Role of Spleen Stiffness Measurement by 2D-Shear Wave Elastography in Ruling Out the Presence of High-Risk Varices in Cirrhotic Patients

• Published in: Digestive diseases and sciences Vol. 64; no. 9; pp. 2653 - 2660
• Main Authors: Karagiannakis, Dimitrios S., Voulgaris, Theodoros, Koureta, Evgenia, Chloupi, Elissavet, Papatheodoridis, George V., Vlachogiannakos, John
• Format: Journal Article
• Language: English
• Published: New York Springer US 01.09.2019; Springer; Springer Nature B.V
• Subjects: Aged; Area Under Curve; Biochemistry; Development and progression; Elasticity; Elasticity Imaging Techniques - methods; Endoscopy; Endoscopy, Gastrointestinal; Esophageal and Gastric Varices - diagnostic imaging; Esophageal and Gastric Varices - etiology; Esophagus; Female; Gastroenterology; Hepatology; Humans; Liver; Liver cirrhosis; Liver Cirrhosis - complications; Liver Cirrhosis - diagnostic imaging; Liver diseases; Male; Measurement; Medical research; Medicine; Medicine & Public Health; Medicine, Experimental; Middle Aged; Oncology; Original Article; Predictive Value of Tests; Risk Factors; ROC Curve; Spleen; Spleen - diagnostic imaging; Spleen - physiopathology; Transplant Surgery; Varicose veins; Variceal bleeding; Cirrhosis; Spleen stiffness; Portal hypertension
• ISSN: 0163-2116; 1573-2568
• DOI: 10.1007/s10620-019-05616-4

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.