Liver stiffness plus platelet count can be used to exclude high‐risk oesophageal varices

• DOI: 10.1111/liv.12916
• Publication Date: 2015-07-25T09:41:09Z
• Authors: Nik S. Ding; Tin Nguyen; David M. Iser; Thai Hong; Emma Flanagan; Avelyn Wong; Lauren Luiz; Jonathan Y. C. Tan; James Fulforth; Jacinta Holmes; Marno Ryan; Sally J. Bell; Paul V. Desmond; Stuart K. Roberts; John Lubel; William Kemp; Alexander J. Thom...
• Keywords: Liver Cirrhosis; Male; Platelet Count; Reproducibility of Results; Middle Aged; Esophageal and Gastric Varices; Risk Assessment; 3. Good health; 03 medical and health sciences; 0302 clinical medicine; Liver; Elasticity Imaging Techniques; Humans; Female; Endoscopy, Digestive System; Aged

AbstractBackground/AimsEndoscopic screening for high‐risk gastro‐oesophageal varices (GOV) is recommended for compensated cirrhotic patients with transient elastography identifying increasing numbers of patients with cirrhosis without portal hypertension. Using liver stiffness measurement (LSM) ± platelet count, the aim was to develop a simple clinical rule to exclude the presence of high‐risk GOV in patients with Child–Pugh A cirrhosis.MethodsA retrospective analysis of 71 patients with Child–Pugh A cirrhosis diagnosed by transient elastography (LSM >13.6 kPa) who underwent screening gastroscopy was conducted. A predictive model using LSM ± platelet count was assessed to exclude the presence of high‐risk GOV (diameter >5 mm and/or the presence of high‐risk stigmata) and validated using a second cohort of 200 patients from two independent centres.ResultsHigh‐risk GOV were present in 10 (15%) and 16 (8%) of the training and validation cohorts, respectively, which was associated with LSM and Pl count (P < 0.05). A combined model based on LSM and Pl count was more accurate for excluding the presence of high‐risk GOV than either alone (training cohort AUROC: 0.87 [0.77–0.96] vs. 0.78 [0.65–0.92] for LSM and 0.71 [0.52–0.90] for platelets) with the combination of LSM ≤25 kPa and Pl ≥100 having a NPV of 100% in both the training and validation cohorts. A total of 107 (39%) patients meet this criterion.ConclusionThe combination of LSM ≤25 kPa and Pl ≥100 can be used in clinical practice to exclude the presence of high‐risk GOV in patients with Child–Pugh A cirrhosis.