Value of hepatic elastography and Doppler indexes for predictions of esophageal varices in liver cirrhosis

Bințințan, Adriana; Chira, Romeo; Bințințan, Vasile; Nagy, G; Manzat-Saplacan, Maria Roberta; Lupșor-Platon, Monica; Ştefănescu, Horia; Duma, Mihaela; Vălean, Simona; Mircea, Petru Adrian

doi:10.11152/mu.2013.2066.171.abric

Cited by 25 publications

(31 citation statements)

References 28 publications

(50 reference statements)

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“…Table 1 outlines the baseline characteristics of the included 20 studies. [ 6 7 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 ] Twelve studies[ 6 7 13 14 15 16 17 18 24 26 27 30 ] were performed in European countries, whereas five[ 19 21 22 28 29 ] were performed in China. The other three studies were performed in the USA, Egypt, and India, respectively.…”

Section: Resultsmentioning

confidence: 99%

A Beginning or the End? A Meta-analysis to Assess the Diagnostic Accuracy of Transient Elastography for the Prediction of Esophageal Varices

Qu¹,

Li²,

Ye³

et al. 2016

Saudi J Gastroenterol

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Background/Aims:To assess the accuracy of transient elastography (TE) in the prediction of esophageal varices (EV).Materials and Methods:The literature search was conducted by using PubMed, EMBASE, Web of Science, and CENTRAL on The Cochrane Library without time or language restrictions. Terms used were “FibroScan,” “transient elastography,” “stiffness,” and “esophageal varices.” The pooled sensitivity, specificity, and other parameters were obtained using a bivariate mixed-effects regression model.Result:Twenty studies (2530 patients) were identified for inclusion. The pooled sensitivity, specificity, positive and negative likelihood ratios, and diagnostic odds ratio were 0.84 (95% confidence interval [CI], 0.79–0.87), 0.68 (95% CI, 0.61–0.73), 2.58 (95% CI, 2.15–3.10), 0.24 (95% CI, 0.19–0.32), and 10.60 (95%CI, 7.20–15.62), respectively. The summary area under receiver operating characteristics (AUROC) curves was 0.82 (95% CI, 0.79–0.86). Especially, for hepatitis C patients, the diagnostic performance of TE for detecting the presence of EV was similar to all other patients with a sensitivity of 0.83 and a specificity of 0.63, but without heterogeneity (I2 = 0.00). For the prediction of large esophageal varices in patients with viral liver cirrhosis, the pooled sensitivity and specificity of TE were 0.82 (95% CI 0.74–0.89) and 0.77 (95% CI 0.65-0.85), respectively, without significant heterogeneity (I2 = 0.00).Conclusion:Transient elastography has good sensitivity and moderate specificity. TE can be used as an effective noninvasive screening tool for the prediction of esophageal varices, especially in hepatitis C patients, and for the prediction of large esophageal varices in patients with viral liver cirrhosis.

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Section: Resultsmentioning

confidence: 99%

A Beginning or the End? A Meta-analysis to Assess the Diagnostic Accuracy of Transient Elastography for the Prediction of Esophageal Varices

Qu¹,

Li²,

Ye³

et al. 2016

Saudi J Gastroenterol

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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%

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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“…Salvatore et al showed that the SA-RI cut-off of 0.56 enabled the identification of patients with liver stiffness values >13kPa obtained by TE (value associated to the presence of cirrhosis) [42], and in two independent studies it was shown that SA-RI was significantly and selectively increased in patients with cirrhosis [25,43]. Binţinţan et al found that the SA-RI was higher in patients with oesophageal varices than in patients with no varices [44].…”

Section: Discussionmentioning

confidence: 99%

Doppler ultrasonography combined with transient elastography improves the non-invasive assessment of fibrosis in patients with chronic liver diseases

et al. 2017

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Aims: Accurate clinical assessment of liver fibrosis is essential and the aim of our study was to compare and combine hemodynamic Doppler ultrasonography, liver stiffness by transient elastography, and non-invasive serum biomarkers with the degree of fibrosis confirmed by liver biopsy, and thereby to determine the value of combining non-invasive method in the prediction significant liver fibrosis. Material and methods: We included 102 patients with chronic liver disease of various etiology. Each patient was evaluated using Doppler ultrasonography measurements of the velocity and flow pattern at portal trunk, hepatic and splenic artery, serum fibrosis biomarkers, and transient elastography. These parameters were then input into a multilayer perceptron artificial neural network with two hidden layers, and used to create models for predicting significant fibrosis. Results: According to METAVIR score, clinically significant fibrosis (≥F2) was detected in 57.8% of patients. A model based only on Doppler parameters (hepatic artery diameter, hepatic artery systolic and diastolic velocity, splenic artery systolic velocity and splenic artery Resistance Index), predicted significant liver fibrosis with a sensitivity and specificity of75.0% and 60.0%. The addition of unrelated non-invasive tests improved the diagnostic accuracy of Doppler examination. The best model for prediction of significant fibrosis was obtained by combining Doppler parameters, non-invasive markers (APRI, ASPRI, and FIB-4) and transient elastography, with a sensitivity and specificity of 88.9% and 100%. Conclusion: Doppler parameters alone predict the presence of ≥F2 fibrosis with fair accuracy. Better prediction rates are achieved by combining Doppler variables with non-invasive markers and liver stiffness by transient elastography.

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Value of hepatic elastography and Doppler indexes for predictions of esophageal varices in liver cirrhosis

Cited by 25 publications

References 28 publications

A Beginning or the End? A Meta-analysis to Assess the Diagnostic Accuracy of Transient Elastography for the Prediction of Esophageal Varices

A Beginning or the End? A Meta-analysis to Assess the Diagnostic Accuracy of Transient Elastography for the Prediction of Esophageal Varices

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

Doppler ultrasonography combined with transient elastography improves the non-invasive assessment of fibrosis in patients with chronic liver diseases

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