Prediction for Improvement of Liver Function after Balloon-Occluded Retrograde Transvenous Obliteration for Gastric Varices to Manage Portosystemic Shunt Syndrome

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• 作者：Akira Yamamoto ; MD ; PhD^a ; Norifumi Nishida ; MD ; PhD^a ; ^{norifumin@med.osaka-cu.ac.jp" class="auth_mail" title="E-mail the corresponding author} ; Hiroyasu Morikawa ; MD ; PhD^b ; Atsushi Jogo ; MD ; PhD^a ; Ken Kageyama ; MD ; PhD^a ; Etsuji Sohgawa ; MD ; PhD^a ; Shinichi Hamamoto ; MD ; PhD^a ; Toru Takeshita ; MD ; PhD^a ; Yukimasa Sakai ; MD ; PhD^a ; Toshiyuki Matsuoka ; MD ; PhD^a ; Norifumi Kawada ; MD ; PhD^c ; Yukio Miki ; MD ; PhD^a
• 关键词：BRTO ; balloon-occluded retrograde transvenous obliteration ; EV ; esophageal varices ; GV ; gastric varices ; LSM ; liver stiffness measurement ; PSS ; portosystemic shunt syndrome ; PT ; prothrombin time ; ROC ; receiver operating characteristic ; T-bil ; total bilirubin ; TE ; transient elastography
• 刊名：Journal of Vascular and Interventional Radiology
• 出版年：2016
• 出版时间：August 2016
• 年：2016
• 卷：27
• 期：8
• 页码：1160-1167
• 全文大小：978 K

文摘

To investigate predictive factors and cutoff value of transient elastography (TE) measurements for assessing improvement in liver function after balloon-occluded retrograde transvenous obliteration (BRTO) for gastric varices (GV).

Materials and Methods

Retrospective analysis was performed of 50 consecutive patients followed for > 3 months after BRTO, who had undergone TE before BRTO between January 2011 and February 2015. The correlation between change in liver function (total bilirubin, albumin, and prothrombin time) and baseline liver function values and liver stiffness measurement (LSM) by TE was evaluated by Pearson correlation test. Receiver operating characteristic curves were used to determine cutoff values for discriminating between patients who had improved liver function and patients who did not. The time interval from BRTO to aggravation of esophageal varices (EV) (worsening morphology, development of new varices, or variceal rupture) grouped by cutoff values was also analyzed.

Results

Serum albumin was significantly improved at 3 months after BRTO (3.57 g/dL vs 3.74 g/dL, P < .001). There was a significant negative correlation between change in albumin and baseline LSM (r = –0.50, P < .001). The best cutoff point for LSM was ≤ 22.9 kPa, with sensitivity and specificity of 78.4% and 69.2%, respectively, for predicting which patients would have improved albumin after BRTO. Among 33 patients, 29 (88%) patients had improved albumin. The 1-year progression rate of EV after BRTO was 13.6% in patients with LSM ≤ 22.9 kPa.

Conclusions

The predictive factor for improvement in albumin after BRTO was lower LSM (≤ 22.9 kPa) using TE.