Abstract :
Background: Endoscopic variceal surveillance is recommended in patients with liver cirrhosis. However,
the procedure is invasive and needs an experienced endoscopist. Recent study showed that liver stiffness
measurement (LSM) was correlated with cirrhosis and portal hypertension. The aim of this study was to evaluate
the role of transient elastography in predicting presence of esophageal varices that require primary the prophylaxis.
Methods: Cirrhotic patients without history of upper gastrointestinal bleeding underwent LSM with
transient elastography followed by upper gastrointestinal endoscopy. Clinically significant esophageal varices were
defined as esophageal varices ≥ grade II and/or presence of red wale sign. Relationship between LSM and clinically
significant esophageal varices was analyzed in all patients.
Results: A total of 52 patients, 35 male and 17 female, were enrolled in this study. Forty-seven patients
had CTS class A. The median age was 58. Clinically significant esophageal varices were noted in 14 patients. The
means LSM were 30.2 and 15.5 kPa in patients with and without clinically significant esophageal varices respectively.
Patients with clinically significant esophageal varices had significantly higher liver stiffness scores than
those without (p < 0.001). ROC curve analysis showed that LSM value less than 16.2 kPa was a predictor of
clinically significant esophageal varices (sensitivity: 85%, PPV: 41%, NPV: 91% and area under the curve was
0.81).
Conclusion: LSM less than 16.2 kPa was a predictor of the absence of clinically significant esophageal
varices with 91% NPV. The result may be useful in identifying patients who do not require endoscopic procedure.
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file/Thai-Journal-of-gastroenterology-vol-14-no-2-297445.pdf