Clinical, laboratory and radiological indicators of esophageal varices in child patients with cirrhosis

Esophagogastroduodenoscopic (EGD) screening has been recommended to prevent esophageal varices (EV) bleedings in cirrhotic patients. Nevertheless, routine screening of all patients with cirrhosis with upper EGD is invasive and associated with risk, especially in children. Studies have shown that, patients with large EV and/or varices with red wale signs have high risk esophageal varices (HREV) for bleeding. In our study, we investigated the presence of EV and HREV and their association with clinical, biochemical and laboratory parameters in cirrhotic children. In this study, EV was observed in 71.1% of children with cirrhosis. EV was present in 61% of patients with cryptogenic cirrhosis, 65.7% with Wilson disease, 85.7% with biliary atresia. HREV was observed in 20.8% of patients with EV. Patients with EV had significantly lower thrombocyte counts and albumin levels compared to patients without EV. The presence of ascites, splenomegaly and Child Plugh score were higher in the EV group than the group without EV. Lower thrombocyte counts, increased spleen diameter and spleen fold was observed in the HREV group than the group without HREV. Spleen diameter and spleen fold were independently associated with the presence of HREV. The spleen diameter cutoff point was found to be 159 mm in cirrhotic patients with HREV and patients with a spleen diameter >159 mm were 3.2-fold more likely to have HREV. The presence of ascites, splenomegly, hypoalbuminemia, high Child-Pugh scores and lower thrombocyte counts were found to be important variables for EV in children with cirrhosis. We think, lower thrombocyte counts and a spleen diameter >159 mm may predict the presence of HREV but endoscopic screening is still more valuable in child patients. Keywords: Esophageal varices, splenomegaly, thrombocytopenia, children, varice bleedings