EUS Elastography for Predicting Cirrhotic-related Complications

Summary

Evaluation of the tissue stiffness as a surrogate marker of degree of liver cirrhosis has gained popularity in recent decades. Current guidelines also advocate the use of Fibroscan® machine (EchoSens, Paris, France) to detect any advanced liver fibrosis as represented by high liver stiffness, for prediction of varices development. Apart from liver stiffness, studies have shown that spleen stiffness (SS) has been proven another useful parameter to severity of underlying portal hypertension and liver cirrhosis. However, spleen stiffness measurement by Fibroscan® is highly limited by the thickness of subcutaneous soft tissue or abdominal wall tissue, especially in obese subjects. It carries certain technical difficulty as well due to its deep-seated anatomical position. Recently, the technique of endoscopic ultrasound elastography (EUS-E) has been described. It can overcome the limitations of Fibroscan by making measurements of liver and spleen stiffness through the gastric wall, which has a shorter distance than the abdominal wall. It also allows concomitant upper GI tract luminal examination, incorporating both esophagogastroduodenoscopy and elastography measurements into one procedure at the same time. This research study aims to prospectively study the utility of EUS-E in patients with chronic liver diseases, both in terms of diagnostic and prognostic indications for future cirrhotic-related complications.

Eligibility

Inclusion Criteria:

* Patients with radiologic features suggestive of cirrhosis on abdominal imaging studies such as transabdominal ultrasound, CT or MRI and indication for variceal screening
* Patients with suspected advanced liver fibrosis as detected by Fibroscan
* Patients with clinical evidence of hypersplenism
* Age \> 18 years
* Written informed consent available

Exclusion Criteria:

* Patients with features of decompensated cirrhosis, such as history of ascites, prior variceal bleeding, hepatic encephalopathy, hepatorenal syndrome
* Patients with history of hepatocellular carcinoma
* Patients with history of liver transplant or TIPS or shunting surgery
* Patients with portal and/or mesenteric vein thrombosis
* Moribund patients from terminal illnesses
* Patients with terminal malignancy
* Contraindications for endoscopy
* Unable to provide written informed consent
* Pregnancy

Conditions2

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