Muhammad Masroor, Rana Qamar, Iftekhar Ahmed, Salman Danish, Abdul Sattar, Khalid Imran, Masood Hameed Khan.
Do we always need Endoscopy to predict varices.
Med Channel Jan ;13(1):55-8.

OBJECTIVE: To determine the value of serum-ascites albumin gradient (SAAG) in the prediction of presence of esophageal varices in patients with liver cirrhosis and to study the association between the degree of SAAG and the presence and size (i.e; grading) of esophageal varices. DESIGN: Observational Case Series PLACE: Medical Unit III, Civil Hospital Karachi DURATION: January 2001 to March 2002 PATIENTS AND METHODS: Patients diagnosed clinically having cirrhosis with ascites were included in the study. Ascitic fluid analysis, serum proteins, ultrasonography and endoscopy were the basic investigations performed in all patients. There upon SAAG was calculated and presence or absence of esophageal varices and their grading were documented in all patients. RESULTS: This study included 50 patients with cirrhosis of liver SAAG was found to be between 1.1 and 3.2 in all 50 patients while esophageal varices were present in 46(92%) of them. This suggests that high SAAG reflects higher chances of presence of esophageal varices in patients with liver cirrhosis. Furthermore the presence and size of esophageal varices is found to be directly related to the degree of SAAG. Esophageal varices were found to be present in all the patients having SAAG value > 1.4 CONCLUSION: Our findings indicate that SAAG is a useful indirect indicator in the estimation of portal hypertension and so is a useful mean in the prediction ofpresence of esophageal varices in patients with liver cirrhosis.

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