Hristov Bozhidar, Andonov Vladimir, Doykov Daniel, Doykova Katya, Valova Siyana, Nacheva-Georgieva Emiliya, Uchikov Petar, Kostov Gancho, Doykov Mladen, Tilkian Eduard
Second Department of Internal Diseases, Section "Gastroenterology", Medical Faculty, Medical University of Plovdiv, 6000 Plovdiv, Bulgaria.
Gastroenterology Clinic, University Hospital "Kaspela", 4001 Plovdiv, Bulgaria.
Diagnostics (Basel). 2023 Jan 18;13(3):356. doi: 10.3390/diagnostics13030356.
Portal hypertension (PH) and esophageal varices (EVs) are a matter of extensive research. According to current Baveno VII guidelines, in patients with compensated advanced chronic liver disease (cACLD), liver stiffness measurement (LSM) < 15 kPa and PLT count > 150 × 10/L, upper endoscopy (UE) is not mandatory, and the emphasis should be set on non-invasive methods for evaluation of clinically significant portal hypertension (CSPH). The aim of this study is to establish whether liver stiffness (LS) measured by 2D-SWE could be used as a predictor for the presence and severity of EVs in cirrhotic patients. In total, 86 patients of whom 32 with compensated liver cirrhosis (cLC) and 54 with decompensated liver cirrhosis (dLC) were examined in the Gastroenterology clinic of University hospital "Kaspela", Plovdiv, Bulgaria. Each patient underwent LS assessment by 2D-SWE and EVs grading by UE. EVs were detected in 47 (54.7%) patients, 23 (49%) of them were stage 4-high-risk EVs (HREV). The cut-off value for LS that differentiates HREV from the rest was set at 2.49 m/s with 100% sensitivity and 100% specificity (AUC 1.000, CI 0.925). Conclusions: 2D-SWE can be used as a non-invasive method in the assessment of only high-grade esophageal varices. For the other grades, upper endoscopy remains the method of choice.
门静脉高压（PH）和食管静脉曲张（EVs）是广泛研究的课题。根据当前的巴韦诺VII指南，对于代偿期晚期慢性肝病（cACLD）患者，肝脏硬度测量（LSM）<15 kPa且血小板计数>150×10⁹/L时，上消化道内镜检查（UE）并非必需，应重点关注评估临床显著门静脉高压（CSPH）的非侵入性方法。本研究的目的是确定二维剪切波弹性成像（2D-SWE）测量的肝脏硬度（LS）是否可作为肝硬化患者食管静脉曲张的存在及严重程度的预测指标。在保加利亚普罗夫迪夫“卡斯佩拉”大学医院胃肠病科，共检查了86例患者，其中32例为代偿期肝硬化（cLC）患者，54例为失代偿期肝硬化（dLC）患者。每位患者均接受了2D-SWE肝脏硬度评估和UE食管静脉曲张分级。47例（54.7%）患者检测到食管静脉曲张，其中23例（49%）为4期高危食管静脉曲张（HREV）。区分HREV与其他情况的肝脏硬度临界值设定为2.49 m/s，敏感性和特异性均为100%（曲线下面积1.000，可信区间0.925）。结论：2D-SWE仅可作为评估高级别食管静脉曲张的非侵入性方法。对于其他级别，上消化道内镜检查仍是首选方法。
