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Spleen stiffness measurement for assessing the response to β-blockers therapy for high-risk esophageal varices patients

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Abstract

Background

Non-selective β-blocker (NSBB) therapy is the treatment of choice for primary prophylaxis of cirrhotic patients with high-bleeding risk esophageal varices (HRV). The hemodynamic response to NSBB is assessed by the measurement of the hepatic venous pressure gradient (HVPG). Recently, liver and spleen stiffness measurements (LSM and SSM) were proposed as non-invasive surrogates of HVPG. We aimed to evaluate LSM and SSM changes for assessing hemodynamic response in these patients.

Methods

Cirrhotic patients with HRV were prospectively enrolled and evaluated at our Department before starting NSBB and after 3 months. Correlation between changes (delta) of HVPG after NSBB treatment and those of LSM or SSM by transient elastography was performed.

Results

From the initial 59 patients considered for the study, 20 were finally included in the analysis. Fifteen (15) patients reached hemodynamic response to NSBB according to HVPG. Changes in LSM did not correlate with changes in HVPG (r = 0.107, p value = 0.655), unlike changes in SSM (r = 0.784, p value < 0.0001). Delta SSM presented excellent accuracy in identifying HVPG responders (AUROC 0.973; 95% CI 0.912–1). The best cut-off for delta SSM to identify responders was -10% (sensitivity 100%, specificity 60%, NPV 100% and PPV 90%).

Conclusions

SSM could be a reliable non-invasive test for the assessment of hemodynamic response to NSBB therapy as primary prophylaxis for HRV. Similar to HVPG, SSM reduction ≥ 10% is able to assess hemodynamic response.

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Abbreviations

PH:

Portal hypertension

EV:

Esophageal varices

HVPG:

Hepatic venous gradient pressure

NSBB:

Non-selective β-blockers

HRV:

High-bleeding risk esophageal varices

NITs:

Non-invasive tests

LSM:

Liver stiffness measurement

SSM:

Spleen stiffness measurement

ARFI:

Acoustic radiation forced impulse

TE:

Transient elastography

EGD:

Esophagogastroduodenoscopy

HCC:

Hepatocellular carcinoma

EBL:

Esophageal banding ligation

US:

Ultrasound

EFSUMB:

European Federation of Societies for Ultrasound in Medicine and Biology

WHVP:

Wedged hepatic venous pressure

FHVP:

Free hepatic venous pressure

CSPH:

Clinically significant portal hypertension

IQR:

Inter quartile range

CI:

Confidence interval

NPV:

Negative predictive value

PPV:

Positive predictive value,

MELD:

Model for End-Stage Liver Disease

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Author notes

  1. Giovanni Marasco and Elton Dajti contributed equally as first author.

  2. Davide Festi and Antonio Colecchia contributed equally as last author.

Authors and Affiliations

  1. Department of Medical and Surgical Sciences (DIMEC), University of Bologna, Via Massarenti 9, 40138, Bologna, Italy

    Giovanni Marasco, Elton Dajti, Federico Ravaioli, Luigina Vanessa Alemanni, Luigi Colecchia & Davide Festi

  2. Unit of Gastroenterology, Borgo Trento University Hospital of Verona, P.le Aristide Stefani 1, 37126, Verona, Italy

    Fabiana Capuano, Kamela Gjini, Caterina Cusumano & Antonio Colecchia

  3. Radiology Unit, Borgo Trento University Hospital, P.le Aristide Stefani 1, 37126, Verona, Italy

    Giovanni Puppini

  4. Radiology Unit, Sant’Orsola Malpighi Hospital, Via Albertoni 4, 40126, Bologna, Italy

    Matteo Renzulli & Rita Golfieri

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  1. Giovanni Marasco
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Contributions

GM, DF and AC designed the study; GM, ED, FR, DF, AC analyzed and interpreted the data; GM, ED and AC drafted the article. All authors acquired the data, revised the manuscript and approved its final version for publication.

Corresponding author

Correspondence to Giovanni Marasco.

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Conflict of interest

Giovanni Marasco, Elton Dajti, Federico Ravaioli, Luigina Vanessa Alemanni, Fabiana Capuano, Kamela Gjini, Luigi Colecchia, Giovanni Puppini, Caterina Cusumano, Matteo Renzulli, Rita Golfieri, Davide Festi, Antonio Colecchia declare that they have no conflict of interest.

Informed consent in studies with human subjects

All procedures followed were in accordance with the ethical standards of the responsible committee on human experimentation (institutional and national) and with the Helsinki Declaration of 1975, as revised in 2008. Informed consent was obtained from all patients for being included in the study.

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This article does not contain any studies with human or animal subjects.

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Marasco, G., Dajti, E., Ravaioli, F. et al. Spleen stiffness measurement for assessing the response to β-blockers therapy for high-risk esophageal varices patients. Hepatol Int 14, 850–857 (2020). https://doi.org/10.1007/s12072-020-10062-w

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