Modified spleen stiffness measurement by transient elastography is associated with presence of large oesophageal varices in patients with compensated hepatitis <scp>C</scp> virus cirrhosis

Calvaruso, Vincenza; Bronte, F.; Conte, Elisabetta; Simone, F.; Craxı̀, Antonio; Marco, Vito Di

doi:10.1111/jvh.12114

Cited by 102 publications

(103 citation statements)

References 30 publications

(58 reference statements)

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“…Nevertheless, noninvasive methods of predicting PH, such as spleen size and platelet count, as well as the ratio between platelet count and spleen size, lack both sensitivity and specificity [15][16][17][18] . Recent studies have demonstrated that PH results not only in an increase in spleen size, but also in modifications of splenic blood flow, tissue hyperplasia, and fibrosis [14,15,19] . Accordingly, spleen stiffness measurement (SSM) may be a valuable tool for assessing the degree of PH, the presence and severity of EVs and the risk of bleeding among patients with chronic liver disease.…”

Section: Introductionmentioning

confidence: 99%

“…Accordingly, spleen stiffness measurement (SSM) may be a valuable tool for assessing the degree of PH, the presence and severity of EVs and the risk of bleeding among patients with chronic liver disease. Recent studies have shown that SSM can assess the severity of PH, the risk of variceal bleeding and the presence of (large) EVs and variceal hemorrhage among patients with cirrhosis, although it cannot predict the grade of EVs [12,14,15,[20][21][22] .…”

Section: Introductionmentioning

confidence: 99%

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Spleen and Liver Stiffness Is Positively Correlated with the Risk of Esophageal Variceal Bleeding

et al. 2016

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Background/Aims: Portal hypertension (PH) is a common complication of chronic liver disease and results in esophageal and gastric variceal bleeding, which is associated with a high mortality rate. Measurement of the hepatic venous pressure gradient (HVPG) is considered the gold standard for diagnosing PH and estimating the risk of varices and bleeding. In contrast, upper gastrointestinal (GI) endoscopy (UGE) can reliably demonstrate the presence of varices and bleeding. Both measures are invasive, and HVPG is mainly restricted to tertiary centers. Therefore, the development of noninvasive methods of assessing the severity of PH and the risk of variceal bleeding is warranted. Methods: We retrospectively examined the correlation of spleen stiffness (SSM) and liver stiffness measurements (LSM) with the incidence of variceal bleeding among 143 patients who underwent combined liver and spleen elastography between 2013 and 2015. Results: For 19 of 103 patients (16.8%), upper GI variceal bleeding was diagnosed and treated endoscopically. The median SSM of all patients was 35.3 kilopascals (kPa); the median LSM, 11.7 kPa. Patients with previous bleeding episodes had significantly higher SSM (75.0 kPa) and LSM (37.3 kPa) than those without a history of bleeding (SSM, 30.6 kPa; LSM, 8.2 kPa; p < 0.0001). Seventy-five patients (66.4%) underwent UGE in addition to SSM and LSM: 25 with no esophageal varices (EVs; SSM, 29.5 kPa; LSM, 11.4 kPa), 16 with EV grade 1 (SSM, 35.9 kPa; LSM, 33.4 kPa), 21 with EV grade 2 (SSM, 67.8 kPa; LSM, 27.0 kPa) and 13 with EV grade 3 (SSM, 75.0 kPa; LSM, 26.3 kPa). No statistically significant differences were found between respective grades of EV but were found between the presence and absence of varices. At a calculated cutoff level of 42.6 kPa (with application of 95% CI), SSM had sensitivity of 89% and specificity of 64% in determining the risk of bleeding, with a negative predictive value (NPV) of 0.97 (LSM sensitivity, 84%; LSM specificity, 80%; LSM NPV, 0.96 at LSM cutoff level of 20.8 kPa). When LSM (cutoff level, 20.8 kPa) and SSM (cutoff level, 42.6 kPa) were combined, the NPV was 1 (sensitivity, 100%; specificity, 55%). Conclusion: SSM and LSM as determined by FibroScan (a noninvasive method of detecting PH) is positively correlated with upper GI variceal bleeding (optimal SSM cutoff level, 42.6 kPa; optimal LSM cutoff level, 20.8 kPa). No patients with both SSM and LSM below cutoff levels had a history of bleeding complications.

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Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Spleen and Liver Stiffness Is Positively Correlated with the Risk of Esophageal Variceal Bleeding

et al. 2016

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“…This is consistent with Saad et al (16) . Also, SSM and LSM were evaluated by Calvaruso et al (17) , and like our results both of them were sensitive to detect the presence of EV. We observed a highly significant difference in mean SSM values between patients with EV and those without (65.3±26.3versus24.6 ± 13.7 kPa respectively; P < 0.01).…”

Section: Discussionmentioning

confidence: 99%

Measurement of Liver and Spleen Stiffness by Fibroscan in Comparison to other Validated Indices for Non-Invasive Assessment of Esophageal Varices in Egyptian Patients with HCV-Related Cirrhosis

2016

Int. J. Adv. Res. Biol. Sci.

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Background and Aim: Several investigators have devised non-invasive predictors for presence of esophageal varices (EV) in cirrhotic patients, thus avoiding unnecessary endoscopic screening. This work aimed at evaluating the role of liver and spleen stiffness measurements by Fibroscan in comparison to other validated indices for non-invasive assessment of EV in Egyptian patients with HCV-related cirrhosis. Methods and Material: This cross-sectional study included sixty patients with HCV-related cirrhosis who underwent complete clinical evaluation, laboratory investigations, abdominal ultrasonography, liver and spleen stiffness measurements (LSM and SSM) using Fibroscan and upper gastrointestinal endoscopy. Also, non-invasive predictive scores were calculated: AST-to-ALT ratio (AAR), platelet count/spleen diameter ratio (PSR) and AST-to-platelet ratio index (APRI). The diagnostic performance of each parameter was assessed using receiver operating characteristic (ROC) curves. Results: Patients were classified into two groups; Group 1: 33 patients (55%) with EV, and Group 2: 27 patients (45%) with no EV. There was a highly significant difference between the two groups regarding spleen diameter, PSR, APRI, LSM and SSM (P < 0.01). SSM showed a good performance as regards EV detection in comparison to LSM. At cut-off value ≥ 29 for SSM, sensitivity was 94.4%, specificity 86.4%, PPV 85% and NPV 95% (AUROC 0.934). Conclusion: Spleen stiffness measurement is a sensitive and reliable tool for detection of EV.

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“…As a result, the NPV to exclude large varices increased to 100%. This encouraging result would require further confirmation (24). LSM assessed by other methods, such as Acoustic Radiation Force Impulse, shear-wave elastography, and magnetic resonance elastography, has shown promising results but available data is still scarce (25,26).…”

Section: Non-invasive Methods For the Detection Of Vntmentioning

confidence: 97%

Non-invasive diagnosis of esophageal varices after Baveno VI

Velázquez

Abraldes²

2017

Turk J Gastroenterol

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Modified spleen stiffness measurement by transient elastography is associated with presence of large oesophageal varices in patients with compensated hepatitis C virus cirrhosis

Abstract: Modified spleen stiffness measurement by transient elastography is associated with presence of large oesophageal varices in patients with compensated hepatitis C virus cirrhosis 1

Cited by 102 publications

References 30 publications

Spleen and Liver Stiffness Is Positively Correlated with the Risk of Esophageal Variceal Bleeding

Spleen and Liver Stiffness Is Positively Correlated with the Risk of Esophageal Variceal Bleeding

Measurement of Liver and Spleen Stiffness by Fibroscan in Comparison to other Validated Indices for Non-Invasive Assessment of Esophageal Varices in Egyptian Patients with HCV-Related Cirrhosis

Non-invasive diagnosis of esophageal varices after Baveno VI

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