title: Transient elastography for predicting esophageal/gastric varices in children with biliary atresia.
abstract: BACKGROUND
  Transient elastography (TE) is an innovative, noninvasive technique to assess liver fibrosis by measuring liver stiffness in patients with chronic liver diseases. The purpose of this study has been to explore the accuracy of TE and clinical parameters in predicting the presence of esophageal/gastric varices in children with biliary atresia (BA) following portoenterostomy.
  
  
  METHODS
  Patients with BA status post portoenterostomy and normal children were recruited. Splenomegaly and presence of EV/GV were determined by physical examination and endoscopy, respectively. Aspartate transaminase to platelet ratio index (APRI) was used as a serum fibrosis marker. TE was performed by using FibroScan. Data was expressed as mean ± SD.
  
  
  RESULTS
  Seventy-three BA patients (male:female = 32:41; age 9.11 ± 5.64 years) and 50 normal controls (male:female = 19:31; age 11.00 ± 3.31 years) were enrolled. The liver stiffness score of BA patients was significantly higher than that of normal controls (27.37 ± 22.48 and 4.69 ± 1.03 kPa; p < 0.001). Patients with EV/GV had significantly higher liver stiffness score and APRI than those without EV/GV. As for EV/GV diagnosis, the areas under the receiver operating characteristic curve were 0.89 (95% CI 0.80 to 0.98) for TE and 0.87 (95% CI 0.78 to 0.96) for APRI, respectively. The sensitivity (and specificity) of TE (using a cut-off value of 12.7 kPa) and APRI (using a cut-off value of 1.92) in predicting EV/GV were 84% (77%) and 84% (83%), respectively, whereas the sensitivity (and specificity) of splenomegaly in predicting EV/GV were 92% (85%).
  
  
  CONCLUSIONS
  Transient elastography is a useful tool for predicting the presence of EV/GV. In addition, basic physical examination, routine biochemical and hematological tests, are still worthwhile and correlate well with the presence of EV/GV in patients with BA post portoenterostomy.
authors.affiliation: Department of Pediatrics, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand.
authors.forename: Voranush
authors.initials: V
authors.lastname: Chongsrisawat
authors.forename: Paisarn
authors.initials: P
authors.lastname: Vejapipat
authors.forename: Nipaporn
authors.initials: N
authors.lastname: Siripon
authors.forename: Yong
authors.initials: Y
authors.lastname: Poovorawan
mesh_terms: D001219:Aspartate Aminotransferases / Q000097:blood; D001656:Biliary Atresia / Q000601:surgery*; D001792:Blood Platelets; D002648:Child; D002675:Child, Preschool; D054459:Elasticity Imaging Techniques / Q000379:methods*; D004932:Esophageal and Gastric Varices / Q000175:diagnosis*; D005260:Female; D006801:Humans; D008103:Liver Cirrhosis / Q000175:diagnosis; D008297:Male; D011171:Portoenterostomy, Hepatic / Q000009:adverse effects*; D011183:Postoperative Complications / Q000175:diagnosis*; D012680:Sensitivity and Specificity; D016896:Treatment Outcome
chemical_list: D001219:Aspartate Aminotransferases