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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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).
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.
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.
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.
KeywordsSpleen stiffness Variceal bleeding Cirrhosis Portal hypertension
Hepatic venous pressure gradient
Clinically significant portal hypertension
Upper gastrointestinal endoscopy
Liver stiffness measurements
Spleen stiffness measurement
Shear wave elastography
Transjugular intrahepatic portosystemic shunt
International normalized ratio
Model for end stage liver disease
Area under receiving operating characteristic
Positive predictive value
Negative predictive value
Acoustic radiation force impulse imaging
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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