Spleen Stiffness as Predictor of Esophageal Varices in Cirrhosis of Different Etiologies

Carmen Fierbinteanu-Braticevici; Laura Tribus; Razvan Peagu; Ana Petrisor; Cristian Baicus; Dragos Cretoiu; Artur Pasternak; Gabriela Oprea; Adina Purcareanu; Alexandru C. Moldoveanu

doi:10.1038/s41598-019-52407-y

journal article Open Access Nov 07, 2019

Spleen Stiffness as Predictor of Esophageal Varices in Cirrhosis of Different Etiologies

Carmen Fierbinteanu-Braticevici Laura Tribus Razvan Peagu Ana Petrisor Cristian Baicus

Dragos Cretoiu

Artur Pasternak

Gabriela Oprea

Adina Purcareanu Alexandru C. Moldoveanu

Scientific Reports Vol. 9 No. 1 · Springer Science and Business Media LLC

View at Publisher Save 10.1038/s41598-019-52407-y

Abstract

AbstractThe purpose of this study is to determine whether esophageal varices (EV) can be identified through the evaluation of spleen stiffness (SSM) via acoustic radiation force impulse (ARFI). A total of 135 patients suffering from cirrhosis underwent a clinical exam, laboratory tests, abdominal ultrasound, liver stiffness (LSM) measurement, SSM evaluation and upper gastrointestinal endoscopy. Based on the endoscopy results, the patients were classified into three groups: those with no evident EV, those with small EV and those with varices needing treatment (VNT). Patients with EV of any grade had significantly higher average SSM values over those with no EV (3.37 m/s versus 2.79 m/s, p-value < 0.001), while patients with VNT showed an even greater difference (3.96 m/s versus 2.93 m/s, p-value < 0.001). SSM proved to be an excellent method of predicting patients with VNT.

Topics

No keywords indexed for this article. Browse by subject →

References

53

[1]

Management of Varices and Variceal Hemorrhage in Cirrhosis

Guadalupe Garcia-Tsao, Jaime Bosch

New England Journal of Medicine 2010 10.1056/nejmra0901512

[2]

Prevention and management of gastroesophageal varices and variceal hemorrhage in cirrhosis

Guadalupe Garcia-Tsao, Arun J. Sanyal, Norman D. Grace et al.

Hepatology 2007 10.1002/hep.21907

[3]

The clinical use of HVPG measurements in chronic liver disease

Jaime Bosch, Juan G. Abraldes, Annalisa Berzigotti et al.

Nature Reviews Gastroenterology & Hepatology 2009 10.1038/nrgastro.2009.149

[4]

Expanding consensus in portal hypertension

Roberto de Franchis

Journal of Hepatology 2015 10.1016/j.jhep.2015.05.022

[5]

Kim, H. Y. et al. The Role of Spleen Stiffness in Determining the Severity and Bleeding Risk of Esophageal Varices in Cirrhotic Patients. Medicine (Baltimore) 94, e1031 (2015). 10.1097/md.0000000000001031

[6]

Measurement of Spleen Stiffness With Acoustic Radiation Force Impulse Imaging Predicts Mortality and Hepatic Decompensation in Patients With Liver Cirrhosis

Yoshitaka Takuma, Youichi Morimoto, Hiroyuki Takabatake et al.

Clinical Gastroenterology and Hepatology 2017 10.1016/j.cgh.2016.10.041

[7]

Buechter, M. et al. Spleen and Liver Stiffness Is Positively Correlated with the Risk of Esophageal Variceal Bleeding. Digestion 94, 138–144 (2016). 10.1159/000450704

[8]

Singh, S. et al. Accuracy of spleen stiffness measurement in detection of esophageal varices in patients with chronic liver disease: systematic review and meta-analysis. Clin Gastroenterol Hepatol. 12, 935–945 e934 (2014). 10.1016/j.cgh.2013.09.013

[9]

Llop, E. et al. Validation of noninvasive methods to predict the presence of gastroesophageal varices in a cohort of patients with compensated advanced chronic liver disease. J Gastroenterol Hepatol. 32, 1867–1872 (2017). 10.1111/jgh.13781

[10]

Takuma, Y. et al. Portal Hypertension in Patients with Liver Cirrhosis: Diagnostic Accuracy of Spleen Stiffness. Radiology 279, 609–619 (2016). 10.1148/radiol.2015150690

[11]

Roccarina, D., Rosselli, M., Genesca, J. & Tsochatzis, E. A. Elastography methods for the non-invasive assessment of portal hypertension. Expert Rev Gastroenterol Hepatol. 12, 155–164 (2018). 10.1080/17474124.2017.1374852

[12]

Colecchia, A., Ravaioli, F., Marasco, G., Festi, D. Spleen Stiffness by Ultrasound Elastography. In: Berzigotti, A., Bosch, J. Diagnostic Methods for Cirrhosis and Portal Hypertension, 113−137 (2018) 10.1007/978-3-319-72628-1_8

[13]

Karagiannakis, D.S., 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, (2019) 10.1007/s10620-019-05616-4

[14]

A combined model based on spleen stiffness measurement and Baveno VI criteria to rule out high-risk varices in advanced chronic liver disease

Antonio Colecchia, Federico Ravaioli, Giovanni Marasco et al.

Journal of Hepatology 2018 10.1016/j.jhep.2018.04.023

[15]

Dietrich, C. F. et al. EFSUMB Guidelines and Recommendations on the Clinical Use of Liver Ultrasound Elastography, Update 2017 (Long Version). Ultraschall in Med. 38, e16–e47 (2017).

[16]

Spleen stiffness measurement can predict clinical complications in compensated HCV-related cirrhosis: A prospective study

Antonio Colecchia, Agostino Colli, Giovanni Casazza et al.

Journal of Hepatology 2014 10.1016/j.jhep.2014.02.024

[17]

Wong, G. L. et al. Measuring spleen stiffness to predict varices in chronic hepatitis B cirrhotic patients with or without receiving non-selective beta-blockers. J Dig Dis. 17, 538–546 (2016). 10.1111/1751-2980.12359

[18]

Ye, X. P. et al. Liver and spleen stiffness measured by acoustic radiation force impulse elastography for noninvasive assessment of liver fibrosis and esophageal varices in patients with chronic hepatitis B. J Ultrasound Med. 31, 1245–1253 (2012). 10.7863/jum.2012.31.8.1245

[19]

Hirooka, M. et al. Splenic elasticity measured with real-time tissue elastography is a marker of portal hypertension. Radiology 261, 960–968 (2011). 10.1148/radiol.11110156

[20]

Chen, Y. P. et al. Is transient elastography valuable for high-risk esophageal varices prediction in patients with hepatitis-B-related cirrhosis? J Gastroenterol Hepatol. 27, 533–539 (2012). 10.1111/j.1440-1746.2011.06889.x

[21]

Prospective Comparison of Spleen and Liver Stiffness by Using Shear-Wave and Transient Elastography for Detection of Portal Hypertension in Cirrhosis

Laure Elkrief, Pierre-Emmanuel Rautou, Maxime Ronot et al.

Radiology 2015 10.1148/radiol.14141210

[22]

Cassinotto, C. et al. Liver and spleen elastography using supersonic shear imaging for the non-invasive diagnosis of cirrhosis severity and oesophageal varices. Dig Liver Dis. 47, 695–701 (2015). 10.1016/j.dld.2015.04.008

[23]

Heidelbaugh, J. J. & Bruderly, M. Cirrhosis and chronic liver failure: part I. Diagnosis and evaluation. Am Fam Physician 74, 756–762 (2006).

[24]

Romania MoHo. Annex 12 - Cirrhosis and complications (Anexa 12 - Ciroza hepatica si complicatiile cirozei hepatice).

[25]

Augustin, S. et al. Expanding the Baveno VI criteria for the screening of varices in patients with compensated advanced chronic liver disease. Hepatology 66, 1980–1988 (2017). 10.1002/hep.29363

[26]

Bureau, C. et al. Transient elastography accurately predicts presence of significant portal hypertension in patients with chronic liver disease. Aliment Pharmacol Ther. 27, 1261–1268 (2008). 10.1111/j.1365-2036.2008.03701.x

[27]

Carrion, J. A. et al. Transient elastography for diagnosis of advanced fibrosis and portal hypertension in patients with hepatitis C recurrence after liver transplantation. Liver Transpl. 12, 1791–1798 (2006). 10.1002/lt.20857

[28]

Reiberger, T. et al. Vienna Hepatic Hemodynamic Lab. Non-selective betablocker therapy decreases intestinal permeability and serum levels of LBP and IL-6 in patients with cirrhosis. J Hepatol. 58, 911–921 (2013). 10.1016/j.jhep.2012.12.011

[29]

Lemoine, M. et al. Liver stiffness measurement as a predictive tool of clinically significant portal hypertension in patients with compensated hepatitis C virus or alcohol-related cirrhosis. Aliment Pharmacol Ther. 28, 1102–1110 (2008). 10.1111/j.1365-2036.2008.03825.x

[30]

Schwabl, P. et al. New reliability criteria for transient elastography increase the number of accurate measurements for screening of cirrhosis and portal hypertension. Liver Int. 35, 381–390 (2015). 10.1111/liv.12623

[31]

Sanchez-Conde, M. et al. Use of transient elastography (FibroScan(R)) for the noninvasive assessment of portal hypertension in HIV/HCV-coinfected patients. J Viral Hepat. 18, 685–691 (2011). 10.1111/j.1365-2893.2010.01371.x

[32]

Elastography, Spleen Size, and Platelet Count Identify Portal Hypertension in Patients With Compensated Cirrhosis

Annalisa Berzigotti, Susana Seijo, Umberto Arena et al.

Gastroenterology 2013 10.1053/j.gastro.2012.10.001

[33]

Castera, L. et al. Early detection in routine clinical practice of cirrhosis and oesophageal varices in chronic hepatitis C: comparison of transient elastography (FibroScan) with standard laboratory tests and non-invasive scores. J Hepatol. 50, 59–68 (2009). 10.1016/j.jhep.2008.08.018

[34]

Kazemi, F. et al. Liver stiffness measurement selects patients with cirrhosis at risk of bearing large oesophageal varices. J Hepatol. 45, 230–235 (2006). 10.1016/j.jhep.2006.04.006

[35]

Sporea, I., Ratiu, I., Bota, S., Sirli, R. & Jurchis, A. Are different cut-off values of liver stiffness assessed by transient elastography according to the etiology of liver cirrhosis for predicting significant esophageal varices? Med Ultrason. 15, 111–115 (2013). 10.11152/mu.2013.2066.152.is1ir2

[36]

Saad, Y., Said, M., Idris, M. O., Rabee, A. & Zakaria, S. Liver stiffness measurement by fibroscan predicts the presence and size of esophageal varices in egyptian patients with HCV related liver cirrhosis. J Clin Diagn Res. 7, 2253–2257 (2013).

[37]

Nguyen-Khac, E. et al. Noninvasive diagnosis of large esophageal varices by Fibroscan: strong influence of the cirrhosis etiology. Alcohol Clin Exp Res. 34, 1146–1153 (2010). 10.1111/j.1530-0277.2010.01191.x

[38]

Vizzutti, F., Arena, U., Rega, L. & Pinzani, M. Non invasive diagnosis of portal hypertension in cirrhotic patients. Gastroenterol Clin Biol. 32, 80–87 (2008). 10.1016/s0399-8320(08)73997-6

[39]

Pu, K. et al. Diagnostic accuracy of transient elastography (FibroScan) in detection of esophageal varices in patients with cirrhosis: A meta-analysis. World J Gastroenterol. 23, 345–356 (2017). 10.3748/wjg.v23.i2.345

[40]

Bolognesi, M., Merkel, C., Sacerdoti, D., Nava, V. & Gatta, A. Role of spleen enlargement in cirrhosis with portal hypertension. Dig Liver Dis. 34, 144–150 (2002). 10.1016/s1590-8658(02)80246-8

[41]

Mejias, M. et al. Relevance of the mTOR signaling pathway in the pathophysiology of splenomegaly in rats with chronic portal hypertension. J Hepatol. 52, 529–539 (2010). 10.1016/j.jhep.2010.01.004

[42]

Calvaruso, V. et al. Modified spleen stiffness measurement by transient elastography is associated with presence of large oesophageal varices in patients with compensated hepatitis C virus cirrhosis. J Viral Hepat. 20, 867–874 (2013). 10.1111/jvh.12114

[43]

Colecchia, A. et al. Measurement of spleen stiffness to evaluate portal hypertension and the presence of esophageal varices in patients with HCV-related cirrhosis. Gastroenterology 143, 646–654 (2012). 10.1053/j.gastro.2012.05.035

[44]

Spleen Stiffness in Patients With Cirrhosis in Predicting Esophageal Varices

Praveen Sharma, Vijender Kirnake, Pankaj Tyagi et al.

American Journal of Gastroenterology 2013 10.1038/ajg.2013.119

[45]

Fraquelli, M. et al. Feasibility and reproducibility of spleen transient elastography and its role in combination with liver transient elastography for predicting the severity of chronic viral hepatitis. J Viral Hepat. 21, 90–98 (2014). 10.1111/jvh.12119

[46]

Stefanescu, H. et al. Spleen stiffness measurement using Fibroscan for the noninvasive assessment of esophageal varices in liver cirrhosis patients. J Gastroenterol Hepatol. 26, 164–170 (2011). 10.1111/j.1440-1746.2010.06325.x

[47]

Stefanescu, H. et al. Non-invasive menage a trois for the prediction of high-risk varices: stepwise algorithm using lok score, liver and spleen stiffness. Liver Int. 35, 317–325 (2015). 10.1111/liv.12687

[48]

Rizzo, L. et al. A new sampling method for spleen stiffness measurement based on quantitative acoustic radiation force impulse elastography for noninvasive assessment of esophageal varices in newly diagnosed HCV-related cirrhosis. Biomed Res Int. 2014, 365982 (2014). 10.1155/2014/365982

[49]

Park, J. et al. Is the spleen stiffness value acquired using acoustic radiation force impulse (ARFI) technology predictive of the presence of esophageal varices in patients with cirrhosis of various etiologies. Med Ultrason. 18, 11–17 (2016). 10.11152/mu.2013.2066.181.sf

[50]

Bota, S. et al. Can ARFI elastography predict the presence of significant esophageal varices in newly diagnosed cirrhotic patients? Annals of hepatology 11, 519–525 (2012). 10.1016/s1665-2681(19)31466-8

Showing 50 of 53 references

Cited By

36

Spleen stiffness measurement as a non-invasive assessment in patients with portal hypertension

Xiaoming Xu, Jiacheng Liu · 2024

eGastroenterology

Diagnostic accuracy of spleen stiffness to evaluate portal hypertension and esophageal varices in chronic liver disease: a systematic review and meta-analysis

Xing Hu, Xiaojie Huang · 2020

European Radiology

Metrics

36

Citations

53

References

Details

Published: Nov 07, 2019
Vol/Issue: 9(1)
License: View

Authors

C

Carmen Fierbinteanu-Braticevici

University of Medicine and Pharmacy “Carol Davila”; Department of Internal Medicine, Colentina Clinical Hospital

D

Dragos Cretoiu

Alessandrescu-Rusescu National Institute for Mother and Child Health, Fetal Medicine Excellence Research Center, 020395 Bucharest, Romania; Department of Cell and Molecular Biology and Histology, Carol Davila University of Medicine and Pharmacy, 8 Eroii Sanitari Blvd., 050474 Bucharest, Romania

Alexandru C. Moldoveanu

Cite This Article

Carmen Fierbinteanu-Braticevici, Laura Tribus, Razvan Peagu, et al. (2019). Spleen Stiffness as Predictor of Esophageal Varices in Cirrhosis of Different Etiologies. Scientific Reports, 9(1). https://doi.org/10.1038/s41598-019-52407-y

Spleen Stiffness as Predictor of Esophageal Varices in Cirrhosis of Different Etiologies

You May Also Like