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

Background: Portal hypertension with subsequent esophageal varices (EVs) development is a common complication of HCV related cirrhosis. Aim: To evaluate the rule 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-F4 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 esophagogastroscopy. 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 ± 31.34 vs. 161.21 ± 52.97 × 103/μL) 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 FibroScanTM or their combinations are useful for esophageal varices diagnosis.