Spleen Stiffness as Predictor of Esophageal Varices in Cirrhosis of Different Etiologies

Fierbinţeanu-Braticevici, Carmen; Tribus, Laura; Peagu, Răzvan; Petrişor, Ana; Băicuș, Cristian; Crețoiu, Dragoș; Pasternak, Artur; Oprea, Gabriela; Purcareanu, Adina; Moldoveanu, Alexandru Constantin

doi:10.1038/s41598-019-52407-y

Cited by 36 publications

(28 citation statements)

References 49 publications

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“…As it was already shown in other studies [ 10 , 32 – 34 ], in our group, the mean SSM values determined by both techniques were significantly higher for patients with VNT as compared to those without. The diagnostic accuracy of SSM by both p-SWE and 2D-SWE for predicting the presence of VNT was evaluated and good diagnostic accuracy was found (AUROC 0.90 and 0.84, resp.…”

Section: Discussionsupporting

confidence: 89%

Spleen Stiffness for Predicting Varices Needing Treatment: Comparison between Two Different Elastography Techniques (Point vs. 2D-SWE)

Fofiu

Bende

Lupușoru

et al. 2021

Canadian Journal of Gastroenterology and Hepatology

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The study aimed to establish the benefits of using spleen stiffness values measured by two elastography techniques as noninvasive markers for predicting varices needing treatment and comparing their performances. A prospective study was performed, including 107 subjects with compensated liver cirrhosis, who underwent upper digestive endoscopy, as well as spleen stiffness measurements by means of two elastography techniques: pSWE (point shear wave elastography using Virtual Touch Quantification-Siemens Acuson S2000) and 2D-SWE (2D-shear wave elastography-LOGIQ E9, General Electric). Reliable spleen stiffness measurements were obtained in 96.2% (103/107) patients by means of 2D-SWE and in 94.4% (101/107) subjects with pSWE; therefore, 98 subjects were included in the final analysis, of which 40.8% (40/98) had varices needing treatment. The optimal spleen stiffness cut-off value by 2D-SWE for predicting varices needing treatment was 13.2 kPa (AUROC 0.84), while for pSWE, it was 2.91 m/s (AUROC 0.90). Based on AUROC comparison, no difference between the performance of the two techniques for predicting varices needing treatment was found ( p = 0.1606 ). In conclusion, spleen stiffness measured by either 2D-SWE or pSWE is a reliable surrogate marker, with good feasibility, applicability, and predictive accuracy for varices needing treatment, with no significant difference between techniques.

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Section: Discussionsupporting

confidence: 89%

Spleen Stiffness for Predicting Varices Needing Treatment: Comparison between Two Different Elastography Techniques (Point vs. 2D-SWE)

Fofiu

Bende

Lupușoru

et al. 2021

Canadian Journal of Gastroenterology and Hepatology

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“…Attempts have been made to use less invasive modalities as an alternative tool for the stratification of GEVs [4, 13,14]. Spleen stiffness accurately reflects the severity of portal hypertension and is effective in EV prediction [15,16]. A recent study developed a model with spleen stiffness assessed by point-shear-wave elastography, and it provides accurate information in cirrhotic patients for excluding endoscopy requirements [17].…”

Section: Discussionmentioning

confidence: 99%

Efficacy of CTPV for Diagnostic and Therapeutic Assessment: Comparison with Endoscopy in Cirrhotic Patients with Gastroesophageal Varices

Cui

Yang

Jin

et al. 2020

Gastroenterology Research and Practice

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Background and Aims. Computed tomography portal venography (CTPV) shows potential in detecting varices that need treatment and their drainage pathways. However, its agreement with endoscopy requires further study. We investigated the feasibility of CTPV as an alternative tool to endoscopy in screening gastroesophageal varices (GEVs) and developed a CTPV-based model to provide a less invasive assessment of endotherapy for cirrhotic patients with GEVs. Methods. The study included 33 cirrhotic patients with a recent history of variceal hemorrhage. The presence, grade, and classification of GEVs on endoscopy and CTPV were compared (kappa test). Twenty-four patients were treated endoscopically, including 12 for esophageal varices (EVs), 8 for gastric varices (GVs), and 4 for GEVs. Treatment efficacies were assessed with the newly developed CTPV-based method at 1 week and 1 month after treatment. Efficiency evaluated by CTPV and endoscopy was compared by Fisher’s exact test to determine whether CTPV is efficient in the assessment of endotherapy efficacy. Results. For the screening and grading/classification of EVs and GVs, substantial agreement (EV kappa: 0.63 and 0.68; GV kappa: 0.62 and 0.75, respectively) was noted between endoscopy and CTPV. The therapeutic efficacy of EVs was higher when assessed by CTPV than when evaluated by endoscopy (37.50% vs. 12.50% at 1 week postoperation, P=0.22; 62.50% vs. 25.00% at 1 month postoperation, P=0.07), but without statistical significance. The same trend was also found in the assessment of therapeutic efficacy for GVs (25.00% vs. 16.67% at 1 week postoperation, P=1; 58.33% vs. 41.67% at 1 month postoperation, P=0.68). Conclusion. CTPV is comparable to endoscopy in the detection of GEVs and in the evaluation of endotherapy efficacy, which suggests that it could be a less invasive alternative for endoscopy in cirrhotic patients with GEVs needing treatment.

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“…Several studies have explored SSM in the prediction of EV[ 40 , 44 - 47 ]. A prospective study of 135 patients demonstrated that patients with any EV had higher SSM than those with no EV (3.37 m/s vs 2.79 m/s, P < 0.001); and patients with HREV had an even greater difference in SSM (3.96 m/s vs 2.93 m/s, P < 0.001)[ 44 ]. In addition, at a cutoff value of < 3.20 m/s, NPV for excluding HREV was 99%[ 44 ].…”

Section: Spleen Stiffness Measurementmentioning

confidence: 99%

“…A prospective study of 135 patients demonstrated that patients with any EV had higher SSM than those with no EV (3.37 m/s vs 2.79 m/s, P < 0.001); and patients with HREV had an even greater difference in SSM (3.96 m/s vs 2.93 m/s, P < 0.001)[ 44 ]. In addition, at a cutoff value of < 3.20 m/s, NPV for excluding HREV was 99%[ 44 ]. SSM was therefore evaluated in 2 prospective studies and demonstrated good diagnostic accuracy for prediction of any EV, with AUROC of 0.872 to 0.933 at a cutoff of 2.89-3.18 m/s, and good diagnostic accuracy for the prediction of HREV, with AUROC of 0.930–0.969 at cutoffs of 3.30 m/s[ 45 , 47 ].…”

Section: Spleen Stiffness Measurementmentioning

confidence: 99%

Noninvasive scores for the prediction of esophageal varices and risk stratification in patients with cirrhosis

Bangaru¹,

Benhammou²,

Tabibian³

2020

WJH

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The primary purpose of variceal screening in patients with cirrhosis is to detect gastroesophageal varices at high risk of hemorrhage and implement preventative intervention(s). It was previously recommended that all patients with cirrhosis undergo initial and periodic longitudinal variceal screening via upper endoscopy. However, there has been growing interest and methods to identify patients with cirrhosis who may not have clinically significant portal hypertension and therefore be unlikely to have varices requiring intervention or benefit from upper endoscopy. Because the population of patients with compensated advanced chronic liver disease continues to grow, it is neither beneficial nor cost-effective to perform endoscopic variceal screening in all patients. Therefore, there is ongoing research into the development of methods to non-invasively risk stratify patients with cirrhosis for the presence of high-risk esophageal varices and effectively limit the population that undergoes endoscopic variceal screening. This is particularly important and timely in light of increasing healthcare reform and barriers to healthcare. In this review, we discuss and compare, with respect to test characteristics and clinical applicability, the available methods used to non-invasively predict the presence of esophageal varices.

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Spleen Stiffness as Predictor of Esophageal Varices in Cirrhosis of Different Etiologies

Cited by 36 publications

References 49 publications

Spleen Stiffness for Predicting Varices Needing Treatment: Comparison between Two Different Elastography Techniques (Point vs. 2D-SWE)

Spleen Stiffness for Predicting Varices Needing Treatment: Comparison between Two Different Elastography Techniques (Point vs. 2D-SWE)

Efficacy of CTPV for Diagnostic and Therapeutic Assessment: Comparison with Endoscopy in Cirrhotic Patients with Gastroesophageal Varices

Noninvasive scores for the prediction of esophageal varices and risk stratification in patients with cirrhosis

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