Performance of spleen stiffness measurement to rule out high-risk varices in patients with porto-sinusoidal vascular disorder.

Baveno VII consensus suggests that screening endoscopy can be spared in patients with compensated cirrhosis when spleen stiffness measurement (SSM) by vibration-controlled transient elastography (VCTE) is ≤40 kPa as they have a low probability of high-risk varices (HRV). Conversely, screening endoscopy is required in all patients with porto-sinusoidal vascular disorder (PSVD). This study aimed to evaluate the performance of SSM-VCTE to rule out HRV in patients with PSVD and signs of portal hypertension. We retrospectively included patients with PSVD, ≥1 sign of portal hypertension, without a history of variceal bleeding, who underwent an SSM-VCTE within 2 years before or after an upper endoscopy in 21 VALDIG centers, divided into a derivation and a validation cohort. One hundred fifty-four patients were included in the derivation cohort; 43% had HRV. By multivariable logistic regression analysis, SSM-VCTE >40 kPa and serum bilirubin ≥1 mg/dL were associated with HRV. SSM-VCTE ≤40 kPa combined with bilirubin <1 mg/dL had a sensitivity of 96% to rule out HRV and could spare 38% of screening endoscopies, with 4% of HRV missed, and a 95% negative predictive value. In the validation cohort, including 155 patients, SSM combined with bilirubin could spare 21% of screening endoscopies, with 4% of HRV missed and a 94% negative predictive value. This study gathering a total of 309 patients with PSVD showed that SSM-VCTE ≤40 kPa combined with bilirubin <1 mg/dL identifies patients with PSVD and portal hypertension with a probability of HRV <5%, in whom screening endoscopy can be spared.

Moga L ，Paradis V ，Ferreira-Silva J ，Gudavalli K ，Indulti F ，Dajti E ，Nicoara-Farcau O ，Tosetti G ，Antonenko A ，Fodor A ，Vidal-González J ，Turco L ，Capinha F ，Elkrief L ，Monllor-Nunell T ，Goria O ，Balcar L ，Lannes A ，Mallet V ，Poujol-Robert A ，Thabut D ，Houssel-Debry P ，Wong YJ ，Ronot M ，Vilgrain V ，Rampally SP ，Payancé A ，Castera L ，Reiberger T ，Ferrusquía-Acosta J ，Noronha Ferreira C ，Vitale G ，Simon-Talero M ，Procopet B ，Berzigotti A ，Caccia R ，Turon F ，Schepis F ，Ravaioli F ，Colecchia A ，Valsan A ，Macedo G ，Plessier A ，Rautou PE ，ERN RARE-LIVER; a study of VALDIG, an EASL consortium ... -  《-》

Spleen Stiffness-Based Algorithms Are Superior to Baveno VI Criteria to Rule Out Varices Needing Treatment in Patients With Advanced Chronic Liver Disease.

The Baveno VI criteria have set the stage for noninvasive assessment of compensated advanced chronic liver disease (ACLD). The algorithm combining liver stiffness measurement (LSM, <20 kPa) and platelet count (>150,000/μL) safely avoids screening endoscopy for varices needing treatment (VNT) but identifies only a relatively low number of patients. We aimed to evaluate the value of spleen stiffness measurement (SSM) using spleen-dedicated elastography in ruling out VNT. In this real-life multicenter retrospective derivation-validation cohort, all consecutive patients with ACLD (defined by LSM ≥10 kPa) with available upper endoscopy, laboratory results, spleen diameter, LSM, and SSM measured with spleen-dedicated transient elastography were included. VNT were defined as medium-to-large varices or small varices with red spots. In the derivation cohort (n = 201, 11.9% VNT), SSM demonstrated excellent capability at identifying VNT (area under the receiver operating characteristic curve [AUROC] 0.88), outperforming LSM (AUROC 0.77, P = 0.03) and platelets (AUROC 0.73, P = 0.002). In comparison with Baveno VI criteria (33.8% spared endoscopies), the sequential Baveno VI plus SSM and a novel spleen size and stiffness model were able to increase the number of patients avoiding endoscopy (66.2% and 71.1%, respectively) without missing more than 5% of VNT. These findings were confirmed in an external validation cohort of patients with more advanced liver disease (n = 176, 34.7% VNT) in which the number of spared endoscopies tripled (27.3% and 31.3% for SSM-based algorithms) compared with Baveno VI criteria (8.5%). Spleen stiffness-based algorithms are superior to Baveno VI criteria in ruling out VNT in patients with ACLD and double the number of patients avoiding screening endoscopy.

Vanderschueren E ，Armandi A ，Kwanten W ，Cassiman D ，Francque S ，Schattenberg JM ，Laleman W ... -  《-》

Performance of spleen stiffness measurement by 100-Hz vibration-controlled transient elastography, liver stiffness, APRI score and their combination for predicting oesophageal varices in liver cirrhosis.

Oesophageal varices (EV) rupture remains one of the most severe complications of cirrhosis. As the gold standard to predict this accident, esophagogastroduodenoscopy (EGD) itself also has a weakness. Not all patients are convenient with this modality in clinical practice apart from the risk and cost burden. Hence, the search for other non-invasive modalities with high accuracy is still noteworthy. Among them, spleen stiffness measurement (SSM) with 100 Hz probe, liver stiffness measurement (LSM), and the aspartate amino transferase to platelet ratio index (APRI) score became popular and intensively studied with good accuracy, but the results remain conflicting. This study aims to investigate the performance of SSM, LSM, APRI score, and their combination especially as a screening tool for predicting EV in liver cirrhosis patients. In this cross-sectional study, we included 141 patients with liver cirrhosis who had undergone endoscopy, SSM, LSM, and APRI score calculation between January and March 2023 were enrolled. Diagnostic accuracy was assessed by the area under the receiver-operator curve (AUC). Transient elastography (TE) measurement was performed using a spleen-dedicated FibroScan with a 100-Hz probe. Of the 141 patients, the most common aetiology was hepatitis B in 71 patients (50.4 %). EV were found in 116 patients. Using the AUC, SSM at a cutoff of 40 kPa had the best performance with an AUC of 0.892 (CI 95 %: 0.814-0.969, p <0.0001), with sensitivity 88.79 % and specificity 80 %). Meanwhile, LSM and APRI score had an AUC of 0.832 (CI 95 %: 0.742-0.922, p <0.0001) and 0.780 (CI 95 %: 0.660-0.900, p <0.0001), respectively. The combination of all measurement tools did not show better performance than SSM alone with an AUC of 0.892 (CI 95 %: 0.802-0.982, P <0.0001) CONCLUSION: SSM provides better performance than LSM and APRI scores for predicting EV. Performance of SSM alone is non-inferior compare to multiple diagnostic tools combined.

Kurniawan J ，Siahaan BSP 《-》

Erratum: Eyestalk Ablation to Increase Ovarian Maturation in Mud Crabs.

《Jove-Journal of Visualized Experiments》

Porto-sinusoidal vascular liver disorder with portal hypertension: Natural history and long-term outcome.

Current knowledge of the natural history of patients with porto-sinusoidal vascular disorder (PSVD) is derived from small studies. The aim of the present study was to determine the natural history of PSVD and prognostic factors in a large multicenter cohort of patients. We performed a retrospective study on patients with PSVD and signs of portal hypertension (PH) prospectively registered in 27 centers. A total of 587 patients were included, median age of 47 years and 38% were women. Four-hundred and one patients had an associated condition, which was graded as severe in 157. Median follow-up was 68 months. At diagnosis, 64% of patients were asymptomatic while 36% had a PH-related complication: PH-related bleeding in 112 patients, ascites in 117, and hepatic encephalopathy in 11. In those not presenting with bleeding, the incidence of first bleeding was 15% at 5 years, with a 5-year rebleeding rate of 18%. The 5-year cumulative incidence of new or worsening ascites was 18% and of developing PVT was 16%. Fifty (8.5%) patients received a liver transplantation and 109 (19%) died, including 55 non-liver-related deaths. Transplant-free survival was 97% and 83% at 1 and 5 years, respectively. Variables independently associated with transplant-free survival were age, ascites, serum bilirubin, albumin and creatinine levels at diagnosis and severe associated conditions. This allowed for the creation of a nomogram that accurately predicted prognosis. The prognosis of PSVD is strongly determined by the severity of the associated underlying conditions and parameters of liver and renal function. Porto-sinusoidal vascular liver disorder (PSVD) is a rare entity that usually affects young people, frequently causes severe complications of portal hypertension, and may reduce life expectancy. To date, there is scarce information regarding its clinical manifestations, natural history and prognostic factors. The present study, including the largest number of patients with PSVD reported so far, shows that overall, when managed at centers of expertise, the prognosis of patients with PSVD is good, with LT-free survival rates of 83% and 72% at 5 and 10 years, respectively. Presence and severity of an underlying associated condition, presence of ascites, age and bilirubin, albumin and creatinine levels were associated with poor prognosis. These results are important to know for hepatologists. A final model combining these parameters enabled development of a nomogram that predicts prognosis with good discrimination and calibration capacity and can be easily applied in clinical practice.

Magaz M ，Giudicelli-Lett H ，Abraldes JG ，Nicoară-Farcău O ，Turon F ，Rajoriya N ，Goel A ，Raymenants K ，Hillaire S ，Téllez L ，Elkrief L ，Procopet B ，Orts L ，Nery F ，Shukla A ，Larrue H ，Degroote H ，Aguilera V ，Llop E ，Turco L ，Indulti F ，Gioia S ，Tosetti G ，Bitto N ，Becchetti C ，Alvarado E ，Roig C ，Diaz R ，Praktiknjo M ，Konicek AL ，Olivas P ，Fortea JI ，Masnou H ，Puente Á ，Ardèvol A ，Navascués CA ，Romero-Gutiérrez M ，Scheiner B ，Semmler G ，Mandorfer M ，Damião F ，Baiges A ，Ojeda A ，Simón-Talero M ，González-Alayón C ，Díaz A ，García-Criado Á ，De Gottardi A ，Hernández-Guerra M ，Genescà J ，Drilhon N ，Noronha Ferreira C ，Reiberger T ，Rodríguez M ，Morillas RM ，Crespo J ，Trebicka J ，Bañares R ，Villanueva C ，Berzigotti A ，Primignani M ，La Mura V ，Riggio O ，Schepis F ，Verhelst X ，Calleja JL ，Bureau C ，Albillos A ，Nevens F ，Hernández-Gea V ，Tripathi D ，Rautou PE ，García-Pagán JC ，ERN RARE-LIVER; a study of VALDIG, an EASL consortium ... -  《-》