Application of Supersonic Shear Imaging to the Baveno VI Criteria and a Combination Model with Spleen Stiffness Measurement to Rule Out High-Risk Varices in Compensated Advanced Chronic Liver Disease

Abstract

Purpose Recently, Colecchia et al. reported that by adding a spleen stiffness (SS) criterion sequentially to the Baveno VI criteria, screening endoscopy could be safely avoided. We aimed to compare the Baveno VI criteria, SS values and a sequential combination of the Baveno VI and SS values, measured by supersonic shear imaging (SSI), as approaches for safely avoiding screening endoscopy for high-risk varices (HRV).

Materials and Methods Between April 2017 and July 2018, we enrolled 274 compensated advanced chronic liver disease patients who had successfully undergone liver stiffness (LS) and SS measurements with SSI and esophagogastroduodenoscopy (EGD). 52 HRV patients were included, and we analyzed risk factors for HRV and compared proportions of patients who were spared EGD when Baveno VI criteria, SS cut-off and the combination of the two approaches were used.

Results The AUROC values for estimating HRV by platelet count, LS and SS were 0.701, 0.757 and 0.844, respectively, and all three measures were found to be independent predictors of HRV. The SS cut-off value for excluding HRV was ≤ 27.3 kPa. The percentages of patients spared EGD were 18.6 % for Baveno VI, 28.8 % for SS cut-off and 36.1 % for the sequential combination of Baveno VI and SS cut-off. Less than 2 % of HRV patients were missed when using all of the criteria.

Conclusion The Baveno VI criteria can be applied to LS measurement by SSI. SS measurement by SSI is an excellent predictor of HRV. Screening endoscopy can be safely avoided when Baveno VI criteria and SS cut-off are applied together.

Zusammenfassung

Ziel Colecchia et al. berichteten vor kurzem, dass durch sequenzielles Hinzufügen eines Milzsteifigkeits (SS)-Kriteriums zu den Baveno-VI-Kriterien eine Screening-Endoskopie sicher vermieden werden könnte. Unser Ziel war es, die Baveno-VI-Kriterien, die SS-Werte und eine sequenzielle Kombination der durch Ultraschall-Scherbildgebung (SSI) bestimmten Baveno-VI- und SS-Werte als Ansätze zur sicheren Vermeidung einer Screening-Endoskopie für Hochrisikovarizen (HRV) zu vergleichen.

Material und Methoden Von April 2017 bis Juli 2018 rekrutierten wir 274 Patienten mit kompensierter fortgeschrittener chronischer Lebererkrankung, bei denen Lebersteifigkeits- (LS) und SS-Messungen mittels SSI und Ösophagogastroduodenoskopie (ÖGD) erfolgreich durchgeführt wurden. Eingeschlossen wurden 52 HRV-Patienten. Wir analysierten die Risikofaktoren für HRV und verglichen die Anteile der Patienten, die von einer EGD verschont blieben, wenn die Baveno-VI-Kriterien, der SS-Cut-off oder die Kombination beider Ansätze verwendet wurden.

Ergebnisse Die AUROC-Werte für die Einschätzung von HRV betrugen 0,701 nach Thrombozytenzahl, 0,757 nach LS und 0,844 nach SS. Alle 3 Messgrößen erwiesen sich als unabhängige Prädiktoren für HRV. Der SS-Cut-off-Wert für den Ausschluss von HRV betrug ≤ 27,3kPa. Der prozentuale Anteil der Patienten, die von einer ÖGD verschont blieben, betrug 18,6 % für Baveno VI, 28,8 % für den SS-Cut-off und 36,1 % für die sequenzielle Kombination von Baveno VI und SS-Cut-off. Weniger als 2 % der HRV-Patienten wurden bei Anwendung aller Kriterien übersehen.

Schlussfolgerung Die Baveno-VI-Kriterien können auf die LS-Messung mittels SSI angewendet werden. Die SS-Messung mittels SSI ist ein ausgezeichneter Prädiktor für HRV. Eine Screening-Endoskopie kann sicher vermieden werden, wenn die Baveno-VI-Kriterien und die SS-Cut-off-Messung zusammen angewendet werden.

Key words

esophageal varix - portal hypertension - liver stiffness - spleen stiffness

Publication History

Received: 28 June 2019

Accepted: 13 April 2020

Article published online:
20 May 2020

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