The Role of Spleen Stiffness in Determining the Severity and Bleeding Risk of Esophageal Varices in Cirrhotic Patients.

Journal Article (Journal Article)

Esophageal varix and its hemorrhage are serious complications of liver cirrhosis. Recent studies have focused on noninvasive prediction of esophageal varices. We attempted to evaluate the association of liver and spleen stiffness (LS and SS) as measured by acoustic radiation force impulse imaging, with the presence and severity of esophageal varices and variceal hemorrhage in cirrhotic patients. We measured LS and SS, along with endoscopic examination of esophageal varices for a total of 125 cirrhotic patients at a single referral hospital in this prospective observational study. The diagnostic utility of noninvasive methods for identifying varices and their bleeding risk was compared, including LS, SS, spleen length, Child-Pugh score, and various serum fibrosis indices. Esophageal varices were present in 77 patients (61.6%). SS was significantly higher in patients with varices than in those without varices (3.58 ± 0.47 vs 3.02 ± 0.49; P < 0.001). A tendency toward increasing SS levels was observed with increasing severity of varices (no varix, 3.02 ± 0.49; F1, 3.39 ± 0.51; F2, 3.60 ± 0.42; F3, 3.85 ± 0.37; P < 0.001). SS was significantly higher in patients who experienced variceal hemorrhage than in those who did not (3.80 ± 0.36 vs 3.20 ± 0.51; P = 0.002). An optimal cut-off value of SS for high-risk varices (≥ F2) or variceal hemorrhage was 3.40 m/s. SS was significantly correlated with the presence, severity, and bleeding risk of esophageal varices. Prompt endoscopic evaluation of variceal status and prophylactic measures based on the SS may be warranted for cirrhotic patients.

Full Text

Duke Authors

Cited Authors

  • Kim, HY; Jin, EH; Kim, W; Lee, JY; Woo, H; Oh, S; Seo, J-Y; Oh, HS; Chung, KH; Jung, YJ; Kim, D; Kim, BG; Lee, KL

Published Date

  • June 2015

Published In

Volume / Issue

  • 94 / 24

Start / End Page

  • e1031 -

PubMed ID

  • 26091449

Pubmed Central ID

  • PMC4616530

Electronic International Standard Serial Number (EISSN)

  • 1536-5964

Digital Object Identifier (DOI)

  • 10.1097/MD.0000000000001031

Language

  • eng

Conference Location

  • United States