Abstract

CRISTINO, Ana et al. Transient Hepatic Elastography and Detection of Clinically Significant Esophageal Varices. Medicina Interna [online]. 2017, vol.24, n.4, pp.275-284. ISSN 0872-671X.  https://doi.org/10.24950/rspmi/O274/16/2017.

Introduction:Esophageal varices (EV) are a complication of portal hypertension, and its rupture is associated with a high mortality rate. The use of non-invasive diagnostic methods, including hepatic elastography, have been under investigation. Aim: Evaluate the usefulness of transient hepatic elastography as a non-invasive test for the prediction of presence of EV, to avoid systematic screening with esophagogastroduodenoscopy in a selected group of patients. Material and Methods: Retrospective analysis of the patients of our Hepatology Unit with a hepatic elastography value >13 kPa who underwent esophagogastroduodenoscopy within 18 months of its evaluation. Results:We included 259 patients (80.7% males), with a medium age of 57.9 ± 9.8 years; 65.3% had EV (52.1% grade II-III). We built ROC curves correlating hepatic elastography value and presence of EV, and obtained an area under the curve (AUC) for presence of EV of 0.755 (cut-off >26.6 kPa, sensitivity 81.1%, specificity 64.4%) and AUC of 0.68 (cut-off > 28,1 kPa, sensitivity 82.9%, specificity 49.7%) for grade II-III EV. For viral cirrhosis we obtained AUC of 0.83 for presence of EV (cut-off > 19.8 kPa, sensitivity 95.4%, specificity 62.2%) and AUC of 0.69 for grade II-III EV (cut-off > 19.8 kPa, sensitivity 94.7%, specificity 42.0%). In patients without splenomegaly or thrombocytopenia, AUC was 0.89 (cut-off > 26.6 kPa, sensitivity 86.3%, specificity 81.8%) for presence of EV and 0.75 (cut-off > 26. 6kPa, sensitivity 90.9%, specificity 60.6%) for grade IIIII EV. Conclusion: Hepatic elastography values and presence of EV were related, with a higher significance in the groups of viral cirrhosis and those without splenomegaly or thrombocytopenia. Cut-off points had high sensitivity, illustrating the potential utility of transient hepatic elastography in identifying patients who may not need to undergo esophagogastroduodenoscopy.

Keywords : Elasticity Imaging Techniques; Esophageal and Gastric Varices; Hypertension, Portal; Liver Cirrhosis.

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