Noninvasive prediction of high-risk esophageal varices by spleen and liver stiffness measurements using sound touch elastography

Abstract

Background and aims: Noninvasive assessments play a crucial role in ruling out high-risk esophageal varices (HREV) in cirrhotic patients. However, the value of sound touch elastography (STE) in predicting HREV has not been comprehensively investigated. Therefore, this study aimed to establish prediction models based on liver and spleen stiffness measurements obtained by STE and provide assessment strategies and cutoff values tailored for different clinical situations.

Methods: This prospective study included cirrhotic patients who underwent esophagogastroduodenoscopy (EGD). Liver and spleen stiffness measurements by STE were performed within six months of EGD examination. Various prediction models and their corresponding cutoff values were established for different clinical situations, incorporating spleen diameter and laboratory parameters.

Results: A total of 154 cirrhotic patients were included in the study and stratified into training (n = 119) and validation (n = 35) sets. Multivariable analysis revealed platelet, spleen diameter and spleen stiffness measurement as independent predictors of HREV. The model incorporating spleen stiffness measurement, platelet, and spleen diameter demonstrated superior performance in predicting HREV, yielding an area under the receiver operating characteristic curve (AUC) of 0.878 and 0.853 in the training set and validation set, respectively. Application of this model for screening cirrhotic patients could avoid EGDs in 39.7% (27/68) and 35.3% (6/17) of patients in the training and validation sets, respectively.

Conclusions: Liver and spleen stiffness measurements obtained through STE are valuable for predicting HREV in cirrhotic patients. The developed prediction models and their corresponding cutoff values provide tailored solutions for various clinical situations, thereby effectively reducing the need for unnecessary endoscopies.

Keywords

High-risk esophageal varices (HREV) / Cirrhosis / Liver stiffness measurement (LSM) / Spleen stiffness measurement (SSM) / Sound touch elastography (STE) / Prediction models

Authors’ contributions

Jinfen Wang: Writing - original draft, Formal analysis, Data curation. Siwei Tan: Writing - original draft, Project administration, Data curation. Ruiying Zheng: Project administration, Formal anal-ysis, Data curation. Bilun Ke: Supervision, Resources, Project administration. Bin Wu: Writing - review & editing, Project administration, Conceptualization, Supervision. Manli Wu: Writing - review & editing, Writing - original draft, Funding acquisition, Formal analysis, Conceptualization.

Data availability statement

The data used and analyzed during the current study are available from the corresponding authors upon reasonable request.

Declaration of competing interest

Bin Wu is an editorial board member for Liver Research and was not involved in the editorial review or the decision to publish this article. The authors declare that they have no conflict of interest.

Acknowledgements

This study was supported by the National Natural Science Foundation of China (No. 82202191).

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