Transient Elastography- a Non-invasive Alternative to Upper Endoscopy for Detection of Gastric and Esophageal Varices in HBV and HCV Cirrhosis

Abstract

Introduction: Esophageal and gastric varices are one of the most important complications of liver cirrhosis leading to Upper GI Bleed with a significant mortality and morbidity. Upper endoscopy is the currently recommended method for variceal screening and treatment to prevent upper GI bleed. However this method is invasive and carries a small but definitive risk of complications as well as an incremental expense. Non invasive methods to detect patients with large esophageal varices at high risk for bleeding are desirable. In this respect, several clinical, biological, ultrasonographic and elastrographic (transient elastography-TE) methods have been proposed Some of these have been validated as non-invasive alternatives to endoscopy Our study was done with the objective of studying the validity of liver stiffness measurement by fibroscan to predict the presence of esophageal and gastric varices in cirrhotic patients due to hepatitis C and B infection Methods: A retrospective analysis of medical records of 75 patients who underwent fibro scan and then screening endoscopy was carried out. This data was then analyzed to correlate the fibroscan findings with the presence of esophageal and gastric varices. Patients aged 18 to 80 years with HCV and HBV related chronic liver disease were included in this study. Patients with Hepatocellular carcinoma and cirrhosis due to non- HBV/ HCV related liver disease were excluded. Results: The results produced from this data shows that there is a significant association between liver stiffness measured during transient elastography and the presence of esophageal varices. .The results also show that fibro scan score is a better predictor of esophageal varices then gastric varices. There is no strong association between gastric varices and fibro scan score. So fibro scan can be used as screening for only esophageal varices and not for gastric varices Conclusion: The results produced from this data shows that there is a significant association between fibro scan score and esophageal varices. This shows that a non invasive modality like fibroscan score can be used as a screening tool for presence and degree of esophageal varices in patients with chronic hepatitis B and C. The results also show that fibro scan score is a better predictor of esophageal varices then gastric varices.