Publicação
Transient Hepatic Elastography and Detection of Clinically Significant Esophageal Varices
| Resumo: | Introduction: Esophageal varices (EV) are a complicationof portal hypertension, and its rupture is associated witha high mortality rate. The use of non-invasive diagnosticmethods, including hepatic elastography, have been underinvestigation.Aim: Evaluate the usefulness of transient hepatic elastographyas a non-invasive test for the prediction of presenceof EV, to avoid systematic screening with esophagogastroduodenoscopyin a selected group of patients.Material and Methods: Retrospective analysis of the patientsof our Hepatology Unit with a hepatic elastography value >13kPa who underwent esophagogastroduodenoscopy within18 months of its evaluation.Results: We included 259 patients (80.7% males), with amedium age of 57.9 ± 9.8 years; 65.3% had EV (52.1%grade II-III). We built ROC curves correlating hepatic elastographyvalue and presence of EV, and obtained an areaunder the curve (AUC) for presence of EV of 0.755 (cut-off>26.6 kPa, sensitivity 81.1%, specificity 64.4%) and AUCof 0.68 (cut-off > 28,1 kPa, sensitivity 82.9%, specificity49.7%) for grade II-III EV. For viral cirrhosis we obtainedAUC of 0.83 for presence of EV (cut-off > 19.8 kPa, sensitivity95.4%, specificity 62.2%) and AUC of 0.69 for gradeII-III EV (cut-off > 19.8 kPa, sensitivity 94.7%, specificity42.0%). In patients without splenomegaly or thrombocytopenia,AUC was 0.89 (cut-off > 26.6 kPa, sensitivity 86.3%,specificity 81.8%) for presence of EV and 0.75 (cut-off >26. 6kPa, sensitivity 90.9%, specificity 60.6%) for grade IIIII EV.Conclusion: Hepatic elastography values and presence ofEV were related, with a higher significance in the groups ofviral cirrhosis and those without splenomegaly or thrombocytopenia. Cut-off points had high sensitivity, illustrating thepotential utility of transient hepatic elastography in identifyingpatients who may not need to undergo esophagogastroduodenoscopy. |
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| Autores principais: | Catarino, Ana |
| Outros Autores: | Pais, Carmen; Silva, Renata; Silva, Nuno; Carrola, Paulo; Presa, José |
| Assunto: | Cirrose Hepática Hipertensão Portal Técnicas de Imagem por Elasticidade Varizes Esofágicas e Gástricas Elasticity Imaging Techniques Esophageal and Gastric Varices Hypertension, Portal Liver Cirrhosis |
| Ano: | 2017 |
| País: | Portugal |
| Tipo de documento: | artigo |
| Tipo de acesso: | unknown |
| Instituição associada: | Sociedade Portuguesa de Medicina Interna |
| Idioma: | português |
| Origem: | Revista Portuguesa de Medicina Interna |
| Resumo: | Introduction: Esophageal varices (EV) are a complicationof portal hypertension, and its rupture is associated witha high mortality rate. The use of non-invasive diagnosticmethods, including hepatic elastography, have been underinvestigation.Aim: Evaluate the usefulness of transient hepatic elastographyas a non-invasive test for the prediction of presenceof EV, to avoid systematic screening with esophagogastroduodenoscopyin a selected group of patients.Material and Methods: Retrospective analysis of the patientsof our Hepatology Unit with a hepatic elastography value >13kPa who underwent esophagogastroduodenoscopy within18 months of its evaluation.Results: We included 259 patients (80.7% males), with amedium age of 57.9 ± 9.8 years; 65.3% had EV (52.1%grade II-III). We built ROC curves correlating hepatic elastographyvalue and presence of EV, and obtained an areaunder the curve (AUC) for presence of EV of 0.755 (cut-off>26.6 kPa, sensitivity 81.1%, specificity 64.4%) and AUCof 0.68 (cut-off > 28,1 kPa, sensitivity 82.9%, specificity49.7%) for grade II-III EV. For viral cirrhosis we obtainedAUC of 0.83 for presence of EV (cut-off > 19.8 kPa, sensitivity95.4%, specificity 62.2%) and AUC of 0.69 for gradeII-III EV (cut-off > 19.8 kPa, sensitivity 94.7%, specificity42.0%). In patients without splenomegaly or thrombocytopenia,AUC was 0.89 (cut-off > 26.6 kPa, sensitivity 86.3%,specificity 81.8%) for presence of EV and 0.75 (cut-off >26. 6kPa, sensitivity 90.9%, specificity 60.6%) for grade IIIII EV.Conclusion: Hepatic elastography values and presence ofEV were related, with a higher significance in the groups ofviral cirrhosis and those without splenomegaly or thrombocytopenia. Cut-off points had high sensitivity, illustrating thepotential utility of transient hepatic elastography in identifyingpatients who may not need to undergo esophagogastroduodenoscopy. |
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