الفهرس 
Validation of liver stiffness measurement by using fibroscan in grading and prediction of the risk of bleeding of gastro-esophageal varices in HCV related cirrhotic patients
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Abstract
Liver stiffness (LS) measured by transient elastography (TE) had studied portal hypertension and presence of oesophageal varices (OV).This study investigated value of LS and splenic stiffness (SS) in prediction, grading and risk of bleeding OV. Methods: 250 Egyptian HCV related cirrhotic patients, age {u2265}18, body mass index (BMI) < 35 with no history of ascites, GIT bleeding, HCC, abdominal collaterals, portal or splenic vein thrombosis by ultrasonography. Patients underwent upper gastrointestinal endoscopy and fibro scan. Demographic, biochemical, endoscopic data and LS and SS parameters were collected. They divided into group I= no varices, group II =small varices, group III = large varices. All Groups were age and BMI matched, in group III platelet count was lower and MELD was higher significantly than groups I and II (115.4±41.6 vs149.6±60.6 and 132.1±44.9) and (12.1±2.9 vs 9.1+2.5 and 10.1+2.2) respectively. Mean LS in group I vs II and III was (20.5±4.3 vs 40.5±11.9 and 61.4±13.1), cutoff value for presence of OV: 27.3 Kpa (sensitivity 92.5% and specificity 98%) while LS cutoff value between group II and III: 40.9 Kpa (sensitivity 93% and specificity 52%). LS in bleeding vs none bleeding OV was (66.6±10.5 vs 43.8±18.8), cutoff value 55.7 Kpa (sensitivity 91.7% and specificity 73.5%). SS cutoff values for prediction and grading of OV: 47.2 and 60.1 Kpa - sensitivity specificity; 90% / 80% - 100% / 50% respectively. 1- liver stiffness is highly sensitive and specific for prediction of presence and grading of OV as well as risk of bleeding. 2- Splenic stiffness is highly sensitive and specific in prediction with moderate specificity for grading of OV. 3- LS and SS could replace upper gastrointestinal endoscopy in screening for OV in HCV related cirrhotic patients