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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

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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.

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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

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Authors and Affiliations

  1. Academic Department of Gastroenterology, Laiko General Hospital, Medical School of National, Kapodistrian University of Athens, 17 Aghiou Thoma, 11527, Athens, Greece

    Dimitrios S. Karagiannakis, Theodoros Voulgaris, Evgenia Koureta, Elissavet Chloupi, George V. Papatheodoridis & John Vlachogiannakos

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  1. Dimitrios S. Karagiannakis
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  2. Theodoros Voulgaris
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  3. Evgenia Koureta
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Correspondence to Dimitrios S. Karagiannakis.

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Karagiannakis, D.S., Voulgaris, T., Koureta, E. et al. Role of Spleen Stiffness Measurement by 2D-Shear Wave Elastography in Ruling Out the Presence of High-Risk Varices in Cirrhotic Patients. Dig Dis Sci 64, 2653–2660 (2019). https://doi.org/10.1007/s10620-019-05616-4

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