Transient elastography for predicting esophageal/gastric varices in children with biliary atresia

BMC Gastroenterology

Yong Poovorawan¹  Nipaporn Siripon¹  Paisarn Vejapipat²  Voranush Chongsrisawat¹ 

[1] Department of Pediatrics, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand;Department of Surgery, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand

关键词: biliary atresia;    gastric varices;    esophageal varices;    Transient elastography;   

Others  :  1114572
DOI  :  10.1186/1471-230X-11-41

 received in 2011-01-13, accepted in 2011-04-18,  发布年份 2011

【 摘 要 】

Background

Transient elastography (TE) is an innovative, noninvasive technique to assess liver fibrosis by measuring liver stiffness in patients with chronic liver diseases. The purpose of this study has been to explore the accuracy of TE and clinical parameters in predicting the presence of esophageal/gastric varices in children with biliary atresia (BA) following portoenterostomy.

Methods

Patients with BA status post portoenterostomy and normal children were recruited. Splenomegaly and presence of EV/GV were determined by physical examination and endoscopy, respectively. Aspartate transaminase to platelet ratio index (APRI) was used as a serum fibrosis marker. TE was performed by using FibroScan. Data was expressed as mean ± SD.

Results

Seventy-three BA patients (male:female = 32:41; age 9.11 ± 5.64 years) and 50 normal controls (male:female = 19:31; age 11.00 ± 3.31 years) were enrolled. The liver stiffness score of BA patients was significantly higher than that of normal controls (27.37 ± 22.48 and 4.69 ± 1.03 kPa; p < 0.001). Patients with EV/GV had significantly higher liver stiffness score and APRI than those without EV/GV. As for EV/GV diagnosis, the areas under the receiver operating characteristic curve were 0.89 (95% CI 0.80 to 0.98) for TE and 0.87 (95% CI 0.78 to 0.96) for APRI, respectively. The sensitivity (and specificity) of TE (using a cut-off value of 12.7 kPa) and APRI (using a cut-off value of 1.92) in predicting EV/GV were 84% (77%) and 84% (83%), respectively, whereas the sensitivity (and specificity) of splenomegaly in predicting EV/GV were 92% (85%).

Conclusions

Transient elastography is a useful tool for predicting the presence of EV/GV. In addition, basic physical examination, routine biochemical and hematological tests, are still worthwhile and correlate well with the presence of EV/GV in patients with BA post portoenterostomy.

【 授权许可】

   
2011 Chongsrisawat et al; licensee BioMed Central Ltd.

【 图 表 】

Figure 1.

【 参考文献 】

• [1]Haber BA, Russo P: Biliary atresia. Gastroenterol Clin North Am 2003, 32(3):891-911.
• [2]Otte JB, de Ville de Goyet J, Reding R, Hausleithner V, Sokal E, Chardot C, Debande B: Sequential treatment of biliary atresia with Kasai portoenterostomy and liver transplantation. Hepatology 1994, 20(1 Pt 2):41S-48S.
• [3]Weigand K, Weigand K: Percutaneous liver biopsy: retrospective study over 15 years comparing 287 inpatients with 428 outpatients. J Gastroenterol Hepatol 2009, 24(5):792-799.
• [4]Amaral JG, Schwartz J, Chait P, Temple M, John P, Smith C, Taylor G, Connolly B: Sonographically guided percutaneous liver biopsy in infants: a retrospective review. Am J Roentgenol 2006, 187(6):W644-649.
• [5]van der Poorten D, Kwok A, Lam T, Ridley L, Jones DB, Ngu MC, Lee AU: Twenty-year audit of percutaneous liver biopsy in a major Australian teaching hospital. Intern Med J 2006, 36(11):692-699.
• [6]Seeff LB, Everson GT, Morgan TR, Curto TM, Lee WM, Ghany MG, Shiffman ML, Fontana RJ, Di Bisceglie AM, Bonkovsky HL, Dienstag JL: Complication rate of percutaneous liver biopsies among persons with advanced chronic liver disease in the HALT-C Trial. Clin Gastroenterol Hepatol 2010, 8(10):877-883.
• [7]Colloredo G, Guido M, Sonzogni A, Leandro G: Impact of liver biopsy size on histological evaluation of chronic viral hepatitis: the smaller the sample, the milder the disease. J Hepatol 2003, 39(2):239-244.
• [8]Regev A, Berho M, Jeffers LJ, Milikowski C, Molina EG, Pyrsopoulos NT, Feng ZZ, Reddy KR, Schiff ER: Sampling error and intraobserver variation in liver biopsy in patients with chronic HCV infection. Am J Gastroenterol 2002, 97(10):2614-2618.
• [9]Imbert-Bismut F, Ratziu V, Pieroni L, Charlotte F, Benhamou Y, Poynard T, MULTIVIRC Group: Biochemical markers of liver fibrosis in patients with hepatitis C virus infection: a prospective study. Lancet 2001, 357(9262):1069-1075.
• [10]Forns X, Ampurdanès S, Llovet JM, Aponte J, Quintó L, Martínez-Bauer E, Bruguera M, Sánchez-Tapias JM, Rodés J: Identification of chronic hepatitis C patients without hepatic fibrosis by a simple predictive model. Hepatology 2002, 36(4 Pt 1):986-992.
• [11]Wai CT, Greenson JK, Fontana RJ, Kalbfleisch JD, Marrero JA, Conjeevaram HS, Lok AS: A simple noninvasive index can predict both significant fibrosis and cirrhosis in patients with chronic hepatitis C. Hepatology 2003, 38(2):518-526.
• [12]de Lédinghen V, Le Bail B, Rebouissoux L, Fournier C, Foucher J, Miette V, Castéra L, Sandrin L, Merrouche W, Lavrand F, Lamireau T: Liver stiffness measurement in children using FibroScan: Feasibility study and comparison with Fibrotest, aspartate transaminase to platelets ratio index, and liver biopsy. J Pediatr Gastroenterolol Nutr 2007, 45(4):443-450.
• [13]Sandrin L, Fourquet B, Hasquenoph JM, Yon S, Fournier C, Mal F, Christidis C, Ziol M, Poulet B, Kazemi F, Beaugrand M, Palau R: Transient elastography: a new noninvasive method for assessment of hepatic fibrosis. Ultrasound Med Biol 2003, 29(12):1705-1713.
• [14]Castera L, Forns X, Alberti A: Non-invasive evaluation of liver fibrosis using transient elastography. J Hepatol 2008, 48(5):835-847.
• [15]Fraquelli M, Rigamonti C, Casazza G, Conte D, Donato MF, Ronchi G, Colombo M: Reproducibility of transient elastography in the evaluation of liver fibrosis in patients with chronic liver disease. Gut 2007, 56(7):968-973.
• [16]Duché M, Ducot B, Tournay E, Fabre M, Cohen J, Jacquemin E, Bernard O: Prognostic value of endoscopy in children with biliary atresia at risk for early development of varices and bleeding. Gastroenterology 2010, 139(6):1952-1960.
• [17]Kazemi F, Kettaneh A, N'kontchou G, Pinto E, Ganne-Carrie N, Trinchet JC, Beaugrand M: Liver stiffness measurement selects patients with cirrhosis at risk of bearing large oesophageal varices. J Hepatol 2006, 45(2):230-235.
• [18]Vizzutti F, Arena U, Romanelli RG, Rega L, Foschi M, Colagrande S, Petrarca A, Moscarella S, Belli G, Zignego AL, Marra F, Laffi G, Pinzani M: Liver stiffness measurement predicts severe portal hypertension in patients with HCV-related cirrhosis. Hepatology 2007, 45(5):1290-1297.
• [19]Chang HK, Park YJ, Koh H, Kim SM, Chung KS, Oh JT, Han SJ: Hepatic fibrosis scan for liver stiffness score measurement: a useful preendoscopic screening test for the detection of varices in postoperative patients with biliary atresia. J Pediatr Gastroenterolol Nutr 2009, 49(3):323-328.
• [20]de Franchis R, Dell'Era A, Primignani M: Diagnosis and monitoring of portal hypertension. Dig Liver Dis 2008, 40(5):312-317.
• [21]Kaushansky K: Thrombopoietin. N Eng J Med 1998, 339(11):746-754.
• [22]Abdelaal UM, Morita E, Nouda S, Kuramoto T, Miyaji K, Fukui1 H, Tsuda Y, Fukuda A, Murano M, Tokioka S, Arafa UA, Kassem AM, Umegaki E, Higuchi K: Evaluation of portal hypertensive enteropathy by scoring with capsule endoscopy: is transient elastography of clinical impact? J Clin Biochem Nutr 2010, 47(1):37-44.
• [23]Cole TJ, Bellizzi MC, Flegal KM, Dietz WH: Establishing a standard definition for child overweight and obesity worldwide: international survey. BMJ 2000, 320(7244):1240-1243.
• [24]Arena U, Vizzutti F, Corti G, Ambu S, Stasi C, Bresci S, Moscarella S, Boddi V, Petrarca A, Laffi G, Marra F, Pinzani M: Acute viral hepatitis increases liver stiffness values measured by transient elastography. Hepatology 2008, 47(2):380-384.
• [25]Sagir A, Erhardt A, Schmitt M, Häussinger D: Transient elastography is unreliable for detection of cirrhosis in patients with acute liver damage. Hepatology 2008, 47(2):592-595.
• [26]Fagundes ED, Ferreira AR, Roquete ML, Penna FJ, Goulart EM, Figueiredo Filho PP, Bittencourt PF, Carvalho SD, Albuquerque W: Clinical and laboratory predictors of esophageal varices in children and adolescents with portal hypertension syndrome. J Pediatr Gastroenterol Nutr 2008, 46(2):178-183.
• [27]Castéra L, Le Bail B, Roudot-Thoraval F, Bernard PH, Foucher J, Merrouche W, Couzigou P, de Lédinghen V: Early detection in routine clinical practice of cirrhosis and oesophageal varices in chronic hepatitis C: comparison of transient elastography (FibroScan) with standard laboratory tests and non-invasive scores. J Hepatol 2009, 50(1):59-68.
• [28]Breton E, Bridoux-Henno L, Guyader D, Daniélou H, Jouan H, Beuchée A, Nousbaum JB, Dabadie A: Value of transient elastography in noninvasive assessment in children's hepatic fibrosis. Arch Pediatr 2009, 16(7):1005-1010.
• [29]Sebastiani G, Tempesta D, Fattovich G, Castera L, Halfon P, Bourliere M, Noventa F, Angeli P, Saggioro A, Alberti A: Prediction of oesophageal varices in hepatic cirrhosis by simple serum non-invasive markers: Results of a multicenter, large-scale study. J Hepatol 2010, 53(4):630-638.