Spleen stiffness predicted risk for large, bleeding esophageal varices in cirrhotic patients

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Sharma P. Am J Gastroenterol. 2013;doi:10.1038/ajg.2013.119.

May 23, 2013

Measuring spleen stiffness in patients with cirrhosis was an effective, noninvasive method of predicting and differentiating large and small esophageal varices and determining those at risk for bleeding, according to recent study results.

Using transient elastography (FibroScan), researchers measured spleen stiffness (SS) and liver stiffness (LS) in 200 consecutive patients with cirrhosis between September 2011 and March 2012. Other measurements conducted in some of the cohort included hepatic venous pressure gradient (HVPG), upper gastrointestinal endoscopy, LS-spleen diameter to platelet ratio score (LSPS) and platelet count to spleen diameter ratio (PSR).

Among 174 evaluable patients who met inclusion criteria and had valid LS and SS measurements, 124 (71%) had esophageal varices (EV). Seventy-eight patients had large EV (more than 5 mm); 46 had small varices (less than 5 mm). Patients with EV displayed a significant difference in median SS (54 kPa compared with 32 kPa), LS (51.4 kPa vs. 23.9 kPa), LSPS (6.1 vs. 2.5) and PSR (812 vs. 1,165) compared with patients without EV (P=.001 for all differences).

Although LS could not be used to differentiate between large and small varices (53 kPa vs. 45.3 kPa; P=.57), SS was greater and indicative of patients with large varices (56 kPa vs. 49 kPa; P=.001) compared with small varices. Patients who had variceal bleed (n=46) also had greater SS than nonbleeder (n=78) patients (58 kPa vs. 50.2 kPa; P=.001).

Among only patients who submitted to HVPG (n=52), a significant correlation was observed with SS (P=.001) and LSPS (P=.01), but not LS (P=.207).

“Given the need to screen patients with cirrhosis, noninvasive tests, such as SS, may help to identify patients at risk of having EVs, particularly large, and those at risk of bleeding,” the researchers concluded. “Spleen stiffness, along with liver stiffness measurement, could select patients with cirrhosis, who should undergo upper gastrointestinal endoscopy to decrease burden upon endoscopy units.”

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