Value of Hitachi Shear Wave Elastography (SWE) to rule-in and rule-out the presence of esophageal varices in patients with compensated advanced liver disease

Introduction According to Baveno VI consensus, patients with an LS<20 kPa assessed by Transient Elastography (TE) and platelet count>150000 cell/mm³ have a very low risk for esophageal varices, and screening gastroscopy by patients with compensated advanced liver disease (cALD) can be avoided safely.

Aim To assess the value of the Hitachi SWE to rule-in and rule-out the presence of esophageal varices in patients with cALD.

Methods LS was measured with Hitachi SWE (AriettaV70) and TE.

Results Our cohort included 195 patients with chronic liver diseases and different degrees of liver fibrosis, of which 107 were diagnosed as cALD (mean age 57.3±12.4years,69.1 % men). The most common etiology was alcohol use(50.4 %). Esophageal varices were diagnosed in 43.9 % of these patients. Best predictive LS cut-off value by Hitachi SWE for the presence of F4 fibrosis was>8.7kPa (Se 94.4 %, Sp 92.5 %,AUC=0.965).None of the patients with esophageal varices had LS assessed by TE<20kPa and platelet count>150000 cells/mm³, showing very good performance of the Baveno VI criteria.The best LS cut-off value assessed by Hitachi SWE for predicting the presence of esopageal varices was>11.7kPa (Se 66 %, Sp 70 %, AUC=0.742); while for a cut-off value>16.5kPa more than 90 % Sp was observed. None of the patients with esophageal varices assessed by Hitachi SWE had LS<11.7kPa and platelet count>150000 cells/mm3, demonstrating a very good performance to rule out the presence of esophageal varices. Rule-in esophageal varices performance of LS assessed by Hitachi SWE und platelets count was significant lower. When both criteria (LS>16.5kPa, platelet count<150.000 cells/mm3) were fulfilled, a significantly higher positive predictive value (PPV=76.9 %, 10/13 patients) was calculated to rule-in esophageal varices compared to the presence of one criterion only (PPV=57.3 %, 47/82 patients)

Conclusions LS assessed by Hitachi SWE combined with platelet count seems to be a reliable method to rule-out the presence of the esophageal varices in cALD patients.

Publication History

Article published online:
01 September 2021