https://www.ncbi.nlm.nih.gov/pubmed/31348121 Biliary atresia
J Pediatr Gastroenterol Nutr. 2019 Jul 24. doi: 10.1097/MPG.0000000000002430. [Epub ahead of print]
Spleen and Liver Stiffness to Detect Esophageal Varices in Children with Biliary Atresia.
Sintusek P1,2, Siriporn N3, Punpanich D4, Chongsrisawat V1, Poovorawan Y5.

Abstract

OBJECTIVES:
To determine the accuracy of non-invasive parameters such as liver (LS) and spleen stiffness (SS) to detect esophageal varices (EV) in children with biliary atresia (BA).

METHODS:
Children with BA between 2000 and 2015 were recruited. All underwent esophagogastroduodenoscopy and transient elastography. Demographic data, laboratory investigations, alanine transferase-to-platelet ratio index (APRI), and Varices Prediction Rule (VPR) score were collected.

RESULTS:
A total of 51 children (mean age 10.63 years, standard deviation [SD]=6.08 years; 53% males) were enrolled. There were differences in onset and outcome of portoenterostomy, spleen palpablility, platelet count, albumin, LS, SS, and VPR between the varice and varice-free groups (P < 0.05). In the varice group, the median LS was 18.12 [interquartile ratio, IQR 13.15-19.12] and the median SS was 46.85 [IQR 25.95-54.55] kPa. In the varice-free group, the median LS was 7.85 [IQR 5.88-16.75] and the median SS was 16.54 [IQR 11.75-21.75] kPa. Both LS and SS were higher in the varice than the varice-free group (P < 0001). The area under the receiver operating characteristic curve of LS, SS, spleen palpability, platelet count, APRI and VPR were 0.734, 0.870, 0.817, 0.810, 0.751 and 0.794, respectively. Using a cut-off value of 12.5 kPa for LS, the sensitivity and specificity were 80% and 70% respectively. Using a cut-off value of 28.9 kPa for SS, the sensitivity and specificity were 75% and 87% respectively. Combination of LS and SS to diagnose varices increased the specificity to 93%.

CONCLUSIONS:
SS as a single marker had the best diagnostic value to predict esophageal varices in children with BA. The combination of SS and LS furthermore increased the diagnostic yield.