Sonographic gallbladder wall thickness measurement and the prediction of esophageal varices among cirrhotics

Table 1 Studies focusing gallbladder wall thickness measurement in the prediction of varices

Ref.	Target patients	Number of patients	GBWT cut-off	Reported sensitivity	Conclusions
Li et al[13]	Cirrhotic	152			GBWT is closely related to hemodynamic parameters. It is feasible to predict the degree of portal hypertension through the observation of GBWT
Begum et al[26]	CLDs	61			GBWT among CLD patients with EVs was 5.6 ± 0.2 mm compared to 2.7 ± 0.1 mm in non-variceal group (P < 0.05). GBWT may be considered as an important marker for the presence of esophageal varices in CLD patients
de Alcantara et al[15]	Children and adolescents younger than 20 years with CLD and extrahepatic portal venous obstruction (EHPVO)	53	≥ 4.35 mm	For group I‎ (n = 35; patients with ‎CLD)‎: 60%. For group II‎ (n = 18; patients with ‎EHPVO)‎: 90.9%	The presence of SS and greater LOT were indicative of EVs in patients with CLD. The presence of gallbladder varices and greater GBWT indicated the presence of EVs in patients with EHPVO. The presence of an SS and a greater LOT indicated the presence of PHG in patients with CLD
Pathak et al[21]	Alcoholic Cirrhosis	60	> 4 mm		Thus, the presence of increased GBWT on ultrasonography in patients of cirrhosis without intrinsic gallbladder disease should be considered as an early sign of portal hypertension
Tsaknakis et al[12]	Chronic hepatic diseases of variable etiologies	194	≥ 4 mm	46%	GBWT occurs significantly more often in patients with EVs. However, because of the low sensitivity, combination with other non-invasive parameters such as platelet count is recommended
Elkerdawy et al[24]	Post-viral cirrhosis with portal hypertension	105	≥ 3.1 mm	54.29%	GBWT was associated not only with the presence of EVs, but also with advanced EVs. Although, the reported sensitivity of GBWT in prediction of EVs was low, its diagnostic accuracy was comparable and even superior to some simple non-invasive predictors
Khan et al[28]	Liver cirrhosis of Child-Pugh class A (80% were due to HCV)	160	> 4 mm	Not calculated	Patients with esophageal varices had significantly increased gallbladder wall thickness 4.96 ± 0.85 mm as compared to patients without esophageal varices 2.54 ± 076 mm. In group A, 65 (81.25%) patients had GBWT > 4 mm while in group B, 8 (10%) patients had GBWT > 4 mm and significant difference was observed between both groups with P value < 0.0001
Shehata et al[29]	Cirrhosis (multiple etiologies; causes not mentioned)	120	4	82%	Significant correlation was observed between GBWT and portal hypertension, they recommend that GBWT can be used as a non-invasive predictor of esophageal varices in cirrhotic patients
Amer et al[25]	Liver cirrhosis	100	> 3.5 mm	64%	Sensitivity and specificity of GBWT in prediction of PHG were 64% and 68%
Afifi et al[14]	Cirrhosis (causes not mentioned)	100	3.35 mm	68%	GBWT was significantly higher in EVs patients compared to the non-EVs group (mean: 4.2 mm vs 2.7 mm, P < 0.001)

CLD: Chronic liver diseases; EHPVO: Extra-hepatic venous obstruction; EVs: Esophageal varices; GBWT: Gallbladder wall thickness; HCV: Hepatitis C virus LOT: Lesser omental thickness; PHG: Portal hypertensive gastropathy; SS: Splenorenal shunt.

Table 2 Studies focusing gallbladder wall thickness measurement and the degree of esophageal varices

Ref.	Target patients	Number of patients	GBWT cut-off	Reported sensitivity	Conclusions
Yousaf et al[23]	Child B and C cirrhosis	103	4 mm	Not reported	GBWT most profound in the patients with smaller (F1) and moderate (f2) esophageal varices. Most of the patients with no varices had normal gall bladder wall
Begum et al[26]	CLDs	61			The mean GBWT was significantly (P < 0.05) higher in CLD patients with grade III and IV varices (6.1 ± 0.8 mm) compared to grade I and II (3.9 ± 0.7 mm).
Elkerdawy et al[24]	Post-hepatitis cirrhosis with portal hypertension	105	≥ 3.1 mm	54.29%	GBWT was associated not only with the presence of EVs, but also with advanced EVs. Although, the reported sensitivity of GBWT in prediction of EVs was low, its diagnostic accuracy was comparable and even superior to some simple non-invasive predictors
Afifi et al[14]	Cirrhosis (Child A, B and C)	100	≥ 3.950	92%	GBWT at cut-off level ≥ 3.950 had 92% sensitivity, 95% specificity, 86.7% PPV, and 97.1% NPV for detection of large-sized EVs, with AUC = 0.986

AUC: Area under the curve; CLD: Chronic liver disease; EVs: Esophageal varices; GBWT: Gallbladder wall thickness; NPV: Negative predictive value; PPV: Positive predictive value.