TY - JOUR
TI - Role of Spleen Stiffness Measurement by 2D-Shear Wave Elastography in Ruling Out the Presence of High-Risk Varices in Cirrhotic Patients
AU - Karagiannakis, D.S.
AU - Voulgaris, T.
AU - Koureta, E.
AU - Chloupi, E.
AU - Papatheodoridis, G.V.
AU - Vlachogiannakos, J.
JO - Digestive Diseases and Sciences
PY - 2019
VL - 64
TODO - 9
SP - 2653-2660
PB - Springer New York LLC
SN - 0163-2116, 1573-2568
TODO - 10.1007/s10620-019-05616-4
TODO - alanine aminotransferase;  aspartate aminotransferase, acoustic radiation force impulse imaging;  adult;  aged;  alcoholism;  Article;  ascites;  aspartate aminotransferase blood level;  Child Pugh score;  chronic hepatitis;  clinical evaluation;  diagnostic test accuracy study;  digestive tract parameters;  esophagus varices;  female;  gastrointestinal endoscopy;  hepatic encephalopathy;  hepatic portal vein;  high risk patient;  human;  international normalized ratio;  liver cirrhosis;  liver stiffness;  major clinical study;  male;  Model For End Stage Liver Disease Score;  non invasive procedure;  nonalcoholic fatty liver;  outpatient;  portal hypertension;  prediction;  predictive value;  priority journal;  sensitivity and specificity;  shear wave elastography;  spleen stiffness measurement;  splenectomy;  splenomegaly;  thrombocyte;  transient elastography;  transjugular intrahepatic portosystemic shunt;  virus hepatitis;  area under the curve;  complication;  diagnostic imaging;  elasticity;  elastography;  esophagus varices;  liver cirrhosis;  middle aged;  pathophysiology;  procedures;  receiver operating characteristic;  risk factor;  spleen, Aged;  Area Under Curve;  Elasticity;  Elasticity Imaging Techniques;  Endoscopy, Gastrointestinal;  Esophageal and Gastric Varices;  Female;  Humans;  Liver Cirrhosis;  Male;  Middle Aged;  Predictive Value of Tests;  Risk Factors;  ROC Curve;  Spleen
TODO - 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. © 2019, Springer Science+Business Media, LLC, part of Springer Nature.
ER -