Spleen Stiffness Measurement by Transient Elastography to Diagnose Portal Hypertension in Children

Abstract

BACKGROUND: The development of esophageal varices is a late complication of chronic liver disease (LD) in children. The diagnosis is presently limited to invasive procedures such as endoscopy. Noninvasive tools to diagnose the presence and degree of esophageal varices would alter management decisions and support indications for invasive procedures in affected children. The aim of the study was to test the feasibility of spleen stiffness measurement (SSM) by transient elastography (TE; FibroScan) in children and compare data on its diagnostic use with established markers of liver fibrosis and parameters of portal hypertension. METHODS: A total of 99 children (62 with chronic LD, 6 after liver transplantation, 31 controls) underwent SSM by TE. Fibrotest was determined in 37 children, 45 children had an additional liver stiffness measurement, and 19 underwent upper endoscopy. RESULTS: SSM by FibroScan is feasible. Spleen size significantly determined success rate (90.5% in patients with splenomegaly vs 70.2% in patients without, P = 0.02). Spleen stiffness was significantly higher in patients with splenomegaly (62.96 vs 18.4 kPa, P < 0.001), in patients with varices (75 vs 24 kPa, P < 0.01), and in patients with a history of variceal hemorrhage (75 vs 50.25 kPa, P < 0.05). Variceal hemorrhage did not occur in patients with SSM results <60 kPa. Spleen stiffness decreased after liver transplantation, but remained elevated compared with controls (27.5 vs 16.3 kPa). Liver stiffness measurements and Fibrotest did not reflect the presence or degree of esophageal varices. CONCLUSIONS: SSM by TE is feasible in children and the results reflect the degree and occurrence of complications. A prospective follow-up study with larger patient numbers and performance of screening endoscopies appears justified and desirable.