Performance of spleen stiffness measurement to rule out high-risk varices in patients with porto-sinusoidal vascular disorder.

Moga, Lucile; Paradis, Valérie; Ferreira-Silva, Joel; Gudavalli, Koushik; Indulti, Federica; Dajti, Elton; Nicoara-Farcau, Oana; Tosetti, Giulia; Antonenko, Antonina; Fodor, Andreea; Vidal-González, Judit; Turco, Laura; Capinha, Francisco; Elkrief, Laure; Monllor-Nunell, Teresa; Goria, Odile; Balcar, Lorenz; Lannes, Adrien; Mallet, Vincent; Poujol-Robert, Armelle; ... (2024). Performance of spleen stiffness measurement to rule out high-risk varices in patients with porto-sinusoidal vascular disorder. (In Press). Hepatology Wiley 10.1097/HEP.0000000000001004

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BACKGROUND AIMS

Baveno VII consensus suggests that screening endoscopy can be spared in patients with compensated cirrhosis when spleen stiffness measurement (SSM) by vibration-controlled transient elastography (VCTE) is ≤40 kPa as they have a low probability of high-risk varices (HRV). Conversely, screening endoscopy is required in all patients with porto-sinusoidal vascular disorder (PSVD). This study aimed to evaluate the performance of SSM-VCTE to rule out HRV in patients with PSVD and signs of portal hypertension.

APPROACH RESULTS

We retrospectively included patients with PSVD, ≥1 sign of portal hypertension, without history of variceal bleeding, who underwent a SSM-VCTE within 2 years before or after an upper endoscopy in 21 VALDIG centers, divided into a derivation and a validation cohort. 154 patients were included in the derivation cohort; 43% had HRV. By multivariable logistic regression analysis, SSM-VCTE >40 kPa and serum bilirubin ≥1 mg/dL were associated with HRV. SSM-VCTE ≤40 kPa combined with bilirubin <1 mg/dL had a sensitivity of 96% to rule out HRV, and could spare 38% of screening endoscopies, with 4% of HRV missed, and a 95% negative predictive value (NPV). In the validation cohort, including 155 patients, SSM combined with bilirubin could spare 21% of screening endoscopies, with 4% of HRV missed and a 94% NPV.

CONCLUSION

This study gathering a total of 309 PSVD patients showed that SSM-VCTE ≤40 kPa combined with bilirubin <1 mg/dL identifies patients with PSVD and portal hypertension with a probability of HRV <5%, in whom screening endoscopy can be spared.

Item Type:	Journal Article (Original Article)
Division/Institute:	04 Faculty of Medicine > Department of Gastro-intestinal, Liver and Lung Disorders (DMLL) > Clinic of Visceral Surgery and Medicine > Hepatology 04 Faculty of Medicine > Department of Gastro-intestinal, Liver and Lung Disorders (DMLL) > Clinic of Visceral Surgery and Medicine
UniBE Contributor:	Antonenko, Antonina
Subjects:	600 Technology > 610 Medicine & health
ISSN:	1527-3350
Publisher:	Wiley
Language:	English
Submitter:	Pubmed Import
Date Deposited:	03 Jul 2024 08:06
Last Modified:	03 Jul 2024 08:06
Publisher DOI:	10.1097/HEP.0000000000001004
PubMed ID:	38954825
URI:	https://boris.unibe.ch/id/eprint/198394