SPLEEN STIFFNESS AS NON INVASIVE TOOL IN PREDICTION OF PORTAL HYPERTENSION AND GASTRO-ESOPHAGEAL VARICES IN ADULT CIRRHOTIC PATIENTS

Abstract

The study was carried out on 80 cirrhotic patients (group I) and 20 healthy individual (group II) (as control). The patients were recruited from the Gastroenterology and Hepatology department at Ain Shams University Hospital and Ahmed Maher Teaching Hospital. All patients with following criteria were excluded from the study: Patients < 18 years, BMI> 35, history of upper endoscopy intervention, patients with moderate and severe ascites, patients with implantable device, patients with HCC, with portal vein thrombosis and splenic vein thrombosis and patients on beta blockers. The aim of this study was to assess the ability of spleen stiffness measured by transient elastography (fibroscan) in prediction of portal hypertension and gastro-esophageal varices in adult cirrhotic patients. Multiple clinical, laboratory parameters, ultrasonography and transient elastography to assess the liver and spleen stiffness were carried out to all studied persons. Upper gastrointestinal endoscopy was done to 80 cirrhotic patients.

It was found that: • The spleen stiffness was found higher in cirrhotic patients (group I) than non-cirrhotic persons (group II).The spleen stiffness was higher in child (B) patients than child (A) patients. • The spleen stiffness had significant negative correlations with platelets counts, Platelets count/Spleen size ratio and prothrombin concentration but, there was significant positive correlations between splenic stiffness and total bilirubin, direct bilirubin, spleen size, portal vein diameter, liver stiffness. • Among cirrhotic patients the spleen stiffness had significant diagnostic value to differentiate between the patients with significantupper endoscopy findings and those without significantupper endoscopy findings. • The spleen stiffness had a low relatively diagnostic value in prediction of portal hypertensive gastropathy, grades of esophageal varices and gastric varices, but it had significant diagnostic value in presence of esophageal varices at cut off (≥40.0 K Pascal).