A strategy for varices screening based on acoustic radiation force impulse combined with platelet (CHESS2001): An alternative of Baveno VI criteria

Abstract

Few studies have reported on acoustic radiation force impulse (ARFI) for varices screening. Our study aimed to identify a strategy based on liver stiffness measurement (LSM) and spleen stiffness measurement (SSM) by ARFI combined with platelet count (PLT), named the ARP strategy, for ruling out high-risk varices (HRV) and avoiding unnecessary esophagogastroduodenoscopy (EGD) in patients with compensated cirrhosis. We retrospectively reviewed patients who underwent ARFI from a previous cohort (NCT04307264). Of them, patients between 2017 and 2019 composed the training cohort to develop the ARP strategy. The validation cohort consisted of others between 2015 and 2016 to validate and compare it with Baveno VI criteria about the performance for varices screening. Primary outcomes were the rates of spared EGDs and HRV missed. A total of 741 consecutive patients were included in the final analysis. Of them, 576 patients were included in the training cohort and 165 patients in the validation cohort. In the training cohort, ARP strategy was defined as LSM < 1.805 m/s or SSM < 2.445 m/s and PLT > 110 × 10 9 /L. ARP strategy could spare 234 (40.6%) EGDs with a missed HRV rate of 3.4% (8 of 234). In the validation cohort, compared with Baveno VI criteria, the ARP strategy improved the proportion of avoided EGDs (49.7% vs. 34.5%; p < 0.001) and lowered the rate of misclassified HRV (1.2% vs.3.5%; p < 0.001). Conclusion: The ARP strategy was an efficient and safe tool for varices screening in compensated cirrhosis, and it might be an auxiliary or even alternative to Baveno VI criteria.

Acoustic Radiation Forced Impulse of the Liver and the Spleen, Combined with Spleen Dimension and Platelet Count in New Ratio Scores, Identifies High-Risk Esophageal Varices in Well-Compensated Cirrhotic Patients

“…Nowadays, few studies have explored the role of ARFI in predicting HRVs in cirrhotic patients. Huang et al [30], in an extensive study on 741 consecutive patients, combined liver and spleen ARFI measurements with platelet count, in a strategy named ARP, and compared them to the Baveno VI criteria [22] for OEV screening. In the training cohort, ARP strategy was defined as an LSM of <1.805 m/s or an SSM of <2.445 m/s and a platelet count of >110 × 10 9 /L, sparing 40.6% of EGDs with a missing rate of HRVs of 3.4%.…”

“…In the training cohort, ARP strategy was defined as an LSM of <1.805 m/s or an SSM of <2.445 m/s and a platelet count of >110 × 10 9 /L, sparing 40.6% of EGDs with a missing rate of HRVs of 3.4%. In the validation cohort, ARP strategy improved the Baveno VI criteria avoiding unnecessary EGDs [30]. In another study, Wang et al prospectively evaluated the performance of liver and spleen ARFI stiffness in a subpopulation of liver cirrhotic patients suffering from chronic hepatitis B under pharmacological viral suppression.…”