Liver stiffness measurement selects patients with cirrhosis at risk of bearing large oesophageal varices.
OBJECTIVE
Periodic endoscopic screening for oesophageal varices is recommended in patients with cirrhosis, but might be limited to a subgroup of patients if a simple non-invasive test was available to select those at risk of bleeding.


METHODS
We studied in 165 patients with cirrhosis the relation between the presence of oesophageal varices assessed by endoscopy, and liver stiffness measurement by Fibroscan, a non-invasive parameter related to liver fibrosis. The results were compared to those of other parameters reflecting portal hypertension, splenic size, platelet count, and platelet count/spleen size ratio.


RESULTS
Liver stiffness measurement was correlated to the grade of oesophageal varices (r = 0.6, p < 0.0001). AUROC values of liver stiffness measurement were 0.84 (95% CI: 0.78-0.90) for the presence of oesophageal varices and 0.83 (0.76-0.89) for varices grade > or = II. Liver stiffness measurement value < 19 kPa was highly predictive of the absence of oesophageal varices grade > or = II (Se: 84%, PPV: 47%, NPV: 93%).


CONCLUSIONS
Liver stiffness measurement allows to predict the presence of large oesophageal varices in patients with cirrhosis, and may help to select patients for endoscopic screening.
Kazemi
Farhad
F
Hepatology Department, Hôpital Jean Verdier, APHP, Université Paris 13, Bondy, France. farhad.efka@club-internet.fr
Kettaneh
Adrien
A
N'kontchou
Gisèle
G
Pinto
Emmanuel
E
Ganne-Carrie
Nathalie
N
Trinchet
Jean-Claude
JC
Beaugrand
Michel
M
D004548:Elasticity; D016099:Endoscopy, Gastrointestinal; D004932:Esophageal and Gastric Varices / Q000175:diagnosis / Q000209:etiology*; D005260:Female; D006801:Humans; D006975:Hypertension, Portal / Q000150:complications / Q000503:physiopathology; D008103:Liver Cirrhosis / Q000150:complications / Q000503:physiopathology*; D008297:Male; D008875:Middle Aged; D011379:Prognosis; D012189:Retrospective Studies; D012307:Risk Factors; D012720:Severity of Illness Index