Transient Elastography (Fibroscan) in Patients with Non-cirrhotic Portal Fibrosis

Sharma, Praveen; Agarwal, Rachit; Dhawan, Shashi; Bansal, Naresh; Singla, Vikas; Kumar, Ashish; Arora, Anil

doi:10.1016/j.jceh.2017.03.002

Cited by 37 publications

(22 citation statements)

References 17 publications

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“…The prevalence of HRV in our study is lower than in some other reported series [17, 18]. This may reflect the heterogeneity of causes of NCPH in our patient cohort, as different causes of NCPH may be associated with varying risk of varices or variceal bleeding [6, 19].…”

Section: Discussioncontrasting

confidence: 68%

“…The number of patients with HRV in this cohort however was very small. LSM has been proposed as an adjunctive tool to distinguish between cirrhosis and idiopathic NCPH as the values are generally higher than healthy controls but lower than matched patients with cirrhosis [17, 18]. Complicating the issue is the diverse range of causes of NCPH.…”

Section: Discussionmentioning

confidence: 99%

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Noninvasive Predictors of High-Risk Varices in Patients with Non-Cirrhotic Portal Hypertension

Cunningham

Parastandeh-Chehr

Cerocchi

et al. 2019

Canadian Journal of Gastroenterology and Hepatology

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Non-cirrhotic portal hypertension (NCPH) comprises a heterogeneous group of liver disorders causing portal hypertension without cirrhosis and carries a high risk of variceal bleeding. Recent guidelines, based largely on patients with viral cirrhosis, suggest low likelihood of high risk varices (HRV) in patients with a liver stiffness measurement (LSM) <20 kPa and platelet count >150 × 109/L. In NCPH, LSM is often higher than healthy controls but lower than matched cirrhotic patients. The aim of this study was to assess whether LSM or other noninvasive assessments of portal hypertension could predict HRV in NCPH patients. Methods. Records of patients with NCPH seen at a single centre between 2007 and 2018 were reviewed retrospectively. Primary outcome measure was presence or absence of HRV at gastroscopy within 12 months of clinical assessment. Association of LSM or other clinical features of portal hypertension (spleen size, platelet count, platelet count/spleen length ratio (PSL), LSM-spleen length/platelet count ratio score (LSP)) with HRV and ability of these variables to predict HRV was analysed. Results. Of 44 patients with NCPH who met inclusion criteria, 34% (15/44) had HRV. In a multivariate model, spleen size and PSL correlated with HRV but platelet count, LSM, and LSP did not (spleen size: β = 0.35, p = 0.02; OR 1.42, 95% CI 1.06-1.92; PSL: β = -1.47, p = 0.02; OR 0.23, 95% CI 0.07-0.80). There was no significant difference between spleen size and PSL in predicting HRV (AUROC 0.81 (95% CI 0.66 – 0.91) versus 0.71 (95% CI 0.54 – 0.84), respectively, p = 0.400). Spleen size >17.2cm had sensitivity 78.6% and specificity 64.3% for prediction of HRV. Conclusions. In NCPH patients, spleen size may predict risk of HRV at gastroscopy within 12 months. LSM and platelet count are not useful to assess risk of HRV in NCPH.

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Section: Discussioncontrasting

confidence: 68%

Section: Discussionmentioning

confidence: 99%

Noninvasive Predictors of High-Risk Varices in Patients with Non-Cirrhotic Portal Hypertension

Cunningham

Parastandeh-Chehr

Cerocchi

et al. 2019

Canadian Journal of Gastroenterology and Hepatology

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“…Noninvasive methods, in particular US elastography, are very helpful for diagnosing PSVD with portal hypertension 8 (i.e., INCPH), as normal or only slightly increased LSM (i.e., < 10 kPa for VCTE) indicates the absence of ACLD. [128][129][130] In these patients, the presence of specific (varices, portal hypertensive bleeding, portosystemic collaterals) and nonspecific signs of portal hypertension (PLT < 150G Â L À1 , or spleen size ! 13 cm) is suggestive of prehepatic or intrahepatic presinusoidal causes of portal hypertension, which are both situations in which HVPG underestimates the severity of portal hypertension.…”

Section: Diagnosing Portosinusoidal Vascular Disease With Portal Hypementioning

confidence: 99%

Noninvasive Diagnostics for Portal Hypertension: A Comprehensive Review

et al. 2020

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Noninvasive diagnostics for portal hypertension include imaging and functional tests, as well as blood-based biomarkers, and capture different features of the portal hypertensive syndrome. Definitive conclusions regarding their clinical utility require assessment of their diagnostic value in specific clinical settings (i.e., diagnosing a particular hemodynamic condition within a well-defined target population). Several noninvasive methods are predictive of clinically significant portal hypertension (CSPH; hepatic venous pressure gradient [HVPG] ≥ 10 mm Hg; the threshold for complications of portal hypertension); however, only a minority of them have been evaluated in compensated advanced chronic liver disease (i.e., the target population). Importantly, most methods correlate only weakly with HVPG at high values (i.e., in patients with CSPH). Nevertheless, selected methods show promise for diagnosing HVPG ≥ 16 mm Hg (the cut-off for increased risks of hepatic decompensation and mortality) and monitoring HVPG changes in response to nonselective beta-blockers or etiological treatments. Finally, we review established and potential future clinical applications of noninvasive methods.

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“…We also do not agree with the investigators that among noninvasive tests transient elastography (TE) is inadequate for diagnosis of NCPH. In our recent study, we showed that TE in patients with NCPH was significantly lower compared to patients with cirrhosis, and it correlated well with HVPG. Thus, TE can be a useful noninvasive technique to differentiate between Child's A cirrhosis and NCPH.…”

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confidence: 77%

Letter to the Editor: Portal Pressure in Non‐Cirrhotic Portal Hypertension: To Measure or Not to Measure

2020

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Transient Elastography (Fibroscan) in Patients with Non-cirrhotic Portal Fibrosis

Abstract: Transient elastography (Fibroscan) is significantly low in patients with NCPF compared to patients with cirrhosis. It is a very useful non-invasive technique to differentiate between Child's A cirrhosis and non-cirrhotic portal fibrosis.

Cited by 37 publications

References 17 publications

Noninvasive Predictors of High-Risk Varices in Patients with Non-Cirrhotic Portal Hypertension

Noninvasive Predictors of High-Risk Varices in Patients with Non-Cirrhotic Portal Hypertension

Noninvasive Diagnostics for Portal Hypertension: A Comprehensive Review

Letter to the Editor: Portal Pressure in Non‐Cirrhotic Portal Hypertension: To Measure or Not to Measure

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