Liver and Spleen Stiffness Measured by TE and 2D-SWE for Diagnosis of GOV in Patients With cACLD

Liver and Spleen Stiffness Measured by Transient Elastography and 2D-shear Wave Elastography for Diagnosis of Gastroesophageal Varices in Patients With Compensated Advanced Chronic Liver Disease: a Diagnostic Accuracy Study

A observational diagnostic study will be conducted to compare the performance of liver stiffness and spleen stiffness measured by 2D-shear wave elastography (2D-SWE) and transient elastography (TE) for diagnosing gastroesophageal varices (GOV) in people with compensated Advanced Chronic Liver Disease (cACLD), and explore the cut-off value of 2D-SWE for diagnosing GOV.

Patients with chronic liver disease who visit Fifth Affiliated Hospital, Sun Yat-Sen University will be enrolled from October 2023 to January 2025. Their liver stiffness measured by transient elastography (TE) should be at least 10 kilopascal (kPa) and with no previous decompensation symptoms.

Patients will be asked to sign an informed consent form. After that, researchers will assess the eligibility of the participants according to inclusion and exclusion criteria, and record their demographic data, history of disease, and the etiology of liver disease.

The participants will be required to complete relevant laboratory tests such as blood routine, liver function, kidney function, coagulation function and etiology. After completing the tests, the results will be recorded by primary researchers.

Abdominal ultrasound and 2D-shear wave elastography (2D-SWE) will be conducted by a sonographer, the interval between ultrasonic examination and laboratory tests should be less than a week, and the patients should fast for at least 4 hours before the examination. Abdominal ultrasound findings, liver stiffness, spleen stiffness, spleen thickness, spleen diameter, portal vein trunk diameter will be recorded by primary researchers.

TE examination will be conducted by experienced nurses, instructing patients to have a fasting period of at least 4 hours prior to the tests. An interval of no more than 1 week should separate the abdominal ultrasound and 2D-SWE examination. The report will be considered highly reliable only if the interquartile range to median ratio (IQR/med) is ≤ 30%, at least 10 successful acquisitions are obtained, and the success rate is at least 60%. Liver stiffness, spleen stiffness and controlled attenuation parameter (CAP) will be recorded by primary researchers.

Gastroscopy will be conducted and reported by experienced endoscopists. There should be a maximum interval of no more than 1 month between the gastroscopy and ultrasound examination, and patients should fast for at least 8 hours before undergoing gastroscopy. Primary researchers will record the site of varices veins, their maximum diameter, risk factors, risk levels, and the determination of whether they are high-risk varices or not.

Demographic characteristics and laboratory results will be collected to describe participants' condition, and the sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV), and area under the receiver operating characteristic (AUROC) of 2D-SWE will be compared with that of TE in diagnosing GOV, and the cut-off value of 2D-SWE for diagnosing GOV will be explored.

Inclusion Criteria:

• Age≥18 years old;
• Chronic liver disease (alcoholic liver disease, chronic hepatitis B, chronic hepatitis C or non-alcoholic fatty liver disease);
• Liver stiffness ≥10kPa measured by transient elastography (TE);
• No previous decompensation-related manifestations (such as ascites, gastrointestinal varicose bleeding, hepatic encephalopathy, etc.);
• Informed consent has been signed.

Exclusion Criteria:

• Hepatocellular carcinoma or other advanced malignant tumor;
• Acute liver disease or ALT≥5×ULN;
• A history of splenectomy or splenic embolism;
• Acute or chronic thrombosis of the portal vein;
• Pregnancy or HIV infection;
• A history of transjugular intrahepatic portosystemic shunts (TIPs), endoscopic variceal ligation(EVL) , hardener or tissue gel therapy;
• A history of using non-selective beta blockers (NSBB) or diuretic in the last 3 months;
• Persistent substance abuse other than alcohol;
• There are conditions that seriously affect TE and 2D-SWE measurements (such as the intercostal space is too narrow, BMI≥30, etc.);
• There are contraindications of gastroscopy (such as heart failure, severe coagulation dysfunction, hepatic encephalopathy, etc.);
• Subjects considered unsuitable for including in this study but not included by the above exclusion criteria.