Assessment of Spleen Stiffness for Prediction of Varices in Patients with Hepatitis C Related Cirrhosis Using Transient Elastography

Background and Study Aims: Portal hypertension is one of the most important complications of liver cirrhosis. The prevalence of varices among cirrhotic patients is variable. Therefore, endoscopic screening of all patients with liver cirrhosis would result in a large number of unnecessary additional burdens to endoscopic units. Our aim was to assess the diagnostic accuracy of spleen stiffness measured by transient elastography (Fibroscan) for prediction of the presence of varices in patients with hepatitis C related cirrhosis. Patients and Methods: The study was carried out on 100 patients with HCV-induced cirrhosis and were divided into 2 groups according to presence or absence of varices by Esophago-gastroduodenoscopy: Group I: patients with HCV-induced cirrhosis with varices; Group II: patients with HCV-induced cirrhosis without varices. Clinical and laboratory parameters, andominal Review Article El-Toukhy et al.; IJTDH, 41(24): 9-18, 2020; Article no.IJTDH.65137 10 ultrasonography, Upper gastrointestinal endoscopy and transient elastography to assess the liver and spleen stiffness were carried out to all studied persons. Results: Spleen stiffness had significant diagnostic value to differentiate between cirrhotic patients with varices and cirrhotic patients without varices , it had significant diagnostic value in presence of esophageal varices at cut-off (≥46.4 K Pascal) the sensitivity for detection of esophageal varices was 93%, specificity 100%, positive predictive value (PPV) was 80%, negative predictive value (NPV) was 100%; accuracy was 95% and area under the curve was 0.98 denoting that spleen stiffness is a good predictor of esophageal varices. Conclusion: Spleen stiffness was considered as an excellent predictor of esophageal varices and better than liver stiffness in prediction of esophageal varices presence and had significant diagnostic value to differentiate between the patients with varices and patients without varices at cut off (≥46.4 K Pascal) and it may have a role in variceal grading.

[1]  H. Tilg,et al.  Austrian consensus guidelines on the management and treatment of portal hypertension (Billroth III) , 2017, Wiener klinische Wochenschrift.

[2]  D. Matei,et al.  Predictors of variceal or nonvariceal source of upper gastrointestinal bleeding. An etiology predictive score established and validated in a tertiary referral center. , 2013, Journal of gastrointestinal and liver diseases : JGLD.

[3]  F. Bronte,et al.  Modified spleen stiffness measurement by transient elastography is associated with presence of large oesophageal varices in patients with compensated hepatitis C virus cirrhosis , 2013, Journal of viral hepatitis.

[4]  H. Xiang,et al.  [Non-invasive assessment of portal hypertension in patients with liver cirrhosis using FibroScan transient elastography]. , 2013, Zhonghua gan zang bing za zhi = Zhonghua ganzangbing zazhi = Chinese journal of hepatology.

[5]  M. Said,et al.  Liver stiffness measurement by fibroscan predicts the presence and size of esophageal varices in egyptian patients with HCV related liver cirrhosis. , 2013, Journal of clinical and diagnostic research : JCDR.

[6]  Ashish Kumar,et al.  Spleen Stiffness in Patients With Cirrhosis in Predicting Esophageal Varices , 2013, The American Journal of Gastroenterology.

[7]  D. Gorard,et al.  Endoscopic Management of Oesophageal and Gastric Varices , 2013 .

[8]  G. Casazza,et al.  Measurement of spleen stiffness to evaluate portal hypertension and the presence of esophageal varices in patients with HCV-related cirrhosis. , 2012, Gastroenterology.

[9]  Diana Feier,et al.  A new and simple algorithm for the noninvasive assessment of esophageal varices in cirrhotic patients using serum fibrosis markers and transient elastography. , 2011, Journal of gastrointestinal and liver diseases : JGLD.

[10]  V. de Lédinghen,et al.  Transient elastography for the diagnosis of liver fibrosis , 2010, Expert review of medical devices.

[11]  Mercedes Fernandez,et al.  Hepatic endothelial dysfunction and abnormal angiogenesis: new targets in the treatment of portal hypertension. , 2010, Journal of hepatology.

[12]  N. Ganne-Carrié,et al.  Liver stiffness measurement selects patients with cirrhosis at risk of bearing large oesophageal varices. , 2006, Journal of hepatology.

[13]  A. Magnano,et al.  Which patients with cirrhosis should undergo endoscopic screening for esophageal varices detection? , 2001, Hepatology.

[14]  K. Nouso,et al.  Measurement of spleen stiffness by acoustic radiation force impulse imaging identifies cirrhotic patients with esophageal varices. , 2013, Gastroenterology.

[15]  A. Sarangapani,et al.  Noninvasive Prediction of Large Esophageal Varices in Chronic Liver Disease Patients , 2010, Saudi journal of gastroenterology : official journal of the Saudi Gastroenterology Association.