DOI: http://dx.doi.org/10.18203/2394-6040.ijcmph20213267

Elastography ultrasound for screening and early detection of esophageal varices

Abdelhamid Mohamed Abdou, Doha Jawad Alsafwani, Kamal Jamal Alamrousi, Alaa Ali Muri, Aseel Hassan Almagrabi, Faisal Thiab Alenazi, Almaha Abdulaziz Alabdullatif, Al-Khansa'a Ahmed Khabt, Alhareth Khalid Alhussain, Nawaf Nhari Kadomi, Noor Munir Altaroubi

Abstract


Despite that esophageal varices can be effectively detected by using upper gastrointestinal tract endoscopy, the procedure is invasive and requires the integration of adequate experience and training, and it is not suitable for many patients. Accordingly, ultrasound elastography has been developed and validated by many studies in the recent literature as effective and non-invasive modalities for the early observation and diagnosis of esophageal varices and the relevant hepatic diseases. In this study, we aim to conduct a literature review to furtherly elaborate on the role and validity of elastography ultrasound to screen and early detect esophageal varices. We have discussed the diagnostic efficacy of three different types of ultrasound elastography including two-dimensional shear wave elastography, point shear wave elastography, and transient elastography in detecting and early diagnosis of esophageal varies. Transient elastography (TE) has been reported to be efficacious and the simplest technique. However, it was reported with some limitations. These limitations could be compensated by the two-dimensional shear wave elastography and the point shear wave, Nevertheless, these two modalities need high levels of experience and are not widely available. Besides, there are a few investigations that have validated the efficacy of the latter in detecting esophageal varices. Accordingly, we encourage further investigation for a future relevance.


Keywords


Elastography, Ultrasound, Radiology, Esophageal varices, Diagnosis

Full Text:

PDF

References


Tsochatzis EA, Bosch J, Burroughs AK. Liver cirrhosis. Lancet (London, England). 2014;383(9930):1749-61.

Reiberger T, Ulbrich G, Ferlitsch A. Carvedilol for primary prophylaxis of variceal bleeding in cirrhotic patients with haemodynamic non-response to propranolol. Gut. 2013;62(11):1634-41.

Garcia-Tsao G, Abraldes JG, Berzigotti A, Bosch J. Portal hypertensive bleeding in cirrhosis: Risk stratification, diagnosis, and management: 2016 practice guidance by the American Association for the study of liver diseases. Hepatology (Baltimore, Md). 2017;65(1):310-35.

de Franchis R. Expanding consensus in portal hypertension: Report of the Baveno VI Consensus Workshop: Stratifying risk and individualizing care for portal hypertension. Journal of hepatology. 2015;63(3):743-52.

Reiberger T, Püspök A, Schoder M. Austrian consensus guidelines on the management and treatment of portal hypertension (Billroth III). Wiener klinische Wochenschrift. 2017;129(3):135-58.

Paternostro R, Reiberger T, Bucsics T. Elastography-based screening for esophageal varices in patients with advanced chronic liver disease. World journal of gastroenterology. 2019;25(3):308-29.

Sigrist RMS, Liau J, Kaffas AE, Chammas MC, Willmann JK. Ultrasound Elastography: Review of Techniques and Clinical Applications. Theranostics. 2017;7(5):1303-29.

Schwabl P, Bota S, Salzl P. New reliability criteria for transient elastography increase the number of accurate measurements for screening of cirrhosis and portal hypertension. Liver international : official journal of the International Association for the Study of the Liver. 2015;35(2):381-90.

Friedrich-Rust M, Poynard T, Castera L. Critical comparison of elastography methods to assess chronic liver disease. Nature reviews Gastroenterology & hepatology. 2016;13(7):402-11.

Kazemi F, Kettaneh A, N'Kontchou G. Liver stiffness measurement selects patients with cirrhosis at risk of bearing large oesophageal varices. Journal of hepatology. 2006;45(2):230-5.

Foucher J, Chanteloup E, Vergniol J. Diagnosis of cirrhosis by transient elastography (FibroScan): a prospective study. Gut. 2006;55(3):403-8.

Wong GL, Kwok R, Chan HL. Measuring spleen stiffness to predict varices in chronic hepatitis B cirrhotic patients with or without receiving non-selective beta-blockers. Journal of digestive diseases. 2016;17(8):538-46.

Stefanescu H, Grigorescu M, Lupsor M, Procopet B, Maniu A, Badea R. Spleen stiffness measurement using Fibroscan for the noninvasive assessment of esophageal varices in liver cirrhosis patients. J Gastroenterol Hepatol. 2011;26(1):164-70.

Abraldes JG, Bureau C, Stefanescu H. Noninvasive tools and risk of clinically significant portal hypertension and varices in compensated cirrhosis: The "Anticipate" study. Hepatology (Baltimore, Md). 2016;64(6):2173-84.

Nguyen-Khac E, Saint-Leger P, Tramier B, Coevoet H, Capron D, Dupas JL. Noninvasive diagnosis of large esophageal varices by Fibroscan: strong influence of the cirrhosis etiology. Alcoholism, clinical and experimental research. 2010;34(7):1146-53.

Bintintan A, Chira RI, Bintintan VV. Value of hepatic elastography and Doppler indexes for predictions of esophageal varices in liver cirrhosis. Medical ultrasonography. 2015;17(1):5-11.

Maurice JB, Brodkin E, Arnold F. Validation of the Baveno VI criteria to identify low risk cirrhotic patients not requiring endoscopic surveillance for varices. Journal of hepatology. 2016;65(5):899-905.

Augustin S, Pons M, Maurice JB. Expanding the Baveno VI criteria for the screening of varices in patients with compensated advanced chronic liver disease. Hepatology (Baltimore, Md). 2017;66(6):1980-88.

Marot A, Trépo E, Doerig C, Schoepfer A, Moreno C, Deltenre P. Liver stiffness and platelet count for identifying patients with compensated liver disease at low risk of variceal bleeding. Liver international : official journal of the International Association for the Study of the Liver. 2017;37(5):707-16.

Pu K, Shi JH, Wang X. Diagnostic accuracy of transient elastography (FibroScan) in detection of esophageal varices in patients with cirrhosis: A meta-analysis. World journal of gastroenterology. 2017;23(2):345-56.

Wong GLH, Kwok R, Hui AJ. A new screening strategy for varices by liver and spleen stiffness measurement (LSSM) in cirrhotic patients: A randomized trial. Liver international: official journal of the International Association for the Study of the Liver. 2018;38(4):636-44.

Berzigotti A. Non-invasive evaluation of portal hypertension using ultrasound elastography. Journal of hepatology. 2017;67(2):399-411.

Salzl P, Reiberger T, Ferlitsch M. Evaluation of portal hypertension and varices by acoustic radiation force impulse imaging of the liver compared to transient elastography and AST to platelet ratio index. Ultraschall in der Medizin (Stuttgart, Germany: 1980). 2014;35(6):528-33.

Takuma Y, Nouso K, Morimoto Y. Portal Hypertension in Patients with Liver Cirrhosis: Diagnostic Accuracy of Spleen Stiffness. Radiology. 2016;279(2):609-19.

Lucchina N, Recaldini C, Macchi M. Point Shear Wave Elastography of the Spleen: Its Role in Patients with Portal Hypertension. Ultrasound in medicine & biology. 2018;44(4):771-8.

Vermehren J, Polta A, Zimmermann O. Comparison of acoustic radiation force impulse imaging with transient elastography for the detection of complications in patients with cirrhosis. Liver international: official journal of the International Association for the Study of the Liver. 2012;32(5):852-8.

Bota S, Sporea I, Sirli R. Can ARFI elastography predict the presence of significant esophageal varices in newly diagnosed cirrhotic patients? Annals of hepatology. 2012;11(4):519-25.

Rizzo L, Attanasio M, Pinzone MR. A new sampling method for spleen stiffness measurement based on quantitative acoustic radiation force impulse elastography for noninvasive assessment of esophageal varices in newly diagnosed HCV-related cirrhosis. BioMed research international. 2014;2014:365982.

Takuma Y, Nouso K, Morimoto Y. Measurement of spleen stiffness by acoustic radiation force impulse imaging identifies cirrhotic patients with esophageal varices. Gastroenterology. 2013;144(1):92-101.e102.

Grădinaru-Taşcău O, Sporea I, Bota S. Does experience play a role in the ability to perform liver stiffness measurements by means of supersonic shear imaging (SSI)? Medical ultrasonography. 2013;15(3):180-3.

Ferraioli G, De Silvestri A, Reiberger T. Adherence to quality criteria improves concordance between transient elastography and ElastPQ for liver stiffness assessment-A multicenter retrospective study. Digestive and liver disease: official journal of the Italian Society of Gastroenterology and the Italian Association for the Study of the Liver. 2018;50(10):1056-61.

Zhang W, Zhu Y, Zhang C, Ran H. Diagnostic Accuracy of 2-Dimensional Shear Wave Elastography for the Staging of Liver Fibrosis: A Meta-analysis. Journal of ultrasound in medicine : official journal of the American Institute of Ultrasound in Medicine. 2019;38(3):733-40.

Bota S, Paternostro R, Etschmaier A. Performance of 2-D shear wave elastography in liver fibrosis assessment compared with serologic tests and transient elastography in clinical routine. Ultrasound in medicine & biology. 2015;41(9):2340-9.

Herrmann E, de Lédinghen V, Cassinotto C. Assessment of biopsy-proven liver fibrosis by two-dimensional shear wave elastography: An individual patient data-based meta-analysis. Hepatology (Baltimore, Md). 2018;67(1):260-72.

Jansen C, Bogs C, Verlinden W. Shear-wave elastography of the liver and spleen identifies clinically significant portal hypertension: A prospective multicentre study. Liver international: official journal of the International Association for the Study of the Liver. 2017;37(3):396-405.

Grgurević I, Bokun T, Mustapić S. Real-time two-dimensional shear wave ultrasound elastography of the liver is a reliable predictor of clinical outcomes and the presence of esophageal varices in patients with compensated liver cirrhosis. Croatian medical journal. 2015;56(5):470-81.

Kasai Y, Moriyasu F, Saito K. Value of shear wave elastography for predicting hepatocellular carcinoma and esophagogastric varices in patients with chronic liver disease. Journal of medical ultrasonics. 2015;42(3):349-55.

Kim TY, Kim TY, Kim Y, Lim S, Jeong WK, Sohn JH. Diagnostic Performance of Shear Wave Elastography for Predicting Esophageal Varices in Patients With Compensated Liver Cirrhosis. Journal of ultrasound in medicine : official journal of the American Institute of Ultrasound in Medicine. 2016;35(7):1373-81.

Elkrief L, Rautou PE, Ronot M. Prospective comparison of spleen and liver stiffness by using shear-wave and transient elastography for detection of portal hypertension in cirrhosis. Radiology. 2015;275(2):589-98.