Diagnosis of esophageal varices: correlation between non-invasive tests and digestive endoscopy

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Asma Mensi
Amel Medhioub
Nouha Trad
Emna Bel Haj Mabrouk
Yosra Said
Radhouene Debbeche

Abstract

 Introduction: Esophageal variceal bleeding (EVB) is one of the main causes of mortality and morbidity in cirrhotic patients. Non-invasive tests (NIT) of liver fibrosis have been developed to predict the presence of esophageal varices (EV).


Aim: To evaluate the performance of NIT of liver fibrosis such as liver transient elastography (TE) and serum scores in predicting EV.


Methods: We conducted a retrospective collecting patients with chronic liver disease. TE and serum scores were evaluated for all patients and correlated with endoscopic data.


 Results: One hundred and fifty patients were included with an average age of 58.98 years and a sex ratio of 0.68. Sixty-seven patients were cirrhotic. Viral origin C was found in 72% of cases. Thirty-three patients had EV. NIT of liver fibrosis such as TE and serum scores were statistically correlated to the presence of EV. TE had the better performance for the prediction of EV with a Cut-off of 13.5 Kpa and AUC of 0.855. In multivariate analysis, TE, AST to ALT ratio and platelet count were independent predictors of EV.


Conclusion: The performance of TE and serum scores in the diagnosis of EV and LEV was demonstrated. These results suggest that NIT of liver fibrosis make it possible to select patients who are candidates for gastroscopy.

Keywords:

Esophageal varices, Gastroscopy, Fibroscan, Non-invasive markers, Hepatic fibrosis

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References

  1. Kovalak M, Lake J, Mattek N, Eisen G, Lieberman D, Zaman A. Endoscopic screening for varices in cirrhotic patients: data from a national endoscopic database. GastrointestEndosc. 2007 ;65(1):82-8.
  2. Garbuzenko DV, Arefyev NO. Primary prevention of bleeding from esophageal varices in patients with liver cirrhosis: an update and review of the literature. J Evid Based Med. 2020;13(4):313-24.
  3. Hwang JH, Shergill AK, Acosta RD, Chandrasekhara V, Chathadi KV, Decker GA, et al. The role of endoscopy in the management of variceal hemorrhage. GastrointestEndosc. 2014;80(2):221-7.
  4. De Franchis R, Faculty BV. Revising consensus in portal hypertension: report of the bavenoV consensus workshop on methodology of diagnosis and therapy in portal hypertension. J Hepatol. 2010;53(4):762-8.
  5. Spiegel B, Targownik L, Dulai GS, Karsan HA, Gralnek IM. Endoscopic screening for esophageal varices in cirrhosis: is it ever cost effective? Hepatology. 2003;37(2):366-77.
  6. Duah A, Nkrumah KN, Tachi K. Non-invasive markers as predictors of oesophagealvarices in cirrhotic patient in a teaching hospital in Ghana. Ghana Med J. 2019;53(2):142-9.
  7. Kraja B, Mone I, Akshija I, Koçollari A, Prifti S, Burazeri G. Predictors of esophageal varices and first variceal bleeding in liver cirrhosis patients. World J Gastroenterol. 2017;23(26):4806-14.
  8. Deng H, Qi X, Guo X. Diagnostic accuracy of APRI, AAR, FIB-4, FI, king, lok, forns, and fibroindex scores in predicting the presence of esophageal varices in liver cirrhosis: a systematic review and meta-analysis. Medicine. 2015 Oct;94(42):e1795.
  9. Saad Y, Said M, Idris MO, Rabee A, Zakaria S. Liver stiffness measurement by fibroscan predicts the presence and size of esophageal varices in egyptian patients with HCV related liver cirrhosis.JClinDiagn Res. 2013;7(10):2253-7.
  10. Vergniol J, De Ledinghen V. Diagnostic non invasif de la fibrose hépatique : modalités pratiques d’utilisation des marqueurs sanguins et du FibroScan. GastroenterolClin Biol. 2009;33(4):334-44.
  11. Wai CT, Greenson JK, Fontana RJ, Kalbfleisch JD, Marrero JA, Conjeevaram HS, et al. A simple noninvasive index can predict both significant fibrosis and cirrhosis in patients with chronic hepatitis C. Hepatology. 2003;38(2):518-26.
  12. ValletPichard A, Mallet V, Nalpas B, Verkarre V, Nalpas A, DhalluinVenier V, et al. FIB-4: an inexpensive and accurate marker of fibrosis in HCV infection. Comparison with liver biopsy and fibrotest. Hepatology. 2007;46(1):32-6.
  13. De Franchis R, Bosch J, Garcia Tsao G, Reiberger T, Ripoll C,Abraldes JG, et al. Baveno VII renewing consensus in portal hypertension. J Hepatol. 2022;76(4):959-74.
  14. Castera L. Intérêt de l’élastométrie (FibroScan®) pour l’évaluation non invasive de la fibrose hépatique. Gastroenterol Clin Biol. 2007 ;31(5):524-30
  15. Berzigotti A, Tsochatzis E, Boursier J, Castera L, Cazzagon N, Friedrich Rust M, et al. EASL clinical practice guidelines on non-invasive tests for evaluation of liver disease severity and prognosis – 2021 update. J Hepatol. 2021;75(3):659-89.
  16. Mnif L, Hachicha S, Abid F, Gdoura H, Chtourou L, Amouri A, et al. Rôle des élasticités splénique et hépatique dans la prédiction des varices oesophagiennes. Tunis Med. 2021;99(5):544‑51.
  17. Castéra L, Bail BL, RoudotThoraval F, Bernard PH, Foucher J, Merrouche W, et al. Early detection in routine clinical practice of cirrhosis and oesophagealvarices in chronic hepatitis C: comparison of transient elastography (FibroScan) with standard laboratory tests and non-invasive scores. J Hepatol. 2009 ;50(1):59-68.
  18. Buechter M, Kahraman A, Manka P, Gerken G, Jochum C, Canbay A, et al. Spleen and liver stiffness is positively correlated with the risk of esophageal variceal bleeding. Digestion. 2016;94(3):138-44.
  19. Calvaruso V, Bronte F, Conte E, Simone F, Craxì A, Di Marco V. Modified spleen stiffness measurement by transient elastography is associated with presence of large oesophagealvarices in patients with compensated hepatitis C virus cirrhosis. J Viral Hepat. 2013;20(12):867-74.
  20. Kazemi F, KettanehA, N’kontchou G, Pinto E, Ganne Carrie N, Trinchet JC, et al. Liver stiffness measurement selects patients with cirrhosis at risk of bearing large oesophagealvarices. J Hepatol. 2006 ;45(2):230-5.
  21. Stefanescu H, Grigorescu M, Lupsor M, Procopet B, Maniu A, Badea R. Spleen stiffness measurement using fibroscan for the noninvasive assessment of esophageal varices in liver cirrhosis patients: transient elastographyof the spleen. J GastroenterolHepatol. 2011;26(1):164-70.
  22. Vizzutti F, Arena U, Romanelli RG, Rega L, Foschi M, Colagrande S, et al. Liver stiffness measurement predicts severe portal hypertension in patients with HCV-related cirrhosis. Hepatology. 2007;45(5):1290-7.
  23. Pritchett S, Cardenas A, Manning D, Curry M, Afdhal NH. The optimal cut-off for predicting large oesophagealvarices using transient elastography is disease specific: transient elastography for prediction of oesophagealvarices. J Viral Hepat. 2011;18(4):75-80.
  24. Malik R, Lai M, Sadiq A, Farnan R, Mehta S, Nasser I, et al. Comparison of transient elastography, serum markers and clinical signs for the diagnosis of compensated cirrhosis: non-invasive assessment of cirrhosis. J GastroenterolHepatol. 2010 ;25(9):1562-8.
  25. Al Hamoudi WK, Abdelrahman AA, Helmy A, Anil S, Khamis N, Arafah M, et al. The role of fibroscan in predicting the presence of varices in patients with cirrhosis. Eur J GastroenterolHepatol. 2015;27(11):1307-12.
  26. Zhu Q, Wang W, Zhao J, AL Asbahi AM, Huang Y, Du F, et al. Transient Elastographyidentifies the risk of esophageal varices and bleeding in patients with hepatitis B virus–related liver cirrhosis. Ultrasound Q. 2018;34(3):141-7.
  27. Hassan EM, Omran DA, El Beshlawey ML, Abdo M, El Askary A. Can transient elastography, Fib-4, forns index, and lok score predict esophageal varices in HCV-related cirrhotic patients? GastroenterolHepatol. 2014;37(2):58-65.
  28. Bureau C, Metivier S, Peron JM, Selves J, Robic MA, Gourraud PA, et al. Transient elastography accurately predicts presence of significant portal hypertension in patients with chronic liver disease: investigating the performance of transient elastography. Aliment PharmacolTher. 2008 ;27(12):1261-8.
  29. Wang JH, Chuah SK, Lu SN, Hung CH, Chen CH, Kee KM, et al. Transient elastography and simple blood markers in the diagnosis of esophageal varices for compensated patients with hepatitis B virus-related cirrhosis: elastographyand blood marker in varices. J GastroenterolHepatol. 2012 ;27(7):1213-8.
  30. Sporea I, Raţiu I, Bota S, Şirli R, Jurchiş A. Are different cut-off values of liver stiffness assessed by transient elastography according to the etiology of liver cirrhosis for predicting significant esophageal varices? Med Ultrason. 2013;15(2):111-5.
  31. AbdElsalam SM, Ezz MM, GamalelDin S, Esmat G, Elakel W, ElHefnawi M. Derivation of “egyptianvaricesprediction (EVP) index”: a novel noninvasive index for diagnosing esophageal varices in HCV patients. J Adv Res. 2021 ;35:87-97.
  32. Liu H, Chen P, Jiang B, Li F, Han T. The value of platelet parameters and related scoring system in predicting esophageal varices and collateral veins in patients with liver cirrhosis. J Clin Lab Anal. 2021;35(3):e23694.
  33. Sebastiani G, Tempesta D, Fattovich G, Castera L, Halfon P, Bourliere M, et al. Prediction of oesophagealvarices in hepatic cirrhosis by simple serum non-invasive markers: results of a multicenter, large-scale study. J Hepatol. 2010;53(4):630-8.