A novel spleen-dedicated stiffness measurement by FibroScan® improves the screening of high-risk oesophageal varices

Horia Stefanescu, Giovanni Marasco, Paul Calès, Mirella Fraquelli, Matteo Rosselli, Nathalie Ganne-Carriè, Victor de Ledinghen, Federico Ravaioli, Antonio Colecchia, Corina Rusu, Pietro Andreone, Giuseppe Mazzella, Davide Festi

Research output: Contribution to journalArticle

Abstract

Background & Aims: Several non-invasive tests (NITs) have been developed to diagnose oesophageal varices (EV), including the recent Baveno VI criteria to rule out high-risk varices (HRV). Spleen stiffness measurement (SSM) with the standard FibroScan® (SSM@50Hz) has been evaluated. However, the EV grading could be underestimated because of a ceiling threshold (75 kPa) of the SSM@50Hz. The aims were to evaluate SSM by a novel spleen-dedicated FibroScan® (SSM@100Hz) for EV diagnosis compared with SSM@50Hz, other validated NITs and Baveno VI criteria. Methods: This prospective multicentre study consecutively enrolled patients with chronic liver disease; blood data, endoscopy, liver stiffness measurement (LSM), SSM@50Hz and SSM@100Hz were collected. Results: Two hundred and sixty patients met inclusion criteria. SSM@100Hz success rate was significantly higher than that of SSM@50Hz (92.5% vs 76.0%, P <.001). SSM@100Hz accuracy for the presence of EV (AUC = 0.728) and HRV (AUC = 0.756) was higher than in other NITs. SSM@100Hz AUC for large EV (0.782) was higher than SSM@50Hz (0.720, P =.027). AUC for HRV with SSM@100Hz (0.780) was higher than with LSM (0.615, P <.001). The spared endoscopy rate of Baveno VI criteria (8.1%) was significantly increased by the combination to SSM@50Hz (26.5%) or SSM@100Hz (38.9%, P <.001 vs others). The missed HRV rate was, respectively, 0% and 4.7% for combinations. Conclusions: SSM@100Hz is a new performant non-invasive marker for EV and HRV providing a higher accuracy than SSM@50Hz and other NITs. The combination of Baveno VI criteria and SSM@100Hz significantly increased the spared endoscopy rate compared to Baveno VI criteria alone or combined with SSM@50Hz. Clinical trial number: NCT02180113.

Original languageEnglish
Pages (from-to)175-185
JournalLiver International
Volume40
Issue number1
DOIs
Publication statusPublished - 2020

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Keywords

  • Baveno VI criteria
  • liver stiffness measurement
  • portal hypertension
  • spleen stiffness measurement

ASJC Scopus subject areas

  • Hepatology

Cite this

Stefanescu, H., Marasco, G., Calès, P., Fraquelli, M., Rosselli, M., Ganne-Carriè, N., de Ledinghen, V., Ravaioli, F., Colecchia, A., Rusu, C., Andreone, P., Mazzella, G., & Festi, D. (2020). A novel spleen-dedicated stiffness measurement by FibroScan® improves the screening of high-risk oesophageal varices. Liver International, 40(1), 175-185. https://doi.org/10.1111/liv.14228