Endoscopic Screening of Esophageal Varices in Asymptomatic HCV Infected Patients: A Single Center Study

Abstract

Background: Varices are a major complication of HCV induced cirrhosis. AASLD recommend upper GI endoscopy in all cirrhotic
patients to screen for esophageal varices in all cirrhotic patients irrespective of severity of disease.
Objective: To determine the frequency of esophageal varices in apparently asymptomatic patients with cirrhosis due to chronic
hepatitis C presenting at tertiary care hospital at Sialkot.
Material & Methods: This descriptive cross sectional study was conducted in Allama Iqbal memorial teaching hospital Sialkot from January to December 2017. We studied 261 cirrhotic patients due to HCV who never had an upper GI bleed in past and subjected them to upper GI endoscopy for screening for esophageal varices. All patients were stratified according to their Child-Pugh class. Frequency of esophageal varices was calculated as percentage and compared between three Child classes by Chi-square test.
Results: Mean age of our population was 44.9+16.2 years. Almost 70% of cirrhotic patients who never had upper GI bleed had varices on screening endoscopy. Out of 261 patients, 59 patients (22.6%) had large and moderate sized varices that deserved banding. Frequency of high grade esophageal varices was higher with advancing Child-Pugh class. 9% in Child class A, 18% in class B, and 30% in class C had moderate to large sized varices that deserved banding. Surprisingly, there were 22 patients (16.6%) in Child class C who had no esophageal varices at all. 
Conclusion: Upper GI endoscopy should be essentially performed in all cirrhotic patients even without history of upper GI
bleeding.