EVALUATION OF LIVER AND SPLEEN TRANSIENT ELASTOGRAPHY IN THE DIAGNOSIS OF ESOPHAGEAL VARICES

Abstract

Background: Portal hypertension with subsequent esophageal varices (EVs) development is a common complication of HCV related cirrhosis. Aim: is to evaluate the role of liver stiffness measurement (LSM), spleen stiffness measurement (SSM) and their combination (CLSM) using FibroScan™ in diagnosis of EVs. Methods: One hundred sixty five HCV related F3-4 Metavir score fibrosis were included. Liver, renal function tests, CBC, INR and abdominal ultrasonography were done before the FibroScan™. Transient elastography measurement was done using FibroScan™ in the supine position after 6-8 hours fasting followed by diagnostic esophageogastroscopy. Varices were classified into none (n= 110), small (n =30) and large (n =25). Results: Patients with varices had higher serum bilirubin (1.68±0.82 vs. 1.00±0.55 mg/dl) and lower platelet count (105.09±31.34vs. 161.21±52.97 ×103/mL) that patients without varices (p=0.001). The patients with varices had statistically significant (p=0.001) higher platelets spleen ratio (671.14±258.89 vs 1215.41±445.58), LSM (31.93±13.29 vs. 17.55±6.53 kPa), SSM (62.85±12.71 vs. 36.94±8.83 kPa) and CLSS (94.78±20.98 vs. 54.49±12.84 kPa) than patients without varices. In patients with small and large varices LSM was comparable (30.84±12.69 vs 33.64±13.97 kPa; p=0.391) but a statistically significant difference was detected with SSM (59.92±13.47 vs. 66.98±8.67 kPa; p=0.031) and CLSS (90.76±21.76 vs 100.62±19.00 kPa; p=0.043). With a cutoff of 20.4 kPa LSM (81.0% sensitivity, 71.8% specificity, 52.3% PPV, 90.8% NPV, 74.3% accuracy), 43.2 kPa SSM (92.9% sensitivity, 84% specificity, 69.6% PPV, 96.9% NPV, 86.8% accuracy) and 59.3 kPa CLSS (95.2% sensitivity, 70% specificity, 54.8% PPV, 97.5% NPV, 76.9% accuracy) esophageal varices can be detected. Conclusion: The measurement of liver, spleen stiffness by FibroScan™ or their combinations are useful for esophageal varices diagnosis.