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A Study on Duplex Doppler Ultrasonography as a Non-Invasive Test for Diagnosis of Portal Hypertension in Children Attending a Tertiary Care Hospital in Bangladesh

Author(s): Marjan P, Karim ASMB, Rukunuzzaman M, Das SR, Mondal M, Sarker N, Akther H, Nahar L, Chowdhury AS

Background: Portal hypertension is the hemodynamic abnormality frequently associated with serious liver disease, although it is recognized in a variety of extrahepatic diseases also. Endoscopy of upper GIT is the gold standard for diagnosis of oesophageal varices but it is invasive, costly and not easily available. Doppler ultrasound is a non-invasive, relatively cheap and easily accessible imaging modality that helps in making the diagnosis of clinically significant portal hypertension.

Objective: To observe the efficacy of Doppler Ultrasonography for predicting the presence of portal hypertension in children.

Methods: This cross-sectional descriptive study was conducted at the Department of Pediatric Gastroenterology & Nutrition, BSMMU during the period Jan 2018 to July 2019. 47 patients who were diagnosed as portal hypertension by upper GIT endoscopy were selected purposively according to inclusion and exclusion criteria. Demographic data and other related information regarding etiology and complications were recorded in a standard datasheet. Doppler USG was done in Nuclear medicine department, BSMMU by a single sonologist. Collected data were checked manually and analyzed by computer-based program SPSS for Windows (version 22.0).

Results: 47 patients were enrolled in this study with a mean age of 9.2 ± 3.9 years. 42.6% of patients were diagnosed as CLD and 57.4 % were extrahepatic portal hypertension. Among CLD patients Wilson disease was the most common etiology (61%). Doppler USG could detect portal hypertension in 85% of patients. Among 3 different parameters (Portal vein parameter, portal vein flow velocity, the direction of flow in portal vein) of Doppler USG, portal vein flow velocity was most sensitive in detecting portal hypertension. PV: BSA was superior to portal vein diameter alone for diagnosing portal hypertension (p < 0.05). When endoscopic grading of oesophageal varices was compared with the grading of portal hypertension according to portal vein mean flow velocity (Indian childhood classification) p-value was not significant.

Conclusions: Portal vein flow velocity is the most effective parameter for the detection of portal hypertension. In case of children, PV: BSA > 12 can be used as a marker for diagnosis of portal hypertension instead of PV diameter alone. Doppler USG can be used as a non-invasive test for diagnosis of portal hypertension in children.

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