title: Non-invasive methods can predict oesophageal varices in patients with biliary atresia after a Kasai procedure.
abstract: BACKGROUND
  After a Kasai procedure, 70% of patients with biliary atresia develop chronic liver disease with portal hypertension and oesophageal varices.
  
  
  OBJECTIVE
  To investigate the role of new non-invasive parameters in predicting the presence of varices in patients with biliary atresia after a Kasai procedure and to identify the cut-off values of these parameters in predicting the presence of varices.
  
  
  METHODS
  31 patients with biliary atresia who had undergone a Kasai portoenterostomy were studied. Clinical, biochemical and abdominal ultrasound examination, liver stiffness measurement (LSM), LSM-spleen diameter to platelet ratio score (LSPS) and upper digestive endoscopy were performed.
  
  
  RESULTS
  15 (47%) patients had oesophageal varices (Group A) and 16 had no varices (Group B). Median values of LSM (kPa) and LSPS were significantly higher in Group A than in Group B (LSM: 17.0 vs. 7.5, respectively; p=0.0001; LSPS: 19.62 vs. 2.94, respectively; p=0.0001). The optimal cut-offs for predicting oesophageal varices were: LSM>10.6 kPa (sensitivity: 87%, specificity: 87.5%, PPV: 87%, NPV: 87.5%, and AUC: 0.92) and LSPS ≥9.2 (sensitivity: 91%, specificity: 92%, PPV: 91%, NPV: 92%, and AUC: 0.96).
  
  
  CONCLUSIONS
  Non-invasive methods can predict the presence of oesophageal varices in patients with biliary atresia; the sequential use of two non-invasive methods improves accuracy.
authors: Department of Clinical Medicine, University of Bologna, Italy. antonio.colecchia@aosp.bo.it
authors: Antonio
authors: A
authors: Colecchia
authors: Anna Rita
authors: AR
authors: Di Biase
authors: Eleonora
authors: E
authors: Scaioli
authors: Barbara
authors: B
authors: Predieri
authors: Lorenzo
authors: L
authors: Iughetti
authors: Maria Letizia Bacchi
authors: ML
authors: Reggiani
authors: Lucia
authors: L
authors: Montrone
authors: Pier Luca
authors: PL
authors: Ceccarelli
authors: Amanda
authors: A
authors: Vestito
authors: Laura
authors: L
authors: Viola
authors: Paolo
authors: P
authors: Paolucci
authors: Davide
authors: D
authors: Festi