Z Gastroenterol 2013; 51 - A52
DOI: 10.1055/s-0033-1347502

Liver stiffness measurement selects patients with chronic liver diseases at risk of bearing large oesophageal varices

G Pár 1, A Trosits 1, F Pakodi 1, I Szabó 1, J Czimmer 1, A Illés 1, S Gódi 1, J Bajor 1, P Sarlós 1, P Kenyeres 1, Á Vincze 1, A Pár 1
  • 1First Department of Medicine, University of Pecs

Introduction: One of the most serious complications of liver cirrhosis is the variceal bleeding. The early recognition of the esophageal varices is of primary importance in the prevention of their bleeding. Liver stiffness (LS) measured by transient elastometry (FibroScan) may associate with portal pressure and could predict the presence of esophageal varices. We studied the diagnostic accuracy of LS by FibroScan for selecting patients at risk of bearing large oesophageal varices and high risk (Paquet =>II grade) of bleeding.

Methods: We performed oesohago-gastro-bulboscopy and FibroScan examination in 74 patients with chronic liver disease simultaneously. We examined the relation between the presence of oesophageal varices (Paquet grade 0-IV) and the LS (kPa) as well as the blood hematological and biochemical laboratory parameters (INR, platelet count, ALT, AST, albumin). We analysed the predictive role of LS by FibroScan for selecting patients at high risk of variceal bleeding (Paquet =>II grade).

Results: LS values correlated to the grade of oesophageal varices (Paquet-grade) (r = 0,67, pII) (AUROC: 0,85, 95% CI: 0,754 – 0,94). We found high measurement sensitivity: (sens) 85%, specificity (spec): 87%, positive predictive value (PPV): 85%, negative predictive value (NPV):87% and validity: 86% at the cutoff 19,2 kPa LS value. LS value II (sens.: 95%, spec.: 70%, PPV:54%, NPV: 97%), thus we verified that below LS 19,2 kPa the high grade of oesophageal varices (Pq =>II) is not probable. The laboratory parameters did not predict oesphageal varices.

Conclusion: The non-invasive LS measurement by FibroScan allows to predict the presence of large oesophageal varices in patients with chronic liver disease, and may help to select patients for endoscopic screening. A LS above 19,2 kPa indicates an oesophageal-gastro-buboscopy for the judgement of varices.

Grant support: National Scientific Research Fund (OTKA K81454, OTKA/11 – 19), Pecs University Research Fund (34039/KA)