Senior Resident.
Professor and Head of the Department, Government Medical College, Thiruvananthapuram, Kerala, India.
J Assoc Physicians India. 2022 Nov;70(11):11-12. doi: 10.5005/japi-11001-0163.
Total number of avoided endoscopies using Baveno VI criteria is relatively low. Spleen elastography is an attractive tool and when compared with liver stiffness, it better represents the dynamic changes occurring in portal hypertension. The aim of the study was to evaluate spleen shear wave elastography (SWE) in compensated advanced chronic liver disease (cACLD) patients for ruling out the presence of esophageal high-risk varices (HRV).
A total of 401 patients with cACLD were included in this cross-sectional study. The total sample was split into training set (200 patients) and validation set (201 patients). Spleen stiffness was measured with two-dimensional shear wave elastography (2D SWE). Esophageal HRV were defined as large varices (diameter >5 mm) or small varices with red color signs. In the training set, the receiver operating characteristic (ROC) curve was drawn and the area under the curve (AUC) of spleen SWE was assessed. A cutoff value was chosen (highest sensitivity and negative predictive value). In the validation set, the spleen SWE cutoff score and Baveno VI criteria were validated.
The prevalence of HRV was 12% in the training set and 13% in the validation set. Spleen SWE had an AUC of 0.89 in ruling out the presence of high-risk esophageal varices (cutoff value of 48.7 kPa, sensitivity of 100%, and specificity of 53%). Validating spleen SWE ≤48.7 kPa in a different cohort of 201 cACLD patients, 55% of screening endoscopies could be avoided without missing any HRV, whereas using Baveno VI criteria only 30% of screening endoscopies could be spared.
Spleen SWE ≤48.7 kPa was able to identify cACLD patients who could safely avoid screening endoscopy with good accuracy. Spleen SWE could avoid an additional 25% of screening endoscopies compared to the Baveno VI criteria and no HRV were missed.
应用 Baveno VI 标准可避免的内镜检查总数相对较低。脾脏弹性成像具有吸引力，与肝硬度相比，它能更好地反映门脉高压发生的动态变化。本研究旨在评估代偿性慢性肝病（cACLD）患者脾脏剪切波弹性成像（SWE）在排除食管高危静脉曲张（HRV）中的作用。
本横断面研究共纳入 401 例 cACLD 患者。总样本分为训练集（200 例）和验证集（201 例）。采用二维剪切波弹性成像（2D SWE）测量脾脏硬度。食管 HRV 定义为大静脉曲张（直径>5mm）或红色征小静脉曲张。在训练集中，绘制受试者工作特征（ROC）曲线，评估脾脏 SWE 的曲线下面积（AUC）。选择一个截断值（最高灵敏度和阴性预测值）。在验证集中，验证脾脏 SWE 截断评分和 Baveno VI 标准。
在训练集中，HRV 的患病率为 12%，在验证集中为 13%。脾脏 SWE 用于排除高危食管静脉曲张的 AUC 为 0.89（截断值为 48.7kPa，灵敏度为 100%，特异性为 53%）。在 201 例不同队列的 cACLD 患者中验证脾脏 SWE≤48.7kPa 时，55%的筛查内镜检查可以避免，而不遗漏任何 HRV，而仅使用 Baveno VI 标准，仅可避免 30%的筛查内镜检查。
脾脏 SWE≤48.7kPa 能够准确识别可以安全避免筛查内镜检查的 cACLD 患者。与 Baveno VI 标准相比，脾脏 SWE 可避免 25%的额外筛查内镜检查，且未遗漏任何 HRV。
