with portal hypertension, with parameters such as PVFV and HVWM potentially predicting the presence and severity of EV. Accurate evaluation of these Doppler indices may allow for better risk stratification and reduce unnecessary endoscopies.