title: The Role of Spleen Stiffness in Determining the Severity and Bleeding Risk of Esophageal Varices in Cirrhotic Patients.
abstract: Esophageal varix and its hemorrhage are serious complications of liver cirrhosis. Recent studies have focused on noninvasive prediction of esophageal varices. We attempted to evaluate the association of liver and spleen stiffness (LS and SS) as measured by acoustic radiation force impulse imaging, with the presence and severity of esophageal varices and variceal hemorrhage in cirrhotic patients. We measured LS and SS, along with endoscopic examination of esophageal varices for a total of 125 cirrhotic patients at a single referral hospital in this prospective observational study. The diagnostic utility of noninvasive methods for identifying varices and their bleeding risk was compared, including LS, SS, spleen length, Child-Pugh score, and various serum fibrosis indices. Esophageal varices were present in 77 patients (61.6%). SS was significantly higher in patients with varices than in those without varices (3.58 ± 0.47 vs 3.02 ± 0.49; P < 0.001). A tendency toward increasing SS levels was observed with increasing severity of varices (no varix, 3.02 ± 0.49; F1, 3.39 ± 0.51; F2, 3.60 ± 0.42; F3, 3.85 ± 0.37; P < 0.001). SS was significantly higher in patients who experienced variceal hemorrhage than in those who did not (3.80 ± 0.36 vs 3.20 ± 0.51; P = 0.002). An optimal cut-off value of SS for high-risk varices (≥ F2) or variceal hemorrhage was 3.40 m/s. SS was significantly correlated with the presence, severity, and bleeding risk of esophageal varices. Prompt endoscopic evaluation of variceal status and prophylactic measures based on the SS may be warranted for cirrhotic patients.
authors.affiliation: From Department of Internal Medicine, Seoul National University Boramae Medical Center, Seoul, Republic of Korea (HYK, WK, YJJ, BGK, KLL); Department of Internal Medicine, Seoul National University Hospital, Seoul, Republic of Korea (EHJ, J-YS, HSO, KHC); Department of Radiology and Institute of Radiation Medicine, Seoul National University Hospital, Seoul, Republic of Korea (JYL, HW); Department of Biostatistics, Seoul National University Boramae Medical Center, Seoul, Republic of Korea (SO); Department of Internal Medicine, Healthcare Research Institute, Gangnam Healthcare Center, Seoul National University Hospital, Seoul, Republic of Korea (DK).
authors.forename: Hwi Young
authors.initials: HY
authors.lastname: Kim
authors.forename: Eun Hyo
authors.initials: EH
authors.lastname: Jin
authors.forename: Won
authors.initials: W
authors.lastname: Kim
authors.forename: Jae Young
authors.initials: JY
authors.lastname: Lee
authors.forename: Hyunsik
authors.initials: H
authors.lastname: Woo
authors.forename: Sohee
authors.initials: S
authors.lastname: Oh
authors.forename: Ji-Yeon
authors.initials: JY
authors.lastname: Seo
authors.forename: Hong Sang
authors.initials: HS
authors.lastname: Oh
authors.forename: Kwang Hyun
authors.initials: KH
authors.lastname: Chung
authors.forename: Yong Jin
authors.initials: YJ
authors.lastname: Jung
authors.forename: Donghee
authors.initials: D
authors.lastname: Kim
authors.forename: Byeong Gwan
authors.initials: BG
authors.lastname: Kim
authors.forename: Kook Lae
authors.initials: KL
authors.lastname: Lee
mesh_terms: D000368:Aged; D054459:Elasticity Imaging Techniques; D004932:Esophageal and Gastric Varices / Q000209:etiology* / Q000503:physiopathology*; D004945:Esophagoscopy; D005260:Female; D006471:Gastrointestinal Hemorrhage; D006801:Humans; D008099:Liver / Q000473:pathology*; D008103:Liver Cirrhosis / Q000150:complications*; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D012307:Risk Factors; D012720:Severity of Illness Index; D013154:Spleen / Q000033:anatomy & histology / Q000473:pathology*