Controversies in Budd-Chiari Syndrome Management: Potential Role of Liver Stiffness

Mancuso, Andrea; Amata, Michele; Politi, F.; Mitra, Mario; Marsala, Maria Grazia Laura; Maringhini, Alberto

doi:10.14309/ajg.0000000000000586

Cited by 8 publications

(5 citation statements)

References 5 publications

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“…An alternative approach could be to explore which subgroups of patients on only medical therapy would benefit from early intervention (using non-invasive tools capable of addressing the efficacy of intervention for BCS [ 72 , 73 , 74 ]). To this end, as shown in preliminary findings on four cases, which applied an approach that incorporates elastography, preliminary data would suggest that LS variations from baseline could predict outcome for BCS on sole medical therapy [ 75 ]. Further studies could explore whether computational models are useful in the field of BCS [ 76 ].…”

Section: Timing Of Treatment For Bcsmentioning

confidence: 99%

Budd–Chiari Syndrome Management: Controversies and Open Issues

Mancuso

2022

Diagnostics

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Section: Timing Of Treatment For Bcsmentioning

confidence: 99%

Budd–Chiari Syndrome Management: Controversies and Open Issues

Mancuso

2022

Diagnostics

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“…Mancuso et al recently claimed that LS alterations from baseline could predict BCS outcomes when treated with only medicinal therapy. They measured LS every 4-5 months with FibroScan Echosens, and after an average 10-month follow-up, three patients, two with improved LS and one with stable LS, had stable liver disease, whereas one with worsening LS developed refractory ascites, with an increase in both creatinine and bilirubin, and was referred for evaluation of both liver and kidney transplantation [20]. In two cases with BCS, a recent case report investigated the efficacy of the hepatic vein (HV) waveform by Doppler ultrasonography and quantified liver stiffness (LS) using transient elastography (TE) before and after percutaneous transhepatic angioplasty (PTA).…”

Section: Discussionmentioning

confidence: 99%

Utility of transient elastography in evaluation and follow-up of Budd-Chiari syndrome patients after endovascular intervention

et al. 2021

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Background Liver stiffness measurement (LSM) using transient elastography (TE) is a common noninvasive method for assessing hepatic fibrosis. The purpose of this study was to show the utility of LSM in the evaluation and short-term follow-up of Budd-Chiarri syndrome (BCS) patients as well as to investigate the relationships between LSM, hepatic venous pressure, and liver fibrosis. We conducted a prospective cohort study in which 25 patients with a confirmed diagnosis of primary BCS underwent endovascular intervention for BCS treatment. All patients had pressure gradient changes across the stenosed hepatic veins/inferior vena cava (HV/IVC) measured before and after the procedure, a transvenous liver biopsy during the procedure, and LSM (using Transient Elastography 3 days before and 3 months after the intervention as a short-term follow-up). Comparisons and correlations were made between liver stiffness, hepatic venous pressure, and fibrosis. Results The HV/IVC pressure gradient measured immediately before and after the intervention had a direct proportionate correlation with the LS measured 3 days before and 3 months after the intervention (r = 0.41 & 0.44, p: 0.04 & 0.03, respectively). LSM drops significantly 3 months after intervention (from 51.62 ± 22 kPa to 28.80 ± 19.25 kPa (p: 0.001)). There is a significant improvement in LSM post-intervention among patients with moderate to severe fibrosis (METAVIR scores of ≥ F2 before intervention (p: 0.001). Conclusions LSM in BCS patients reflects congestion rather than fibrosis stage. TE can be used for the short-term monitoring of patients with BCS following the endovascular intervention as a noninvasive tool.

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“…Unique to the APASL consensus guidance is the incorporation of liver stiffness measurement (LSM) as an additional tool to estimate the severity of hepatic congestion and assess therapeutic response (1). This is an emerging area of investigation and in some preliminary studies, variations in liver stiffness measurements have correlated with the clinical trajectory in patients who received anticoagulation and endovascular interventions (13)(14)(15). As the evidence for this practice grows, LSM may be useful to guide selection of initial and/ or subsequent treatment modalities (9,13).…”

Section: Editorialmentioning

confidence: 99%

“…This is an emerging area of investigation and in some preliminary studies, variations in liver stiffness measurements have correlated with the clinical trajectory in patients who received anticoagulation and endovascular interventions (13)(14)(15). As the evidence for this practice grows, LSM may be useful to guide selection of initial and/ or subsequent treatment modalities (9,13).…”

Section: Editorialmentioning

confidence: 99%