A0480 - Endoscopic Ultrasound-Guided Shear Wave Elastography of the Liver and Spleen to Predict Complications of Cirrhosis and Correlation With EUS-Guided Portal Pressure Gradient

Sunday, October 23, 2022

5:00 PM – 7:00 PM ET

Location: Crown Ballroom

Has Audio

Presenting Author(s)

Joseph Simmons, MD

Marshall University Joan C. Edwards School of Medicine
Huntington, WV

Joseph Simmons, MD¹, Tejas Joshi, MD¹, Fredy Nehme, MD, MS², Ahmed Sherif, MD¹, Wesam Frandah, MD¹
¹Marshall University Joan C. Edwards School of Medicine, Huntington, WV; ²University of Texas MD Anderson Cancer Center, Houston, TX

Introduction: Endo-hepatology (EH) is an emerging field which utilizes endoscopic ultrasound (EUS) to evaluate patients with chronic liver disease (CLD). This workup includes EUS-guided liver biopsies, EUS-guided portal pressure gradients (EUS-PPG), EUS-shear wave elastography of the liver (EUS-SWE-L) and spleen (EUS-SWE-S). Our study aimed to determine a correlation between EUS-SWE of the liver , spleen, and EUS-PPG and complications of CLD.

Methods: Retrospective analysis of 28 patients from 2021-22. Pearson correlation (PC) coefficients were used to compare EUS-SWE-L and EUS-SWE-S to EUS-PPG. T tests were used to compare EUS-SWE-L and EUS-SWE-S to complications of CLD such as ascites, presence of esophageal varices, and thrombocytopenia. Receiver Operating Characteristics Curve (ROCC) analysis was done to evaluate the utility of shear wave/liver stiffness and shear wave/spleen stiffness to predict the presence of esophageal varices or ascites.

Results: 23 patients underwent EUS-SWE-S and 20 had EUS-PPG. Significant correlation noted between platelet count and EUS-SWE-L measurement (PC= -0.496, p=0.01). There was a significant difference in EUS-SWE-L measurement in patients with and without thrombocytopenia (28.90 kPa vs. 17.66 kPa, p=0.002) and in those with and without ascites (29.67 kPa vs. 18.64 kPa, p=0.003). There was also a significant difference in EUS-SWE-S measurements in patients with and without ascites (39.44 kPa vs. 30.06 kPa, p= 0.029). There was a weak correlation between EUS-PPG and EUS-SWE-S (PC = -0.45, p=0.05). ROCC analysis determined the best cut-off for EUS-SWE-L to predict the presence of esophageal varices or ascites was > 22.7 kPa with sensitivity of 78.6% and specificity of 55.6%. Best cut-off for EUS-SWE-S to predict the presence of esophageal varices or ascites was > 31.12 kPa with sensitivity of 85.7% and specificity of 55.6%.

Discussion: EUS-SWE of Liver and Spleen showed utility in predicting complications of liver disease such as varices, ascites and thrombocytopenia. There was also a weak, but statistically insignificant correlation between EUS-SWE-S and EUS-PPG. The limitations of our study include small sample size and, therefore, decreased power of the study. Further evaluation with a larger sample size is needed to better elucidate the findings determined in our study regarding EUS-PPG, EUS-SWE-S, and EUS-SWE-L. Our data suggests that these techniques have significant potential in determining those at greatest risk of complications of clinically significant CLD.

Figure: Descriptive Statistical Analysis

Table 1: Patient characteristics
Total number of patients, n	28
Age, mean in years (std. dev.)	50.25 (+/- 12.02)
Male, n (%)	16 (57%)
Race- white, n (%)	28 (100%)
BMI, mean (std. dev)	31.53 (+/- 9.85)
Liver biopsy performed, n (%)	22 (78.6%)
Stage > F3 on biopsy, n (%)	16 (72.7%)
Esophageal varices, n (%)	9 (32.1%)
Ascites, n (%)	12 (42.9%)
Plt count < 150, n (%)	16 (57.1%)
MELD-Na, mean (std. dev.)	12.67 (+/- 4.97)
Child score, mean (std. dev.)	6.81 (+/- 1.82)

Table: Table 1: Patient characteristics

Disclosures:

Joseph Simmons indicated no relevant financial relationships.

Tejas Joshi indicated no relevant financial relationships.

Fredy Nehme indicated no relevant financial relationships.

Ahmed Sherif indicated no relevant financial relationships.

Wesam Frandah: Endo gastric solution – Consultant. Olympus – Consultant.

Joseph Simmons, MD¹, Tejas Joshi, MD¹, Fredy Nehme, MD, MS², Ahmed Sherif, MD¹, Wesam Frandah, MD¹. A0480 - Endoscopic Ultrasound-Guided Shear Wave Elastography of the Liver and Spleen to Predict Complications of Cirrhosis and Correlation With EUS-Guided Portal Pressure Gradient, ACG 2022 Annual Scientific Meeting Abstracts. Charlotte, NC: American College of Gastroenterology.