A Simple Noninvasive Score Predicts Gastroesophageal Varices in Patients With Chronic Viral Hepatitis

Background: Guidelines recommend upper endoscopic screening of cirrhotic patients for gastroesophageal varices. Cirrhosis is not always distinguishable from chronic hepatitis. Goals: To identify low-risk patients who can be spared upper endoscopy irrespective of a diagnosis of cirrhosis. Study: We evaluated 13 nonendoscopic variables as predictors of esophagogastric varices in 254 patients with hepatitis B or hepatitis C-related chronic liver disease who underwent upper endoscopy. Results: Any size varices occurred in 30.3% (77/254), and large varices in 12.2% of patients (31/254), Age > 50 years [odds ratio (OR); 11.29; 95% confidence interval (CI); 2.33-54.67], platelet count 150,000 mmc (OR; 4.40; 95% CI: 1.31-6.79), and aspartate aminotransferase alanine aminotransferase ratio >1 (OR: 2.83%; 95% CI: 1.26-6.34) independently predicted varices by logistic regression. Using a score based on age > 50 years, platelets 150,000 mmc and asparatate aminotransferase/alanine aminotransferase ratio > 1 (1 point predictor), only 3.2% of patients with a score <2 had varices, all small. Conclusions: Patients with chronic viral hepatitis and a score <2 need not undergo upper endoscopy, as they are unlikely to have large varices. Because about 50% of upper endoscopies may be safely avoided.