Esophageal varices on computed tomography and subsequent variceal hemorrhage

Ma Somsouk, Katherine To'o, Mujtaba Ali, Eric Vittinghoff, Benjamin M. Yeh, Judy Yee, Alex Monto, John M. Inadomi, Rizwan Aslam

Research output: Contribution to journalArticlepeer-review

13 Scopus citations


Purpose: Endoscopy is recommended to screen for esophageal varices in patients with cirrhosis. The objective of this study was to identify features on abdominal CT imaging associated variceal hemorrhage (VH). Methods: A case-control study was performed among patients with cirrhosis who had a CT scan. Consecutive patients who experienced VH were included as cases, and patients without VH served as controls. Two radiologists recorded the maximal esophageal varix diameter in addition to other measures of portal hypertension at CT. Results: The most powerful CT parameter associated with VH was the esophageal varix diameter (5.8 vs. 2.7 mm, p < 0.001; adjusted OR 1.84 per mm, p = 0.009). 63% of individuals with VH had a maximal varix diameter ≥5 mm compared to 7.5% of cirrhotic patients without VH (p < 0.001). In contrast, the proportion of individuals whose largest varix was <3 mm was 7.4% among VH cases compared to 54.7% among controls (p = 0.001). The varix diameter powerfully discriminated those with and without VH (C-statistic 0.84). Conclusions: A large esophageal varix diameter is strongly associated with subsequent VH. A threshold of <3 and ≥5 mm appears to identify patients with cirrhosis at low and high risk for hemorrhage.

Original languageEnglish (US)
Pages (from-to)251-256
Number of pages6
JournalAbdominal Imaging
Issue number2
StatePublished - Apr 2014
Externally publishedYes


  • CT
  • Cirrhosis
  • Portal hypertension
  • Variceal hemorrhage

ASJC Scopus subject areas

  • Radiological and Ultrasound Technology
  • Radiology Nuclear Medicine and imaging
  • Gastroenterology
  • Urology


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