Liver and spleen elastography as predictor of portal hypertension and esophageal varices.

Published on May 1, 2021in Minerva gastroenterologica e dietologica3.072
· DOI :10.23736/S1121-421X.20.02779-8
Jorge Aquino-Matus2
Estimated H-index: 2
,
Misael Uribe50
Estimated H-index: 50
,
Norberto C. Chávez-Tapia35
Estimated H-index: 35
Source
Abstract
Liver stiffness is related to the degree of hepatic fibrosis which ultimately causes portal hypertension and gastroesophageal varices. Variceal bleeding is a worrisome and potentially fatal complication of cirrhosis, primary prophylaxis has demonstrated a reduction in decompensation and mortality. Portal hypertension and esophageal varices needing treatment could be predicted through noninvasive methods, including elastography, that evaluates the mechanical properties of liver or spleen tissue in concordance to the propagation of mechanical waves. The accurate prediction of the risk of gastroesophageal varices could spare unnecessary endoscopies in patients with low probability of finding varices needing treatment. In the current review, we discuss the elastography modalities available and the current evidence for its implementation in daily clinical practice.
References44
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#1Mauro Giuffrè (UniTS: University of Trieste)H-Index: 10
#2Sofia Fouraki (UniTS: University of Trieste)H-Index: 2
Last. Lory Saveria Crocè (UniTS: University of Trieste)H-Index: 24
view all 12 authors...
BACKGROUND: Spleen stiffness (SS) has gained a lot of interest in the context of liver cirrhosis and portal hypertension stratification. However, there is a paucity of data on confounding factors that may alter SS values. METHODS: Between January 2018 and October 2019, we enrolled 120 healthy subjects and 117 patients with hepatitis C virus (HCV) infection who did not have significant liver fibrosis (i.e., F0-1). Abdominal ultrasound evaluation was performed on each individual to measure portal ...
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#1Mauro Giuffrè (UniTS: University of Trieste)H-Index: 10
#2Giorgio BedogniH-Index: 61
Last. Lory Saveria Crocè (UniTS: University of Trieste)H-Index: 24
view all 6 authors...
INTRODUCTION Spleen stiffness (SS) has been found to mirror dynamic changes in portal pressure after transjugular intrahepatic portosystemic shunt (TIPS) placement. However, there is no data available regarding SS in patients with spontaneous portosystemic shunting (SPSS), especially in regards to prediction of hepatic decompensation. METHODS We retrospectively selected patients with confirmed SPSS and esophageal varices (EVs) at endoscopic examination, and recorded any decompensating event (i.e...
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#1Silvia Nardelli (Sapienza University of Rome)H-Index: 17
#2Oliviero Riggio (Sapienza University of Rome)H-Index: 62
Last. Lorenzo Ridola (Sapienza University of Rome)H-Index: 29
view all 6 authors...
Spontaneous porto-systemic shunts (SPSS) are frequent in liver cirrhosis and their prevalence increases as liver function deteriorates, probably as a consequence of worsening portal hypertension, but without achieving an effective protection against cirrhosis' complications. Several types of SPSS have been described in the literature, each one associated with different clinical manifestations. In particular, recurrent or persistent hepatic encephalopathy is more frequent in patients with splenor...
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#1Mauro Giuffrè (UniTS: University of Trieste)H-Index: 10
#2Sofia Fouraki (UniTS: University of Trieste)H-Index: 2
Last. Lory Saveria Crocè (UniTS: University of Trieste)H-Index: 24
view all 5 authors...
Background: Liver stiffness measurement (LSM) is crucial for appropriate fibrosis staging in patients with ongoing hepatitis C virus (HCV) infection. However, there is still an ongoing debate on the impact of serum transaminases (aspartate-aminotransferase, AST; alanine-aminotransferase, ALT) on LSM. Methods: We selected 110 patients undergoing HCV eradication therapy with LSM compatible with significant liver fibrosis. LSM was evaluated prior to therapy and one year after HCV eradication. Resul...
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#1Mauro Giuffrè (UniTS: University of Trieste)H-Index: 10
#2Daniele Macor (UniTS: University of Trieste)H-Index: 3
Last. Lory Saveria Crocè (UniTS: University of Trieste)H-Index: 24
view all 8 authors...
Abstract Background and objectives Recent findings pointed out that even low-risk esophageal varices (EVs) are markers of severe prognosis. Accordingly, we analyzed spleen stiffness (SS) as a non-invasive method to predict EVs of any grade in a cohort of patients with compensated liver cirrhosis. Method We measured SS and liver stiffness (LS) using point-Shear-Wave Elastography (pSWE) with Philips Affiniti 70 system in 210 cirrhotic patients who had undergone endoscopic screening for EVs. We com...
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#1Carmen Fierbinteanu-Braticevici (UMFCD: Carol Davila University of Medicine and Pharmacy)H-Index: 9
#2Laura Tribus (UMFCD: Carol Davila University of Medicine and Pharmacy)H-Index: 6
Last. Alexandru C. Moldoveanu (UMFCD: Carol Davila University of Medicine and Pharmacy)H-Index: 3
view all 10 authors...
The purpose of this study is to determine whether esophageal varices (EV) can be identified through the evaluation of spleen stiffness (SSM) via acoustic radiation force impulse (ARFI). A total of 135 patients suffering from cirrhosis underwent a clinical exam, laboratory tests, abdominal ultrasound, liver stiffness (LSM) measurement, SSM evaluation and upper gastrointestinal endoscopy. Based on the endoscopy results, the patients were classified into three groups: those with no evident EV, thos...
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#1Laura Turco (University of Modena and Reggio Emilia)H-Index: 14
#2Guadalupe Garcia-Tsao (Yale University)H-Index: 88
: Portal hypertension (PH) is an increase in the pressure gradient between portal vein and inferior vena cava. Increased resistance occurs at different levels within the portal venous system, followed by increased portal venous inflow. PH is the main driver of cirrhosis decompensation. Varices on endoscopy or portosystemic collaterals on imaging indicate PH. Although its cause is determined mostly via noninvasive tests, the gold standard to measure portal pressure in cirrhosis and determine its ...
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Last. Donald G. MitchellH-Index: 85
view all 3 authors...
Use of an optimal liver MR elastography technique, with proper image interpretation and quality control and accurate result reporting, may be helpful in implementing and operating a clinical liver ...
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#1Mauro Giuffrè (UniTS: University of Trieste)H-Index: 10
#2Daniele Macor (UniTS: University of Trieste)H-Index: 3
Last. Lory Saveria Crocè (UniTS: University of Trieste)H-Index: 24
view all 11 authors...
Introduction and Objectives: This study aims to measure the values of spleen stiffness (SS) in healthy subjects, the inter-operator agreement in SS measurement, and to detect statistically significant correlations between SS and age, sex, weight, BMI, portal vein dynamics and splenic dimensions. Materials and methods: The study included 100 healthy volunteers who had no substantial alcohol intake (<30 g/daily for man, <20 g/daily women), were negative on hepatitis B, hepatitis C, HIV blood serol...
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#1Rafael Paternostro (Medical University of Vienna)H-Index: 14
#2Thomas Reiberger (Medical University of Vienna)H-Index: 40
Last. Theresa Bucsics (Medical University of Vienna)H-Index: 15
view all 3 authors...
: Elastography-based liver stiffness measurement (LSM) is a non-invasive tool for estimating liver fibrosis but also provides an estimate for the severity of portal hypertension in patients with advanced chronic liver disease (ACLD). The presence of varices and especially of varices needing treatment (VNT) indicates distinct prognostic stages in patients with compensated ACLD (cACLD). The Baveno VI guidelines suggested a simple algorithm based on LSM 150 G/L for ruling-out VNT in patients with c...
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