Relationship between Liver Stiffness Measured by Fibroscan and the Presence and Grading of Esophageal Varices by Endoscopy in Patients with Liver Cirrhosis

Background: Fibroscan (transient elastography) is a relatively new method of measuring liver stiffness and is a noninvasive liver fibrosis marker. The liver stiffness could be used as predictors of oesophageal varices in cirrhotic patients because portal hypertension is related to liver fibrosis. Objectives: This study aimed to evaluate the diagnostic accuracy of transient elastography for the presence and grade of oesophageal varices (EV) in patients with liver cirrhosis. Methods: This cross-sectional study was conducted in the Department of Medicine and Department of Gastroenterology Sylhet MAG Osmani Medical College Hospital, Sylhet between July 2018 and June 2019. Seventy two consecutive cirrhotic patients (mean age 47.21 ± 14.02 years, 73.6% males) were enrolled. Patients with hepatocellular carcinoma, liver cirrhosis with moderate or massive ascites, acute liver failure, previous variceal bleeding, treatment with ß blockers, sclerotherapy or band ligation of oesophageal varices, transjugular intrahepatic portosystemic shunt or surgery for portal hypertension, liver transplantation, portal, splenic or hepatic vein thrombosis revealed by the abdominal ultrasonography, Spontaneous bacterial peritonitis, extrahepatic cholestatsis, congestive cardia failure, BMI 30 or above were excluded . All patients underwent fibroscan (transient elastography) and upper GI endoscopy. The diagnostic performance of the methods was assessed using sensitivity, specificity, positive predictive value, negative predictive value, accuracy and receiver operating characteristic curves. Results: Oesophageal varices were found in 86.1% with grade-I in 22.2%, Grade-II in 31.9%, Grade-III in 31.9% and no oesophageal varices 13.9% of patients. A significant positive correlation revealed between liver stiffness measured by fibroscan and presence (r=0.568; p<0.001) and grade (r=0.783; p<0.001) of oesophageal varices. The best cutoff value of liver stiffness measurement was 14.45 kPa in predicting the presence of oesophageal varices with the sensitivity of 98.4%, specificity of 90.0%, positive predictive value (PPV) of 98.4%, negative predictive value (NPV) of 90% and area under the curve (AUROC) of 0.967; and 41.55 kPa for large oesophageal varices (grade-II and III) with the sensitivity 95.7%, specificity 92.3%, PPV 95.7%, NPV 92.3% and AUROC 0.965. Conclusion: Liver stiffness measurement by fibroscan is correlated with presence and grading of oesophageal varices in liver cirrhosis. Measurement of liver stiffness by fibroscan is reliable for predicting the presence and larger grade of oesophageal varices by endoscopy in patients with liver cirrhosis. Therefore, it is a good test to replace endoscopy for predicting and grading of oesophageal varices.