981 Spleen Stiffness Using Elastography as Predictor of Esophageal Varices in Cirrhotic Patients

Abstract

INTRODUCTION: Prediction of EV by the measurement of splenic stiffness (SS) by Transient elastography (TE) in cirrhotic patients has been recently proposed. Splenomegaly and splenic stiffness in cirrhosis can be explained by enlargement and hyper activation of the splenic lymphoid tissue, increased angiogenesis, fibrogenesis and passive congestion due to portal hypertension. Thus, the aim of this study is to assess diagnostic accuracy of spleen stiffness as a predictor for the presence of esophageal varices in liver cirrhosis using EGD as gold standard. Spleen stiffness measurement is non-invasive technique as compared to EGD so this test can be used to stratify the liver cirrhotic patient who need screening EGD compared those who do not need it. METHODS: Patients were enrolled from June 2018 to May 2019, all patient with cirrhosis undergoing screening EGD were offered to participate in the study. After fulfilling the inclusion criteria, a blood sample for platelet count, INR, CTP and MELD score was taken. Splenic stiffness was measured by fibroscan by expert radiologist prior to undergoing screening EGD. Exclusion criteria was followed strictly to avoid confounding variables. All information along including age, gender, spleen stiffness, presence or absence of EV were entered in the Performa. RESULTS: Total of 97 patients were included in the study, mean age of patients was 41.1 ± 15.1, predominantly were males 61(62.9%), while 55 (56.7%) belonged to urban areas of province. Common etiologies for cirrhosis includes HCV 49(50.5%) followed by HBV 16(16.5%), HBV and HDV coinfection 10(10.3%), autoimmune hepatitis 7(7.2%) and others were 8 (8.2%). Most patients belonged to CTP class A 58(59.8%), Mean MELD score were 11.7 ± 5.5. Mean platelets and albumin of patients were 128 ± 86.3 and 3.3 ± 0.7. Total 25 (25.7%) had ascites and 55 (56.7%) had esophageal varices on screening EGD and 6(6.2%) patient had fundal varix. Student t-test showed a significant association of low platelets (P = 0.0001, 118.3 vs 57.5) and high splenic stiffness (P = 0.0001, 37.9 vs 23.0) with the presence of esophageal varices. Area under ROC was calculated for APRI, FIB-4 and splenic stiffness was 0.81, 0.79 and 0.93 respectively. CONCLUSION: Splenic stiffness can more reliably predict the presence of esophageal varices as compare to other noninvasive test like APRI and FIB-4. So it can be used to stratify the patient who needs screening EGD and minimize the false negative results.