Is transient elastography valuable for high‐risk esophageal varices prediction in patients with hepatitis‐B‐related cirrhosis?

Chen, Yong Peng; Zhang, Qi; Dai, Letian; Liang, Xie; Peng, Jie; Hou, Jin

doi:10.1111/j.1440-1746.2011.06889.x

Cited by 26 publications

(15 citation statements)

References 30 publications

(89 reference statements)

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“…Ten studies did not provide sufficient information to be able to ascertain if the investigators that performed the endoscopy were unaware of the LS value, or vice versa, which put them at risk of review bias (8,9, 14,15,18,21,23,24,29,30). The time interval between the performance of EGD and the performance of the TE was too long in 2 studies (28,30) and undefined in 8 studies (8,14,15,(20)(21)(22)24,25), putting them at risk of disease progression bias.…”

Section: Resultsmentioning

confidence: 99%

“…Figure 1 shows the flow diagram of literature search and study selection. (15,16,19,20,22,24,27). The other 3 studies were performed in Africa (Egypt [17,29] and Morocco [25]).…”

Section: Resultsmentioning

confidence: 99%

“…The etiology of liver cirrhosis included virus, alcohol, non-alcoholic steatohepatitis (NASH), and autoimmune hepatitis. Seven studies only included patients with viral liver cirrhosis (8,9, 16,17,20,22,29).…”

Section: Resultsmentioning

confidence: 99%

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Evaluation of large esophageal varices in cirrhotic patients by transient elastography: a meta-analysis

Yang

et al. 2016

Rev Esp Enferm Dig

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Background and purpose: Transient elastography (TE) has been shown to be a valuable tool for the prediction of large esophageal varices. However, the conclusions have not been always consistent throughout the different studies. Therefore, we performed a further meta-analysis in order to evaluate the diagnostic accuracy of transient elastography for the prediction of large esophageal varices.Methods: We performed a systematic literature search in PubMed, EMBASE, Web of Science, and CENTRAL in The Cochrane Library without time restriction. The strategy we used was "(fibroscan OR transient elastography OR stiffness) AND esophageal varices". Accuracy measures such as pooled sensitivity, specificity, among others, were calculated using Meta-DiSc statistical software.Results: Twenty studies (2,994 patients) were included in our meta-analysis. The values of pooled sensitivity, specificity, positive and negative likelihood ratios and diagnostic odds ratio were as follows: 0.81 (95% CI, 0.79-0.84), 0.71 (95% CI, 0.69-0.73), 2.63 (95% CI, 2.15-3.23), 0.27 (95% CI, 0.22-0.34) and 10.30 (95% CI, 7.33-14.47). The area under the receiver operating characteristics curve was 0.83. The Spearman correlation coefficient was 0.246 with a p-value of 0.296, indicating the absence of any significant threshold effects. In our subgroup analysis, the heterogeneity could be partially explained by the geographical origin of the study or etiology; or it could be partially explained blindingly, through the appropriate interval and cut-off value of the liver stiffness (LS).Conclusions: Transient elastography could be used as a valuable non-invasive screening tool for the prediction of large esophageal varices. However, since LS cut-off values vary throughout the different studies and significant heterogeneity also exists among them, we need more reasonable approaches or flow diagram in order to improve the operability of this technology.

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Section: Resultsmentioning

confidence: 99%

“…Figure 1 shows the flow diagram of literature search and study selection. (15,16,19,20,22,24,27). The other 3 studies were performed in Africa (Egypt [17,29] and Morocco [25]).…”

Section: Resultsmentioning

confidence: 99%

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Evaluation of large esophageal varices in cirrhotic patients by transient elastography: a meta-analysis

Yang

et al. 2016

Rev Esp Enferm Dig

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“…Established evidences have indicated that LSM has good sensitivity and specificity for liver fibrosis and cirrhosis. So, it has become popular over the past few years especially for obtaining repeated measurements because it eliminates pain, morbidity and mortality that may accompany liver biopsy 25–27…”

Section: Introductionmentioning

confidence: 99%

Impact of hepatitis C virus genotype-4 eradication following direct acting antivirals on liver stiffness measurement

Tag-Adeen

Sabra

Akazawa

et al. 2017

HMER

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BackgroundLiver fibrosis is the most important prognostic factor in chronic hepatitis C virus (HCV) patients, and Egypt shows the highest worldwide HCV prevalence with genotype-4 pre-dominance. The aim of this study was to investigate the degree of liver stiffness measurement (LSM) improvement after successful HCV eradication.Patients and methodsThe study included 84 chronic HCV Egyptian patients, and was conducted at Qena University Hospital from November 1, 2015 till October 31, 2016. LSM was obtained by FibroScan® before starting direct acting antiviral (DAA) treatment and after achieving sustained virologic response-24 (SVR-24). Based on baseline LSM, patients were stratified into F0–F1, F2, F3 and F4 groups (METAVIR). LSM and laboratory data after achieving SVR-24 was compared with that before starting therapy in each fibrosis group (F0-F4), p-value <0.05 was statistically significant.ResultsFollowing DAA treatment, 80 patients achieved SVR-24; of these, 50 were males (62.5%), mean age: 54.2±7.6 years, and mean body mass index: 28.6±2.2 kg/m2. Mean baseline LSM dropped from 15.6±10.8 to 12.1±8.7 kPa post-SVR; the maximum change of −5.8 occurred in F4 versus −2.79, −1.28 and +0.08 in F3, F2 and F0–F1 respectively (p<0.0001). At baseline, 41 patients were in the F4 group; only 16 (39%) regressed to non-cirrhotic range (<12.5 kPa), while 25 (61%) were still cirrhotic despite achieving SVR-24 (p<0.0001). Patients who achieved LSM improvement (n=64) have had significantly higher baseline aspartate transferase (AST) and alanine transaminase (ALT). Also, those patients showed significant improvement in AST, AST/platelets ratio index (APRI) and fibrosis-4 index (Fib-4) after achieving SVR; 91% showed AST improvement (p=0.01) and APRI improvement (p=0.01) and 81% showed Fib-4 improvement (p=0.04). Females, diabetics, patients with S3 steatosis and patients older than 50 years showed less LSM improvements than their counterparts. Baseline LSM ≥9 kPa, bilirubin ≥1 mg/dl, ALT ≥36 U/L and AST ≥31 U/L were significant predictors for LSM improvement.ConclusionSuccessful HCV genotype-4 eradication results in significant LSM improvement; the best improvement occurs in F4 patients. But as the majority of cirrhotics are still at risk for liver decompensation and hepatocellular carcinoma development despite achieving SVR-24, early detection and treatment are highly recommended.

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“…Transient elastography (TE) is a non‐invasive tool that measures liver stiffness (LS) correlating to liver fibrosis stage. While TE also shows potential in the prediction of EV, its role is still under debate. Moreover, the LS‐spleen size‐to‐platelet ratio score (LSPS), which is a combination of three simple examination methods (LS, spleen size and platelet count) has been established to accurately predict EV in patients with compensated cirrhosis .…”

Section: Introductionmentioning

confidence: 99%

Liver stiffness‐spleen size‐to‐platelet ratio risk score identifies esophageal varices in Japanese patients with chronic hepatitis C

Shibata

Umemura

Yamazaki

et al. 2016

Hepatology Research

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Is transient elastography valuable for high‐risk esophageal varices prediction in patients with hepatitis‐B‐related cirrhosis?

Abstract: TE may predict HREV in patients with ALT ≥ 5 × ULN. Overall, the clinical values of TE and USLS for HREV prediction should be evaluated by further studies.

Cited by 26 publications

References 30 publications

Evaluation of large esophageal varices in cirrhotic patients by transient elastography: a meta-analysis

Evaluation of large esophageal varices in cirrhotic patients by transient elastography: a meta-analysis

Impact of hepatitis C virus genotype-4 eradication following direct acting antivirals on liver stiffness measurement

Liver stiffness‐spleen size‐to‐platelet ratio risk score identifies esophageal varices in Japanese patients with chronic hepatitis C

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