Spleen Stiffness as A Predictor of Esophageal Varices in Patients with Cirrhosis of Liver

Abstract

Background: Current guidelines recommend upper GI endoscopy for detection of esophageal varices (EV) in patients with cirrhosis. Upper GI endoscopy is invasive, so several non-invasive methods for detecting varices were proposed. This study evaluates if spleen stiffness measurement (SSM) by vibration controlled transient elastography (VCTE) using FibroScan can be used as a viable predictor of EV.

Materials and Methods: This study was carried out to evaluate the utility of spleen stiffness measurement in detecting the presence of esophageal varices. Study included 100 patients with cirrhosis attending the inpatient and outpatient department of Gastroenterology of Dhaka Medical College Hospital. All patients underwent liver stiffness and spleen stiffness measurements by VCTE and upper GI endoscopy. According to the endoscopic findings, they were divided into no varix, low-risk varices, and high-risk varices groups. Diagnostic performance of the spleen stiffness cutoff for the cirrhotic population obtained from the ROC curve was evaluated in terms of sensitivity, specificity, positive predictive value, negative predictive value and accuracy in detecting high-risk EV.

Results: Of the 100 cirrhosis patients, 76 (76%) had EV (low risk varices=34, high risk varices=42). There was a significant difference (p<0.05) in mean spleen diameter, spleen stiffness measurement, and liver stiffness measurement among the no varix, low-risk varices, andhigh-risk varices groups. A tendency towards increasing spleen stiffness levels was observed with increasing severity of varices (25.87±10.48 kPa in no varix, 46.58±14.03 kPa in low-risk varices, and 77.29±17.59 kPa in high-risk varices). Spleen stiffness cutoff 46.7 kPa has 95.2% sentivety, Sp 81% specificty, 87% accuracy, 78.4% PPV and 95.91% NPV in predicting high-risk varices.

Conclusion: The study result suggests that spleen stiffness is significantly correlated with the presence and severity of esophageal varices. Spleen stiffness measured using VCTE can be useful in diagnosing high-risk varices in patients with cirrhosis.