Screening for esophageal varices in cirrhotic patients – Non-invasive methods

Mattos, Ângelo Zambam de; Schacher, Fernando Comunello; Neto, Guilherme John; Mattos, Angelo A.

doi:10.1016/j.aohep.2019.06.003

Cited by 21 publications

(9 citation statements)

References 44 publications

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“…Platelet counts (PLT) have been attracted more attention among these indexes, since thrombocytopenia is mostly associated with portal hypertension in cirrhotic patients. Another advantage of PLT lies in its easy availability in the clinical practice without an increase in expense for cirrhotic patients [12]. Moreover, combining PLT with other indexes can further improve the accuracy for the estimation of HRVs [13], thus, Baveno VI and its expanded criteria, based on liver stiffness (LS) measured by transient elastography and PLT, have been proposed to avoid unnecessary endoscopy screening for HRVs [14,15].…”

Section: Introductionmentioning

confidence: 99%

The Combination of Shear Wave Elastography and Platelet Counts Can Effectively Predict High-Risk Varices in Patients with Hepatitis B-Related Cirrhosis

Xie

Feng

Lyu

et al. 2021

BioMed Research International

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Background. Baveno VI criteria, based on liver stiffness (LS) measured by transient elastography and platelet counts (PLT), have been proposed to avoid unnecessary endoscopy screening for high-risk varices (HRVs). However, the cut-off value of LS measured by 2D-SWE and PLT to predict HRVs in compensated hepatitis B-related cirrhotic patients remains unknown. Aims. To prospectively analyze the cut-off of the combination of LS measured by 2D-SWE and PLT in predicting HRVs and the influence of antiviral therapies in its efficacy. Methods. Serum parameters, LS, and endoscopy results were obtained from 160 compensated hepatitis B-related cirrhotic patients. The accuracy of the combined algorithm was assessed in the whole cohort and subgroups with or without consecutive antiviral therapies in the past 6 months. Results. In the whole cohort, the optimal cut-off value of LS for HRVs was 14.5 kPa. Patients with a LS value < 14.5 kPa with a PLT value > 110 × 10 9 / L can be excluded from HRVs ( NPV = 0.99 , endoscopy saved rates = 0.68 ). Conversely, a LS value of ≥14.5 kPa and a PLT value of ≤ 110 × 10 9 / L indicated HRVs, with accurate rates of 82.35%, and 10.63% of patients can avoid additional endoscopy screening. Moreover, antiviral therapy had no significant effect on the accuracy and rates saved from further endoscopy screening, when comparing patients with or without antiviral therapies (all p values > 0.05). Conclusions. The combination of LS (14.5 kPa) measured by 2D-SWE and PLT ( 110 × 10 9 / L ) can predict HRVs accurately in compensated hepatitis B-related cirrhotic patients without significant interference of antiviral therapy histories.

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Section: Introductionmentioning

confidence: 99%

The Combination of Shear Wave Elastography and Platelet Counts Can Effectively Predict High-Risk Varices in Patients with Hepatitis B-Related Cirrhosis

Xie

Feng

Lyu

et al. 2021

BioMed Research International

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“…The spleen diameter was measured on MR images and was defined as the greatest longitudinal dimension at the level of the splenic hilum on the PACS monitor using electronic calipers 23 . Spleen diameter and platelet count have been proposed as predictive values that may be directly or indirectly associated with the presence of EV, in particular, the platelet count/spleen diameter ratio is mostly used as the noninvasive predictor of EV 24 .…”

Section: Methodsmentioning

confidence: 99%

Identification of potential metabolic biomarkers in predicting esophageal varices needing treatment in patients with liver cirrhosis

Moon

Lee

Heo

et al. 2021

Sci Rep

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The goal of this study was to determine the diagnostic performance of in vivo quantitative proton magnetic resonance spectroscopy (1H-MRS) to identify the presence of esophageal varices needing treatment (VNT), as well as investigate its correlation with clinical characteristics in patients with liver cirrhosis. Forty cirrhotic patients without VNT showing the negative red color sign, and 40 cirrhotic patients with VNT showing positive red color sign underwent laboratory tests, esophago-gastro-duodenoscopy, and 1H-MRS with single-voxel localization in the cirrhotic liver parenchyma. The levels of lactate + triglyceride (TG) and choline in cirrhotic patients with VNT were significantly higher than those in cirrhotic patients without VNT. In multivariate analysis, spleen diameter, platelet count, and platelet count/spleen diameter ratio, as well as lactate + TG, and choline were associated with the presence of VNT. Moreover, lactate + TG and choline levels were positively correlated with spleen diameter and negatively correlated with platelet count in the combined group of cirrhotic patients with and without VNT. Our study demonstrated that higher hepatic lactate + TG and choline levels in cirrhotic patients in conjunction with longer spleen diameter, lower platelet counts, and lower ratios of platelet count to spleen diameter were associated with the presence of esophageal VNT and the risk of developing variceal bleeding. Therefore, in vivo 1H-MRS might be an effective tool for diagnosing and predicting esophageal VNT in patients with liver cirrhosis.

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“…Aspartate aminotransferase-to-platelet ratio index (APRI) is another option. It was first established in predicting liver fibrosis in subjects with hepatitis C [14]. Mattos et al disclosed that APRI characterized 64.7% sensitivity and 43.2% negative predictive value in predicting esophageal varices in subjects with cirrhosis [15].…”

Section: Laboratory Parametersmentioning

confidence: 99%

The Role of Invasive and Non-Invasive Measurements of HVPG in Decision Making in Patients With Portal Hypertension and Esophageal Varices

Witkowski

Arłukowicz

Bojko³

et al. 2021

Wiad Lek

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Many researchers and clinicians have taken the value of hepatic venous pressure gradient (HVPG) as an essential prognostic factor in subjects with chronic liver disorders. And HVPG alterations characterize a predictive value in subjects at the beginning of the disease (HVPG 6 – 10 mmHg) as well as in subjects in whom hemodynamically significant portal hypertension has developed (HVPG ≥ 10 mmHg). Our review aims to present the feasibility and applicability of HVPG in modern clinical practice in patients with liver cirrhosis, including invasive and non-invasive methods. HVPG measurement is a feasible method with a favorable safety profile. However, hemodynamically significant portal hypertension also might be determined using non-invasive options as elastography, magnetic resonance imaging, and indices derived from laboratory parameters, e.g., aspartate aminotransferase-to-platelet ratio, platelet count/spleen diameter ratio, or VITRO score. Hepatic vein catheterization with the evaluation of HVPG is the current gold standard for determining portal pressure; however, new non-invasive techniques are nowadays more frequently used.

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Screening for esophageal varices in cirrhotic patients – Non-invasive methods

Cited by 21 publications

References 44 publications

The Combination of Shear Wave Elastography and Platelet Counts Can Effectively Predict High-Risk Varices in Patients with Hepatitis B-Related Cirrhosis

The Combination of Shear Wave Elastography and Platelet Counts Can Effectively Predict High-Risk Varices in Patients with Hepatitis B-Related Cirrhosis

Identification of potential metabolic biomarkers in predicting esophageal varices needing treatment in patients with liver cirrhosis

The Role of Invasive and Non-Invasive Measurements of HVPG in Decision Making in Patients With Portal Hypertension and Esophageal Varices

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