title: Liver stiffness plus platelet count can be used to exclude high-risk oesophageal varices.
abstract: OBJECTIVE
  Endoscopic screening for high-risk gastro-oesophageal varices (GOV) is recommended for compensated cirrhotic patients with transient elastography identifying increasing numbers of patients with cirrhosis without portal hypertension. Using liver stiffness measurement (LSM) ± platelet count, the aim was to develop a simple clinical rule to exclude the presence of high-risk GOV in patients with Child-Pugh A cirrhosis.
  
  
  METHODS
  A retrospective analysis of 71 patients with Child-Pugh A cirrhosis diagnosed by transient elastography (LSM >13.6 kPa) who underwent screening gastroscopy was conducted. A predictive model using LSM ± platelet count was assessed to exclude the presence of high-risk GOV (diameter >5 mm and/or the presence of high-risk stigmata) and validated using a second cohort of 200 patients from two independent centres.
  
  
  RESULTS
  High-risk GOV were present in 10 (15%) and 16 (8%) of the training and validation cohorts, respectively, which was associated with LSM and Pl count (P < 0.05). A combined model based on LSM and Pl count was more accurate for excluding the presence of high-risk GOV than either alone (training cohort AUROC: 0.87 [0.77-0.96] vs. 0.78 [0.65-0.92] for LSM and 0.71 [0.52-0.90] for platelets) with the combination of LSM ≤25 kPa and Pl ≥100 having a NPV of 100% in both the training and validation cohorts. A total of 107 (39%) patients meet this criterion.
  
  
  CONCLUSIONS
  The combination of LSM ≤25 kPa and Pl ≥100 can be used in clinical practice to exclude the presence of high-risk GOV in patients with Child-Pugh A cirrhosis.
authors.affiliation: Department of Gastroenterology, St Vincent's Hospital Melbourne and the University of Melbourne, Melbourne, VIC, Australia.
authors.forename: Nik S
authors.initials: NS
authors.lastname: Ding
authors.affiliation: Department of Gastroenterology, St Vincent's Hospital Melbourne and the University of Melbourne, Melbourne, VIC, Australia.
authors.forename: Tin
authors.initials: T
authors.lastname: Nguyen
authors.affiliation: Department of Gastroenterology, St Vincent's Hospital Melbourne and the University of Melbourne, Melbourne, VIC, Australia.
authors.forename: David M
authors.initials: DM
authors.lastname: Iser
authors.affiliation: Department of Gastroenterology, St Vincent's Hospital Melbourne and the University of Melbourne, Melbourne, VIC, Australia.
authors.forename: Thai
authors.initials: T
authors.lastname: Hong
authors.affiliation: Department of Gastroenterology, St Vincent's Hospital Melbourne and the University of Melbourne, Melbourne, VIC, Australia.
authors.forename: Emma
authors.initials: E
authors.lastname: Flanagan
authors.affiliation: Department of Gastroenterology, St Vincent's Hospital Melbourne and the University of Melbourne, Melbourne, VIC, Australia.
authors.forename: Avelyn
authors.initials: A
authors.lastname: Wong
authors.affiliation: Department of Gastroenterology, St Vincent's Hospital Melbourne and the University of Melbourne, Melbourne, VIC, Australia.
authors.forename: Lauren
authors.initials: L
authors.lastname: Luiz
authors.affiliation: Department of Gastroenterology, Alfred Hospital, Melbourne, VIC, Australia.
authors.forename: Jonathan Y C
authors.initials: JY
authors.lastname: Tan
authors.affiliation: Department of Gastroenterology, Eastern Health, Melbourne, VIC, Australia.
authors.forename: James
authors.initials: J
authors.lastname: Fulforth
authors.affiliation: Department of Gastroenterology, St Vincent's Hospital Melbourne and the University of Melbourne, Melbourne, VIC, Australia.
authors.forename: Jacinta
authors.initials: J
authors.lastname: Holmes
authors.affiliation: Department of Gastroenterology, St Vincent's Hospital Melbourne and the University of Melbourne, Melbourne, VIC, Australia.
authors.forename: Marno
authors.initials: M
authors.lastname: Ryan
authors.affiliation: Department of Gastroenterology, St Vincent's Hospital Melbourne and the University of Melbourne, Melbourne, VIC, Australia.
authors.forename: Sally J
authors.initials: SJ
authors.lastname: Bell
authors.affiliation: Department of Gastroenterology, St Vincent's Hospital Melbourne and the University of Melbourne, Melbourne, VIC, Australia.
authors.forename: Paul V
authors.initials: PV
authors.lastname: Desmond
authors.affiliation: Department of Gastroenterology, Alfred Hospital, Melbourne, VIC, Australia.
authors.forename: Stuart K
authors.initials: SK
authors.lastname: Roberts
authors.affiliation: Department of Gastroenterology, Eastern Health, Melbourne, VIC, Australia.|Eastern Health Clinical School, Monash University, Melbourne, VIC, Australia.
authors.forename: John
authors.initials: J
authors.lastname: Lubel
authors.affiliation: Department of Gastroenterology, Alfred Hospital, Melbourne, VIC, Australia.
authors.forename: William
authors.initials: W
authors.lastname: Kemp
authors.affiliation: Department of Gastroenterology, St Vincent's Hospital Melbourne and the University of Melbourne, Melbourne, VIC, Australia.
authors.forename: Alexander J
authors.initials: AJ
authors.lastname: Thompson
mesh_terms: D000368:Aged; D054459:Elasticity Imaging Techniques / Q000379:methods*; D016145:Endoscopy, Digestive System / Q000379:methods; D004932:Esophageal and Gastric Varices / Q000175:diagnosis / Q000209:etiology; D005260:Female; D006801:Humans; D008099:Liver / Q000473:pathology*; D008103:Liver Cirrhosis / Q000150:complications / Q000175:diagnosis; D008297:Male; D008875:Middle Aged; D010976:Platelet Count / Q000379:methods*; D015203:Reproducibility of Results; D018570:Risk Assessment / Q000379:methods
keywords: cirrhosis; elastography; hepatitis C virus; portal hypertension; surveillance