2. Use of vibration controlled transient elastography (fibroscan) with or without platelet count to predict presence of large oesophageal varices

Abstract

Background and Aims: Screening for Oesophageal Varices in cirrhosis is done by upper gastrointestinal endoscopy which is gold standard but an invasive approach. Vibration Controlled Transient Elastography (Fibroscan) measures liver stiffness noninvasively and also correlates with portal hypertension. Liver stiffness >15 kPa are highly suggestive of compensated advanced chronic liver disease (cACLD). Aim is to study the utility of Fibroscan with/without platelet count to predict large oesophageal varices in patients with cACLD in Indian population. Methods: 88 patients with liver stiffness >10 kPa who underwent upper gastrointestinal endoscopy and basic blood investigations were studied prospectively. Patients with ascites, Hepatocellular carcinoma, total bilirubin >5 mg/dl and AST/ALT >5 times upper limit of normal were excluded. Endoscopic varices were graded into no varices, small varices or large varices. Results: Mean age was 51.07 years 69 were males, and 19 were females. Most common etiological factors were probable NASH (42; 47.72%) followed by HBV (18,20.45%), Alcoholic (12; 13.63%), Others (10; 11.36%), HCV (5; 5.68%) and HBV + HCV (1; 1.13%). Total 25 (28.41%) patients didn’t had varices, 36 (40.9%) patients had small varices and 27 (30.68%) patients had large varices. Mean liver stiffness when there were large varices was 45.17 kPa, and 26.40 kPa when large varices were not present. Mean platelet count was 1,12,815/mm3 when there were large varices, and it was 1,74,279/mm3 when large varices were not present. A Cut-off liver stiffness of 20 kPa had 96.3% sensitivity, 45.9% specificity, 44.07% positive predictive value (PPV) and 96.55% negative predictive value (NPV) in predicting large oesophageal varices and when combined with a cut off platelet count of <150000/mm3, these values were 88.46%, 90%, 82% and 93.75% respectively. Conclusion: Fibroscan has good sensitivity and NPV but limited specificity and PPV in predicting large oesophageal varices, adding platelet count to it increases the specificity and PPV significantly with little change in sensitivity and NPV in Indian population and can be used to screen cACLD patients non-invasively. The authors have none to declare.