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Yokoyama S, Ishizu Y, Honda T, Imai N, Ito T, Yamamoto K, Muto H, Shirota C, Tainaka T, Sumida W, Makita S, Takada S, Nakagawa Y, Maeda T, Nakamura M, Ishigami M, Uchida H, Kawashima H. A new criterion including the aspartate aminotransferase-to-platelet ratio index and liver and spleen stiffness to rule out varices needing treatment in children with biliary atresia: Modification of the Baveno VII criteria. Hepatol Res 2024; 54:347-357. [PMID: 37843392 DOI: 10.1111/hepr.13976] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/20/2023] [Revised: 09/16/2023] [Accepted: 10/03/2023] [Indexed: 10/17/2023]
Abstract
AIMS Biliary atresia (BA) is a congestive biliary disease that develops in the neonatal period or early infancy. It may present with portal hypertension and varices needing treatment (VNT) even after successful Kasai portoenterostomy. This study aimed to stratify the risk of VNT in children and adolescents with BA. METHODS In this prospective cross-sectional study, we measured liver stiffness (LS) and spleen stiffness (SS) by two-dimensional shear wave elastography and checked for VNT endoscopically in 53 patients with BA who attended for follow-up between July 2018 and September 2022. Varices needing treatment were defined as large esophageal varices, esophageal varices of any size with red color signs, and/or gastric varices along the cardia. RESULTS Twenty-five patients (aged 0-18 years) had VNT. Eighteen patients met the Baveno VI criteria (LS <20 kPa; platelet count >150 000/L) and were deemed to be at low risk of VNT (spared endoscopies) while three had missed VNT (16.7%). Applying the Baveno VII criteria, which combines the SS cut-off value of 40 kPa with the Baveno VI criteria, resulted in five missed VNTs among 22 spared endoscopies (22.7%). A modification of the Baveno VII criteria using the aspartate aminotransferase-to-platelet ratio index (APRI) instead of the platelet count with cut-off values of 25 kPa, 30 kPa, and 1.04 for LS, SS, and APRI, respectively, missed only one VNT (5.0%) among 20 spared endoscopies. CONCLUSIONS A novel diagnostic criterion that combines LS, SS, and APRI reduced the risk of missing VNT to 5% in children and adolescents with BA.
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Affiliation(s)
- Shinya Yokoyama
- Department of Gastroenterology and Hepatology, Nagoya University Graduate School of Medicine, Nagoya, Aichi, Japan
| | - Yoji Ishizu
- Department of Gastroenterology and Hepatology, Nagoya University Graduate School of Medicine, Nagoya, Aichi, Japan
| | - Takashi Honda
- Department of Gastroenterology and Hepatology, Nagoya University Graduate School of Medicine, Nagoya, Aichi, Japan
| | - Norihiro Imai
- Department of Gastroenterology and Hepatology, Nagoya University Graduate School of Medicine, Nagoya, Aichi, Japan
| | - Takanori Ito
- Department of Gastroenterology and Hepatology, Nagoya University Graduate School of Medicine, Nagoya, Aichi, Japan
| | - Kenta Yamamoto
- Department of Gastroenterology and Hepatology, Nagoya University Graduate School of Medicine, Nagoya, Aichi, Japan
| | - Hisanori Muto
- Department of Gastroenterology and Hepatology, Nagoya University Graduate School of Medicine, Nagoya, Aichi, Japan
| | - Chiyoe Shirota
- Department of Pediatric Surgery, Nagoya University Graduate School of Medicine, Nagoya, Aichi, Japan
| | - Takahisa Tainaka
- Department of Pediatric Surgery, Nagoya University Graduate School of Medicine, Nagoya, Aichi, Japan
| | - Wataru Sumida
- Department of Pediatric Surgery, Nagoya University Graduate School of Medicine, Nagoya, Aichi, Japan
| | - Satoshi Makita
- Department of Pediatric Surgery, Nagoya University Graduate School of Medicine, Nagoya, Aichi, Japan
| | - Shunya Takada
- Department of Pediatric Surgery, Nagoya University Graduate School of Medicine, Nagoya, Aichi, Japan
| | - Yoichi Nakagawa
- Department of Pediatric Surgery, Nagoya University Graduate School of Medicine, Nagoya, Aichi, Japan
| | - Takuya Maeda
- Department of Pediatric Surgery, Nagoya University Graduate School of Medicine, Nagoya, Aichi, Japan
| | - Masanao Nakamura
- Department of Gastroenterology and Hepatology, Nagoya University Graduate School of Medicine, Nagoya, Aichi, Japan
| | - Masatoshi Ishigami
- Department of Gastroenterology and Hepatology, Nagoya University Graduate School of Medicine, Nagoya, Aichi, Japan
| | - Hiroo Uchida
- Department of Pediatric Surgery, Nagoya University Graduate School of Medicine, Nagoya, Aichi, Japan
| | - Hiroki Kawashima
- Department of Gastroenterology and Hepatology, Nagoya University Graduate School of Medicine, Nagoya, Aichi, Japan
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Namisaki T. Noninvasive assessment of portal hypertension based on the Baveno VII criteria. Hepatol Res 2024; 54:323-325. [PMID: 38407529 DOI: 10.1111/hepr.14028] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/27/2024]
Affiliation(s)
- Tadashi Namisaki
- Department of Gastroenterology, Nara Medical University, Nara, Japan
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Herrmann J, Petit P, Grabhorn E, Lenz A, Jürgens J, Franchi-Albella S. Liver cirrhosis in children - the role of imaging in the diagnostic pathway. Pediatr Radiol 2023; 53:714-726. [PMID: 36040526 PMCID: PMC10027649 DOI: 10.1007/s00247-022-05480-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/16/2022] [Revised: 06/23/2022] [Accepted: 07/31/2022] [Indexed: 10/14/2022]
Abstract
Liver cirrhosis in children is a rare disease with multifactorial causes that are distinct from those in adults. Underlying reasons include cholestatic, viral, autoimmune, hereditary, metabolic and cardiac disorders. Early detection of fibrosis is important as clinical stabilization or even reversal of fibrosis can be achieved in some disorders with adequate treatment. This article focuses on the longitudinal evaluation of children with chronic liver disease with noninvasive imaging tools, which play an important role in detecting cirrhosis, defining underlying causes, grading fibrosis and monitoring patients during follow-up. Ultrasound is the primary imaging modality and it is used in a multiparametric fashion. Magnetic resonance imaging and computed tomography are usually applied second line for refined tissue characterization, clarification of nodular lesions and full delineation of abdominal vessels, including portosystemic communications.
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Affiliation(s)
- Jochen Herrmann
- Section of Pediatric Radiology, Department of Diagnostic and Interventional Radiology and Nuclear Medicine, University Medical Center Hamburg-Eppendorf, Martinistrasse 52, 20251, Hamburg, Germany.
| | - Philippe Petit
- Aix Marseille Université, Hopital Timone-Enfants, Marseille, France
| | - Enke Grabhorn
- Department of Pediatric Gastroenterology and Hepatology, University Medical Center Hamburg, Hamburg, Germany
| | - Alexander Lenz
- Department of Diagnostic and Interventional Radiology and Nuclear Medicine, University Medical Center, Hamburg, Germany
| | - Julian Jürgens
- Section of Pediatric Radiology, Department of Diagnostic and Interventional Radiology and Nuclear Medicine, University Medical Center Hamburg-Eppendorf, Martinistrasse 52, 20251, Hamburg, Germany
| | - Stéphanie Franchi-Albella
- Department of Pediatric Radiology, Hôpital Bicêtre, National Reference Centre for Rare Pediatric Liver Diseases, Paris, France
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Comparison of portal vein hemodynamics with ultrasound-based elastography for the prediction of liver fibrosis in patients with chronic liver disease. Sci Rep 2023; 13:3425. [PMID: 36854884 PMCID: PMC9975193 DOI: 10.1038/s41598-023-30279-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2022] [Accepted: 02/20/2023] [Indexed: 03/02/2023] Open
Abstract
Chronic liver disease includes nonalcoholic fatty liver disease, progresses from steatosis and hepatitis to fibrosis and cirrhosis, with hemodynamic changes in portal blood flow. This study aimed to compare portal vein hemodynamics with liver stiffness (LS) and steatosis and included 28 subjects with chronic liver disease, in whom LS and steatosis were evaluated in the same image employing two elastography techniques: transient elastography (TE) with controlled attenuation parameter (CAP) using a FibroScan and two-dimensional shear-wave elastography (2D-SWE) with attenuation imaging (ATI). Additionally, peak maximum velocity (Vmax) of the right portal vein and spleen stiffness with 2D-SWE were evaluated. A strong positive correlation was present between LS values obtained with TE and 2D-SWE and between the attenuation coefficients of steatosis obtained with CAP and ATI. Additionally, a negative correlation was present between LS values and the Vmax of the right portal vein (r = 0.415, p = 0.031). The optimal Vmax cutoff value for discriminating liver fibrosis with an LS value of > 5 kPa was < 17 cm/s; the ability of Vmax to predict fibrosis was comparable to that of the FIB4-index. Low Vmax of the right portal vein was useful for identifying liver fibrosis in patients with chronic liver disease.
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Zhou H, Zhang Z, Zhang J, Sang L, Liu L, Gong X, Sun Y, Zheng Y, Yu M. Performance of spleen stiffness measurement by 2D-shear wave elastography in evaluating the presence of high-risk varices: comparative analysis of idiopathic portal hypertension versus hepatitis B virus. BMC Med Imaging 2023; 23:30. [PMID: 36759764 PMCID: PMC9909910 DOI: 10.1186/s12880-023-00977-9] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2022] [Accepted: 01/27/2023] [Indexed: 02/11/2023] Open
Abstract
BACKGROUND Noninvasive assessment of high-risk varices (HRV) in idiopathic portal hypertension (IPH) is rare. The purpose of this study was to investigate the performance of spleen stiffness (SS) for evaluating the presence of HRV in IPH patients as compared the measurements in patients with hepatitis B virus (HBV). METHODS A retrospective single-center study was performed to evaluate the performance of SS for assessing HRV in IPH and HBV-infected patients, in comparison with liver stiffness (LS), spleen stiffness-to-liver stiffness ratio (SS/LS), LS spleen-diameter-to-platelet-ratio score (LSPS), portal hypertension risk score (PH risk score) and varices risk score, by using upper gastrointestinal endoscopy (UGE) as the gold standard. Finally, 86 IPH and 102 HBV-infected patients were enrolled. UGE, two-dimensional shear wave elastography (2D-SWE) and laboratory data were collected, and noninvasive parameters were calculated. Analysis of receiver operating characteristic (ROC) curves was conducted to acquire the optimal area under the ROC curve (AUC) and cutoff value for predicting the presence of HRV. RESULTS In patients with HRV, the significantly different parameters between IPH (34.9%) and HBV-infected patients (46.1%) were as follows: spleen size (diameter 18.5 ± 3.9 cm vs. 20.8 ± 2.7 cm), SS (50.2 kPa vs. 42.9 kPa), LS (11.1 kPa vs. 18.3 kPa) and PT (prothrombin time 15.1 s vs. 16.7 s). No statistically significant differences were found in liver function, platelet counts, spleen thickness and flow volumes in the portal venous system (p > 0.05). The AUCs of SS were 0.98 and 0.96 for predicting the presence of HRV in IPH (44.0 kPa cutoff value; 0.93 sensitivity; 0.96 specificity) and HBV-infected patients (35.2 kPa cutoff value; 1.00 sensitivity; 0.82 specificity), respectively, which were significantly better than other parameters. CONCLUSION SS shows the optimal overall performance for predicting the presence of HRV in IPH and HBV-infected patients, in comparison with other noninvasive parameters.
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Affiliation(s)
- Huihui Zhou
- grid.417295.c0000 0004 1799 374XDepartment of Ultrasonic Medicine, The First Affiliated Hospital of Fourth Military Medical University, Xi’an, 710032 Shaanxi China
| | - Zhilin Zhang
- grid.417295.c0000 0004 1799 374XDepartment of Ultrasonic Medicine, The First Affiliated Hospital of Fourth Military Medical University, Xi’an, 710032 Shaanxi China
| | - Jun Zhang
- grid.417295.c0000 0004 1799 374XDepartment of Ultrasonic Medicine, The First Affiliated Hospital of Fourth Military Medical University, Xi’an, 710032 Shaanxi China
| | - Lin Sang
- grid.417295.c0000 0004 1799 374XDepartment of Ultrasonic Medicine, The First Affiliated Hospital of Fourth Military Medical University, Xi’an, 710032 Shaanxi China
| | - Lina Liu
- grid.417295.c0000 0004 1799 374XDepartment of Ultrasonic Medicine, The First Affiliated Hospital of Fourth Military Medical University, Xi’an, 710032 Shaanxi China
| | - Xue Gong
- grid.417295.c0000 0004 1799 374XDepartment of Ultrasonic Medicine, The First Affiliated Hospital of Fourth Military Medical University, Xi’an, 710032 Shaanxi China
| | - Yuanyuan Sun
- grid.417295.c0000 0004 1799 374XDepartment of Ultrasonic Medicine, The First Affiliated Hospital of Fourth Military Medical University, Xi’an, 710032 Shaanxi China
| | - Yu Zheng
- Department of Ultrasound, Xi'an Central Hospital, Xi'an, 710003, Shaanxi, China.
| | - Ming Yu
- Department of Ultrasonic Medicine, The First Affiliated Hospital of Fourth Military Medical University, Xi'an, 710032, Shaanxi, China.
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Yokoyama S, Ishizu Y, Honda T, Imai N, Ito T, Yamamoto K, Shirota C, Tainaka T, Sumida W, Makita S, Takimoto A, Nakagawa Y, Takada S, Ishigami M, Uchida H, Kawashima H. The presence of high-risk varices after sclerotherapy in biliary atresia. Pediatr Int 2023; 65:e15454. [PMID: 36541813 DOI: 10.1111/ped.15454] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/12/2022] [Revised: 11/14/2022] [Accepted: 12/20/2022] [Indexed: 12/24/2022]
Abstract
BACKGROUND Esophagogastric varices (EGVs) may develop as a result of portal hypertension in children with biliary atresia (BA). Although endoscopic injection sclerotherapy (EIS) with ethanolamine oleate (EO) is reported useful for children, risk factors associated with the presence of high-risk EGVs after treatment remain unknown. METHODS The subjects were BA patients under 15 years of age who underwent EO-EIS. We retrospectively reviewed a total of 28 treatment sessions of EGVs with red signs and those larger than F2, which were considered to be at high risk of bleeding. Survival analysis was performed for the presence of high-risk EGVs at the time of follow-up endoscopy as the occurrence of an event. RESULTS Univariate analysis showed a significantly increased risk of the presence of high-risk EGVs post-EO-EIS in patients with increased liver stiffness (LS) and Mac-2 binding protein glycan isomer (M2BPGi), with hazard ratios of 1.48 and 1.15, respectively. The median presence-free period was significantly shorter in the LS ≥ 2.8 m/s patients than in those with LS <2.8 m/s (189 vs. 266 days). Similarly, the median presence-free period was significantly shorter in patients with M2BPGi ≥ 4.0 than in those with M2BPGi < 4.0 (182 vs. 203 days). The results of multivariate analysis revealed that the risk of the presence of high-risk EGVs was significantly higher only in the high-LS group, with a hazard ratio of 2.76. CONCLUSIONS Increased LS is associated with risk of the presence of high-risk EGVs following EO-EIS in children with BA.
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Affiliation(s)
- Shinya Yokoyama
- Department of Gastroenterology and Hepatology, Graduate School of Medicine, Nagoya University, Nagoya, Japan
| | - Yoji Ishizu
- Department of Gastroenterology and Hepatology, Graduate School of Medicine, Nagoya University, Nagoya, Japan
| | - Takashi Honda
- Department of Gastroenterology and Hepatology, Graduate School of Medicine, Nagoya University, Nagoya, Japan
| | - Norihiro Imai
- Department of Gastroenterology and Hepatology, Graduate School of Medicine, Nagoya University, Nagoya, Japan
| | - Takanori Ito
- Department of Gastroenterology and Hepatology, Graduate School of Medicine, Nagoya University, Nagoya, Japan
| | - Kenta Yamamoto
- Department of Gastroenterology and Hepatology, Graduate School of Medicine, Nagoya University, Nagoya, Japan
| | - Chiyoe Shirota
- Department of Pediatric Surgery, Graduate School of Medicine, Nagoya University, Nagoya, Japan
| | - Takahisa Tainaka
- Department of Pediatric Surgery, Graduate School of Medicine, Nagoya University, Nagoya, Japan
| | - Wataru Sumida
- Department of Pediatric Surgery, Graduate School of Medicine, Nagoya University, Nagoya, Japan
| | - Satoshi Makita
- Department of Pediatric Surgery, Graduate School of Medicine, Nagoya University, Nagoya, Japan
| | - Aitaro Takimoto
- Department of Pediatric Surgery, Graduate School of Medicine, Nagoya University, Nagoya, Japan
| | - Yoichi Nakagawa
- Department of Pediatric Surgery, Graduate School of Medicine, Nagoya University, Nagoya, Japan
| | - Shunya Takada
- Department of Pediatric Surgery, Graduate School of Medicine, Nagoya University, Nagoya, Japan
| | - Masatoshi Ishigami
- Department of Gastroenterology and Hepatology, Graduate School of Medicine, Nagoya University, Nagoya, Japan
| | - Hiroo Uchida
- Department of Pediatric Surgery, Graduate School of Medicine, Nagoya University, Nagoya, Japan
| | - Hiroki Kawashima
- Department of Gastroenterology and Hepatology, Graduate School of Medicine, Nagoya University, Nagoya, Japan
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Yoon H, Ihn K, Kim J, Lim HJ, Park S, Han SJ, Han K, Koh H, Lee MJ. Pre- and Immediate Post-Kasai Portoenterostomy Shear Wave Elastography for Predicting Hepatic Fibrosis and Native Liver Outcomes in Patients With Biliary Atresia. Korean J Radiol 2023; 24:465-475. [PMID: 37056157 PMCID: PMC10157319 DOI: 10.3348/kjr.2022.0586] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2022] [Revised: 01/26/2023] [Accepted: 02/09/2023] [Indexed: 04/05/2023] Open
Abstract
OBJECTIVE To evaluate the feasibility of ultrasound shear wave elastography (SWE) for predicting hepatic fibrosis and native liver outcomes in patients with biliary atresia. MATERIALS AND METHODS This prospective study included 33 consecutive patients with biliary atresia (median age, 8 weeks [interquartile range, 6-10 weeks]; male:female ratio, 15:18) from Severance Children's Hospital between May 2019 and February 2022. Preoperative (within 1 week from surgery) and immediate postoperative (on postoperative days [PODs] 3, 5, and 7) ultrasonographic findings were obtained and analyzed, including the SWE of the liver and spleen. Hepatic fibrosis, according to the METAVIR score at the time of Kasai portoenterostomy and native liver outcomes during postsurgical follow-up, were compared and correlated with imaging and laboratory findings. Poor outcomes were defined as intractable cholangitis or liver transplantation. The diagnostic performance of SWE in predicting METAVIR F3-F4 and poor hepatic outcomes was analyzed using receiver operating characteristic (ROC) analyses. RESULTS All patients were analyzed without exclusion. Perioperative advanced hepatic fibrosis (F3-F4) was associated with older age and higher preoperative direct bilirubin and SWE values in the liver and spleen. Preoperative liver SWE showed a ROC area of 0.806 and 63.6% (7/11) sensitivity and 86.4% (19/22) specificity at a cutoff of 17.5 kPa for diagnosing F3-F4. The poor outcome group included five patients with intractable cholangitis and three undergoing liver transplantation who showed high postoperative liver SWE values. Liver SWE on PODs 3-7 showed ROC areas of 0.783-0.891 for predicting poor outcomes, and a cutoff value of 10.3 kPa for SWE on POD 3 had 100% (8/8) sensitivity and 73.9% (17/23) specificity. CONCLUSION Preoperative liver SWE can predict advanced hepatic fibrosis, and immediate postoperative liver SWE can predict poor native liver outcomes in patients with biliary atresia.
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Affiliation(s)
- Haesung Yoon
- Department of Radiology and Research Institute of Radiological Science, Severance Hospital, Yonsei University College of Medicine, Seoul, Korea
- Severance Pediatric Liver Disease Research Group, Severance Children's Hospital, Yonsei University College of Medicine, Seoul, Korea
| | - Kyong Ihn
- Severance Pediatric Liver Disease Research Group, Severance Children's Hospital, Yonsei University College of Medicine, Seoul, Korea
- Division of Pediatric Surgery, Severance Children’s Hospital, Yonsei University College of Medicine, Seoul, Korea
| | - Jisoo Kim
- Department of Radiology and Research Institute of Radiological Science, Severance Hospital, Yonsei University College of Medicine, Seoul, Korea
- Severance Pediatric Liver Disease Research Group, Severance Children's Hospital, Yonsei University College of Medicine, Seoul, Korea
| | - Hyun Ji Lim
- Department of Radiology and Research Institute of Radiological Science, Severance Hospital, Yonsei University College of Medicine, Seoul, Korea
- Severance Pediatric Liver Disease Research Group, Severance Children's Hospital, Yonsei University College of Medicine, Seoul, Korea
| | - Sowon Park
- Severance Pediatric Liver Disease Research Group, Severance Children's Hospital, Yonsei University College of Medicine, Seoul, Korea
- Division of Gastroenterology, Hepatology and Nutrition, Department of Pediatrics, Severance Hospital, Yonsei University College of Medicine, Seoul, Korea
| | - Seok Joo Han
- Severance Pediatric Liver Disease Research Group, Severance Children's Hospital, Yonsei University College of Medicine, Seoul, Korea
- Division of Pediatric Surgery, Severance Children’s Hospital, Yonsei University College of Medicine, Seoul, Korea
| | - Kyunghwa Han
- Department of Radiology and Research Institute of Radiological Science, Severance Hospital, Yonsei University College of Medicine, Seoul, Korea
| | - Hong Koh
- Severance Pediatric Liver Disease Research Group, Severance Children's Hospital, Yonsei University College of Medicine, Seoul, Korea
- Division of Gastroenterology, Hepatology and Nutrition, Department of Pediatrics, Severance Hospital, Yonsei University College of Medicine, Seoul, Korea
| | - Mi-Jung Lee
- Department of Radiology and Research Institute of Radiological Science, Severance Hospital, Yonsei University College of Medicine, Seoul, Korea
- Severance Pediatric Liver Disease Research Group, Severance Children's Hospital, Yonsei University College of Medicine, Seoul, Korea
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Sumida W, Tainaka T, Shirota C, Yokota K, Makita S, Okamoto M, Takimoto A, Yasui A, Takada S, Nakagawa Y, Kato D, Yokoyama S, Ishizu Y, Amano H, Guo Y, Hinoki A, Uchida H. Biochemical markers to predict the development of gastrointestinal bleeding and esophageal varices after portoenterostomy in biliary atresia. Pediatr Surg Int 2022; 38:1799-1805. [PMID: 36114864 DOI: 10.1007/s00383-022-05243-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 09/11/2022] [Indexed: 11/29/2022]
Abstract
PURPOSE Gastrointestinal bleeding (GIB) due to esophageal varices (EV) is one of the factors that negatively impact native liver survival of patients with biliary atresia (BA). Gastrointestinal fibroscopy (GIF) is usually used to determine the presence of EVs; however, it requires general anesthesia. The aim of this study is to search for markers in blood tests obtained during routine check-ups that can predict the development of GIB. METHODS Data of patients with BA who underwent portoenterostomy at our hospital from 2014 to 2020 were retrospectively reviewed. The patients' data were assigned to three groups according to specific time points: Group B, which included data at GIB; Group NB-T, which included data at GIF and EV treatment; and Group NB-NT, which included data at GIF without treatment. The data in Group B were compared to those of other groups. RESULTS In our study, GIB occurred in 11 patients, and 12 cases and 8 cases were classified into Groups NB-NT and NB-T, respectively. Compared with the other groups, only ChE and M2BPGi in Group B showed statistically significant differences. CONCLUSIONS ChE and M2BPGi are useful for predicting GIB.
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Affiliation(s)
- Wataru Sumida
- Department of Pediatric Surgery, Nagoya University Graduate School of Medicine, 65 Tsurumai-cho, Showa-ku, Nagoya, 466-8550, Japan.
| | - Takahisa Tainaka
- Department of Pediatric Surgery, Toho University Omori Hospital, Tokyo, Japan
| | - Chiyoe Shirota
- Department of Pediatric Surgery, Nagoya University Graduate School of Medicine, 65 Tsurumai-cho, Showa-ku, Nagoya, 466-8550, Japan
| | - Kazuki Yokota
- Department of Gastrointestinal and Pediatric Surgery, Mie University, Tsu, Japan
| | - Satoshi Makita
- Department of Pediatric Surgery, Nagoya University Graduate School of Medicine, 65 Tsurumai-cho, Showa-ku, Nagoya, 466-8550, Japan
| | - Masamune Okamoto
- Department of Pediatric Surgery, Nagoya University Graduate School of Medicine, 65 Tsurumai-cho, Showa-ku, Nagoya, 466-8550, Japan
| | - Aitaro Takimoto
- Department of Pediatric Surgery, Nagoya University Graduate School of Medicine, 65 Tsurumai-cho, Showa-ku, Nagoya, 466-8550, Japan
| | - Akihiro Yasui
- Department of Pediatric Surgery, Nagoya University Graduate School of Medicine, 65 Tsurumai-cho, Showa-ku, Nagoya, 466-8550, Japan
| | - Shunya Takada
- Department of Pediatric Surgery, Nagoya University Graduate School of Medicine, 65 Tsurumai-cho, Showa-ku, Nagoya, 466-8550, Japan
| | - Yoichi Nakagawa
- Department of Pediatric Surgery, Nagoya University Graduate School of Medicine, 65 Tsurumai-cho, Showa-ku, Nagoya, 466-8550, Japan
| | - Daiki Kato
- Department of Pediatric Surgery, Nagoya University Graduate School of Medicine, 65 Tsurumai-cho, Showa-ku, Nagoya, 466-8550, Japan
| | - Shinya Yokoyama
- Department of Gastroenterology, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Yoji Ishizu
- Department of Gastroenterology, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Hizuru Amano
- Department of Pediatric Surgery, Nagoya University Graduate School of Medicine, 65 Tsurumai-cho, Showa-ku, Nagoya, 466-8550, Japan
| | - Yaohui Guo
- Department of Pediatric Surgery, Nagoya University Graduate School of Medicine, 65 Tsurumai-cho, Showa-ku, Nagoya, 466-8550, Japan
| | - Akinari Hinoki
- Department of Pediatric Surgery, Nagoya University Graduate School of Medicine, 65 Tsurumai-cho, Showa-ku, Nagoya, 466-8550, Japan
| | - Hiroo Uchida
- Department of Pediatric Surgery, Nagoya University Graduate School of Medicine, 65 Tsurumai-cho, Showa-ku, Nagoya, 466-8550, Japan
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Wagner ES, Abdelgawad HAH, Landry M, Asfour B, Slidell MB, Azzam R. Use of shear wave elastography for the diagnosis and follow-up of biliary atresia: A meta-analysis. World J Gastroenterol 2022; 28:4726-4740. [PMID: 36157929 PMCID: PMC9476882 DOI: 10.3748/wjg.v28.i32.4726] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/01/2022] [Revised: 07/10/2022] [Accepted: 08/01/2022] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Timely differentiation of biliary atresia (BA) from other infantile cholestatic diseases can impact patient outcomes. Additionally, non-invasive staging of fibrosis after Kasai hepatoportoenterostomy has not been widely standardized. Shear wave elastography is an ultrasound modality that detects changes in tissue stiffness. The authors propose that the utility of elastography in BA can be elucidated through meta-analysis of existing studies.
AIM To assess the utility of elastography in: (1) BA diagnosis, and (2) post-Kasai fibrosis surveillance.
METHODS A literature search identified articles that evaluated elastography for BA diagnosis and for post-Kasai follow-up. Twenty studies met criteria for meta-analysis: Eleven for diagnosis and nine for follow-up post-Kasai. Estimated diagnostic odds ratio (DOR), sensitivity, and specificity of elastography were calculated through a random-effects model using Meta-DiSc software.
RESULTS Mean liver stiffness in BA infants at diagnosis was significantly higher than in non-BA, with overall DOR 24.61, sensitivity 83%, and specificity 79%. Post-Kasai, mean liver stiffness was significantly higher in BA patients with varices than in patients without, with DOR 16.36, sensitivity 85%, and specificity 76%. Elastography differentiated stage F4 fibrosis from F0-F3 with DOR of 70.03, sensitivity 96%, and specificity 89%. Elastography also differentiated F3-F4 fibrosis from F0-F2 with DOR of 24.68, sensitivity 85%, and specificity 81%.
CONCLUSION Elastography has potential as a non-invasive modality for BA diagnosis and surveillance post-Kasai. This paper’s limitations include inter-study method heterogeneity and small sample sizes. Future, standardized, multi-center studies are recommended.
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Affiliation(s)
- Ellen S Wagner
- Pediatric Gastroenterology, Hepatology, and Nutrition, The University of Chicago Medicine, Comer Children’ s Hospital, Chicago, IL 60637, United States
| | | | - Meghan Landry
- Department of Pediatrics, The University of Chicago Medicine, Comer Children’ s Hospital, Chicago, IL 60637, United States
| | - Belal Asfour
- Graduate School of Professional Education-Biomedical Informatics, University of Chicago, Chicago, IL 60637, United States
| | - Mark B Slidell
- Department of Surgery, The University of Chicago Medicine, Comer Children’ s Hospital, Chicago, IL 60637, United States
| | - Ruba Azzam
- Pediatric Gastroenterology, Hepatology, and Nutrition, The University of Chicago Medicine, Comer Children’ s Hospital, Chicago, IL 60637, United States
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Long-term follow-up of biliary atresia using liver transient elastography. Pediatr Surg Int 2022; 38:1013-1018. [PMID: 35523886 DOI: 10.1007/s00383-022-05137-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 05/01/2022] [Indexed: 10/18/2022]
Abstract
OBJECTIVE Liver transient elastography (TE) using FibroScan® has gained popularity as a non-invasive technique to assess hepatic fibrosis by measuring liver stiffness. This study focused on biliary atresia patients post Kasai operation for more than 10 years to prospectively correlate the hepatic fibrosis score to the biochemical changes of liver fibrosis and clinical development of portal hypertensive complications. METHODS TE was performed in 37 patients who had biliary atresia post Kasai operation done at median age of 60 days. Biochemical indices of liver fibrosis including aspartate aminotransferase/platelet ratio index (APRI) and Fibrosis-4 (FIB-4) score based on age, platelet count, alanine aminotransferase and aspartate aminotransferase level were calculated at the time of TE. Platelet count, spleen size, varices, ascites and hepatic encephalopathy were evaluated as clinical markers of portal hypertension. RESULTS There were 22 female and 15 male with TE done at median age of 17.0 years. Median FibroScan® fibrosis score was 11.4. Fibrosis score of 6.8 kilopascal (kPa) was taken as the upper reference limit of normal. Nine patients (24%) had normal fibrosis score. Score above or equal to 6.8 kPa was significantly associated with lower platelet level (p = 0.001), higher INR (p = 0.043), higher APRI (p = 0.021), higher FIB-4 score (p = 0.013), and larger splenic diameter (p = 0.004). Higher FibroScan® fibrosis score was also significantly associated with portal hypertensive complications (p = 0.001). CONCLUSIONS The FibroScan® fibrosis score correlated well with the biochemical changes of liver fibrosis and development of portal hypertensive complications clinically. Screening of portal hypertensive complications such as varices is recommended for patients with raised fibrosis score upon long-term follow-up. LEVEL OF EVIDENCE Level III, retrospective comparative study.
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11
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Mentzel HJ, Glutig K, Gräger S, Krüger PC, Waginger M. Ultrasound elastography in children - nice to have for scientific studies or arrived in clinical routine? Mol Cell Pediatr 2022; 9:11. [PMID: 35668217 PMCID: PMC9169959 DOI: 10.1186/s40348-022-00143-1] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2021] [Accepted: 04/01/2022] [Indexed: 12/12/2022] Open
Abstract
Ultrasound elastography (USE) is a modality that in addition to fundamental B-mode, Doppler, and contrast-enhanced sonography is suitable to make qualitative and quantitative statements about the stiffness of tissues. Introduced more than 20 years ago in adults, USE becomes now a diagnostic tool also in children. The aim of this paper is to describe current available techniques for USE in children. The significance for routine use in children is shown, and further interesting applications are reported.
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Affiliation(s)
- Hans-Joachim Mentzel
- Section of Pediatric Radiology, Department of Radiology, University Hospital Jena, Am Klinikum 1, 07747, Jena, Germany.
| | - Katja Glutig
- Section of Pediatric Radiology, Department of Radiology, University Hospital Jena, Am Klinikum 1, 07747, Jena, Germany
| | - Stephanie Gräger
- Section of Pediatric Radiology, Department of Radiology, University Hospital Jena, Am Klinikum 1, 07747, Jena, Germany
| | - Paul-Christian Krüger
- Section of Pediatric Radiology, Department of Radiology, University Hospital Jena, Am Klinikum 1, 07747, Jena, Germany
| | - Matthias Waginger
- Section of Pediatric Radiology, Department of Radiology, University Hospital Jena, Am Klinikum 1, 07747, Jena, Germany
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A Model for Early Endoscopic Detection of High-Risk Gastroesophageal Varices in Children With Biliary Atresia. J Pediatr Gastroenterol Nutr 2022; 74:643-650. [PMID: 34984987 DOI: 10.1097/mpg.0000000000003375] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/10/2022]
Abstract
OBJECTIVE In children with biliary atresia and portal hypertension, progression to gastroesophageal varices carrying a risk of bleeding depends on age, total serum bilirubin concentration and initial endoscopic features. We report an attempt to use these factors for early detection of high-risk varices (HRVs). METHODS Based on different combinations of these factors, a model was set to estimate the probabilities of emergence of HRVs at various time intervals. A 10% probability was chosen to set the date of the next endoscopy in children who did not display HRVs initially. A total of 113 children without HRVs who underwent their first endoscopy before age 8 in 2013-2020 were included. A comparison was made with children seen during the period 1990-2012 when this model was not used. RESULTS In all, 65 of the 113 children underwent one to five additional endoscopies at dates set according to the model. The emergence of HRVs was recorded in 22 children after a mean interval of 14 months and was managed by endoscopic primary prophylaxis in all but one who underwent liver transplantation. Three other children bled before the next planned endoscopy. Compared with 175 children of the same age ranges without HRVs in the period 1990-2012, the use of the model was associated with a faster detection of HRVs with a lower number of endoscopic procedures (P = 0.0022 and P = 0.023, respectively). CONCLUSION The results suggest that the model reported may be a useful tool for the early detection of HRVs to allow primary prophylaxis of bleeding.
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Dike PN, Mahmood N, Harpavat S. Recent advances in the use of ultrasound and related techniques in diagnosing and predicting outcomes in biliary atresia. Curr Opin Pediatr 2021; 33:515-520. [PMID: 34369411 PMCID: PMC8615294 DOI: 10.1097/mop.0000000000001048] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
PURPOSE OF REVIEW Biliary atresia (BA) is the leading cause of chronic liver disease and the most common indication for pediatric liver transplantation. The use of ultrasound (US) and related techniques continues to evolve to help diagnose BA as well as potentially to help predict outcomes after treatment with the Kasai portoenterostomy (KP). RECENT FINDINGS There are no US findings that are definitive for BA; however, signs which are consistent with BA include gallbladder abnormalities, the triangular cord sign, presence of hepatic subcapsular flow, and hilar lymphadenopathy. Elastography techniques to measure liver stiffness may also increase the diagnostic accuracy of detecting BA, particularly in older infants or without other US findings. In addition, both US and elastography are still being studied as potential methods to predict outcomes after KP such as the development of portal hypertension and the need for liver transplant. SUMMARY US findings in the diagnosis of BA are well characterized. Future studies will help determine the utility of elastography in diagnosing BA, as well as both US and elastography in monitoring and predicting disease outcomes after KP.
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Affiliation(s)
- Peace N. Dike
- Section of Gastroenterology, Hepatology & Nutrition, Department of Pediatrics, Baylor College of Medicine and Texas Children’s Hospital, Houston, TX, USA
| | - Nadia Mahmood
- E.B. Singleton Department of Pediatric Radiology, Texas Children’s Hospital, Houston, TX, USA
| | - Sanjiv Harpavat
- Section of Gastroenterology, Hepatology & Nutrition, Department of Pediatrics, Baylor College of Medicine and Texas Children’s Hospital, Houston, TX, USA
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Ferraioli G, Barr RG, Dillman JR. Elastography for Pediatric Chronic Liver Disease: A Review and Expert Opinion. JOURNAL OF ULTRASOUND IN MEDICINE : OFFICIAL JOURNAL OF THE AMERICAN INSTITUTE OF ULTRASOUND IN MEDICINE 2021; 40:909-928. [PMID: 32881048 DOI: 10.1002/jum.15482] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/16/2020] [Revised: 07/28/2020] [Accepted: 08/02/2020] [Indexed: 06/11/2023]
Abstract
In adults with chronic liver diseases, ultrasound and magnetic resonance shear wave elastography (SWE) can replace liver biopsy in several clinical scenarios. Several guidelines on the use of ultrasound SWE for the adult population have been published. However, the number of publications in the pediatric population is limited, and available guidelines on SWE do not specifically address pediatric chronic liver diseases. In this article, we review the literature on the use of SWE for pediatric chronic liver diseases and provide expert opinion on how to use SWE, both ultrasound and magnetic resonance techniques, in the pediatric population.
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Affiliation(s)
- Giovanna Ferraioli
- Ultrasound Unit, Department of Clinical Sciences and Infectious Diseases, Fondazione IRCCS Policlinico San Matteo, University of Pavia, Pavia, Italy
| | | | - Jonathan R Dillman
- Department of Radiology, Cincinnati Children's Hospital Medical Center, University of Cincinnati College of Medicine, Cincinnati, Ohio
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Spleen Stiffness Performance in the Noninvasive Assessment of Gastroesophageal Varices after Transjugular Intrahepatic Portosystemic Shunts. BIOMED RESEARCH INTERNATIONAL 2021; 2021:5530004. [PMID: 33959657 PMCID: PMC8077793 DOI: 10.1155/2021/5530004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 01/29/2021] [Revised: 03/14/2021] [Accepted: 03/26/2021] [Indexed: 11/18/2022]
Abstract
Objectives To investigate the performance of spleen stiffness (SS) by using two-dimensional shear-wave elastography (2D-SWE) for assessing the severity of gastroesophageal varices (GEVs) after transjugular intrahepatic portosystemic shunt (TIPS). Methods 102 eligible patients were categorized as in the post-TIPS short-term (n = 69) and long-term (n = 38) follow-up groups. The performance of SS by using 2D-SWE for evaluating the severity of GEVs was compared with liver stiffness (LS), spleen stiffness-to-liver stiffness ratio (SS/LS), liver stiffness spleen-diameter-to-platelet-ratio score (LSPS), portal hypertension (PH) risk score, platelet count-to-spleen diameter ratio (PSR), and varices risk score by using receiver operating characteristic (ROC) curve and DeLong test. Results In the post-TIPS short-term follow-up group, area under the receiver operating characteristic curves (AUCs) of SS were 0.585 for mild (cutoff value = 30.3 kPa), 0.655 for moderate (cutoff value = 30.6 kPa), and 0.739 for severe (cutoff value = 31.9 kPa) GEVs, which were higher than other parameters for severe GEVs. AUCs of SS were lower than other parameters for mild and moderate GEVs, but no difference was found (p > 0.05). In the post-TIPS long-term follow-up group, AUCs of SS were 0.778 for mild (cutoff value = 28.9 kPa), 0.82 for moderate (cutoff value = 29.9 kPa), and 0.824 for severe (cutoff value = 37.7 kPa) GEVs, which were higher than other parameters except for severe GEVs. AUC of SS was lower than other parameters for severe GEVs, but no significant difference was found (p > 0.05). Conclusion SS is an effective noninvasive tool to predict GEV severity during the post-TIPS follow-up.
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Yan H, Du L, Zhou J, Li Y, Lei J, Liu J, Luo Y. Diagnostic performance and prognostic value of elastography in patients with biliary atresia and after hepatic portoenterostomy: protocol for a systematic review and meta-analysis. BMJ Open 2021; 11:e042129. [PMID: 33574147 PMCID: PMC7880098 DOI: 10.1136/bmjopen-2020-042129] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/05/2023] Open
Abstract
INTRODUCTION Biliary atresia (BA) is a life-threatening disease with persistent neonatal cholestasis and progressive liver fibrosis. Timely non-invasive diagnosis of BA can result in early hepatic portoenterostomy (HPE) and better prognosis. Quantitative elastography enables the non-invasive measurement of liver stiffness. However, the studies on elastography methods in the diagnosis of BA and the prediction of post-HPE outcomes vary in their results and have small sample sizes. Thus, we propose this systematic review and meta-analysis to obtain comprehensive evidence on the value of elastography in BA. METHODS AND ANALYSIS We will search the PubMed, Embase and the Cochrane Central Register of Controlled Trials databases for studies evaluating the diagnostic performance of elastography in patients with BA and the prognostic value of postoperative elastography, from inception to 31 December 2020. We plan to use the Quality Assessment of Diagnostic Accuracy Studies-2 list and the Quality In Prognosis Studies tool to assess the risk of bias in the included studies and the study quality. We will evaluate the diagnostic performance of elastography by synthesising the pooled sensitivity, pooled specificity, pooled positive likelihood ratio, pooled negative likelihood ratio, pooled diagnostic OR and summary receiver operating characteristic curve using Meta-Disc V.1.4. We will evaluate the predictive value of elastography after HPE by synthesising the pooled correlation coefficient and pooled OR of prognostic outcomes using STATA V.14. The funnel plot and Egger's test will be used to evaluate the potential publication bias. Sensitivity analysis will be conducted by examining the estimated effects of individual studies. ETHICS AND DISSEMINATION As this study is a meta-analysis based on previously published literature, ethical approval is not necessary according to the ethics committee of West China Hospital, Sichuan University. The results of this study will be published in a peer-reviewed journal. PROSPERO REGISTRATION NUMBER CRD42020162055.
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Affiliation(s)
- Hualin Yan
- Department of Medical Ultrasound, West China Hospital, Sichuan University, Chengdu, China
| | - Lanxin Du
- Department of Medical Ultrasound, West China Hospital, Sichuan University, Chengdu, China
| | - Jiaojiao Zhou
- Department of Medical Ultrasound, West China Hospital, Sichuan University, Chengdu, China
| | - Yan Li
- Department of Ultrasound, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, China
| | - Jing Lei
- Department of Medical Ultrasound, West China Hospital, Sichuan University, Chengdu, China
| | - Juxian Liu
- Department of Medical Ultrasound, West China Hospital, Sichuan University, Chengdu, China
| | - Yan Luo
- Department of Medical Ultrasound, West China Hospital, Sichuan University, Chengdu, China
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Duffy P, Castro-Aragon I, Tivnan P, Volberg FM, Kipervasser E, Harkanyi Z, Paltiel HJ. Spleen and Peritoneal Cavity. PEDIATRIC ULTRASOUND 2021:481-561. [DOI: 10.1007/978-3-030-56802-3_13] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/04/2025]
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Tajiri T, Furukawa T. Protocols of Follow-up Management. INTRODUCTION TO BILIARY ATRESIA 2021:209-215. [DOI: 10.1007/978-981-16-2160-4_30] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/04/2025]
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Kanamori Y. Long-Term Complication after Portoenterostomy: Gastroesophageal and Gastrointestinal Tract Bleeding. INTRODUCTION TO BILIARY ATRESIA 2021:227-232. [DOI: 10.1007/978-981-16-2160-4_32] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/04/2025]
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Zhu H, Guo H, Yin X, Yang J, Yin Q, Xiao J, Wang Y, Zhang M, Han H, Zhuge Y, Zhang F. Spleen Stiffness Predicts Survival after Transjugular Intrahepatic Portosystemic Shunt in Cirrhotic Patients. BIOMED RESEARCH INTERNATIONAL 2020; 2020:3860390. [PMID: 33282945 PMCID: PMC7685811 DOI: 10.1155/2020/3860390] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/09/2020] [Revised: 10/19/2020] [Accepted: 10/29/2020] [Indexed: 12/21/2022]
Abstract
OBJECTIVES Transjugular intrahepatic portosystemic shunt (TIPS) is an effective intervention for portal hypertensive complications. Little is known about the ability of spleen stiffness (SS) for predicting the survival of cirrhotic patients undergoing TIPS. This study is to evaluate the influence of SS detected by point shear wave elastography (pSWE) in predicting survival after TIPS. METHODS This retrospective cohort study screened consecutive patients who underwent TIPS and reliable pSWE measurement between October 2014 and September 2017 from our prospectively maintained database. SS values were measured before TIPS. The primary endpoint was the overall survival after TIPS. The Cox regression analysis model was used for univariate and multivariate analyses. A receiver operating characteristic (ROC) curve analysis was performed to calculate the sensitivity, specificity, and positive and negative predictive values. RESULTS A total of 89 patients were involved in the final analysis. 24 patients (27.0%) died during a median follow-up time of 31 m. Multivariable Cox regression analysis confirmed that higher SS value (P < 0.001), LS value (P = 0.008), diameter of shunt (P = 0.001), and older age (P < 0.001) were independent prognostic factors of survival after TIPS. The risk of death rose 57.440-fold for each SS unit (m/s) increase. SS was also correlated with liver failure after TIPS. ROC analysis showed that the best SS cutoff value was 3.60 m/s for predicting survival, with a sensitivity of 54.2% and specificity of 90.8%. CONCLUSIONS The SS value determined by pSWE in cirrhotic patients was an independent predictive factor for survival after TIPS.
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Affiliation(s)
- Hao Zhu
- Department of Gastroenterology, Affiliated Drum Tower Hospital, Medical School of Nanjing University, Nanjing, Jiangsu, China
| | - Huiwen Guo
- Department of Gastroenterology, Affiliated Drum Tower Clinical Medical School of Nanjing Medical University, Nanjing, Jiangsu, China
| | - Xiaochun Yin
- Department of Gastroenterology, Affiliated Drum Tower Clinical Medical School of Nanjing Medical University, Nanjing, Jiangsu, China
| | - Jian Yang
- Department of Ultrasound, Affiliated Drum Tower Hospital, Medical School of Nanjing University, Nanjing, Jiangsu, China
| | - Qin Yin
- Department of Gastroenterology, Affiliated Drum Tower Hospital, Medical School of Nanjing University, Nanjing, Jiangsu, China
| | - Jiangqiang Xiao
- Department of Gastroenterology, Affiliated Drum Tower Hospital, Medical School of Nanjing University, Nanjing, Jiangsu, China
| | - Yi Wang
- Department of Gastroenterology, Affiliated Drum Tower Hospital, Medical School of Nanjing University, Nanjing, Jiangsu, China
| | - Ming Zhang
- Department of Gastroenterology, Affiliated Drum Tower Hospital, Medical School of Nanjing University, Nanjing, Jiangsu, China
| | - Hao Han
- Department of Ultrasound, Affiliated Drum Tower Hospital, Medical School of Nanjing University, Nanjing, Jiangsu, China
| | - Yuzheng Zhuge
- Department of Gastroenterology, Affiliated Drum Tower Hospital, Medical School of Nanjing University, Nanjing, Jiangsu, China
| | - Feng Zhang
- Department of Gastroenterology, Affiliated Drum Tower Hospital, Medical School of Nanjing University, Nanjing, Jiangsu, China
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Abstract
PURPOSE OF REVIEW Liver disease in cystic fibrosis (CF) usually develops before puberty, is often asymptomatic and slowly progressive. Multilobular cirrhosis develops in approximately 5-10% of patients by the age of 18, and is a significant contributor to the morbidity and mortality. No therapy, including ursodeoxycholic acid and cystic fibrosis transmembrane conductance regulator correctors or potentiators, has proven effective to prevent or halt the progression of liver disease towards cirrhosis and portal hypertension. This review provides the current knowledge in the epidemiology of CF liver disease and development of noninvasive tools to assess liver disease severity and progression overtime in order to optimize clinical management and therapeutic options. RECENT FINDINGS Liver disease not only develops during childhood but also later in the lifetime of patients with CF; the incidence of cirrhosis with portal hypertension increases progressively reaching 10% by age 30. Several noninvasive tools to measure liver stiffness as an indirect measure of fibrosis are being investigated, and show promising results for the assessment of early stages of liver fibrosis and disease progression. SUMMARY Identifying noninvasive biomarkers is fundamental to improving early diagnosis, monitoring disease evolution and measuring treatment effects. A prerequisite is the use of consistent definitions for CF- liver disease (LD) in clinical trials.
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Ultraschallelastographie im Kindes- und Jugendalter. Monatsschr Kinderheilkd 2020. [DOI: 10.1007/s00112-020-00891-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
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