Source Division of Hepato-Gastroenterology, Department of Internal Medicine, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Kaohsiung, Taiwan.
Background and Aim: Transient elastography (TE) was useful in oesophageal varices (OV) diagnosis for chronic hepatitis C patients. We evaluate usefulness of TE and simple blood markers in OV diagnosis for patients with hepatitis B virus (HBV)-related cirrhosis prospectively.
Methods: Consecutive patients with compensated cirrhosis and positive HBV surface antigen were enrolled prospectively. At enrollment, aspartate aminotransferase (AST) to alanine aminotransferase ratio (AAR), AST to platelet ratio index (APRI) were recorded and TE was performed. Two experienced endoscopists assessed OV independently. High-risk OV was defined as small size with red color sign, medium or large size. The diagnostic performances, optimal cut-offs and their validities of TE, APRI, platelet count (PLT) and AAR in OV diagnosis were assessed.
Results: One hundred and twenty-six patients (male/female: 93/33; mean age: 54.5) with reliable TE results were analyzed. There were good agreements between two endoscopists in assessing presence of OV and high-risk OV (kappa value: 0.82 and 0.96). Forty-eight (38.1%) patients had OV (small: 35; high-risk: 13). There was correlation between TE result and OV size (r=0.515, p<0.001). TE, APRI and PLT were similar however, superior to AAR, in diagnostic accuracies for OV and high-risk OV. In high-risk OV prediction, the negative predictive value was 97%, 98% and 98% with the cut-offs of 21 kPa, 1.24 and 110 (x10(9) /L) for TE, APRI and PLT, respectively.
Conclusions: For compensated patients with HBV-related cirrhosis, TE, APRI and PLT are useful in excluding high-risk OV with high negative predictive value.