Transient elastography for predicting esophageal/gastric varices in children with biliary atresia

Abstract

BackgroundTransient elastography (TE) is an innovative, noninvasive technique to assess liver fibrosis by measuring liver stiffness in patients with chronic liver diseases. The purpose of this study has been to explore the accuracy of TE and clinical parameters in predicting the presence of esophageal/gastric varices in children with biliary atresia (BA) following portoenterostomy.MethodsPatients with BA status post portoenterostomy and normal children were recruited. Splenomegaly and presence of EV/GV were determined by physical examination and endoscopy, respectively. Aspartate transaminase to platelet ratio index (APRI) was used as a serum fibrosis marker. TE was performed by using FibroScan. Data was expressed as mean ± SD.ResultsSeventy-three BA patients (male:female = 32:41; age 9.11 ± 5.64 years) and 50 normal controls (male:female = 19:31; age 11.00 ± 3.31 years) were enrolled. The liver stiffness score of BA patients was significantly higher than that of normal controls (27.37 ± 22.48 and 4.69 ± 1.03 kPa; p < 0.001). Patients with EV/GV had significantly higher liver stiffness score and APRI than those without EV/GV. As for EV/GV diagnosis, the areas under the receiver operating characteristic curve were 0.89 (95% CI 0.80 to 0.98) for TE and 0.87 (95% CI 0.78 to 0.96) for APRI, respectively. The sensitivity (and specificity) of TE (using a cut-off value of 12.7 kPa) and APRI (using a cut-off value of 1.92) in predicting EV/GV were 84% (77%) and 84% (83%), respectively, whereas the sensitivity (and specificity) of splenomegaly in predicting EV/GV were 92% (85%).ConclusionsTransient elastography is a useful tool for predicting the presence of EV/GV. In addition, basic physical examination, routine biochemical and hematological tests, are still worthwhile and correlate well with the presence of EV/GV in patients with BA post portoenterostomy.

Diagnosing native liver fibrosis and esophageal varices using liver and spleen stiffness measurements in biliary atresia: a pilot study

“…However, we wonder why some biliary atresia patients show many of the symptoms associated with portal hypertension despite having relatively good liver biochemistry results. The previously reported cutoff values for liver stiffness measurements using transient elastography for diagnosing esophageal varices (9.7-12.7 kPa) are lower than those found in adults [13,26,27,30]. Unfortunately, the current study could not assess patients who showed a discrepancy between liver fibrosis and portal hypertension because such patients were mostly excluded from the assessment of esophageal varices due to prior treatment for esophageal varices and hypersplenism.…”

“…The noninvasive detection of esophageal varices in biliary atresia patients appears to be of great importance in clinical practice. Three reports have described liver stiffness measurements using transient elastography as good markers of the presence of esophageal varices (area under the curve = 0.88-0.92) in postsurgical biliary atresia patients [13,26,27]. The aspartate aminotransferase to platelet ratio index might also be able to diagnose the presence of esophageal varices in postsurgical biliary atresia patients, with reported areas under the curves of 0.87-0.88 [13,27].…”

“…Three reports have described liver stiffness measurements using transient elastography as good markers of the presence of esophageal varices (area under the curve = 0.88-0.92) in postsurgical biliary atresia patients [13,26,27]. The aspartate aminotransferase to platelet ratio index might also be able to diagnose the presence of esophageal varices in postsurgical biliary atresia patients, with reported areas under the curves of 0.87-0.88 [13,27]. Gana et al [17] developed the clinical prediction rule to predict esophageal varices, and reported an area under the curve of 0.93 from a study of 51 pediatric patients with liver disease or portal vein thrombosis, and the validation studies showed areas under the curves of 0.80 and 0.77 [28,29].…”

Current Knowledge in Ultrasound-Based Liver Elastography of Pediatric Patients

“…The sensitivity (and specificity) of TE (using a cut-off value of 12.7 kPa) and APRI (using a cut-off value of 1.92) in predicting esophageal/gastric varices were 84% (77%) and 84% (83%), respectively [57].…”

Ultrasound Elastography - Review of Techniques and Its Clinical Applications in Pediatrics - Part 1

“…The study revealed that transient elastography may be an equally useful tool for predicting the presence of esophageal/gastric varices as physical examination and biochemical or hematological tests. The sensitivity and specificity of TE in this study were 84% and 74% respectively; however, the sensitivity and specificity of splenomegaly (clinical parameter which was also assessed in this research) were 92% and 85% [28]. The other studies focused on TE were presented by Honsawek et al The main goal of this research was apparently to distinguish if serum adiponectin, galectin-3, tissue growth factor, osteopontine or soluble receptor for advanced glycation end products (sRAGE) level might be responsible for liver fibrosis.…”