European Journal of Molecular & Clinical Medicine

Abstract

Esophageal varices are portosystemic collaterals developed in cirrhotic patients with portal hypertension. Noninvasive assessment of cirrhotic patients to predict esophageal varices have been increasingly used instead of endoscopy. Shear wave elastography is a non- invasive technique which is based on an ultrasound device which has been developed to detect liver stiffness. We aim to assess the diagnostic performances of Shear Wave Elastography liver for the noninvasive detection of the presence of esophageal varices. Subjects and Methods: The patients included in the study underwent shear wave elastography (SWE) of liver and underwent endoscopy to determine presence of esophageal varices, Platelet count and spleen size values were calculated. The diagnostic performance of liver stiffness by SWE, platelet count and spleen size were evaluated using receiver operating characteristic (ROC) curve analysis. Correlations of SWE, platelet count and spleen size with endoscopy findings (as the reference standard) were determined using Spearman’s correlation coefficient. Results: Study included, 102 patients of the 58 (56.86%) were grade 0 with mean SWE of 16.32±1.28 kPa, 25 (26.32%) were grade1 with mean SWE of 18.16±1.00kPa;12 (11.76%) were grade2 with mean SWE of 24.42±0.70kPa, and 07(6.86%) were grade3 with mean SWE of   26.50±0.53kPa. There was significant positive correlation between different stages of esophageal varices by endoscopy and liver stiffness detected by SWE (r = 0.9178, p < 0.001). AUC (95% Cl) for diagnosing grade 0, grade 1, grade 2 and grade 3 esophageal varices SWE elastography is 0.926(0.857 to 0.969);0.655 (0.555 to 0.747) ;0.922 (0.852 to 0.966) and 1.000 (0.964 to 1.000) respectively. A cutoff value of >19.3kPa and >25.3kPa was 100% sensitive in diagnosing grade2 and grade 3 esophageal varices respectively. SWE liver stiffness exhibited higher diagnostic accuracy than the platelet and spleen size for the diagnosis of those with high grade varices AUC 1.000(0.964 to 1.000), 0.995 (0.955 to 1.000), 0.913(0.841 to 0.960) respectively. Conclusion: Shear Wave Elastography (SWE) is a novel noninvasive independent variable for predicting high-risk esophageal varices in cirrhotic patients. Since SWE technique can be easily integrated into conventional ultrasound during a conventional liver ultrasound examination it helps to reduce medical, social, and economic costs particularly the endoscopic burden and also improve patient compliance.