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Role of Spleen Stiffness Measurement by 2D-Shear Wave Elastography in Ruling Out the Presence of High-Risk Varices in Cirrhotic Patients

  • Dimitrios S. KaragiannakisEmail author
  • Theodoros Voulgaris
  • Evgenia Koureta
  • Elissavet Chloupi
  • George V. Papatheodoridis
  • John Vlachogiannakos
Original Article
  • 12 Downloads

Abstract

Background and Aim

To evaluate if spleen stiffness measurement (SSM) can rule out the presence of high-risk varices in patients with cirrhosis, avoiding an upper gastrointestinal endoscopy (UGE).

Methods

We enrolled 71 cirrhotic patients irrespective of liver disease’s etiology. 2D shear wave elastography (SWE) of spleen and UGE was performed. High-risk varices (HRV) were defined as esophageal varices ≥ 5 mm and/or red spots and any gastric varices.

Results

Esophageal varices were documented in 37 (52.1%) and HRV in 25 (35.2%) patients. SSM was not technically feasible in 7/71 patients (9.8%). From the remaining 64 patients, when those with cholestatic liver disease were excluded (n = 17), SSM < 35.8 kPa was found to exclude well the existence of HRV offering an AUROC of 0.854 (p < 0.001), sensitivity 88.9%, negative predictive value (NPV) 91.3%, specificity 72.4%, and positive predictive value (PPV) 66.7%. Only 2/47 patients (4.3%) were misclassified, and 23 (48.9%) could avoid endoscopy. In the total cohort of 64 patients, SSM < 33.7 kPa was found to exclude well the presence of HRV offering AUROC 0.792 (p < 0.001), sensitivity 91.7%, specificity 60%, NPV 92.3%, and PPV 57.9%. The misclassification rate was 3.1% (2/64), while 26/64 (40.6%) could avoid endoscopy.

Conclusions

2D-SWE of spleen is a reliable method for ruling out the presence of HRV in cirrhotic patients. If larger studies confirm our results, a large number of endoscopies could be avoided.

Keywords

Spleen stiffness Variceal bleeding Cirrhosis Portal hypertension 

Abbreviations

HVPG

Hepatic venous pressure gradient

CSPH

Clinically significant portal hypertension

GEV

Gastroesophageal varices

HRV

High-risk varices

UGE

Upper gastrointestinal endoscopy

LSM

Liver stiffness measurements

TE

Transient elastography

SSM

Spleen stiffness measurement

SWE

Shear wave elastography

HCC

Hepatocellular carcinoma

TIPS

Transjugular intrahepatic portosystemic shunt

INR

International normalized ratio

AST

Aspartate aminotransferase

ALT

Alanine aminotransferase

MELD

Model for end stage liver disease

SD

Standard deviation

AUROC

Area under receiving operating characteristic

PPV

Positive predictive value

NPV

Negative predictive value

ARFI

Acoustic radiation force impulse imaging

Notes

Compliance with ethical standards

Conflict of interest

All the authors have no financial or other conflict of interest to declare concerning this manuscript.

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Copyright information

© Springer Science+Business Media, LLC, part of Springer Nature 2019

Authors and Affiliations

  1. 1.Academic Department of Gastroenterology, Laiko General Hospital, Medical School of NationalKapodistrian University of AthensAthensGreece

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