Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
Meta-Analysis
. 2017 Apr 26;4(4):CD008759.
doi: 10.1002/14651858.CD008759.pub2.

Platelet count, spleen length, and platelet count-to-spleen length ratio for the diagnosis of oesophageal varices in people with chronic liver disease or portal vein thrombosis

Agostino Colli  1 , Juan Cristóbal Gana  2 , Jason Yap  3 , Thomasin Adams-Webber  4 , Natalie Rashkovan  5 , Simon C Ling  6 , Giovanni Casazza  7
Affiliations
Meta-Analysis

Platelet count, spleen length, and platelet count-to-spleen length ratio for the diagnosis of oesophageal varices in people with chronic liver disease or portal vein thrombosis

Agostino Colli et al. Cochrane Database Syst Rev. .

Abstract

Background: Current guidelines recommend screening of people with oesophageal varices via oesophago-gastro-duodenoscopy at the time of diagnosis of hepatic cirrhosis. This requires that people repeatedly undergo unpleasant invasive procedures with their attendant risks, although half of these people have no identifiable oesophageal varices 10 years after the initial diagnosis of cirrhosis. Platelet count, spleen length, and platelet count-to-spleen length ratio are non-invasive tests proposed as triage tests for the diagnosis of oesophageal varices.

Objectives: Primary objectives To determine the diagnostic accuracy of platelet count, spleen length, and platelet count-to-spleen length ratio for the diagnosis of oesophageal varices of any size in paediatric or adult patients with chronic liver disease or portal vein thrombosis, irrespective of aetiology. To investigate the accuracy of these non-invasive tests as triage or replacement of oesophago-gastro-duodenoscopy. Secondary objectives To compare the diagnostic accuracy of these same tests for the diagnosis of high-risk oesophageal varices in paediatric or adult patients with chronic liver disease or portal vein thrombosis, irrespective of aetiology.We aimed to perform pair-wise comparisons between the three index tests, while considering predefined cut-off values.We investigated sources of heterogeneity.

Search methods: The Cochrane Hepato-Biliary Group Controlled Trials Register, the Cochrane Hepato-Biliary Group Diagnostic Test Accuracy Studies Register, the Cochrane Library, MEDLINE (OvidSP), Embase (OvidSP), and Science Citation Index - Expanded (Web of Science) (14 June 2016). We applied no language or document-type restrictions.

Selection criteria: Studies evaluating the diagnostic accuracy of platelet count, spleen length, and platelet count-to-spleen length ratio for the diagnosis of oesophageal varices via oesophago-gastro-duodenoscopy as the reference standard in children or adults of any age with chronic liver disease or portal vein thrombosis, who did not have variceal bleeding.

Data collection and analysis: Standard Cochrane methods as outlined in the Cochrane Handbook for Diagnostic Test of Accuracy Reviews.

Main results: We included 71 studies, 67 of which enrolled only adults and four only children. All included studies were cross-sectional and were undertaken at a tertiary care centre. Eight studies reported study results in abstracts or letters. We considered all but one of the included studies to be at high risk of bias. We had major concerns about defining the cut-off value for the three index tests; most included studies derived the best cut-off values a posteriori, thus overestimating accuracy; 16 studies were designed to validate the 909 (n/mm3)/mm cut-off value for platelet count-to-spleen length ratio. Enrolment of participants was not consecutive in six studies and was unclear in 31 studies. Thirty-four studies assessed enrolment consecutively. Eleven studies excluded some included participants from the analyses, and in only one study, the time interval between index tests and the reference standard was longer than three months. Diagnosis of varices of any size. Platelet count showed sensitivity of 0.71 (95% confidence interval (CI) 0.63 to 0.77) and specificity of 0.80 (95% CI 0.69 to 0.88) (cut-off value of around 150,000/mm3 from 140,000 to 150,000/mm3; 10 studies, 2054 participants). When examining potential sources of heterogeneity, we found that of all predefined factors, only aetiology had a role: studies including participants with chronic hepatitis C reported different results when compared with studies including participants with mixed aetiologies (P = 0.036). Spleen length showed sensitivity of 0.85 (95% CI 0.75 to 0.91) and specificity of 0.54 (95% CI 0.46 to 0.62) (cut-off values of around 110 mm, from 110 to 112.5 mm; 13 studies, 1489 participants). Summary estimates for detection of varices of any size showed sensitivity of 0.93 (95% CI 0.83 to 0.97) and specificity of 0.84 (95% CI 0.75 to 0.91) in 17 studies, and 2637 participants had a cut-off value for platelet count-to-spleen length ratio of 909 (n/mm3)/mm. We found no effect of predefined sources of heterogeneity. An overall indirect comparison of the HSROCs of the three index tests showed that platelet count-to-spleen length ratio was the most accurate index test when compared with platelet count (P < 0.001) and spleen length (P < 0.001). Diagnosis of varices at high risk of bleeding. Platelet count showed sensitivity of 0.80 (95% CI 0.73 to 0.85) and specificity of 0.68 (95% CI 0.57 to 0.77) (cut-off value of around 150,000/mm3 from 140,000 to 160,000/mm3; seven studies, 1671 participants). For spleen length, we obtained only a summary ROC curve as we found no common cut-off between studies (six studies, 883 participants). Platelet count-to-spleen length ratio showed sensitivity of 0.85 (95% CI 0.72 to 0.93) and specificity of 0.66 (95% CI 0.52 to 0.77) (cut-off value of around 909 (n/mm3)/mm; from 897 to 921 (n/mm3)/mm; seven studies, 642 participants). An overall indirect comparison of the HSROCs of the three index tests showed that platelet count-to-spleen length ratio was the most accurate index test when compared with platelet count (P = 0.003) and spleen length (P < 0.001). DIagnosis of varices of any size in children. We found four studies including 277 children with different liver diseases and or portal vein thrombosis. Platelet count showed sensitivity of 0.71 (95% CI 0.60 to 0.80) and specificity of 0.83 (95% CI 0.70 to 0.91) (cut-off value of around 115,000/mm3; four studies, 277 participants). Platelet count-to-spleen length z-score ratio showed sensitivity of 0.74 (95% CI 0.65 to 0.81) and specificity of 0.64 (95% CI 0.36 to 0.84) (cut-off value of 25; two studies, 197 participants).

Authors' conclusions: Platelet count-to-spleen length ratio could be used to stratify the risk of oesophageal varices. This test can be used as a triage test before endoscopy, thus ruling out adults without varices. In the case of a ratio > 909 (n/mm3)/mm, the presence of oesophageal varices of any size can be excluded and only 7% of adults with varices of any size would be missed, allowing investigators to spare the number of oesophago-gastro-duodenoscopy examinations. This test is not accurate enough for identification of oesophageal varices at high risk of bleeding that require primary prophylaxis. Future studies should assess the diagnostic accuracy of this test in specific subgroups of patients, as well as its ability to predict variceal bleeding. New non-invasive tests should be examined.

PubMed Disclaimer

Conflict of interest statement

None known.

Figures

1
1
Study flow diagram.
2
2
Methodological quality of the 71 included studies.
3
3
Quality assessment summary: review authors' judgements about each risk of bias item for each included study. Not all of the included studies considered all three index tests. Cells are empty when an index test was not considered in a study.
4
4
Forest plot. Adult participants ‐ platelet count ‐ any varices.
5
5
Forest plots. Adult participants ‐ platetelet count ‐ various cut‐off values ‐ any varices.
6
6
Studies in the ROC space. Adult participants ‐ platelet count ‐ various cut‐off values ‐ any varices.
7
7
Forest plot. Adult participants ‐ spleen length ‐ any varices.
8
8
Forest plots. Adult participants ‐ spleen length ‐ any varices: various cut‐off values.
9
9
Studies in the ROC space. Adult participants ‐ spleen length ‐ any varices: various cut‐off values.
10
10
Forest plot. Adult participants ‐ platelet count‐to‐spleen length ratio ‐ any varices.
11
11
Studies in the ROC space. Adult participants ‐ platelet count‐to‐spleen length ratio. Only studies with a cut‐off value of 909 (n/mm3)/mm ‐ any varices.
12
12
Indirect comparison. Forest plot. Adult participants ‐ platelet count compared with spleen length ‐ any varices.
13
13
Forest plot. Indirect comparison. Adult participants ‐ platelet count (cut‐off around 150,000) compared with spleen length (cut‐off around 110 mm) ‐ any varices.
14
14
Indirect comparison. Studies in the ROC space. Adult participants ‐ platelet count (cut‐off around 150,000) compared with spleen length (cut‐off around 110 mm) ‐ any varices.
15
15
Indirect comparison. Forest plots. Adult participants ‐ platelet count compared with platelet count‐to‐spleen length ratio ‐ any varices.
16
16
Direct comparison. Forest plots. Adult participants ‐ platelet count compared with platelet count‐to‐spleen length ratio ‐ any varices.
17
17
Indirect comparison. Forest plots. Adult participants ‐ platelet count (cut‐off around 150.000/mm3) compared with platelet count‐to‐spleen length ratio (cut‐off 909 (n/mm3)/mm) ‐ any varices.
18
18
Indirect comparison. Studies in the ROC space. Adult participants ‐ platelet count (cut‐off around 150.000) compared with platelet count‐to‐spleen length ratio (cut‐off 909 (n/mm3)/mm) ‐ any varices.
19
19
Indirect comparison. Forest plots. Adult participants ‐ platelet count‐to‐spleen length ratio compared with spleen length ‐ any varices.
20
20
Indirect comparison. Forest plots. Adult participants ‐ platelet count‐to‐spleen length ratio (cut‐off 909 (n/mm3)/mm) compared with spleen length (cut‐off around 110) ‐ any varices.
21
21
Indirect comparison. Studies in the ROC space. Adult participants ‐ platelet count‐to‐spleen length ratio (cut‐off 909 (n/mm3)/mm) compared with spleen length (cut‐off around 110 mm) ‐ any varices.
22
22
Forest plot. Adult participants ‐ platelet count ‐ high‐risk varices.
23
23
Forest plots. Adult participants ‐ platelet count ‐ various cut‐off values ‐ high‐risk varices.
24
24
Studies in the ROC space. Adult participants ‐ platelet count ‐ various cut‐off values ‐ high‐risk varices.
25
25
Forest plot. Adult participants ‐ spleen length ‐ high‐risk varices.
26
26
Forest plot. Adult participants ‐ platelet count‐to‐spleen length ratio ‐ high‐risk varices.
27
27
Forest plot. Adult participants ‐ platelet count‐to‐spleen length ratio ‐ cut‐off around 909 (n/mm3)/mm ‐ high‐risk varices.
28
28
Studies in the ROC space. Adult participants ‐ platelet count‐to‐spleen length ratio ‐ cut‐off around 909 (n/mm3)/mm ‐ high‐risk varices.
29
29
Indirect comparison. Forest plot. Adult participants ‐ platelet count compared with spleen length ‐ high‐risk varices.
30
30
Indirect comparison. Forest plots. Adult participants ‐ platelet count compared with platelet count‐to‐spleen length ratio ‐ high‐risk varices.
31
31
Direct comparison. Forest plots. Adult participants ‐ platelet count compared with platelet count‐to‐spleen length ratio ‐ high‐risk varices.
32
32
Indirect comparison. Forest plots. Adult participants ‐ platelet count (cut‐off around 150.000/mm3) compared with platelet count‐to‐spleen length ratio (cut‐off 909 (n/mm3)/mm) ‐ high‐risk varices.
33
33
Indirect comparison. Studies in the ROC space. Adult participants ‐ platelet count (cut‐off around 150,000/mm3) compared with platelet count‐to‐spleen length ratio (cut‐off 909 (n/mm3)/mm) ‐ high‐risk varices.
34
34
Indirect comparison. Forest plots. Adult participants ‐ platelet count‐to‐spleen length ratio compared with spleen length ‐ high‐risk varices.
35
35
Forest plot. Paediatric participants ‐ platelet count ‐ any varices.
36
36
Forest plot. Paediatric participants ‐ platelet count‐to‐spleen length z‐score ratio ‐ any varices.
1
1. Test
Adults ‐ platelet count ‐ any varices.
2
2. Test
Adults ‐ platelet count ‐ any varices ‐ cut‐off around 100,000.
3
3. Test
Adults ‐ platelet count ‐ any varices ‐ cut‐off around 120,000.
4
4. Test
Adults ‐ platelet count ‐ any varices ‐ cut‐off around 150,000.
5
5. Test
Adults ‐ platelet/spleen ratio ‐ any varices.
6
6. Test
Adults ‐ platelet/spleen ratio ‐ any varices ‐ cut‐off 909.
7
7. Test
Adults ‐ spleen diameter ‐ any varices.
8
8. Test
Adults ‐ spleen diameter ‐ any varices ‐ cut‐off around 110 mm.
9
9. Test
Adults ‐ spleen diameter ‐ any varices ‐ cut‐off around 150 mm.
10
10. Test
Adults ‐ platelet count ‐ high‐risk varices.
11
11. Test
Adults ‐ platelet count ‐ high‐risk varices ‐ cut‐off around 90,000.
12
12. Test
Adults ‐ platelet count ‐ high‐risk varices ‐ cut‐off around 150,000.
13
13. Test
Adults ‐ platelet/spleen ratio ‐ high‐risk varices.
14
14. Test
Adults ‐ platelet/spleen ratio ‐ high‐risk varices ‐ cut‐off around 909.
15
15. Test
Adults ‐ spleen diameter ‐ high‐risk varices.
16
16. Test
Paediatrics ‐ platelet count ‐ any varices.
17
17. Test
Paediatrics ‐ platelet/spleen ratio z‐score ‐ any varices.
See this image and copyright information in PMC

Update of

  • doi: 10.1002/14651858.CD008759

Similar articles

See all similar articles

Cited by

See all "Cited by" articles

References

References to studies included in this review

Abd‐Elsalam 2016b {published data only}
    1. Abd‐Elsalam S, Habba E, Elkhalawany W, Tawfeek S, Elbatea H, El‐Kalla F, et al. Correlation of platelet count with endoscopic findings in a cohort of Egyptian patients with liver cirrhosis. Medicine (Baltimore) 2016;95:e3853. - PMC - PubMed
    1. Habba E, Abd‐Elsalam S, Ibrahim S, Dwidar A. Correlation of platelet count with endoscopic findings in Egyptian patients with liver cirrhosis. Hepatology International 2016;10:S365. - PMC - PubMed
Abu 2011 {published data only}
    1. Abu El Makarem MA, Shatat ME, Shaker Y, Abdel Aleem AA, Sherif AM, Moaty MA, et al. Platelet count/bipolar spleen diameter ratio for the prediction of esophageal varices: the special Egyptian situation. Hepatitis Monthly 2011;11(4):278‐84. - PMC - PubMed
Adami 2013 {published data only}
    1. Adami MR, Ferreira CT, Kieling CO, Hirakata V, Vieira SMG. Noninvasive methods for prediction of esophageal varices in pediatric patients with portal hypertension. World Journal of Gastroenterology 2013;19(13):2053‐9. - PMC - PubMed
Agha 2009 {published data only}
    1. Agha A, Anwar E, Bashir K, Savarino V, Giannini EG. External validation of the platelet count/spleen diameter ratio for the diagnosis of esophageal varices in hepatitis C virus‐related cirrhosis. Digestive Diseases and Sciences 2009;54(3):654‐60. [PUBMED: 18594972] - PubMed
Agha 2011 {published data only}
    1. Agha A, Abdulhadi MM, Marenco S, Bella A, Alsaudi D, Haddad A, et al. Use of the platelet count/spleen diameter ratio for the noninvasive diagnosis of esophageal varices in patients with schistosomiasis. Saudi Journal of Gastroenterology 2011;17(5):307‐11. - PMC - PubMed
Alcantara 2012 {published data only}
    1. Alcantara RV, Yamada RM, Tommaso A, Bellomo‐Brandão MA, Hessel G. Non‐invasive predictors of esophageal varices in children and adolescents with chronic liver disease or extrahepatic portal venous obstruction. Jornal de Pediatria 2012;88(4):341‐6. - PubMed
Amin 2012 {published data only}
    1. Amin K, Muhammad D, Anjum A, Jamil K, Hassan A. Platelet count to spleen diameter ratio as a predictor of esophageal varices in patients of liver cirrhosis due to hepatitis C virus. Journal of University Medical Dental College 2012;3:6‐11.
Aqodad 2011 {published data only}
    1. Aqodad N, Ighoudane H, Elyousfi M, Mellouki I, Elabkari M, Benajeh D, et al. Correlation of platelet count with grading of esophageal varices in cirrhotic patients. Hepatology International 2011;5(1):362.
Baig 2008 {published data only}
    1. Baig WW, Nagaraja MV, Varma M, Prabhu R. Platelet count to spleen diameter ratio for the diagnosis of esophageal varices: is it feasible?. Canadian Journal of Gastroenterology 2008;22(10):825‐8. - PMC - PubMed
Barikbin 2010 {published data only}
    1. Barikbin R, Hekmatnia A, Omidifar N, Farghadani M, Adibi P. Prediction severity of esophageal varices: a new cutoff point for platelet count/spleen diameter ratio. Minerva Gastroenterologica e Dietologica 2010;56(1):1‐6. - PubMed
Burton 2007a {published data only}
    1. Burton JR Jr, Liangpunsakul S, Lapidus J, Giannini E, Chalasani N, Zaman A. Validation of a multivariate model predicting presence and size of varices. Journal of Clinical Gastroenterology 2007;41(6):609‐15. - PubMed
Burton 2007b {published data only}
    1. Burton JR Jr, Liangpunsakul S, Lapidus J, Giannini E, Chalasani N, Zaman A. Validation of a multivariate model predicting presence and size of varices. Journal of Clinical Gastroenterology 2007;41(6):609‐15. - PubMed
Burton 2007c {published data only}
    1. Burton JR Jr, Liangpunsakul S, Lapidus J, Giannini E, Chalasani N, Zaman A. Validation of a multivariate model predicting presence and size of varices. Journal of Clinical Gastroenterology 2007;41(6):609‐15. - PubMed
Burton 2007d {published data only}
    1. Burton JR Jr, Liangpunsakul S, Lapidus J, Giannini E, Chalasani N, Zaman A. Validation of a multivariate model predicting presence and size of varices. Journal of Clinical Gastroenterology 2007;41(6):609‐15. - PubMed
Camma 2009 {published data only}
    1. Camma C, Petta S, Marco V, Bronte F, Ciminnisi S, Licata G, et al. Insulin resistance is a risk factor for esophageal varices in hepatitis C virus cirrhosis. Hepatology (Baltimore, Md) 2009;49(1):195‐203. [PUBMED: 19065558] - PubMed
Castera 2009 {published data only}
    1. Castera L, Bail B, Roudot‐Thoraval F, Bernard PH, Foucher J, Merrouche W, et al. Early detection in routine clinical practice of cirrhosis and oesophageal varices in chronic hepatitis C: comparison of transient elastography (FibroScan) with standard laboratory tests and non‐invasive scores. Journal of Hepatology 2009;50(1):59‐68. - PubMed
Cherian 2011 {published data only}
    1. Cherian JV, Deepak N, Ponnusamy RP, Somasundaram A, Jayanthi V. Non‐invasive predictors of esophageal varices. Saudi Journal of Gastroenterology 2011;17(1):64‐8. - PMC - PubMed
Chiodi 2014 {published data only}
    1. Chiodi D, Hernandez N, Saona G, Sanchez A, Berrueta J, Mescia G, et al. [Noninvasive diagnosis of esophageal varices in cirrhotic patients] [Spanish]. Acta Gastroenterologica Latinoamericana 2014;44(2):108‐13. - PubMed
Colecchia 2011 {published data only}
    1. Colecchia A, Biase AR, Scaioli E, Predieri B, Iughetti L, Reggiani MLB, et al. Non‐invasive methods can predict oesophageal varices in patients with biliary atresia after a Kasai procedure. Digestive and Liver Disease 2011;43(8):659‐63. - PubMed
Colecchia 2012 {published data only}
    1. Colecchia A, Montrone L, Scaioli E, Bacchi‐Reggiani ML, Colli A, Casazza G, et al. Measurement of spleen stiffness to evaluate portal hypertension and the presence of esophageal varices in patients with HCV‐related cirrhosis. Gastroenterology 2012;143(3):646‐54. - PubMed
De Mattos 2010 {published data only}
    1. Mattos AZ, Mattos AA, Vianna FF, Musskopf MI, Pereira‐Lima JC, Maciel AC. Platelet count/spleen diameter ratio: analysis of its capacity as a predictor of the existence of esophageal varices. Arquivos de Gastroenterologia 2010;47(3):275‐8. - PubMed
Ding 2016 {published data only}
    1. Ding NS, Nguyen T, Iser DM, Hong T, Flanagan E, Wong A, et al. Liver stiffness plus platelet count can be used to exclude high‐risk oesophageal varices. Liver International 2016;36(2):240‐5. [CRS: 6800131000104399; EMBASE: 20151018144] - PubMed
Ditchfield 1992 {published data only}
    1. Ditchfield MR, Gibson RN, Donlan JD, Gibson PR. Duplex Doppler ultrasound signs of portal hypertension: relative diagnostic value of examination of paraumbilical vein, portal vein and spleen. Australasian Radiology 1992;36(2):102‐5. [PUBMED: 1520164] - PubMed
El Makarem 2011 {published data only}
    1. Abu El Makarem MA, Shatat ME, Shaker Y, Abdel Aleem AA, Sherif AM, Moaty MA, et al. Platelet count/bipolar spleen diameter ratio for the prediction of esophageal varices: the special Egyptian situation. Hepatitis Monthly 2011;11:278‐84. - PMC - PubMed
El Ray 2015 {published data only}
    1. Ray A, Azab MM, El‐Aziz IM, El‐Aleem AA, El‐Talkawy MD, El‐Badea MA, et al. Non‐invasive predictors for the presence, grade and risk of bleeding from esophageal varices in patients with post‐hepatic cirrhosis. Journal of the Egyptian Society of Parasitology 2015;45:421‐8. - PubMed
Esmat 2012 {published data only}
    1. Esmat S, Omarn D, Rashid L. Can we consider the right hepatic lobe size/albumin ratio a noninvasive predictor of oesophageal varices in hepatitis C virus‐related liver cirrhotic Egyptian patients?. European Journal of Internal Medicine 2012;23(3):267‐72. - PubMed
Gana 2011 {published data only}
    1. Gana JC, Turner D, Mieli‐Vergani G, Davenport M, Miloh T, Avitzur Y, et al. A clinical prediction rule and platelet count predict esophageal varices in children. Gastroenterology 2011;141(6):2009‐16. - PubMed
Gentile 2009 {published data only}
    1. Gentile I, Viola C, Graf M, Liuzzi R, Quarto M, Cerini R. A simple noninvasive score predicts gastroesophageal varices in patients with chronic viral hepatitis. Journal of Clinical Gastroenterology 2009;43(1):81‐7. - PubMed
Giannini 2003a {published data only}
    1. Giannini E, Botta F, Borro P, Risso D, Romagnoli P, Fasoli A, et al. Platelet count/spleen diameter ratio: proposal and validation of a non‐invasive parameter to predict the presence of oesophageal varices in patients with liver cirrhosis. Gut 2003;52(8):1200‐5. [PUBMED: 12865282] - PMC - PubMed
Giannini 2003b {published data only}
    1. Giannini E, Botta F, Borro P, Risso D, Romagnoli P, Fasoli A, et al. Platelet count/spleen diameter ratio: proposal and validation of a non‐invasive parameter to predict the presence of oesophageal varices in patients with liver cirrhosis. Gut 2003;52(8):1200‐5. [PUBMED: 12865282] - PMC - PubMed
Giannini 2005 {published data only}
    1. Giannini EG, Botta F, Borro P, Dulbecco P, Testa E, Mansi C, et al. Application of the platelet count/spleen diameter ratio to rule out the presence of oesophageal varices in patients with cirrhosis: a validation study based on follow‐up. Digestive and Liver Disease 2005;37(10):779‐85. [PUBMED: 15996912] - PubMed
Giannini 2006 {published data only}
    1. Giannini EG, Zaman A, Kreil A, Floreani A, Dulbecco P, Testa E, et al. Platelet count/spleen diameter ratio for the noninvasive diagnosis of esophageal varices: results of a multicenter, prospective, validation study. American Journal of Gastroenterology 2006;101(11):2511‐9. [PUBMED: 17029607] - PubMed
Gonzalez‐Ojeda 2014 {published data only}
    1. Gonzalez‐Ojeda A, Cervantes‐Guevara G, Chavez‐Sanchez M, Davalos‐Cobian C, Ornelas‐Cazares S, Macias‐Amezcua MD, et al. Platelet count/spleen diameter ratio to predict esophageal varices in Mexican patients with hepatic cirrhosis. World Journal of Gastroenterology 2014;20(8):2079‐84. - PMC - PubMed
Grgurevic 2014 {published data only}
    1. Grgurevic I, Jukic I, Sokol S, Banic M, Bilic B, Gunjaca I, et al. Low specificity of platelet to spleen ratio for noninvasive prediction and characterization of esophageal varices in patients with alcoholic liver cirrhosis [Omjer broja trombocita i velicine slezene ima nisku specificnost u neinvazivnoj predikciji i karakterizaciji varikoziteta jednjaka kod bolesnika s alkoholnom cirozom jetre]. Acta Medica Croatica 2014;68(4‐5):353‐60. [CRS: 6800131000062413; EMBASE: 2015400928; JC‐‐NLM: Journal ID:bh2, 9208249; PUBMED: 26285468] - PubMed
Jeon 2006 {published data only}
    1. Jeon SW, Cho CM, Tak WY, Ryeom HK, Kweon YO, Kim SK, et al. The value of Doppler‐ultrasonography and laboratory tests as non‐invasive predictors of the presence of esophageal varices in patients with chronic liver disease. Korean Journal of Gastroenterology 2006;48(3):180‐7. [PUBMED: 17047433] - PubMed
Karatzas 2016 {published data only}
    1. Karatzas A, Triantos C, Kalafateli M, Marzigie M, Labropoulou‐Karatza C, Thomopoulos K, et al. Multidetector computed tomography versus platelet/spleen diameter ratio as methods for the detection of gastroesophageal varices. Annals of Gastroenterology 2016;29(1):71‐8. [CRS: 6800131000104406; EMBASE: 20160031721] - PMC - PubMed
Legasto 2006 {published data only}
    1. Legasto JMA, Sevilla J, Balay A, Tan JA, Cham LV, Vitug A, et al. Platelet count/spleen diameter ratio: a noninvasive parameter to predict the presence of esophageal varices. Philippine Journal of Gastroenterology 2006;2:33‐8.
Lei 2007 {published data only}
    1. Lei JB, Huang TZ. Value of the platelet count/spleen diameter ratio on predicting esophageal varices of liver cirrhosis. Practical Clinical Medicine 2007;8:25‐7.
Levy 2007a {published data only}
    1. Levy C, Zein CO, Gomez J, Soldevila‐Pico C, Firpi R, Morelli G, et al. Prevalence and predictors of esophageal varices in patients with primary biliary cirrhosis. Clinical Gastroenterology and Hepatology 2007;5(7):803‐8. [PUBMED: 17544879] - PubMed
Levy 2007b {published data only}
    1. Levy C, Zein CO, Gomez J, Soldevila‐Pico C, Firpi R, Morelli G, et al. Prevalence and predictors of esophageal varices in patients with primary biliary cirrhosis. Clinical Gastroenterology and Hepatology 2007;5(7):803‐8. [PUBMED: 17544879] - PubMed
Madhotra 2002 {published data only}
    1. Madhotra R, Mulcahy HE, Willner I, Reuben A. Prediction of esophageal varices in patients with cirrhosis. Journal of Clinical Gastroenterology 2002;34(1):81‐5. [PUBMED: 11743252] - PubMed
Mahassadi 2012a {published data only}
    1. Mahassadi AK, Bathaix FY, Assi C, Bangoura AD, Allah‐Kouadio E, Kissi HY, et al. Usefulness of noninvasive predictors of oesophageal varices in black African cirrhotic patients in Cote d'Ivoire (West Africa). Gastroenterology Research and Practice 2012;2012:(no pagination). [CRS: 6800131000104543; EMBASE: 2012476143] - PMC - PubMed
Mahassadi 2012b {published data only}
    1. Mahassadi AK, Bathaix FY, Assi C, Bangoura AD, Allah‐Kouadio E, Kissi HY, et al. Usefulness of noninvasive predictors of oesophageal varices in black African cirrhotic patients in Cote d'Ivoire (West Africa). Gastroenterology Research and Practice 2012;2012:(no pagination). [CRS: 6800131000104543; EMBASE: 2012476143] - PMC - PubMed
Mosqueira 2011 {published data only}
    1. Mosqueira JR, Montiel JB, Rodriguez D, Monge E. Evaluation of the diagnostic test of index platelet counts/size spleen, as a predictor of the presence of esophageal varices in cirrhosis [Spanish]. Revista de Gastroenterologia del Peru 2011;31(1):11‐6. - PubMed
Parrino 2008 {published data only}
    1. Parrino A, Gesaro V, Terranova A, Sesti R, Corsale S, Patti AM, et al. Non‐invasive diagnosis of esophageal varices in cirrhotic patients: endoscopic vs ultrasonographic findings [Italian]. Acta Medica Mediterranea 2008;24(1):11‐8.
Pilette 1999 {published data only}
    1. Pilette C, Oberti F, Aube C, Rousselet MC, Bedossa P, Gallois Y, et al. Non‐invasive diagnosis of esophageal varices in chronic liver diseases. Journal of Hepatology 1999;31(5):867‐73. [PUBMED: 10580584] - PubMed
Prihatini 2005 {published data only}
    1. Prihatini J, Lesmana LA, Manan C, Gani RA. Detection of esophageal varices in liver cirrhosis using non‐invasive parameters. Acta Medica Indonesiana 2005;37(3):126‐31. [PUBMED: 16110174] - PubMed
Primignani 2002 {published data only}
    1. Primignani M, Savojardo V, Dell'Era A, Fazzini L, Zatelli S, Pedotti P, et al. Presence of esophageal varices in patients with a recent histologic diagnosis of cirrhosis of the liver: evaluation of clinical predictors. Gastroenterology 2002; Vol. 122, issue Suppl 4:A354.
Sanyal 2006 {published data only}
    1. Sanyal AJ, Fontana RJ, Bisceglie AM, Everhart JE, Doherty MC, Everson GT, et al. The prevalence and risk factors associated with esophageal varices in subjects with hepatitis C and advanced fibrosis. Gastrointestinal Endoscopy 2006;64(6):855‐64. [PUBMED: 17140886] - PubMed
Sarangapani 2010 {published data only}
    1. Sarangapani A, Shanmugam C, Kalyanasundaram M, Rangachari B, Thangavelu P, Subbarayan JK. Noninvasive prediction of large esophageal varices in chronic liver disease patients. Saudi Journal of Gastroenterology 2010;16(1):38‐42. - PMC - PubMed
Schwarzenberger 2010 {published data only}
    1. Schwarzenberger E, Meyer T, Golla V, Sahdala NP, Min AD. Utilization of platelet count spleen diameter ratio in predicting the presence of esophageal varices in patients with cirrhosis. Journal of Clinical Gastroenterology 2010;44(2):146‐50. - PubMed
Sebastiani 2010 {published data only}
    1. Sebastiani G, Tempesta D, Fattovich G, Castera L, Halfon P, Bourliere M, et al. Prediction of oesophageal varices in hepatic cirrhosis by simple serum non‐invasive markers: results of a multicenter, large‐scale study. Journal of Hepatology 2010;53(4):630‐8. - PubMed
Sen 2008a {published data only}
    1. Sen S, Griffiths WJH. Non‐invasive prediction of oesophageal varices in cirrhosis. World Journal of Gastroenterology 2008;14:2454‐5. - PMC - PubMed
Sen 2008b {published data only}
    1. Sen S, Griffiths WJH. Non‐invasive prediction of oesophageal varices in cirrhosis. World Journal of Gastroenterology 2008;14:2454‐5. - PMC - PubMed
Sharma 2013 {published data only}
    1. Sharma P, Kirnake V, Tyagi P, Bansal N, Singla V, Kumar A, et al. Spleen stiffness in patients with cirrhosis in predicting esophageal varices. American Journal of Gastroenterology 2013;108(7):1101‐7. - PubMed
Sharma 2014 {published data only}
    1. Sharma J, Yadav MK, Gupta A, Arya TS. A study of role of platelet count/spleen diameter ratio as a predictor of esophageal varices in patient with chronic liver disease. National Journal of Medical Research 2014;4(3):232‐4.
    1. Sharma J, Yadav MK, Gupta A, Arya TS. A study of the role of platelet count/spleen diameter ratio as a predictor of esophageal varices in patients with chronic liver disease. Indian Journal of Gastroenterology 2012;31(1 Suppl):A136‐7.
Sheta 2016 {published data only}
    1. Abd‐Elsalam SM, Sheta EA, Yousef M, Mohamed REE, Amer I, Ismail A. Non invasive diagnosis of esophageal varices: can it replace screening endoscopy?. Hepatology International 2016;10(1 Suppl):S496. [CRS: 6800131000104388; EMBASE: 72201392]
    1. Sheta EAE, Yousef M, Abd‐Elsalam S, Mohamed REE, Ismail A, El‐Kalla F, et al. Non invasive diagnosis of esophageal varices: can it replace screening endoscopy?. International Journal of Current Microbiology and Applied Sciences 2016;5:701‐16.
Stefanescu 2011 {published data only}
    1. Stefanescu H, Grigorescu M, Lupsor M, Procopet B, Maniu A, Badea R. Spleen stiffness measurement using fibroscan for the noninvasive assessment of esophageal varices in liver cirrhosis patients. Journal of Gastroenterology and Hepatology 2011;26:164‐70. - PubMed
Tafarel 2011 {published data only}
    1. Tafarel JR, Tolentino LHL, Correa LM, Bonilha DR, Piauilino P, Martins FP, et al. Prediction of esophageal varices in hepatic cirrhosis by noninvasive markers. European Journal of Gastroenterology & Hepatology 2011;23(9):754‐8. - PubMed
Takuma 2013 {published data only}
    1. Takuma Y, Nouso K, Morimoto Y, Tomokuni J, Sahara A, Toshikuni N, et al. Measurement of spleen stiffness by acoustic radiation force impulse imaging identifies cirrhotic patients with esophageal varices. Gastroenterology 2013;144(1):92‐101. - PubMed
Tarantino 2009 {published data only}
    1. Tarantino G, Citro V, Esposito P, Giaquinto S, Leone A, Milan G, et al. Blood ammonia levels in liver cirrhosis: a clue for the presence of portosystemic collateral veins. BMC Gastroenterology 2009;9:21. [PUBMED: 19292923] - PMC - PubMed
Wadhva 2012 {published data only}
    1. Wadhva R, Abbas Z, Luck NH, Hassan SM, Abubakr M. Platelet count to splenic diameter ratio and splenoportal index for predicting esophageal varices among patients with cirrhosis. Hepatology International 2012;6(1):294.
Wang CC 2015 {published data only}
    1. Wang C‐C, Tsai M‐C, Yang T‐W, Lin C‐B, Chen T‐Y, Lin C‐C. Acoustic radiation force impulse sonography‐based non‐invasive prediction of esophageal varices. Journal of Gastroenterology and Hepatology 2015;30(Suppl S4):367‐8. [CRS: 6800131000104411; EMBASE: 72135359]
Wang HM 2012 {published data only}
    1. Wang H‐M, Lo G‐H, Chen W‐C, Hsu P‐I, Yu H‐C, Lin C‐K, et al. Efficacy of transient elastography in screening for large esophageal varices in patients with suspicious or proven liver cirrhosis. Journal of Digestive Diseases 2012;13(8):430‐8. - PubMed
Wang JH 2012 {published data only}
    1. Wang J‐H, Chuah S‐K, Lu S‐N, Hung C‐H, Chen C‐H, Kee K‐M. Transient elastography and simple blood markers in diagnosis of oesophageal varices for compensated patients with hepatitis B virus‐related cirrhosis. Hepatology International 2012;6(1):6. - PubMed
Xu 2016a {published data only}
    1. Xu X‐D, Xu C‐F, Dai J‐J, Qian J‐Q, Pin X. Ratio of platelet count/spleen diameter predicted the presence of esophageal varices in patients with schistosomiasis liver cirrhosis. European Journal of Gastroenterology & Hepatology 2016;28(5):588‐91. [CRS: 6800131000104363; EMBASE: 20160122451] - PubMed
Zafar 2014 {published data only}
    1. Zafar S, Latif MM. Diagnostic accuracy of platelet count/spleen diameter ratio for detection of esophageal varices in cirrhotic patients taking endoscopy as gold standard. Pakistan Journal of Medical and Health Sciences 2014;8(4):951‐4.
Zaman 2001 {published data only}
    1. Zaman A, Becker T, Lapidus J, Benner K. Risk factors for the presence of varices in cirrhotic patients without a history of variceal hemorrhage. Archives of Internal Medicine 2001;161(21):2564‐70. - PubMed
Zein 2004a {published data only}
    1. Zein CO, Lindor KD, Angulo P. Prevalence and predictors of esophageal varices in patients with primary sclerosing cholangitis. Hepatology (Baltimore, Md) 2004;39(1):204‐10. [PUBMED: 14752839] - PubMed
Zein 2004b {published data only}
    1. Zein CO, Lindor KD, Angulo P. Prevalence and predictors of esophageal varices in patients with primary sclerosing cholangitis. Hepatology (Baltimore, Md) 2004;39(1):204‐10. [PUBMED: 14752839] - PubMed
Zimbwa 2004 {published data only}
    1. Zimbwa TA, Blanshard C, Subramaniam A. Platelet count/spleen diameter ratio as a predictor of oesophageal varices in alcoholic cirrhosis. Gut 2004; Vol. 53, issue 7:1055. [PUBMED: 15194662] - PMC - PubMed

References to studies excluded from this review

Albreedy 2015 {published data only}
    1. Albreedy AM. Platelet count to spleen diameter ratio and to spleen area ratio as predictors for esophageal varices in chronic hepatitis C patients with liver cirrhosis. Journal of the Egyptian Society of Parasitology 2015;45:485‐92. - PubMed
Amarapurkar 1994 {published data only}
    1. Amarapurkar DN, Parikh SS, Shankaran K, Chopra K, Dhawan P, Kalro RH, et al. Correlation between splenomegaly and oesophageal varices in patients with liver cirrhosis. Endoscopy 1994; Vol. 26, issue 6:563. [PUBMED: 7828573] - PubMed
Barrera 2009 {published data only}
    1. Barrera F, Riquelme A, Soza A, Contreras A, Barrios G, Padilla O, et al. Platelet count/spleen diameter ratio for non‐invasive prediction of high risk esophageal varices in cirrhotic patients. Annals of Hepatology 2009;8(4):325‐30. - PubMed
Chalasani 1999 {published data only}
    1. Chalasani N, Imperiale TF, Ismail A, Sood G, Carey M, Wilcox CM, et al. Predictors of large esophageal varices in patients with cirrhosis. American Journal of Gastroenterology 1999;94(11):3285‐91. [PUBMED: 10566731] - PubMed
Cho 2015 {published data only}
    1. Cho EJ, Kim MY, Lee JH, Lee IY, Lim YL, Choi DH, et al. Diagnostic and prognostic values of noninvasive predictors of portal hypertension in patients with alcoholic cirrhosis. PloS One 2015;10(7):e0133935. [CRS: 6800131000104272; JC‐‐NLM: Journal ID:101285081; OI:SOURCE:: NLM. PMC4511411; PUBMED: 26196942] - PMC - PubMed
El Guindi 2008 {published data only}
    1. Guindi M, Arabi H, Henawy I, Basiouny H. Non‐invasive parameters as predictors for esophageal varices in children with chronic liver disease. Hepatology (Baltimore, Md) 2008; Vol. 48, issue 4 Suppl:1040A.
El‐Sherif 2008 {published data only}
    1. Sherif AM, Abou‐Shady MA, Al Bahrawy AM, Bakr RM, Hosny A. Nitric oxide levels in chronic liver disease patients with and without oesophageal varices. Hepatology International 2008;2:341‐5. - PMC - PubMed
Fagundes 2008 {published data only}
    1. Fagundes ED, Ferreira AR, Roquete ML, Penna FJ, Goulart EM, Figueiredo Filho PP, et al. Clinical and laboratory predictors of esophageal varices in children and adolescents with portal hypertension syndrome. Journal of Pediatric Gastroenterology and Nutrition 2008;46(2):178‐83. [PUBMED: 18223377] - PubMed
Gana 2010 {published data only}
    1. Gana JC, Turner D, Roberts EA, Ling SC. Derivation of a clinical prediction rule for the noninvasive diagnosis of varices in children. Journal of Pediatric Gastroenterology and Nutrition 2010;50:188‐93. - PubMed
Giannini 2007 {published data only}
    1. Giannini EG, Anwar E, Bashir K, Savarino V, Agha A. Platelet count/spleen diameter ratio and AASLD criterion for screening esophageal varices in patients with hepatitis C virus related compensated cirrhosis. Hepatology (Baltimore, Md) 2007; Vol. 46, issue 4 Suppl 1:568A.
Hong 2009 {published data only}
    1. Hong WD, Zhu QH, Huang ZM, Chen XR, Jiang ZC, Xu SH, et al. Predictors of esophageal varices in patients with HBV‐related cirrhosis: a retrospective study. BMC Gastroenterology 2009;9:11. [PUBMED: 19196464] - PMC - PubMed
Koncoro 2014 {published data only}
    1. Koncoro H, Mariadi K, Somayana G, Suryadarma GA, Purwadi N, Wibawa DN. Prediction of large esophageal varices among patients with liver cirrhosis in Sanglah Hospital Danpasar. Journal of Gastroenterology and Hepatology 2014;29(Suppl S3):193.
Lee 2009 {published data only}
    1. Lee JH, Yoon JH, Lee CH, Myung SJ, Keam B, Kim BH, et al. Complete blood count reflects the degree of oesophageal varices and liver fibrosis in virus‐related chronic liver disease patients. Journal of Viral Hepatitis 2009;16(6):444‐52. [PUBMED: 19200133] - PubMed
Malik 2015 {published data only}
    1. Malik K, Batool F, Khan SA, ul Amir Z. Platelet count/splenic size ratio as a non‐invasive parameter to predict the presence of esophageal varices in cirrhotics. Rawal Medical Journal 2015;40(4):371‐4. [CRS: 6800131000063484; EMBASE: 2015504984]
Nashaat 2010 {published data only}
    1. Nashaat EH, Abd‐Elaziz H, Sabry M, Ibrahim AA. Non‐endoscopic predictors of esophageal varices and portal hypertensive gastropathy. Nature and Science 2010;8:43‐50.
Nazish 2011 {published data only}
    1. Nazish Z, Inayatullah M, Tanweer S. Non endoscopic predictors of esophageal varices in cirrhotics. Medical Forum Monthly 2011;22:3‐7.
Ng 1999 {published data only}
    1. Ng FH, Wong SY, Loo CK, Lam KM, Lai CW, Cheng CS. Prediction of oesophagogastric varices in patients with liver cirrhosis. Journal of Gastroenterology and Hepatology 1999;14(8):785‐90. [PUBMED: 10482429] - PubMed
Park 2015 {published data only}
    1. Park Y, Kim SU, Park SY, Kim BK, Park JY, Kim DY, et al. A novel model to predict esophageal varices in patients with compensated cirrhosis using acoustic radiation force impulse elastography. PLoS One 2015;10(3):e0121009. - PMC - PubMed
Qamar 2008 {published data only}
    1. Qamar AA, Grace ND, Groszmann RJ, Garcia‐Tsao G, Bosch J, Burroughs AK. Platelet count is not a predictor of the presence or development of gastroesophageal varices in cirrhosis. Hepatology (Baltimore, Md) 2008;47:153‐9. - PubMed
Rockey 2016 {published data only}
    1. Rockey DC, Elliott A, Lyles T. Prediction of esophageal varices and variceal hemorrhage in patients with acute upper gastrointestinal bleeding. Journal of Investigative Medicine 2016;64(3):745‐51. [CRS: 6800131000104572] - PubMed
Sebastiani 2008 {published data only}
    1. Sebastiani G, Albert A, Castera l, Halfon P, Bourliere M, Angeli P, et al. Prediction of oesophageal varices in hepatic cirrhosis by simple non invasive markers: results of a multicenter, international study. Hepatology (Baltimore, Md) 2008; Vol. 48, issue 4 Suppl:624A. - PubMed
Sethar 2006 {published data only}
    1. Sethar GH, Ahmed R, Rathi SK, Shaikh NA. Platelet count/splenic size ratio: a parameter to predict the presence of esophageal varices in cirrhotics. Journal of the College of Physicians and Surgeons ‐ Pakistan 2006;16(3):183‐6. [PUBMED: 16542615] - PubMed
Shah 2011 {published data only}
    1. Shah ZH, Sarwar S, Saleem K, Abaidullah S, Mehboob F, Afzal A. Identification of non‐endoscopic predictors of esophageal varices in cirrhosis. Pakistan Journal of Medical and Health Sciences 2011;5:257‐61.
Sharma 2007 {published data only}
    1. Sharma SK, Aggarwal R. Prediction of large esophageal varices in patients with cirrhosis of the liver using clinical, laboratory and imaging parameters. Journal of Gastroenterology and Hepatology 2007;22(11):1909‐15. [PUBMED: 17914969] - PubMed
Takuma 2016 {published data only}
    1. Takuma Y, Nouso K, Morimoto Y, Tomokuni J, Sahara A, Takabatake H, et al. Portal hypertension in patients with liver cirrhosis: diagnostic accuracy of spleen stiffness. Radiology 2016;279(2):609‐19. [CRS: 6800131000104355; EMBASE: 20160357558] - PubMed
Tao 2008 {published data only}
    1. Tao W, Yang SQ, Lv XC, Yang L. Value of the platelet count/spleen diameter ratio on diagnosis of esophageal varices in patients with cirrhosis. Journal of Ningxia Medical College 2008;30:349‐50.
Thayumanavan 2012 {published data only}
    1. Thayumanavan L, Jaisankar P, Ramani R, Kannan M, Sangumani J, Sreeraj V. Validating the usefulness of doppler study of hepatic veins in predicting esophageal varices in cirrhotic patients. Journal of Clinical and Experimental Hepatology 2012;2(1 Suppl):S19.
Thomopoulos 2003 {published data only}
    1. Thomopoulos KC, Labropoulou‐Karatza C, Mimidis KP, Katsakoulis EC, Iconomou G, Nikolopoulou VN. Non‐invasive predictors of the presence of large oesophageal varices in patients with cirrhosis. Digestive and Liver Disease 2003;35(7):473‐8. [PUBMED: 12870732] - PubMed
Treeprasertsuk 2010 {published data only}
    1. Treeprasertsuk S, Kowdley KV, Luketic VAC, Harrison ME, Mccashland T, Befeler AS. The predictors of the presence of varices in patients with primary sclerosing cholangitis. Hepatology (Baltimore, Md) 2010;51:1302‐10. - PMC - PubMed
Valente {published data only}
    1. Valente Pinto M, Castanhinha S, Pereira L, Lopes AI, Barreto C. Liver disease in children with cystic fibrosis ‐ The contribution of ultrasound evaluation. Journal of Cystic Fibrosis 2013;12(Suppl 1):S112.
Yu 2008 {published data only}
    1. Yu JY, Liu XN, Wang D, Cui JJ. Non‐invasive predictive factors of esophageal varices in patients with post‐hepatitis B cirrhosis. Journal of Binzhou Medical University 2008;31:345‐9.
Zaman 1999 {published data only}
    1. Zaman A, Hapke R, Flora K, Rosen HR, Benner K. Factors predicting the presence of esophageal or gastric varices in patients with advanced liver disease. American Journal of Gastroenterology 1999;94(11):3292‐6. [PUBMED: 10566732] - PubMed
Zhang 2013 {published data only}
    1. Zhang J, Tao R, You Z, Dai Y, Fan Y, Cui J, et al. Gamna‐Gandy bodies of the spleen detected with susceptibility weighted imaging: maybe a new potential non‐invasive marker of esophageal varices. PloS One 2013;8(1):e55626. [CRS: 6800131000104538; EMBASE: 2013079030] - PMC - PubMed
Zhang 2016 {published data only}
    1. Zhang C‐X, Xu J‐M, Li J‐B, Kong D‐R, Wang L, Xu X‐Y, et al. Predict esophageal varices via routine trans‐abdominal ultrasound: a design of classification analysis model. Journal of Gastroenterology and Hepatology (Australia) 2016;31(1):194‐9. [CRS: 6800131000104397; EMBASE: 20160106034] - PubMed

Additional references

Abraldes 2016
    1. Abraldes JG, Bureau C, Stefanescu H, Augustin S, Ney M, Blasco H, et al. Non‐invasive tools and risk of clinically significant portal hypertension and varices in compensated cirrhosis: the "Anticipate" study. Hepatology 2016 Sep 17 [Epub ahead of print]. [DOI: 10.1002/hep.28824] - DOI - PubMed
Adams 2004
    1. Adams PC, Arthur MJ, Boyer TD, DeLeve LD, Bisceglie AM, Hall M, et al. Screening in liver disease: report of an AASLD clinical workshop. Hepatology (Baltimore, Md) 2004;39(5):1204‐12. [PUBMED: 15122748] - PubMed
Arguedas 2002
    1. Arguedas MR, Heudebert GR, Eloubeidi MA, Abrams GA, Fallon MB. Cost‐effectiveness of screening, surveillance, and primary prophylaxis strategies for esophageal varices. American Journal of Gastroenterology 2002;97(9):2441‐52. [PUBMED: 12358270] - PubMed
ASGE Standards of Practice Committee 2012
    1. ASGE Standards of Practice Committee, Ben‐Menachem T, Decker GA, Early DS, Evans J, Fanelli RD, Fisher DA, et al. Adverse events of upper GI endoscopy. Gastrointestinal Endoscopy 2012;76:707‐18. - PubMed
Bambha 2008
    1. Bambha K, Kim WR, Pedersen R, Bida JP, Kremers WK, Kamath PS. Predictors of early re‐bleeding and mortality after acute variceal haemorrhage in patients with cirrhosis. Gut 2008;57(6):814‐20. [PUBMED: 18250126] - PubMed
Bellentani 1994
    1. Bellentani S, Tiribelli C, Saccoccio G, Sodde M, Fratti N, Martin C, et al. Prevalence of chronic liver disease in the general population of northern Italy: the Dionysos study. Hepatology (Baltimore, Md) 1994;20(6):1442‐9. [PUBMED: 7982643] - PubMed
Bendtsen 1990
    1. Bendtsen F, Skovgaard LT, Sorensen TI, Matzen P. Agreement among multiple observers on endoscopic diagnosis of esophageal varices before bleeding. Hepatology (Baltimore, Md) 1990;11(3):341‐7. [PUBMED: 2312048] - PubMed
Cales 1989
    1. Cales P, Buscail L, Bretagne JF, Champigneulle B, Bourbon P, Duclos B, et al. Interobserver and intercenter agreement of gastro‐esophageal endoscopic signs in cirrhosis. Results of a prospective multicenter study [Concordance inter‐observateurs inter‐centres des signes endoscopiques gastro‐oesophagiens au cours de la cirrhose. Resultats d'une etude prospective multicentrique]. Gastroenterologie Clinique et Biologique 1989;13(12):967‐73. [PUBMED: 2696663] - PubMed
Cales 1990
    1. Cales P, Desmorat H, Vinel JP, Caucanas JP, Ravaud A, Gerin P, et al. Incidence of large oesophageal varices in patients with cirrhosis: application to prophylaxis of first bleeding. Gut 1990;31(11):1298‐302. [PUBMED: 2253916] - PMC - PubMed
Chawla 2012
    1. Chawla S, Katz A, Attar BM, Gupta A, Sandhu DS, Agarwal R. Platelet count/spleen diameter ratio to predict the presence of esophageal varices in patients with cirrhosis: a systematic review. European Journal of Gastroenterology and Hepatology 2012;24:431‐6. - PubMed
Colli 2014a
    1. Colli A, Fraquelli M, Casazza G, Conte D, Nikolova D, Duca P, et al. The architecture of diagnostic research: from bench to bedside ‐ research guidelines using liver stiffness as an example. Hepatology (Baltimore, Md) 2014;60:408‐18. [DOI: 10.1002/hep.26948] - DOI - PubMed
Colli 2014b
    1. Colli A, Gana JC, Turner D, Yap J, Adams‐Webber T, Ling SC, et al. Capsule endoscopy for the diagnosis of oesophageal varices in people with chronic liver disease or portal vein thrombosis. Cochrane Database of Systematic Reviews 2014, Issue 10. [DOI: 10.1002/14651858.CD008760.pub2] - DOI - PMC - PubMed
Cotton 2006
    1. Cotton PB, Hawes RH, Barkun A, Ginsberg GG, Amman S, Cohen J, et al. Excellence in endoscopy: toward practical metrics. Gastrointestinal Endoscopy 2006;63:286‐91. - PubMed
D'Amico 1999
    1. D'Amico G, Pagliaro L, Bosch J. Pharmacological treatment of portal hypertension: an evidence‐based approach. Seminars in Liver Disease 1999;19(4):475‐505. [PUBMED: 10643630] - PubMed
D'Amico 2003
    1. D'Amico G, Franchis R. Upper digestive bleeding in cirrhosis. Post‐therapeutic outcome and prognostic indicators. Hepatology (Baltimore, Md) 2003;38(3):599‐612. [PUBMED: 12939586] - PubMed
D'Amico 2006 a
    1. D'Amico G, Garcia‐Pagan JC, Luca A, Bosch J. Hepatic vein pressure gradient reduction and prevention of variceal bleeding in cirrhosis: a systematic review. Gastroenterology 2006;131(5):1611‐24. [PUBMED: 17101332] - PubMed
D'Amico 2006 b
    1. D’Amico G, Garcia‐Tsao G, Pagliaro L. Natural history and prognostic indicators of survival in cirrhosis: a systematic review of 118 studies. Journal of Hepatology 2006;44:217–31. - PubMed
D'Amico 2014
    1. D'Amico G, Pasta L, Morabito A, D'Amico M, Caltagirone M, Malizia G, et al. Competing risks and prognostic stages of cirrhosis: a 25‐year inception cohort study of 494 patients. Alimentary Pharmacology & Therapeutics 2014;39:1180‐93. - PubMed
de Franchis 1992
    1. Franchis R, Pascal JP, Ancona E, Burroughs AK, Henderson M, Fleig W, et al. Definitions, methodology and therapeutic strategies in portal hypertension. A Consensus Development Workshop, Baveno, Lake Maggiore, Italy, April 5 and 6, 1990. Journal of Hepatology 1992;15(1‐2):256‐61. [PUBMED: 1506645] - PubMed
de Franchis 2010
    1. Franchis R. Revising consensus in portal hypertension: report of the Baveno V consensus workshop on methodology of diagnosis and therapy in portal hypertension. Journal of Hepatology 2010;53(4):762‐8. [PUBMED: 20638742] - PubMed
de Franchis 2015
    1. Franchis R, Baveno VI Faculty. Expanding consensus in portal hypertension: report of the Baveno VI Consensus Workshop: stratifying risk and individualizing care for portal hypertension. Journal of Hepatology 2015;63:743‐52. - PubMed
DTA Handbook 2010
    1. Diagnostic Test Accuracy Working Group. Handbook for DTA Reviews. srdta.cochrane.org/handbook‐dta‐reviews 2010 (accessed 23 September 2016).
EASL 2011
    1. European Association for the Study of the Liver. EASL Clinical Practice Guidelines: management of hepatitis C virus infection. Journal of Hepatology 2011;55:245‐64. - PubMed
Gana 2010a
    1. Gana JC, Turner D, Yap J, Adams‐Webber T, Rashkovan N, Ling SC. Magnetic resonance imaging, computer tomography scan, and oesophagography for the diagnosis of oesophageal varices in patients with chronic liver disease or portal vein thrombosis. Cochrane Database of Systematic Reviews 2010, Issue 10. [DOI: 10.1002/14651858.CD008763] - DOI
Gana 2010b
    1. Gana JC, Turner D, Yap J, Adams‐Webber T, Rashkovan N, Ling SC. Transient ultrasound elastography and magnetic resonance elastography for the diagnosis of oesophageal varices in patients with chronic liver disease or portal vein thrombosis. Cochrane Database of Systematic Reviews 2010, Issue 10. [DOI: 10.1002/14651858.CD008761] - DOI
Gana 2010c
    1. Gana JC, Turner D, Yap J, Adams‐Webber T, Rashkovan N, Ling SC. Non‐invasive test of liver fibrosis for the diagnosis of oesophageal varices in patients with chronic liver disease or portal vein thrombosis. Cochrane Database of Systematic Reviews 2010, Issue 10. [DOI: 10.1002/14651858.CD008764] - DOI
Garcia‐Tsao 2007
    1. Garcia‐Tsao G, Sanyal AJ, Grace ND, Carey WD. Prevention and management of gastroesophageal varices and variceal hemorrhage in cirrhosis. American Journal of Gastroenterology 2007;102(9):2086‐102. [PUBMED: 17727436] - PubMed
Garcia‐Tsao 2008
    1. Garcia‐Tsao G, Bosch J, Groszmann RJ. Portal hypertension and variceal bleeding ‐ unresolved issues. Summary of an American Association for the study of liver diseases and European Association for the study of the liver single‐topic conference. Hepatology (Baltimore, Md) 2008; Vol. 47, issue 5:1764‐72. [PUBMED: 18435460] - PubMed
Garcia‐Tsao 2017
    1. Garcia‐Tsao G, Abraldes JG, Berzigotti A, Bosch J. Portal hypertensive bleeding in cirrhosis: risk stratification, diagnosis, and management: 2016 practice guidance by the American Association for the Study of Liver Diseases. Hepatology 2017;65:310‐35. - PubMed
Geraci 2009
    1. Geraci G, Pisello F, Modica G, Li Volsi F, Arnone E, Sciumè C. Complications of elective esophago‐gastro‐duodenoscopy (EGDS). Personal experience and literature review. Il Giornale di Chirurgia 2009;30:502‐6. - PubMed
Gluud 2007
    1. Gluud LL, Klingenberg S, Nikolova D, Gluud C. Banding ligation versus beta‐blockers as primary prophylaxis in esophageal varices: systematic review of randomized trials. American Journal of Gastroenterology 2007;102(12):2842‐8; quiz 2841, 2849. [PUBMED: 18042114] - PubMed
Gluud 2012
    1. Gluud LL, Krag A. Banding ligation versus beta‐blockers for primary prevention in oesophageal varices in adults. CochraneDatabase of Systematic Reviews 2012;Issue 8:CD004544. - PMC - PubMed
Gluud 2016
    1. Gluud C, Nikolova D, Klingenberg SL. Cochrane Hepato‐Biliary Group. About Cochrane (Cochrane Review Groups (CRGs)) 2016, Issue 8. Art. No.: LIVER.
Grace 1998
    1. Grace ND, Groszmann RJ, Garcia‐Tsao G, Burroughs AK, Pagliaro L, Makuch RW, et al. Portal hypertension and variceal bleeding: an AASLD single topic symposium. Hepatology (Baltimore, Md) 1998; Vol. 28, issue 3:868‐80. [PUBMED: 9731585] - PubMed
Graham 1981
    1. Graham DY, Smith JL. The course of patients after variceal hemorrhage. Gastroenterology 1981;80(4):800‐9. [PUBMED: 6970703] - PubMed
Groszmann 2005
    1. Groszmann RJ, Garcia‐Tsao G, Bosch J, Grace ND, Burroughs AK, Planas R, et al. Beta‐blockers to prevent gastroesophageal varices in patients with cirrhosis. New England Journal of Medicine 2005;353(21):2254‐61. [PUBMED: 16306522] - PubMed
Grover 1993
    1. Grover SA, Barkun AN, Sackett DL. Does this patient have splenomegaly?. JAMA 1993;270:2218‐21. - PubMed
Imperiale 2001
    1. Imperiale TF, Chalasani N. A meta‐analysis of endoscopic variceal ligation for primary prophylaxis of esophageal variceal bleeding. Hepatology (Baltimore, Md) 2001;33(4):802‐7. [PUBMED: 11283842] - PubMed
Jalan 2000
    1. Jalan R, Hayes PC. UK guidelines on the management of variceal haemorrhage in cirrhotic patients. British Society of Gastroenterology. Gut 2000;46(Suppl 3‐4):III1‐III15. [PUBMED: 10862604] - PMC - PubMed
Jensen 2002
    1. Jensen DM. Endoscopic screening for varices in cirrhosis: findings, implications, and outcomes. Gastroenterology 2002;122(6):1620‐30. [PUBMED: 12016427] - PubMed
JSPH 1980
    1. Japanese Society for Portal Hypertension. The general rules for recording endoscopic findings on esophageal varices. Japanese Journal of Surgery 1980;10(1):84‐7. - PubMed
Kamath 2001
    1. Kamath PS, Wiesner RH, Malinchoc M, Kremers W, Therneau TM, Kosberg CL, et al. A model to predict survival in patients with end‐stage liver disease. Hepatology (Baltimore, Md) 2001;33(2):464‐70. [PUBMED: 11172350] - PubMed
Lebrec 1980
    1. Lebrec D, Fleury P, Rueff B, Nahum H, Benhamou JP. Portal hypertension, size of esophageal varices, and risk of gastrointestinal bleeding in alcoholic cirrhosis. Gastroenterology 1980;79(6):1139‐44. [PUBMED: 6969201] - PubMed
Leffler 2010
    1. Leffler DA, Kheraj R, Garud S, Neeman N, Nathanson LA, Kelly CP, et al. The incidence and cost of unexpected hospital use after scheduled outpatient endoscopy. Archives of Internal Medicine 2010;170:1752‐7. - PubMed
Liangpunsakul 2003
    1. Liangpunsakul S, Ulmer BJ, Chalasani N. Predictors and implications of severe hypersplenism in patients with cirrhosis. American Journal of the Medical Sciences 2003;326(3):111‐6. [PUBMED: 14501224] - PubMed
McDiarmid 2002
    1. McDiarmid SV, Anand R, Lindblad AS. Development of a pediatric end‐stage liver disease score to predict poor outcome in children awaiting liver transplantation. Transplantation 2002;74(2):173‐81. [PUBMED: 12151728] - PubMed
Megremis 2004
    1. Megremis SD, Vlachonikolis IG, Tsilimigaki AM. Spleen length in childhood with US: normal values based on age, sex, and somatometric parameters. Radiology 2004;231:129‐34. - PubMed
Merli 2003
    1. Merli M, Nicolini G, Angeloni S, Rinaldi V, Santis A, Merkel C, et al. Incidence and natural history of small esophageal varices in cirrhotic patients. Journal of Hepatology 2003;38(3):266‐72. [PUBMED: 12586291] - PubMed
NICE 2016
    1. National Institute for Health and Clinical Excellence (NICE). Cirrhosis in over 16s. Assessment and management. NICE guideline NG50. Methods, evidence and recommendations. National Institute for Health and Care Excellence, 2016.
NIEC 1988
    1. North Italian Endoscopic Club for the Study and Treatment of Esophageal Varices. Prediction of the first variceal hemorrhage in patients with cirrhosis of the liver and esophageal varices. A prospective multicenter study. The North Italian Endoscopic Club for the Study and Treatment of Esophageal Varices. New England Journal of Medicine 1988;319(15):983‐9. [PUBMED: 3262200] - PubMed
Pagliaro 1988
    1. Pagliaro L, Spina GP, D'Amico G, Brocchi E, Caletti G, Cosentino F, et al. Hepatic vein pressure gradient reduction and prevention of variceal bleeding in cirrhosis: a systematic review. Journal of Hepatology 1987;4:93‐8.
Pagliaro 1992
    1. Pagliaro L, D’Amico G, Sorenson TIA, Lebrec D, Burroughs AK, Morabito A, et al. Prevention of first bleeding in cirrhosis. A meta‐analysis of randomized clinical trials of nonsurgical treatment. Annals of Internal Medicine 1992;117:59–70. - PubMed
Peck‐Radosavljevic 2000
    1. Peck‐Radosavljevic M. Thrombocytopenia in liver disease. Canadian Journal of Gastroenterology 2000;14(Suppl D):60D‐6D. [PUBMED: 11110614] - PubMed
Peck‐Radosavljevic 2007
    1. Peck‐Radosavljevic M. Review article: coagulation disorders in chronic liver disease. Alimentary Pharmacology & Therapeutics 2007;26(Suppl 1):21‐8. [PUBMED: 17958516] - PubMed
Pockros 2002
    1. Pockros PJ, Duchini A, McMillan R, Nyberg LM, McHutchison J, Viernes E. Immune thrombocytopenic purpura in patients with chronic hepatitis C virus infection. American Journal of Gastroenterology 2002;97(8):2040‐5. [PUBMED: 12190174] - PubMed
Pugh 1973
    1. Pugh RN, Murray‐Lyon IM, Dawson JL, Pietroni MC, Williams R. Transection of the oesophagus for bleeding oesophageal varices. British Journal of Surgery 1973;60(8):646‐9. [PUBMED: 4541913] - PubMed
Quinn 1997
    1. Quinn PG, Johnston DE. Detection of chronic liver disease: costs and benefits. Gastroenterologist 1997;5(1):58‐77. [PUBMED: 9074920] - PubMed
Royle 2003
    1. Royle P, Milne R. Literature searching for randomized controlled trials used in Cochrane reviews: rapid versus exhaustive searches. International Journal of Technology Assessment in Health Care 2003;19(4):591‐603. - PubMed
Rutter 2001
    1. Rutter CM, Gatsonis CA. A hierarchical regression approach to meta‐analysis of diagnostic test accuracy evaluations. Statistics in Medicine 2001;20(19):2865‐84. [PUBMED: 11568945] - PubMed
Saab 2003
    1. Saab S, DeRosa V, Nieto J, Durazo F, Han S, Roth B. Costs and clinical outcomes of primary prophylaxis of variceal bleeding in patients with hepatic cirrhosis: a decision analytic model. American Journal of Gastroenterology 2003;98(4):763‐70. [PUBMED: 12738453] - PubMed
Sarin 2008
    1. Sarin SK, Kumar A, Angus PV, Baijal SS, Chawla YK, Dhiman RK, et al. Primary prophylaxis of gastroesophageal variceal bleeding: consensus recommendations of the Asian Pacific Association for the Study of the Liver. Hepatology International 2008;2:429‐39. - PMC - PubMed
Sharara 2001
    1. Sharara AI, Rockey DC. Gastroesophageal variceal hemorrhage. New England Journal of Medicine 2001;345(9):669‐81. [PUBMED: 11547722] - PubMed
Silvis 1976
    1. Silvis SE, Nebel O, Rogers G, Sugawa C, Mandelstam P. Endoscopic complications. Results of the 1974 American Society for Gastrointestinal Endoscopy Survey. JAMA 1976;235:928‐30. - PubMed
Spiegel 2003
    1. Spiegel BM, Targownik L, Dulai GS, Karsan HA, Gralnek IM. Endoscopic screening for esophageal varices in cirrhosis: is it ever cost effective?. Hepatology (Baltimore, Md) 2003;37(2):366‐77. [PUBMED: 12540787] - PubMed
Tripathi 2015
    1. Tripathi D, Stanley AJ, Hayes PC, Patch D, Millson C, Mehrzad H, et al. U.K. guidelines on the management of variceal haemorrhage in cirrhotic patients. Gut 2015;64:1680‐704. - PMC - PubMed
Whiting 2011
    1. Whiting PF, Rutjes AW, Westwood ME, Mallett S, Deeks JJ, Reitsma JB, et al. QUADAS‐2: a revised tool for the quality assessment of diagnostic accuracy studies. Annals of Internal Medicine 2011;155(8):529‐36. - PubMed
Winkfield 2003
    1. Winkfield B, Aube C, Burtin P, Cales P. Inter‐observer and intra‐observer variability in hepatology. European Journal of Gastroenterology & Hepatology 2003;15(9):959‐66. [PUBMED: 12923367] - PubMed
Wolfsen 2004
    1. Wolfsen HC, Hemminger LL, Achem SR, Loeb DS, Stark ME, Bouras EP, et al. Complications of endoscopy of the upper gastrointestinal tract: a single‐center experience. Mayo Clinic Proceedings 2004;79:1264‐7. - PubMed
Ying 2012
    1. Ying L, Lin X, Xie ZL, Hu YP, Shi KQ. Performance of platelet count/spleen diameter ratio for diagnosis of esophageal varices in cirrhosis: a meta‐analysis. Digestive Diseases and Sciences 2012;57:1672‐81. - PubMed
Zoli 1996
    1. Zoli M, Merkel C, Magalotti D, Marchesini G, Gatta A, Pisi E. Evaluation of a new endoscopic index to predict first bleeding from the upper gastrointestinal tract in patients with cirrhosis. Hepatology (Baltimore, Md) 1996;24(5):1047‐52. [PUBMED: 8903373] - PubMed