Transient Elastography (Fibroscan) Compared to Diagnostic Endoscopy in the Diagnosis of Varices in Patients with Cirrhosis
Science Journal of Clinical Medicine
Volume 5, Issue 6, November 2016, Pages: 55-59
Received: Nov. 26, 2016;
Accepted: Jan. 3, 2017;
Published: Jan. 24, 2017
Views 3823 Downloads 129
Mahmoud Hassan Al Ghamdi, Department of Surgery, King Abdulaziz University, Jeddah, Saudi Arabia
Hind I. Fallatah, Hepatology Unit, Department of Internal Medicine, King Abdulaziz University, Jeddah, Saudi Arabia
Hisham O. Akbar, Hepatology Unit, Department of Internal Medicine, King Abdulaziz University, Jeddah, Saudi Arabia
We evaluated the effectiveness of the Transient elastography using (Fibroscan) for the prediction of varices and portal hypertensive gastropathy in patients with chronic liver disease. We performed a cross-sectional study of patients with compensated chronic liver disease who had never experienced variceal bleeding and underwent both a Fibroscan assessment for liver fibrosis and a diagnostic UGIE no more than 3 months apart. We collected the patients’ demographic data, serum ALT and platelet count values, and Fibroscan and endoscopy results. We included 75 patients in the final analysis; 39 (52%) had males. Hepatitis C was the most common diagnosis (27, 36%). A total of 37 patients (49.3%) had either gastric or esophageal varices (OV), portal hypertensive gastropathy (PHG), or both. The mean stiffness score was 30.1 kPa (SD 1.2 kPa). The Fibroscan score was highly correlated with the presence of varices (r=.85 and P=.002). The mean stiffness score was higher in patients with OVs or PHG than in patients without OVs or PHG, (34.5, SD 18.3 and 25.8, SD 14.9, respectively, P=.027), but no difference was found in the stiffness scores between the patients with small and large varices. The ROC analysis of a stiffness score showed AUC of.67 for the detection of varices. In conclusion: Fibroscan can predict the presence of varices and PHG in patients with cirrhosis, but it cannot distinguish between small and large varices.
Mahmoud Hassan Al Ghamdi,
Hind I. Fallatah,
Hisham O. Akbar,
Transient Elastography (Fibroscan) Compared to Diagnostic Endoscopy in the Diagnosis of Varices in Patients with Cirrhosis, Science Journal of Clinical Medicine.
Vol. 5, No. 6,
2016, pp. 55-59.
Fallatah HI, al Nahdi H, al Khatabi M, Akbar HO, Qari YA, Sibiani AR, Bazaraa S. Variceal hemorrhage: Saudi tertiary center experience of clinical presentations, complications and mortality. World J Hepatol 2012; 4: 268-273 [PMID: 23060972 DOI: 10.4254/wjh.v4.i9.268].
Garcia-Tsao G, Sanyal AJ, Grace ND, Carey W. Prevention and management of gastroesophageal varices and variceal hemorrhage in cirrhosis. Hepatology 2007; 46: 922-938 [PMID: 17879356 DOI: 10.1002/hep.21907].
Kim DH, Park JY. Prevention and management of variceal hemorrhage. Int J Hepatol 2013; 2013: 6 [PMID: 23606973 DOI: 10.1155/2013/434609].
de Franchis R. Expanding consensus in portal hypertension: report of the baveno VI consensus workshop: stratifying risk and individualizing care for portal hypertension. J Hepatol 2015; 63: 743-752 [PMID: 26047908 DOI: 10.1016/j.jhep.2015.05.022].
Palmer KR. Complications of gastrointestinal endoscopy. Gut. 2007;56 (4): 456-457. [PMCID: PMC1856860 DOI: 10.1136/gut.2006.105577.
Krystallis C, Masterton GS, Hayes PC, Plevris JN. Update of endoscopy in liver disease: More than just treating varices. WJG. 2012;18 (5): 401-411. [PMCID: PMC3272639 DOI:10.3748/wjg.v18.i5.401.
Cherian JV, Deepak N, Ponnusamy RP, Somasundaram A, Jayanthi V. Non-invasive predictors of esophageal varices. Saudi J Gastroenterol 2011; 17: 64-68 [PMID: 21196656 DOI: 10.4103/1319-3767.74470].
Thomopoulos KC. Non-invasive prediction of esophageal varices: is it possible? Saudi J Gastroenterol 2011; 17: 1-3 [PMID: 21196644 DOI: 10.4103/1319-3767.74426].
Stefanescu H, Grigorescu M, Lupsor M, Maniu A, Crisan D, Procopet B, Feier D, Badea R. A new and simple algorithm for the noninvasive assessment of esophageal varices in cirrhotic patients using serum fibrosis markers and transient elastography. J Gastrointestin Liver Dis 2011; 20: 57-64 [PMID: 21451799].
Foucher J, Chanteloup E, Vergniol J, Castera L, le Bail B, Adhoute X, Bertet J, Couzigou P, de Ledinghen V. Diagnosis of cirrhosis by transient elastography (FibroScan): a prospective study. Gut 2006; 55: 403-408 [PMID: 16020491 DOI: 10.1136/gut.2005.069153].
Kazemi F, Kettaneh A, N’kontchou G, Pinto E, Ganne-Carrie N, Trinchet J-C, Beaugrand M. Liver stiffness measurement selects patients with cirrhosis at risk of bearing large oesophageal varices. J Hepatol 2006; 45: 230-235 [PMID: 16797100 DOI: 10.1016/j.jhep.2006.04.006].
Saad Y, Said M, Idris MO, Rabee A, Zakaria S. Liver stiffness measurement by fibroscan predicts the presence and size of esophageal varices in egyptian patients with HCV related liver cirrhosis. J Clin Diagn Res 2013; 7: 2253-2257 [PMID: 24298490 DOI: 10.7860/jcdr/2013/6026.3484].
Castera L, Forns X, Alberti A. Non-invasive evaluation of liver fibrosis using transient elastography. J Hepatol 2008; 48: 835-847 [PMID: 18334275 DOI: 10.1016/j.jhep.2008.02.008].
Castera L, Vergniol J, Foucher J, le Bail B, Chanteloup E, Haaser M, Darriet M, Couzigou P, de Ledinghen V. Prospective comparison of transient elastography, Fibrotest, APRI, and liver biopsy for the assessment of fibrosis in chronic hepatitis C. Gastroenterology 2005; 128: 343-350 [PMID: 15685546 DOI: 10.1053/j.gastro.2004.11.018].
Castera L, le Bail B, Roudot-Thoraval F, Bernard PH, Foucher J, Merrouche W, Couzigou P, de Ledinghen V. Early detection in routine clinical practice of cirrhosis and oesophageal varices in chronic hepatitis C: comparison of transient elastography (FibroScan) with standard laboratory tests and non-invasive scores. J Hepatol 2009; 50: 59-68 [PMID: 19013661 DOI: 10.1016/j.jhep.2008.08.018].
Baenas MY, Thalheimer U, Germani G, Burroughs AK. Primary prophylaxis of variceal bleeding. Gastroenterol Hepatol 2011; 7: 560-562 [PMID: 22298996].
Ripoll C, Garcia-Tsao G. Management of gastropathy and gastric vascular ectasia in portal hypertension. Clin Liver Dis 2010; 14: 281-295 [PMID: 20682235 DOI: 10.1016/j.cld.2010.03.013].
Sort P, Muelas M, Isava A, Llao J, Porta F, Puig I, Dominguez-Curell C, Esteve E, Yanguas C, Vida F. Diagnostic accuracy of abdominal ultrasound in the screening of esophageal varices in patients with cirrhosis. Eur J Gastroenterol Hepatol 2014; 26: 1335-1341 [PMID: 25089546 DOI: 10.1097/meg.0000000000000174].
Bintintan A, Chira RI, Mircea PA. Non-invasive ultrasound-based diagnosis and staging of esophageal varices in liver cirrhosis. A systematic review of the literature published in the third millenium. Med Ultrason 2013; 15: 116-124 [PMID: 23702501 DOI: 10.11152/mu.2013.2066.152.ab1ric2].
Calvaruso V, Bronte F, Conte E, Simone F, Craxi A, di Marco V. Modified spleen stiffness measurement by transient elastography is associated with presence of large oesophageal varices in patients with compensated hepatitis C virus cirrhosis. J Viral Hepat 2013; 20: 867-874 [PMID: 24304456 DOI: 10.1111/jvh.12114].
Akbar DH, Kawther AH. Nonalcoholic fatty liver disease in Saudi type 2 diabetic subjects attending a medical outpatient clinic: prevalence and general characteristics. Diabetes Care 2003; 26: 3351-3352 [PMID: 14633828 DOI: 10.2337/diacare.26.12.3351-a].
Al-hamoudi W, El-Sabbah M, Ali S, Altuwaijri M, Bedewi M, Adam M, Alhammad A, Sanai F, Alswat K, Abdo A. Epidemiological, clinical, and biochemical characteristics of Saudi patients with nonalcoholic fatty liver disease: a hospital-based study. Ann Saudi Med 2012; 32: 288-292 [PMID: 22588441 DOI: 10.5144/0256-4947.2012.288].