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Spleen Stiffness Measurement by Transient Elastography to Diagnose Portal Hypertension in Children

Goldschmidt, Imeke*; Brauch, Catharina*; Poynard, Thierry; Baumann, Ulrich*

Journal of Pediatric Gastroenterology & Nutrition: August 2014 - Volume 59 - Issue 2 - p 197–203
doi: 10.1097/MPG.0000000000000400
Original Articles: Hepatology and Nutrition

Background: The development of esophageal varices is a late complication of chronic liver disease (LD) in children. The diagnosis is presently limited to invasive procedures such as endoscopy. Noninvasive tools to diagnose the presence and degree of esophageal varices would alter management decisions and support indications for invasive procedures in affected children. The aim of the study was to test the feasibility of spleen stiffness measurement (SSM) by transient elastography (TE; FibroScan) in children and compare data on its diagnostic use with established markers of liver fibrosis and parameters of portal hypertension.

Methods: A total of 99 children (62 with chronic LD, 6 after liver transplantation, 31 controls) underwent SSM by TE. Fibrotest was determined in 37 children, 45 children had an additional liver stiffness measurement, and 19 underwent upper endoscopy.

Results: SSM by FibroScan is feasible. Spleen size significantly determined success rate (90.5% in patients with splenomegaly vs 70.2% in patients without, P = 0.02). Spleen stiffness was significantly higher in patients with splenomegaly (62.96 vs 18.4 kPa, P < 0.001), in patients with varices (75 vs 24 kPa, P < 0.01), and in patients with a history of variceal hemorrhage (75 vs 50.25 kPa, P < 0.05). Variceal hemorrhage did not occur in patients with SSM results <60 kPa. Spleen stiffness decreased after liver transplantation, but remained elevated compared with controls (27.5 vs 16.3 kPa). Liver stiffness measurements and Fibrotest did not reflect the presence or degree of esophageal varices.

Conclusions: SSM by TE is feasible in children and the results reflect the degree and occurrence of complications. A prospective follow-up study with larger patient numbers and performance of screening endoscopies appears justified and desirable.

*Division of Pediatric Gastroenterology and Hepatology, Hannover Medical School, Hannover, Germany

Department of Hepato-Gastroenterology, Groupe Hospitalier Pitié-Salpêtrière, Paris, France.

Address correspondence and reprint requests to Imeke Goldschmidt, MD, Hannover Medical School, Pediatric Gastroenterology and Hepatology, Carl-Neuberg-Strasse 1, 30625 Hannover, Germany (e-mail: Goldschmidt.imeke@mh-hannover.de).

Received 18 December, 2013

Accepted 5 April, 2014

Drs Goldschmidt and Brauch contributed equally to the article.

This work was supported by a grant from the German Federal Ministry of Education and Research (reference number 01EO0802), which covered 50% of I.G.'s salary.

T.P. is the inventor of the Fibrotest. The other authors report no conflicts of interest.

© 2014 by European Society for Pediatric Gastroenterology, Hepatology, and Nutrition and North American Society for Pediatric Gastroenterology,