Transient Elastography (Fibroscan) for the Prediction of Esophageal Varices in Egyptian Cirrhotic Patients

Background: Esophageal varices (EVs) are atypically dilated submucosal veins, which occurs consequently to portal hypertension. Liver stiffness measurement (LSM), obtained by transient elastography (Fibroscan), strongly correlates with portal hypertension. 
Aim: Is to predict the presence and grading of esophageal varices in Egyptian patients with liver cirrhosis using Fibroscan and other noninvasive tests. 
Methods: A 101 cirrhotic patients indicated for upper endoscopy were enrolled consecutively and subdivided according to endoscopic findings into: Group I (70 patients with EVs) and Group II (31 patients without EVs). Upper endoscopy, ultrasonography, routine lab. and Fibroscan assessment were done to all patients. 
Results: LSM correlated directly and significantly with the presence (p <0.001), and grading of EVs (p = 0.001). A LSM cut off value of 18.55 kPa had an AUC of 0.726, sensitivity of 74.3%, specificity of 54.8%, PPV of 78.79%, and a NPV of 48.57% for predicting the presence of EVs. Platelet count/spleen diameter ratio (PSR) inversely correlated with the EVs presence (p = 0.002), and grading (p <0.001). PSR had a cut off value of 742.17, an AUC of 0.695, sensitivity of 71% and a specificity of 58.6% (PPV of 82%, NPV of 43.14%) for EVs presence. Right lobe diameter/Albumin ratio (RLAR) correlated directly with EVs presence (p = 0.001), and grading (p =0.012). RLAR cut off value of 3.62 had AUC, sensitivity, specificity, PPV, and NPV of 0.7, 64.3%, 67.7%, 81.8%, and 45.7%, respectively for the prediction of EVs presence. 
Conclusion: LSM, PSR, RLAR as noninvasive methods for predicting the presence and grading of EVs are of moderate accuracy.