THE SPLENIC INDEX AS PREDICTOR OF BLEEDING AND VARICEAL RECURRENCE IN THE LATE FOLLOW-UP OF SCHISTOSOMOTIC PATIENTS AFTER EXCLUSIVE ENDOSCOPIC TREATMENT

ABSTRACT - BACKGROUND:

Endoscopic treatment for esophageal variceal has been used as the main intervention in patients with portal hypertension secondary to schistosomiasis, but with significant rates of recurrence of esophageal variceal and rebleeding. The long-term results of exclusive endoscopic treatment are poorly studied as the relationship of the splenic dimensions in this context.

AIM:

The aim of this study was to identify, through ultrasonography, whether the splenic index and the longitudinal (craniocaudal) dimension of the spleen are the predictors of rebleeding and variceal recurrence in late follow-up of patients with nonoperated schistosomiasis, after endoscopic eradication of esophageal variceal.

METHODS:

This is a retrospective and observational study analyzing the medical records of patients diagnosed with hepatosplenic schistosomiasis. The receiver operating characteristic curve was used to determine the best cutoff point for the mean splenic index as a predictor of recurrence and bleeding.

Results:

A follow-up of 54 patients were analyzed during the period from 2002 to 2018. The mean follow-up time was 8 years. The splenic index with value >144 was proved to be a sensitive test for rebleeding. In the analysis of the longitudinal dimension, the spleen length of >20 cm showed a statistically significant test for recurrence of variceal and a length >19 cm presented as a very sensitive and statistically significant test for rebleeding.

CONCLUSION:

Splenic index and craniocaudal dimension analysis, obtained by ultrasonography, can predict recurrence of varicose veins and rebleeding after exclusive endoscopic treatment.

HEADINGS:
Schistosomiasis; Hypertension, Portal; Esophageal and Gastric Varices; Hypersplenism; Endoscopy, Gastrointestinal