Sound Conclusions: How Splenic Elastography May Decrease the Need for Endoscopic Variceal Surveillance

Excerpt

Portal hypertension (PH), a common complication of advanced hepatic cirrhosis, is often accompanied by esophageal varices that can be the source of torrential hemorrhage. In recent years, regular endoscopic variceal surveillance (EVS) combined with prophylactic banding or clipping has decreased the incidence of variceal hemorrhage. One issue is that EVS requires periodic upper endoscopy (EGD) that carries inherent risk and inconvenience to the patient and costs to the healthcare system. To address the issue of patient stratification for EVS, the consensus workshop on definitions, methodology, and therapeutic strategies on PH held in Baveno, Italy, considered this issue. In the latest (sixth) iteration, De Franchis et al. [1] have for the first time highlighted noninvasive tests useful for identifying patients requiring EVS to identify esophageal varices needing treatment (VNT). These experts concluded that patients with liver stiffness measurement (LSM), assessed by transient elastography (TE, FibroScan® Echosens, Paris, France) < 20 kPa and a platelet count > 150 × 10⁹/L have a low (< 5%) prevalence of VNT, thus effectively risk-stratifying this population, consequently avoiding or postponing the need for EVS. One problem, however, is that LSM values vary by operator, technique, and the type of machine used, confounding the calculation. …