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World J Hepatol. Feb 27, 2023; 15(2): 216-224
Published online Feb 27, 2023. doi: 10.4254/wjh.v15.i2.216
Sonographic gallbladder wall thickness measurement and the prediction of esophageal varices among cirrhotics
Mohamed H Emara, Mariam Zaghloul, Ibrahim F Amer, Aya M Mahros, Mohammed Hussien Ahmed, Mahmoud A Elkerdawy, Eslam Elshenawy, Abdelrahman M Ahmed Rasheda, Tarik I Zaher, Mona Talaat Haseeb, Emad Hassan Emara, Hassan Elbatae
Mohamed H Emara, Mariam Zaghloul, Ibrahim F Amer, Aya M Mahros, Mohammed Hussien Ahmed, Mahmoud A Elkerdawy, Eslam Elshenawy, Hassan Elbatae, Department of Hepatology, Gastroenterology and Infectious Diseases, Kafrelsheikh University, Kafr-Elshikh 33516, Egypt
Abdelrahman M Ahmed Rasheda, Department of Internal Medicine, Gastroenterology Unit, Security Forces Hospital, Riyadh 11481, Saudi Arabia
Tarik I Zaher, Tropical Medicine, Zagazig University, Zagazig 44519, Egypt
Mona Talaat Haseeb, Emad Hassan Emara, Department of Diagnostic and Interventional Radiology, Kafrelsheikh University, Kafr-Elshikh 33516, Egypt
Author contributions: Emara MH, Zaghloul M, Ahmed MH, Mahros AM, Zaher TI, Elbatae H, and Emara EH searched the literature; Emara MH, Zaghloul M, Ahmed MH, Amer IF, Rasheda AMA, and Elkerdawy MA retrieved the evidence; Emara MH, Zaghloul M, Ahmed MH, Elshenawy E, and Haseeb MT analyzed the evidence; Emara MH, and Zaghloul M wrote the article draft; All authors revised the article.
Conflict-of-interest statement: All the authors report having no relevant conflicts of interest for this article.
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: https://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Mohamed H Emara, MD, MSc, Professor, Department of Hepatology, Gastroenterology and Infectious Diseases, Kafrelsheikh University, Algeish Street, Kafr-Elshikh 33516, Egypt. emara_20007@yahoo.com
Received: November 13, 2022
Peer-review started: November 13, 2022
First decision: December 14, 2022
Revised: December 25, 2022
Accepted: January 31, 2023
Article in press: January 31, 2023
Published online: February 27, 2023
Processing time: 103 Days and 0.9 Hours
Abstract

Acute variceal bleeding in patients with liver cirrhosis and portal hypertension (PHT) is the most serious emergency complication among those patients and could have catastrophic ‎outcomes if not timely managed. ‎Early screening by esophago-gastro-duodenoscopy (EGD) for the presence of esophageal varices (EVs) is ‎‎currently recommended by the practice guidelines for all cirrhotic patients. Meanwhile, EGD is not readily accepted or preferred by many patients. The literature is rich in ‎studies to investigate and validate ‎ non-invasive markers of EVs prediction aiming at reducing the unneeded endoscopic procedures. Gallbladder (GB) wall thickness (GBWT) ‎measurement has been found promising in many published research ‎articles. We aim to highlight the validity of sonographic GBWT measurement in the ‎prediction of EVs based on the available evidence.‎ We searched databases including Cochrane library, PubMed, Web of Science and many others for relevant articles. GBWT is associated with the presence of EVs in cirrhotic patients with PHT of different etiologies. The cut-off of GBWT that can predict the presence of EVs varied in the literature and ranges from 3.1 mm to 4.35 mm with variable sensitivities of 46%-90.9% and lower cut-offs in viral cirrhosis compared to non-viral, however GBWT > 4 mm in many studies is associated with acceptable sensitivity up to 90%. Furthermore, a relation was also noticed with the degree of varices and portal hypertensive gastropathy. Among cirrhotics, GBWT > 3.5 mm predicts the presence of advanced (grade III-IV) EVs with a sensitivity of 45%, the sensitivity increased to 92% when a cut-off ≥ 3.95 mm was used in another cohort. Analysis of these results should carefully be revised in the context of ascites, hypoalbuminemia and other intrinsic GB diseases among cirrhotic patients. The sensitivity for prediction of EVs improved upon combining GBWT measurement with other non-invasive predictors, e.g., platelets/GBWT.

Keywords: Sonographic; Gallbladder wall thickness; Prediction; Esophageal varices; Portal hypertension; Esophago-gastro-duodenoscopy

Core Tip: Ruptured varices is a medical emergency and is associated with high mortality. Hence, it was recommended by the current practice guidelines to screen cirrhotic patients with portal hypertension for the presence of varices and eradicate the risky varices early. However, many issues exist with this policy. This directed the clinicians to search for non-invasive assessment tools aiming to refer only indicated cases for endoscopic examination. Among the promising tools is sonographic measurement of gallbladder wall thickness that was found related not only with the presence of esophageal varices but also with the degree of varices and portal hypertensive gastropathy.