2017•Zeitschrift für GastroenterologieRequires access
Spleen stiffness is positively correlated with HVPG and decreases significantly after TIPS implantation
Matthias Buechter, A Kahraman, Alexander Dechêne, Paul Manka, Jens Matthias Theysohn, Marcus Paul Reinboldt, Aygün Canbay, G Gerken
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Abstract
Background: Hepatic venous pressure gradient (HVPG) is considered the gold standard for portal hypertension (PH) assessment. Transjugular intrahepatic portosystemic shunt (TIPS) is indicated in patients with decompensated PH and refractory ascites and/or variceal bleeding. Because HVPG measurement is an invasive procedure, non-invasive methods for evaluating the severity of PH are warranted. Patients and Methods: We retrospectively correlated the spleen stiffness as measured by FibroScan with the HVPG in patients who underwent TIPS implantation at the University Hospital Essen between 2015 and 2017. Twenty-four patients from whom valuable spleen stiffness measurement (SSM) was obtained one day before (D-1), one day after (D+1) and 28 days after TIPS placement (D+28) were included in this study. Results: SSM was positively correlated with HVPG (HVPG < 13 mmHg, median SSM: 19.7 ± 8.6 [10.7 – 39.2] kPa; HVPG 13 – 24 mmHg, median SSM: 45.0 ± 15.7 [20.9 – 75.0] kPa; HVPG > 24 mmHg, median SSM: 75.0 ± 6.2 [56.1 – 75.0] kPa; p < 0.05]; r 2 = 0.72; p < 0.001) and decreased significantly after TIPS implantation (D-1, median SSM: 67.1 ± 17.3 [20.9 – 75.0] kPa; D+1, median SSM: 44.7 ± 18.5 [18.8 – 75.0] kPa; D+28, median SSM: 35.6 ± 17.0 [12.2 – 75.0] kPa; p < 0.05), while liver stiffness measurement (LSM) decreased likewise, however without statistical significance (D-1, median LSM: 72.0 ± 26.0 [9.9 – 75.0] kPa; D+1, median LSM: 51.1 ± 23.0 [4.5.-75.0] kPa; D+28, median LSM: 38.5 ± 20.8 [5.7 – 75.0] kPa; p = n.s.). Conclusions: The present study highlights the possibility of using SSM as a clinically relevant non-invasive tool in patients with chronic liver disease suggesting direct positive correlation between spleen stiffness and degree of portal hypertension. This observation is confirmed by a significant decrease of spleen stiffness after TIPS implantation offering a confirmable additional parameter in the surveillance of patients undergoing TIPS procedure.