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Open Access 29-10-2024 | Portal Hypertension | Original Article―Liver, Pancreas, and Biliary Tract

Novel subharmonic-aided pressure estimation for identifying high-risk esophagogastric varices

Authors: Hidekatsu Kuroda, Tamami Abe, Naohisa Kamiyama, Takuma Oguri, Asami Ito, Ippeki Nakaya, Takuya Watanabe, Hiroaki Abe, Kenji Yusa, Yudai Fujiwara, Hiroki Sato, Akiko Suzuki, Kei Endo, Yuichi Yoshida, Takayoshi Oikawa, Keisuke Kakisaka, Kei Sawara, Akio Miyasaka, Takayuki Matsumoto

Published in: Journal of Gastroenterology

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Abstract

Background

Subharmonic-aided pressure estimation (SHAPE) is a technique for determining changes in ambient pressure. We aimed to analyze a novel SHAPE integrated into ultrasound diagnostic equipment to predict patients with liver cirrhosis at high risk of esophagogastric varices (EV).

Methods

This prospective study included 111 patients with liver cirrhosis diagnosed between 2020 and 2023. We obtained liver stiffness measurements (LSM) and spleen stiffness measurements (SSM) using shear wave elastography and hepatic vein-portal vein (HV-PV) gradient using the SHAPE method. The EV risk was determined either as null, low, or high by esophagoscopy and Child–Pugh stage.

Results

HV-PV gradient increased concordantly with the increase in EV risk (− 7.0 dB in null-risk, − 4.4 dB in low-risk, and − 2.0 dB in high-risk) with statistically significant difference among any two groups. The most appropriate cut-off value of the HV-PV gradient was − 3.5 dB, and sensitivity, specificity, and positive and negative predictive values were 80.0%, 89.0%, 80.0%, and 88.0%, respectively. The areas under the curve values for predicting the high-risk EV were 0.920, 0.843, and 0.824 for the HV-PV gradient, LSM, and SSM, respectively.

Conclusions

The novel SHAPE system demonstrated high accuracy in identifying patients with liver cirrhosis at a high risk of EV.
Appendix
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Literature
1.
go back to reference Lee EW, Eghtesad B, Garcia-Tsao G, et al. AASLD Practice Guidance on the use of TIPS, variceal embolization, and retrograde transvenous obliteration in the management of variceal hemorrhage. Hepatology. 2024;79:224–50.CrossRefPubMed Lee EW, Eghtesad B, Garcia-Tsao G, et al. AASLD Practice Guidance on the use of TIPS, variceal embolization, and retrograde transvenous obliteration in the management of variceal hemorrhage. Hepatology. 2024;79:224–50.CrossRefPubMed
2.
3.
go back to reference Garcia-Tsao G, Abraldes JG, Berzigotti A, et al. Portal hypertensive bleeding in cirrhosis: risk stratification, diagnosis, and management: 2016 practice guidance by the American Association for the Study of Liver Diseases. Hepatology. 2017;65:310–35.CrossRefPubMed Garcia-Tsao G, Abraldes JG, Berzigotti A, et al. Portal hypertensive bleeding in cirrhosis: risk stratification, diagnosis, and management: 2016 practice guidance by the American Association for the Study of Liver Diseases. Hepatology. 2017;65:310–35.CrossRefPubMed
4.
5.
go back to reference Magaz M, Baiges A, Hernández-Gea V. Precision medicine in variceal bleeding: are we there yet? J Hepatol. 2020;72:774–84.CrossRefPubMed Magaz M, Baiges A, Hernández-Gea V. Precision medicine in variceal bleeding: are we there yet? J Hepatol. 2020;72:774–84.CrossRefPubMed
6.
go back to reference Allaire M, Thabut D. Portal hypertension and variceal bleeding in patients with liver cancer: evidence gaps for prevention and management. Hepatology. 2024;79:213–23.CrossRefPubMed Allaire M, Thabut D. Portal hypertension and variceal bleeding in patients with liver cancer: evidence gaps for prevention and management. Hepatology. 2024;79:213–23.CrossRefPubMed
7.
go back to reference Mullady DK, Wang AY, Waschke KA. AGA clinical practice update on endoscopic therapies for non-variceal upper gastrointestinal bleeding: expert review. Gastroenterology. 2020;159:1120–8.CrossRefPubMed Mullady DK, Wang AY, Waschke KA. AGA clinical practice update on endoscopic therapies for non-variceal upper gastrointestinal bleeding: expert review. Gastroenterology. 2020;159:1120–8.CrossRefPubMed
8.
go back to reference de Franchis R, Bosch J, Garcia-Tsao G, et al. Baveno VII—renewing consensus in portal hypertension. J Hepatol. 2022;76:959–74.CrossRefPubMed de Franchis R, Bosch J, Garcia-Tsao G, et al. Baveno VII—renewing consensus in portal hypertension. J Hepatol. 2022;76:959–74.CrossRefPubMed
9.
go back to reference D’Amico G, Garcia-Tsao G, Pagliaro L. Natural history and prognostic indicators of survival in cirrhosis: a systematic review of 118 studies. J Hepatol. 2006;44:217–31.CrossRefPubMed D’Amico G, Garcia-Tsao G, Pagliaro L. Natural history and prognostic indicators of survival in cirrhosis: a systematic review of 118 studies. J Hepatol. 2006;44:217–31.CrossRefPubMed
10.
go back to reference Brocchi E, Caletti G, Brambilla G, et al. Prediction of the first variceal hemorrhage in patients with cirrhosis of the liver and esophageal varices. A prospective multicenter study. N Engl J Med. 1988;319:983–9.CrossRef Brocchi E, Caletti G, Brambilla G, et al. Prediction of the first variceal hemorrhage in patients with cirrhosis of the liver and esophageal varices. A prospective multicenter study. N Engl J Med. 1988;319:983–9.CrossRef
11.
go back to reference Merli M, Nicolini G, Angeloni S, et al. Incidence and natural history of small esophageal varices in cirrhotic patients. J Hepatol. 2003;38:266–72.CrossRefPubMed Merli M, Nicolini G, Angeloni S, et al. Incidence and natural history of small esophageal varices in cirrhotic patients. J Hepatol. 2003;38:266–72.CrossRefPubMed
12.
go back to reference Yeo YH, Hwang J, Jeong D, et al. Surveillance of patients with cirrhosis remains suboptimal in the United States. J Hepatol. 2021;75:856–64.CrossRefPubMed Yeo YH, Hwang J, Jeong D, et al. Surveillance of patients with cirrhosis remains suboptimal in the United States. J Hepatol. 2021;75:856–64.CrossRefPubMed
13.
go back to reference Franchis D, Abraldes JG, Bajaj J, et al. Expanding consensus in portal hypertension: report of the Baveno VI consensus workshop: stratifying risk and individualizing care for portal hypertension. J Hepatol. 2015;63:743–52.CrossRefPubMed Franchis D, Abraldes JG, Bajaj J, et al. Expanding consensus in portal hypertension: report of the Baveno VI consensus workshop: stratifying risk and individualizing care for portal hypertension. J Hepatol. 2015;63:743–52.CrossRefPubMed
14.
go back to reference Castro Filho ÉC, Fernandes FF, Villela-Nogueira C, et al. Validation of the Baveno VI criteria to rule out high-risk varices using hepatic shear-wave elastography. Eur J Gastroenterol Hepatol. 2023;35:559–67.CrossRefPubMed Castro Filho ÉC, Fernandes FF, Villela-Nogueira C, et al. Validation of the Baveno VI criteria to rule out high-risk varices using hepatic shear-wave elastography. Eur J Gastroenterol Hepatol. 2023;35:559–67.CrossRefPubMed
15.
go back to reference Wong GLH, Kwok R, Hui AJ, et al. A new screening strategy for varices by liver and spleen stiffness measurement (LSSM) in cirrhotic patients: a randomized trial. Liver Int. 2018;38:636–44.CrossRefPubMed Wong GLH, Kwok R, Hui AJ, et al. A new screening strategy for varices by liver and spleen stiffness measurement (LSSM) in cirrhotic patients: a randomized trial. Liver Int. 2018;38:636–44.CrossRefPubMed
16.
go back to reference Wang H, Wen B, Chang X, et al. Baveno VI criteria and spleen stiffness measurement rule out high-risk varices in virally suppressed HBV-related cirrhosis. J Hepatol. 2021;74:584–92.CrossRefPubMed Wang H, Wen B, Chang X, et al. Baveno VI criteria and spleen stiffness measurement rule out high-risk varices in virally suppressed HBV-related cirrhosis. J Hepatol. 2021;74:584–92.CrossRefPubMed
17.
go back to reference Ishikawa T, Egusa M, Fujioka T, et al. A combination of liver stiffness and international normalized ratio is an ideal prognostic predictor of portosystemic shunt occlusion in patients with portal hypertension. J Gastroenterol. 2023;58:246–56.CrossRefPubMed Ishikawa T, Egusa M, Fujioka T, et al. A combination of liver stiffness and international normalized ratio is an ideal prognostic predictor of portosystemic shunt occlusion in patients with portal hypertension. J Gastroenterol. 2023;58:246–56.CrossRefPubMed
19.
go back to reference Halldorsdottir VG, Dave JK, Eisenbrey JR, et al. Subharmonic aided pressure estimation for monitoring interstitial fluid pressure in tumours—in vitro and in vivo proof of concept. Ultrasonics. 2014;54:1938–44.CrossRefPubMedPubMedCentral Halldorsdottir VG, Dave JK, Eisenbrey JR, et al. Subharmonic aided pressure estimation for monitoring interstitial fluid pressure in tumours—in vitro and in vivo proof of concept. Ultrasonics. 2014;54:1938–44.CrossRefPubMedPubMedCentral
20.
go back to reference Halldorsdottir VG, Dave JK, Marshall A, et al. Subharmonic-aided pressure estimation for monitoring interstitial fluid pressure in tumors: calibration and treatment with paclitaxel in breast cancer xenografts. Ultrasound Med Biol. 2017;43:1401–10.CrossRefPubMedPubMedCentral Halldorsdottir VG, Dave JK, Marshall A, et al. Subharmonic-aided pressure estimation for monitoring interstitial fluid pressure in tumors: calibration and treatment with paclitaxel in breast cancer xenografts. Ultrasound Med Biol. 2017;43:1401–10.CrossRefPubMedPubMedCentral
21.
go back to reference Eisenbrey JR, Dave JK, Halldorsdottir VG, et al. Chronic liver disease: noninvasive subharmonic aided pressure estimation of hepatic venous pressure gradient. Radiology. 2013;268:581–8.CrossRefPubMedPubMedCentral Eisenbrey JR, Dave JK, Halldorsdottir VG, et al. Chronic liver disease: noninvasive subharmonic aided pressure estimation of hepatic venous pressure gradient. Radiology. 2013;268:581–8.CrossRefPubMedPubMedCentral
22.
go back to reference Gupta I, Eisenbrey JR, Machado P, et al. Diagnosing portal hypertension with noninvasive subharmonic pressure estimates from a US contrast agent. Radiology. 2021;298:104–11.CrossRefPubMed Gupta I, Eisenbrey JR, Machado P, et al. Diagnosing portal hypertension with noninvasive subharmonic pressure estimates from a US contrast agent. Radiology. 2021;298:104–11.CrossRefPubMed
23.
go back to reference Machado P, Gupta I, Fenkel JM, et al. Ultrasound pressure estimation for diagnosing portal hypertension in patients undergoing dialysis for chronic kidney disease. J Ultrasound Med. 2022;41:2181–9.CrossRefPubMed Machado P, Gupta I, Fenkel JM, et al. Ultrasound pressure estimation for diagnosing portal hypertension in patients undergoing dialysis for chronic kidney disease. J Ultrasound Med. 2022;41:2181–9.CrossRefPubMed
25.
go back to reference Loomba R, Adams LA. Advances in non-invasive assessment of hepatic fibrosis. Gut. 2020;69:1343–52.CrossRefPubMed Loomba R, Adams LA. Advances in non-invasive assessment of hepatic fibrosis. Gut. 2020;69:1343–52.CrossRefPubMed
26.
go back to reference Dave JK, Halldorsdottir VG, Eisenbrey JR, et al. On the implementation of an automated acoustic output optimization algorithm for subharmonic aided pressure estimation. Ultrasonics. 2013;53:880–8.CrossRefPubMedPubMedCentral Dave JK, Halldorsdottir VG, Eisenbrey JR, et al. On the implementation of an automated acoustic output optimization algorithm for subharmonic aided pressure estimation. Ultrasonics. 2013;53:880–8.CrossRefPubMedPubMedCentral
27.
go back to reference Halldorsdottir VG, Dave JK, Leodore LM, et al. Subharmonic contrast microbubble signals for noninvasive pressure estimation under static and dynamic flow conditions. Ultrason Imaging. 2011;33:153–64.CrossRefPubMedPubMedCentral Halldorsdottir VG, Dave JK, Leodore LM, et al. Subharmonic contrast microbubble signals for noninvasive pressure estimation under static and dynamic flow conditions. Ultrason Imaging. 2011;33:153–64.CrossRefPubMedPubMedCentral
28.
go back to reference Dietrich CF, Bamber J, Berzigotti A, et al. EFSUMB guidelines and recommendations on the clinical use of liver ultrasound elastography, Update 2017 (Long Version). Ultraschall Med. 2017;38:e16–47.CrossRefPubMed Dietrich CF, Bamber J, Berzigotti A, et al. EFSUMB guidelines and recommendations on the clinical use of liver ultrasound elastography, Update 2017 (Long Version). Ultraschall Med. 2017;38:e16–47.CrossRefPubMed
29.
go back to reference Ferraioli G, Filice C, Castera L, et al. WFUMB guidelines and recommendations for clinical use of ultrasound elastography: Part 3: liver. Ultrasound Med Biol. 2015;41:1161–79.CrossRefPubMed Ferraioli G, Filice C, Castera L, et al. WFUMB guidelines and recommendations for clinical use of ultrasound elastography: Part 3: liver. Ultrasound Med Biol. 2015;41:1161–79.CrossRefPubMed
30.
go back to reference Leung VY, Shen J, Wong VW, et al. Quantitative elastography of liver fibrosis and spleen stiffness in chronic hepatitis B carriers: comparison of shear-wave elastography and transient elastography with liver biopsy correlation. Radiology. 2013;269:910–8.CrossRefPubMed Leung VY, Shen J, Wong VW, et al. Quantitative elastography of liver fibrosis and spleen stiffness in chronic hepatitis B carriers: comparison of shear-wave elastography and transient elastography with liver biopsy correlation. Radiology. 2013;269:910–8.CrossRefPubMed
31.
go back to reference Jansen C, Bogs C, Verlinden W, et al. Shear-wave elastography of the liver and spleen identifies clinically significant portal hypertension: a prospective multicentre study. Liver Int. 2017;37:396–405.CrossRefPubMed Jansen C, Bogs C, Verlinden W, et al. Shear-wave elastography of the liver and spleen identifies clinically significant portal hypertension: a prospective multicentre study. Liver Int. 2017;37:396–405.CrossRefPubMed
32.
go back to reference Kuroda H, Fujiwara Y, Abe T, et al. Two-dimensional shear wave elastography and ultrasound-guided attenuation parameter for progressive non-alcoholic steatohepatitis. PLoS ONE. 2021;16: e0249493.CrossRefPubMedPubMedCentral Kuroda H, Fujiwara Y, Abe T, et al. Two-dimensional shear wave elastography and ultrasound-guided attenuation parameter for progressive non-alcoholic steatohepatitis. PLoS ONE. 2021;16: e0249493.CrossRefPubMedPubMedCentral
33.
go back to reference Tajiri T, Yoshida H, Obara K, et al. General rules for recording endoscopic findings of esophagogastric varices (2nd edition). Dig Endosc. 2010;22:1–9.CrossRefPubMed Tajiri T, Yoshida H, Obara K, et al. General rules for recording endoscopic findings of esophagogastric varices (2nd edition). Dig Endosc. 2010;22:1–9.CrossRefPubMed
34.
go back to reference Hajian-Tilaki K. Sample size estimation in diagnostic test studies of biomedical informatics. J Biomed Inform. 2014;48:193–204.CrossRefPubMed Hajian-Tilaki K. Sample size estimation in diagnostic test studies of biomedical informatics. J Biomed Inform. 2014;48:193–204.CrossRefPubMed
Metadata
Title
Novel subharmonic-aided pressure estimation for identifying high-risk esophagogastric varices
Authors
Hidekatsu Kuroda
Tamami Abe
Naohisa Kamiyama
Takuma Oguri
Asami Ito
Ippeki Nakaya
Takuya Watanabe
Hiroaki Abe
Kenji Yusa
Yudai Fujiwara
Hiroki Sato
Akiko Suzuki
Kei Endo
Yuichi Yoshida
Takayoshi Oikawa
Keisuke Kakisaka
Kei Sawara
Akio Miyasaka
Takayuki Matsumoto
Publication date
29-10-2024
Publisher
Springer Nature Singapore
Published in
Journal of Gastroenterology
Print ISSN: 0944-1174
Electronic ISSN: 1435-5922
DOI
https://doi.org/10.1007/s00535-024-02161-4

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