Non-invasive methods can predict oesophageal varices in patients with biliary atresia after a Kasai procedure

Dig Liver Dis. 2011 Aug;43(8):659-63. doi: 10.1016/j.dld.2011.04.006. Epub 2011 May 19.

Abstract

Background: After a Kasai procedure, 70% of patients with biliary atresia develop chronic liver disease with portal hypertension and oesophageal varices.

Aims: To investigate the role of new non-invasive parameters in predicting the presence of varices in patients with biliary atresia after a Kasai procedure and to identify the cut-off values of these parameters in predicting the presence of varices.

Methods: 31 patients with biliary atresia who had undergone a Kasai portoenterostomy were studied. Clinical, biochemical and abdominal ultrasound examination, liver stiffness measurement (LSM), LSM-spleen diameter to platelet ratio score (LSPS) and upper digestive endoscopy were performed.

Results: 15 (47%) patients had oesophageal varices (Group A) and 16 had no varices (Group B). Median values of LSM (kPa) and LSPS were significantly higher in Group A than in Group B (LSM: 17.0 vs. 7.5, respectively; p=0.0001; LSPS: 19.62 vs. 2.94, respectively; p=0.0001). The optimal cut-offs for predicting oesophageal varices were: LSM>10.6 kPa (sensitivity: 87%, specificity: 87.5%, PPV: 87%, NPV: 87.5%, and AUC: 0.92) and LSPS ≥9.2 (sensitivity: 91%, specificity: 92%, PPV: 91%, NPV: 92%, and AUC: 0.96).

Conclusions: Non-invasive methods can predict the presence of oesophageal varices in patients with biliary atresia; the sequential use of two non-invasive methods improves accuracy.

MeSH terms

  • Adolescent
  • Adult
  • Biliary Atresia / complications
  • Biliary Atresia / surgery*
  • Blood Platelets
  • Child
  • Child, Preschool
  • Elasticity / physiology*
  • Esophageal and Gastric Varices / diagnosis*
  • Esophageal and Gastric Varices / etiology
  • Female
  • Humans
  • Liver / diagnostic imaging
  • Liver / metabolism
  • Liver / physiopathology*
  • Logistic Models
  • Male
  • Portoenterostomy, Hepatic / adverse effects*
  • Predictive Value of Tests
  • ROC Curve
  • Spleen / anatomy & histology
  • Ultrasonography
  • Young Adult