Abstract :
Background: Esophageal varices (EV) and portal hypertensive gastropathy (PHG) are consequences
of portal hypertension (PH) and potentially predispose to bleeding complications in cirrhotic patients. To detect
these lesions, especially EV, an esophago-gastro-duodenoscopy (EGD) is mandatory and is recommended as standard
of care in clinical guidelines. An alternative non-invasive test is ideally preferred in order to reduce the endoscopy
unit workload as well as to improve patients’ compliance. The density of the spleen is altered in the portal
hypertensive state which induces tissue hyperplasia and fibrosis. Thus, measured and quantified by transient
elastography may be used to predict the presence and the grading of EV, as well as the occurrence of PHG.
Objective: We aimed to investigate the utility of spleen stiffness for the evaluation of EV and PHG in
cirrhotic patients attending Bhumibol Adulyadej Hospital, Bangkok.
Methods: Spleen stiffness (SS) in 59 cirrhotic patients was evaluated by using FibroScan®. All patients
were underwent EGD for diagnosis and grading severity of EV and PHG.
Results: Forty-six of 59 patients (78%) had a valid SS measurement. Twenty-eight patients (60.9%)
had EV (F1; n = 13, F2; n = 12, F3; n= 3) and 33 (71.7%) had PHG (mild; n = 26, moderate to severe; n = 7). SS was
both significantly higher in patients with EV compared to those without EV, and also in patients with PHG compared
to those without. There was no significant difference of SS between the small (F1) and the large EV (F2 and
F3) groups, nor between the mild and the moderate to severe PHG groups.
Conclusion: SS may be useful as a non-invasive tool for predicting the presence but not the grading of
EV and PHG in cirrhotic patients.
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file/Thai-Journal-of-gastroenterology-vol-16-no-3-4190272.pdf