Lucile Moga, Audrey Payancé, Luis Téllez, Dario Saltini, Lucia Giuli, Asunción Ojeda, Elton Dajti, Ekaterina Liusina, Francisco Capinha, Dominik Bettinger, Teresa Monllor-Nunell, Arathi Venu, Gowripriya Nair, Laure Elkrief, Joel Silva, Magdalena Meszaros, Markus Peck-Radosavljevic, Sara Reinartz Groba, Christiane Stern, Laurent Castéra, Michael Praktiknjo, Boris Guiu, Arun Valsan, José Ferrusquía-Acosta, Carlos Noronha Ferreira, Maria Nadinskaya, Federico Ravaioli, Fanny Turon, Francesco Santopaolo, Filippo Schepis, Agustin Albillos, Pierre-Emmanuel Rautou, Aurélie Plessier, ERN RARE-LIVER; a study of VALDIG, an EASL consortium
This study gathering a total of 346 patients with chronic PVT without cirrhosis showed that SSM-VCTE ≤ 40 kPa can be used to identify patients with a probability of HRV ≤5%, in whom endoscopy can be spared.
BACKGROUND AND AIMS: Screening endoscopy can be spared in patients with compensated cirrhosis when spleen stiffness measurement (SSM) by vibration-controlled transient elastography (VCTE) is ≤40 kPa, as they have a low probability of high-risk varices (HRV). Conversely, endoscopy is required in all patients with chronic portal vein thrombosis (PVT) without cirrhosis. The objective was to evaluate the performance of SSM-VCTE to exclude HRV in patients with chronic PVT.
METHODS: We retrospectively included patients with chronic PVT without cirrhosis, who underwent an upper endoscopy within 2 years before or after SSM-VCTE in 16 VALDIG centers, divided into a derivation and a validation cohort.
RESULTS: 159 patients were included in the derivation cohort; 43% had HRV. 187 patients were included in the validation cohort; 32% had HRV. By univariable analysis, myeloproliferative neoplasm, ascites, hemoglobin, bilirubin, albumin, splenomegaly, portosystemic collaterals, liver stiffness - spleen diameter to platelet ratio score, liver stiffness measurement and SSM-VCTE were associated with HRV in both cohorts. By multivariable binary logistic regression analysis, only SSM-VCTE (p <0.005) remained associated with HRV in both cohorts. In the derivation cohort, SSM-VCTE ≤ 40 kPa had a sensitivity of 97% to rule out HRV, and could spare 41% of endoscopies, with 3% of HRV missed, and a 97% negative predictive value (NPV). In the validation cohort, SSM-VCTE ≤ 40 kPa could spare 43% of endoscopies, with 5% of HRV missed, and a 96% NPV.
CONCLUSIONS: This study gathering a total of 346 patients with chronic PVT without cirrhosis showed that SSM-VCTE ≤ 40 kPa can be used to identify patients with a probability of HRV ≤5%, in whom endoscopy can be spared.
IMPACT AND IMPLICATIONS: Patients with chronic portal vein thrombosis who do not have cirrhosis usually have low liver stiffness measurement values; the liver stiffness cut-offs used to rule out high-risk varices in patients with cirrhosis cannot therefore be used in this population. We show here that spleen stiffness measurement by vibration-controlled transient elastography ≤40 kPa is able to identify patients with chronic portal vein thrombosis with a very low probability of high-risk varices, in whom screening endoscopy can be spared. Annual surveillance of spleen stiffness measurement could reduce the need for repeated screening endoscopies throughout a person's lifetime. This approach could enhance quality of life while also reducing risks associated with endoscopic procedures, particularly those related to anesthesia.