03:54 PM Abstract No. 274 Contrast-enhanced CT may identify high-risk esophageal varices in cirrhotic patients

According to the Baveno VI Consensus report, surveillance esophagogastroduodenoscopy (EGD) for gastroesophageal varices is recommended in select cirrhotic patients to reduce morbidity and mortality. This study was performed to test the hypothesis that contrast-enhanced CT scan can help identify “high-risk” esophageal varices in cirrhotic patients. This single-center, IRB-approved, single-blinded, retrospective study identified 97 CT scans performed in 93 consecutive cirrhotic patients from August 2008 to July 2018 who had a contrast-enhanced CT within three months of an EGD. The mean age was 54.4±10.5; 66% of patients were male. Average MELD score was 13.4±5.4 (range 6-30). The etiology of cirrhosis included alcohol (47%), hepatitis C (38%), nonalcoholic steatohepatitis (19.6%) and hepatitis B (2%). EGD findings, interventions, and laboratory data were reviewed. CT scans were reviewed for the presence and size of esophageal varices and compared to EGD findings, with grade III/IV varices or those that required intervention considered “high-risk.” 31% of EGD indications were for bleeding and 60% of patients had banding at EGD. A receiver operator characteristic (ROC) curve analysis of variceal size at CT and the presence “high-risk” varices at EGD was performed. This found that the presence of varices ≥ 3.5 mm on CT was 80% sensitive and 87% specific for “high-risk” varices at EGD. 54% of CTs had varices ≥ 4 mm. Based on the Chi-square test of independence, the presence of varices ≥ 4 mm on CT was associated with bleeding as the indication for EGD (p = 0.003) and the presence of “high-risk” varices at EGD (p<0.001). Varices ≥ 4 mm on contrast-enhanced CT correlated with the presence of “high-risk” varices at EGD, with 80% sensitivity and 87% specificity. These patients were also more likely to have EGD performed because of bleeding. These findings suggest that esophageal varices ≥ 4mm on CT may be a useful indicator that EGD should be considered for confirmatory diagnosis and treatment as needed.