Authors (including presenting author) :
Lung TS(1), Lam YY(1), Lai SW(1), Yuen WH(1)
Affiliation :
(1) Medical and Geriatrics, Pok Oi Hospital
Introduction :
The Baveno VII algorithm, titled “Personalized Care for Portal Hypertension”, was designed to minimize unnecessary endoscopies for patients meeting rule-out criteria. Clinical significant portal hypertension (CSPH) accelerates cirrhosis complications like ascites, variceal hemorrhage, and hepatic encephalopathy. Therefore, early intervention is essential to reducing morbidity and mortality from variceal bleeding. Recent advancement in non-invasive tests have improved CSPH identification accuracy. While liver stiffness measurement (LSM) has been pivot, the role of spleen is increasingly recognized in pathophysiology of CSPH. Spleen stiffness changes are associated with the presence and severity of CSPH. For patients within the “grey zone” (LSM 12-20 kPa) eligible for endoscopy exemption, incorporating spleen stiffness measurement (SSM) may enhance predictive accuracy. This study aimed at assessing the correlation between LSM and SSM to optimize their predictive value in diagnosing CSPH among patients.
Objectives :
- To minimize need for invasive endoscopic screening by enhancing sensitivity of CSPH prediction through the combined use of LSM and SSM
- To early identify patients at risk for CSPH
- To achieve timely and appropriate treatment
Methodology :
From February 2023 to December 2024, a total of 80 patients (target group with LSM 12-20 kPa n= 40, control group n= 40) were enrolled with paired LSM and SSM by transient elastography (TE) during medical follow-up in Pok Oi Hospital.
Result & Outcome :
The control group included all non-cirrhotic patients who met the Baveno VII rule-out criteria. We achieved 100% sensitivity for being CSPH free with SSM ≤40 kPa, which is recommended as a safe zone to rule out high risk varices according to the Baveno VII consensus. The study establishes a correlation between LSM and SSM. Among patients in the grey zone, 22.5% experienced CSPH, with more than half (55.6%) presenting with an SSM ≥40 kPa. The mean SSM recorded was 39.01 kPa. All of them are under treatment, and the majority of the others (65%) did not undergo endoscopy screening.
Incorporating SSM could potentially enhance the sensitivity of excluding CSPH, particularly when integrated with LSM and platelet count analysis. This approach could save approximately half of the invasive diagnostic procedures. SSM provides a more comprehensive evaluation of patients’ risk for developing CSPH. This additional non-invasive procedure, which requires approximately 15 minutes, may diminish the necessity for endoscopic screenings and enhance the efficiency of identifying high-risk varices, and hence optimizes resource allocation and improves patient outcomes.
