Changes in Liver and Spleen Stiffness by Virtual Touch Quantification Technique after Balloon-Occluded Retrograde Transvenous Obliteration of Gastric Varices and Exacerbation of Esophageal Varices: A Preliminary Study

Abstract

Purpose To assess liver stiffness (LS) and spleen stiffness (SS) values measured by virtual touch quantification (VTQ) technique in the monitoring of portal pressure and their usefulness for the prediction of the exacerbation of esophageal varices (EV) in patients with gastric varices undergoing balloon-occluded retrograde transvenous obliteration (B-RTO).

Materials and Methods The LS, SS, and hepatic venous pressure gradient (HVPG) were measured in 20 patients both before and after B-RTO. The change in each parameter between the two groups (EV exacerbation and non-exacerbation groups) was compared by analysis of variance. The efficacy of the parameters for the prediction of the exacerbation of EV was analyzed using a receiver operating characteristic (ROC) curve analysis.

Results 9 patients (40.9 %) exhibited an exacerbation of EV within 24 months after B-RTO. Significant changes were observed in the HVPG and SS after B-RTO between the two groups (EV exacerbation group vs. non-exacerbation group: HVPG before 12.7 ± 4.4 mmHg vs. 11.0 ± 4.4 mmHg; HVPG after 19.6 ± 6.0 mmHg vs. 13.6 ± 3.1 mmHg P = 0.003; SS before 3.40 ± 0.50 m/s vs. 3.20 ± 0.51 m/s; SS after 3.74 ± 0.53 m/s vs. 3.34 ± 0.43 m/s P = 0.016). However, no significant changes in LS were observed between the two groups. The area under the ROC curves of elevation in HVPG and SS for the prediction of the exacerbation of EV after B-RTO were 0.833 and 0.818, respectively.

Conclusion Elevation of the HVPG and SS measured by VTQ after B-RTO was useful for the prediction of the exacerbation of EV.

Zusammenfassung

Ziel Beurteilung der mittels Virtual-Touch-Quantification (VTQ) gemessenen Lebersteifigkeit (LS) und Milzsteifigkeit (SS) bei der Überwachung des Pfortader-Drucks und dessen Nutzen für die Vorhersage der Exazerbation von Ösophagusvarizen (EV) bei Patienten mit Magenvarizen, die sich einer Ballon-okkludierten retrograden transvenösen Obliteration (BRTO) unterziehen.

Material und Methoden LS, SS und Lebervenendruckgradient (HVPG) wurden bei 20 Patienten sowohl vor, als auch nach B-RTO gemessen. Die Veränderung jedes Parameters zwischen den beiden Gruppen (EV-Exazerbationsgruppe und Nicht-Exazerbationsgruppe) wurde durch eine Varianzanalyse verglichen. Die Wirksamkeit der Parameter für die Vorhersage der Exazerbation von EV wurde mittels Receiver-Operating-Characteristic (ROC)-Kurve analysiert.

Ergebnisse Innerhalb von 24 Monaten nach B-RTO zeigten 9 Patienten (40,9 %) eine EV-Exazerbation. Signifikante Veränderungen wurden im HVPG und in der SS nach B-RTO zwischen beiden Gruppen beobachtet (EV-Exazerbationsgruppe vs. Nicht-Exazerbationsgruppe: HVPG vorher: 12,7 ± 4,4 mmHg vs. 11,0 ± 4,4mmHg; HVPG nachher: 19,6 ± 6,0 mmHg vs. 13,6 ± 3,1mmHg; p = 0,003; SS vorher: 3,40 ± 0,50 m/s vs. 3,20 ± 0,51 m/s; SS nachher: 3,74 ± 0,53 m/s vs. 3,34 ± 0,43 m/s; p = 0,016). Es wurden jedoch keine signifikanten Veränderungen der LS zwischen den beiden Gruppen beobachtet. Die Fläche unter den ROC-Kurven für die Vorhersage einer Exazerbation der EV nach B-RTO betrug für die Erhöhung des HVPG 0,833 und für die Erhöhung der SS 0,818.

Schlussfolgerung Für die Vorhersage einer Exazerbation von EV war die mittels VTQ nach B-RTO gemessene Erhöhung des HVPG und der SS von Nutzen.

Key words

spleen stiffness - balloon-occluded retrograde transvenous obliteration - portal hypertension - virtual touch quantification

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