Swetha S1, Bony George1, Arun Prabhakaran1, Avisek Chakravorty1, Prasanth sudheendran2, Premalatha Narayanan3, Krishnadas Devadas 4
1 Senior Resident, Department of Medical Gastroenterology, Government Medical college, Thiruvananthapuram, India, 2Assistant professor, Department of Medical Gastroenterology, Government Medical college, Thiruvananthapuram, India, 3Professor, Department of Medical Gastroenterology, Government Medical college, Thiruvananthapuram, India, 4Professor and HOD, Department of Medical Gastroenterology, Government Medical college, Thiruvananthapuram, India.
Background/Aims: Endoscopic variceal ligation (EVL) of esophageal varices alters the portal pressure. We looked at the changes in 2D-Shear wave Elastography (2D-SWE) measurements of spleen and liver following EVL. We tried to identify the predictors for rebleeding and mortality at 6 months.
Methods: A prospective observational study of 202 patients who underwent EVL for bleeding esophageal varices was done. 2D-SWE measurements of liver (LS) and spleen (SS) and spleen volume (SV) were measured half an hour before, 1 hour, 2 weeks and 6 weeks after EVL. All were followed up for 6 months for rebleeding and all-cause mortality.
Results: There were 83(41.1%), 72(35.6%) and 47(23.3%) patients of child C, B & A respectively. 47(23.3%) patients had a rebleeding episode and 41 (20.2%) patients died at 6 months.Changes in SS, LS and SV from basline and its relation to rebleeding are tabulated in Table 1. AUROC’s of Delta2 VOL (0.773), Delta2 LS (0.743) and Delta3 LS (0.764), Delta3 SS (0.706) were higher than MELD’s (0.677) in predicting rebleeding. AUROC’s of Delta2 LS(0.841), Delta2 SS(0.754), Delta2 VOL (0.842) Delta3 LS(0.717), Delta3 VOL(0.873), Delta3 SS (0.668) were higher than MELD’s (0.641) in predicting mortality. Significant variables in binary logistic regression analysis for rebleeding were Delta3 LS and Delta3 SS. There were no variables significant for mortality.
Conclusion: Stiffness of Liver and spleen and spleen volume change after EVL. The difference in stiffness of liver and spleen from baseline at 6 weeks had good diagnostic accuracy for rebleeding at 6 months.
Keywords: Cirrhosis, 2D-SWE, SPLEEN STIFFNESS , REBLEEDING, VARICEAL LIGATION