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Spleen stiffness by 2‐D shear wave elastography is the most accurate predictor of high‐risk esophagogastric varices in children with biliary atresia
Author(s) -
Yokoyama Shinya,
Ishigami Masatoshi,
Honda Takashi,
Kuzuya Teiji,
Ishizu Yoji,
Ito Takanori,
Hirooka Yoshiki,
Tanaka Yujiro,
Tainaka Takahisa,
Shirota Chiyoe,
Chiba Kosuke,
Uchida Hiroo,
Fujishiro Mitsuhiro
Publication year - 2019
Publication title -
hepatology research
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.123
H-Index - 75
eISSN - 1872-034X
pISSN - 1386-6346
DOI - 10.1111/hepr.13381
Subject(s) - biliary atresia , medicine , esophageal varices , gastroenterology , gastric varices , receiver operating characteristic , atresia , varices , transient elastography , portal hypertension , cirrhosis , liver transplantation , transplantation , liver fibrosis
Aim Esophagogastric variceal hemorrhage is a cause of poor prognosis in patients with biliary atresia (BA). To prevent variceal hemorrhage, simple and reliable screening methods for high‐risk esophagogastric varices (HR‐EGV) are needed. We evaluated the efficacy of liver stiffness (LS) and spleen stiffness (SS) as measured by 2‐D shear wave elastography (2D‐SWE), which was reported to be more accurate than transient elastography, for detecting HR‐EGV in children with BA. Methods Thirty‐four children with BA were enrolled. Both LS and SS were measured by 2D‐SWE. The presence of large esophageal varices or esophageal varices of any size with red wale marking and/or the presence of gastric varices along the cardia were defined as HR‐EGV. Clinical data were collected and previously reported prediction indices for varices were calculated. Results Liver stiffness and SS were obtained from all patients. Fourteen patients showed HR‐EGV. Significantly different variables between patients with and without HR‐EGV were as follows: spleen diameter (116 mm vs. 95 mm), clinical prediction rule (104.7 vs. 124.7), King's variceal prediction score (78.8 vs. 99.4), aspartic aminotransferase‐to‐platelet ratio index (2.03 vs. 0.98), LS (2.63 m/s vs. 1.87 m/s), and SS (4.44 m/s vs. 3.69 m/s). The highest area under the receiver operating characteristic curve for detecting HR‐EGV was that for SS (0.900), and the cut‐off SS of 4.12 m/s yielded 92.9% sensitivity and 90% specificity. The intraclass correlation coefficient for intra‐observer reproducibility was 0.828. Conclusions Spleen stiffness from 2D‐SWE offered the most accurate predictor of HR‐EGV in BA children.