Department of Ultrasound, PLA General Hospital of Southern Theatre Command, Guangzhou.
Department of Ultrasonic Medicine, Xijing Hospital, Air Force Medical University, Xi'an, China.
Ultrasound Q. 2024 Jun 1;40(2):104-110. doi: 10.1097/RUQ.0000000000000674.
Patients with compensated advanced chronic liver disease (cACLD) can safely spared screening esophagogastroduodenoscopy (EGD) when they meet the Baveno VI criteria as assessed by transient elastography. Recently, the cutoff values of the Baveno VI criteria assessed by 2-dimensional shear wave elastography (2D-SWE) were proposed. We aimed to validate it to rule out high-risk varices (HRVs) in cACLD patients; combine spleen diameter (SPD) with the Baveno VI criteria and assess whether it can spare more screening EGD. A total of 173 cACLD patients with successful liver stiffness (LS) measurements and EGD examinations were included. We analyzed the risk factors that predicted HRVs and compared the performances of different models for ruling out HRVs. The platelet count, LS, and SPD were independent predictors of HRVs. The AUCs of platelet count, LS, spleen stiffness and SPD for diagnosing HRVs were 0.797, 0.757, 0.834, and 0.804, respectively. The Baveno VI criteria assessed by 2D-SWE spared 25.4% of EGD screenings and missed 2.4% of the HRV patients. Combining SPD ≤11.1 cm with the Baveno VI criteria could spare more EGD screenings than just applying the Baveno VI criteria (45.1% vs 25.4%, P < 0.001), and missed 4.9% of the HRV patients. The Baveno VI criteria assessed by 2D-SWE could be safely applied in cACLD patients to rule out HRV patients. The combined model Baveno VI/SPD could safely and significantly increase the rate of spared EGD.
代偿期慢性肝病（cACLD）患者，如果符合瞬时弹性成像（TE）评估的 Baveno VI 标准，可以安全避免接受食管胃十二指肠镜检查（EGD）。最近，提出了二维剪切波弹性成像（2D-SWE）评估的 Baveno VI 标准的截断值。我们旨在验证其在 cACLD 患者中排除高危静脉曲张（HRV）的作用；将脾直径（SPD）与 Baveno VI 标准相结合，并评估其是否可以进一步避免更多的 EGD 筛查。共纳入了 173 例成功进行肝脏硬度（LS）测量和 EGD 检查的 cACLD 患者。我们分析了预测 HRV 的危险因素，并比较了不同模型排除 HRV 的性能。血小板计数、LS 和 SPD 是 HRV 的独立预测因素。血小板计数、LS、脾脏硬度和 SPD 诊断 HRV 的 AUC 分别为 0.797、0.757、0.834 和 0.804。2D-SWE 评估的 Baveno VI 标准避免了 25.4%的 EGD 筛查，漏诊了 2.4%的 HRV 患者。将 SPD≤11.1cm 与 Baveno VI 标准相结合，比仅应用 Baveno VI 标准（45.1%比 25.4%，P<0.001）可进一步避免更多的 EGD 筛查，且漏诊了 4.9%的 HRV 患者。2D-SWE 评估的 Baveno VI 标准可安全应用于 cACLD 患者，以排除 HRV 患者。联合模型 Baveno VI/SPD 可安全且显著提高 EGD 筛查避免率。
