Liver stiffness measurement selects patients with cirrhosis at risk of bearing large oesophageal varices

Background/Aims: Periodic endoscopic screening for oesophageal varices is recommended in patients with cirrhosis, but might be limited to a subgroup of patients if a simple non-invasive test was available to select those at risk of bleeding. Methods: We studied in 165 patients with cirrhosis the relation between the presence of oesophageal varices assessed by endoscopy, and liver stiffness measurement by Fibroscan (R), a non-invasive parameter related to liver fibrosis. The results were compared to those of other parameters reflecting portal hypertension, splenic size, platelet count, and platelet count/ spleen size ratio. Results: Liver stiffness measurement was correlated to the grade of oesophageal varices (r = 0.6, p < 0.0001). AUROC values of liver stiffness measurement were 0.84 (95% CI: 0.784.90) for the presence of oesophageal varices and 0.83 (0.76-0.89) for varices grade >= II. Liver stiffness measurement value < 19 kPa was highly predictive of the absence of oesophageal varicos grade >= II (Se: 84%, PPV: 47%, NPV: 93%). Conclusions: Liver stiffness measurement allows to predict the presence of large oesophageal varices in patients with cirrhosis, and may help to select patients for endoscopic screening. (c) 2006 European Association for the Study of the Liver. Published by Elsevier B.V. All rights reserved.