Performance of spleen stiffness measurement to rule out high-risk varices in patients with porto-sinusoidal vascular disorder

被引：7

作者：

Moga, Lucile ^{[1
,2
]}

Paradis, Valerie ^{[2
,3
]}

Ferreira-Silva, Joel ^{[4
,5
]}

Gudavalli, Koushik ^{[6
]}

Indulti, Federica ^{[7
]}

Dajti, Elton ^{[8
,9
]}

Nicoara-Farcau, Oana ^{[10
,11
,12
]}

Tosetti, Giulia ^{[13
]}

Antonenko, Antonina ^{[14
]}

Fodor, Andreea ^{[10
,11
]}

Vidal-Gonzalez, Judit ^{[15
]}

Turco, Laura ^{[16
]}

Capinha, Francisco ^{[17
]}

Elkrief, Laure ^{[18
]}

Monllor-Nunell, Teresa ^{[19
]}

Goria, Odile ^{[20
]}

Balcar, Lorenz ^{[21
]}

Lannes, Adrien ^{[22
]}

Mallet, Vincent ^{[23
]}

Poujol-Robert, Armelle ^{[24
]}

Thabut, Dominique ^{[25
,26
]}

Houssel-Debry, Pauline ^{[27
]}

Wong, Yu Jun ^{[28
,29
]}

Ronot, Maxime ^{[30
]}

Vilgrain, Valerie ^{[30
]}

Rampally, Sai Prasanth ^{[6
]}

Payance, Audrey ^{[1
,2
]}

Castera, Laurent ^{[32
,33
]}

Reiberger, Thomas ^{[20
]}

Ferrusquia-Acosta, Jose ^{[18
]}

Noronha Ferreira, Carlos ^{[16
]}

Vitale, Giovanni ^{[16
]}

Simon-Talero, Macarena ^{[15
]}

Procopet, Bogdan ^{[10
]}

Berzigotti, Annalisa ^{[14
]}

Caccia, Riccardo ^{[13
]}

Turon, Fanny ^{[31
]}

Schepis, Filippo ^{[7
]}

Ravaioli, Federico ^{[8
,9
]}

Colecchia, Antonio ^{[7
]}

Valsan, Arun ^{[6
]}

Macedo, Guilherme ^{[4
,5
]}

Plessier, Aurelie ^{[1
,2
]}

Rautou, Pierre-Emmanuel ^{[1
,2
,32
]}

机构：

[1] Hop Beaujon, AP HP, Ctr Reference Malad Vasc Foie, Serv Hepatol,DMU DIGEST,FILFOIE,ERN RARE LIVER, Clichy, France

[2] Univ Paris, Inserm, Ctr Rech Inflammat, UMR 1149, Paris, France

[3] Hop Beaujon, Dept Anat Pathol, Clichy, France

[4] Ctr Hosp & Univ Sao Joao, Gastroenterol Dept, Sao Joao, Portugal

[5] Univ Porto, Fac Med, Porto, Portugal

[6] Amrita Inst Med Sci, Dept Gastroenterol, Hepatol & Transplantat Unit, Kochi, India

[7] Univ Modena & Reggio Emilia, Univ Hosp Modena, CHIMOMO Dept, Gastroenterol Unit, Modena, Italy

[8] IRCCS Azienda Osped Univ Bologna, Div Internal Med Hepatobiliary & Immunoallerg Dis, Bologna, Italy

[9] Univ Bologna, Dept Med & Surg Sci DIMEC, Bologna, Italy

[10] Univ Med & Pharm Iuliu Hatieganu, Med Clin 3, Cluj Napoca, Romania

[11] Univ Med & Pharm Iuliu Hatieganu, Reg Inst Gastroenterol & Hepatol Prof Dr Octavian, Hepatol Dept, Cluj Napoca, Romania

[12] Univ Barcelona, Hosp Clin, Liver Unit, Hepat Hemodynam Dept,IDIBAPS, E-08036 Barcelona, Spain

[13] Fdn IRCCS Ca Granda Osped Maggiore Policlin, Div Gastroenterol & Hepatol, Milan, Italy

[14] Univ Bern, Bern Univ Hosp, Dept Visceral Surg & Med, Inselspital, Bern, Switzerland

[15] Univ Autonoma Barcelona, Vall dHebron Univ Hosp, Vall dHebron Inst Res VHIR, Liver Unit,Digest Dis Dept,CIBERehd, Vall dHebron Barcelona Hosp Campus, Barcelona, Spain

[16] IRCCS Azienda Osped Univ Bologna, Internal Med Unit Treatment Severe Organ Failure, I-40138 Bologna, Italy

[17] Ctr Hosp Univ Lisboa Norte, Hosp Santa Maria, Serv Gastrenterol & Hepatol, Lisbon, Portugal

[18] CHRU Tours Hop Trousseau, Fac Medecine Tours, Serv Hepatogastroenterol, Tours, France

[19] Hosp Univ Parc Tauli, Inst Invest & Innovacio Parc Tauli i I3PT, Liver Unit, Sabadell, Spain

[20] Hop Charles Nicolle CHU Rouen, Serv Hepatogastroenterol & Oncol Digest, Rouen, France

[21] Med Univ Vienna, Dept Internal Med 3, Div Gastroenterol & Hepatol, Vienna, Austria

[22] CHU Angers, Hepatogastroenterol & Oncol Digest, Angers, France

[23] Univ Paris Cite, Assistance Publ Hop Paris, Serv Malad Foie, Grp Hosp Cochin Port Royal, Paris, France

[24] Hop St Antoine, Assistance Publ Hop Paris, Hepatol, Paris, France

[25] Hop Pitie Salpetrie`re, Assistance Publ Hop Paris, Hepatogastroenterol Dept, Liver Intens Care Unit, Paris, France

[26] Sorbonne Univ, Ctr Rech St Antoine, Inserm, UMR S 938, Paris, France

[27] Hop Pontchaillou CHU Rennes, Ctr Hepato Digest Malad Foie, Rennes, France

[28] SingHealth, Changi Gen Hosp, Dept Gastroenterol & Hepatol, Singapore, Singapore

[29] Duke NUS Med Sch, Singapore, Singapore

[30] Beaujon Hosp, GHU AP HP Nord Univ Paris Cite, Dept Radiol, Clichy, France

[31] IDIBAPS, Hosp Clin, Liver Unit, CIBERehd, Barcelona, Spain

[32] Hop Beaujon, AP HP, Serv Hepatol, 100 Blvd Gen Leclerc, F-92110 Clichy, France

[33] Univ Paris Cite, Ctr Rech Inflammat, Inserm, UMR 1149, Paris, France

来源：

HEPATOLOGY | 2024年

关键词：

porto-sinusoidal vascular disorder; high-risk varices; spleen stiffness measurement; portal hypertension; HYPERTENSION; ELASTOGRAPHY; CONSENSUS; CIRRHOSIS;

D O I：

10.1097/HEP.0000000000001004

中图分类号：

R57 [消化系及腹部疾病];

学科分类号：

摘要：

Background & Aims: Baveno VII consensus suggests that 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, screening endoscopy is required in all patients with porto-sinusoidal vascular disorder (PSVD). This study aimed to evaluate the performance of SSM-VCTE to rule out HRV in patients with PSVD and signs of portal hypertension. Approach & results: We retrospectively included patients with PSVD, >= 1 sign of portal hypertension, without history of variceal bleeding, who underwent a SSM-VCTE within 2 years before or after an upper endoscopy in 21 VALDIG centers, divided into a derivation and a validation cohort. 154 patients were included in the derivation cohort; 43% had HRV. By multivariable logistic regression analysis, SSM-VCTE >40 kPa and serum bilirubin >= 1 mg/dL were associated with HRV. SSM-VCTE <= 40 kPa combined with bilirubin <1 mg/dL had a sensitivity of 96% to rule out HRV, and could spare 38% of screening endoscopies, with 4% of HRV missed, and a 95% negative predictive value (NPV). In the validation cohort, including 155 patients, SSM combined with bilirubin could spare 21% of screening endoscopies, with 4% of HRV missed and a 94% NPV. Conclusion: This study gathering a total of 309 PSVD patients showed that SSM-VCTE <= 40 kPa combined with bilirubin <1 mg/dL identifies patients with PSVD and portal hypertension with a probability of HRV <5%, in whom screening endoscopy can be spared.

引用

页数：33