50. Value of transient elastography for the prediction of variceal bleeding in patients with cirrhosis

Abstract

Background and Aims: Fibroscan is a relatively new, noninvasive method of measuring liver stiffness. We want to determine if liver stiffness (LS) measurements by means of Fibroscan correlate with the presence of significant Esophageal varices (EV) and if they can predict the occurrence of variceal bleeding. Methods: The study was conducted from January 2015 to June 2017 at Madras Medical College. We studied 250 cases of liver cirrhosis divided into 2 groups: patients without EV or with grade 1 varices (164 cases) and patients with significant varices (grade 2 and 3 EV) (86 cases). We divided the group of 134 cases with EV into another 2 subgroups: without variceal hemorrhage (94 patients) and with variceal bleeding (40 cases). Results: The mean LS values in the 164 patients without or with grade 1 EV was significantly lower than in the 86 patients with significant EV (25 ± 0.60 kPa vs. 47.21 ± 0 .8 kPa, P < 0.0001). Using the ROC curve we established a cut-off value of 32 kPa for the presence of EV, with 83% sensitivity and 62% specificity with 76.2% PPV and 71.3% NPV (P < 0.0001). The mean LS values in the group with a history of variceal bleeding (40 patients) was significantly higher than in the group with no bleeding (94 patients): 53.2 ± 0.5 kPa vs. 38.20 ± 0.91 kPa, P < 0.0001). For a cut-off value of 52.7 kPa, LS had 53.33% sensitivity and 82.67% specificity with 82.71% PPV and 53.66% NPV (P < 0.0001) for the prediction of esophageal bleeding. Conclusions: LS measurement by means of TE is a reliable noninvasive method for the detection of EV and for the prediction of variceal bleeding. The authors have none to declare.