Evaluation of liver stiffness by 2D-SWE in combination with non-invasive parameters as predictors for esophageal varices in patients with advanced chronic liver disease.

Background/aims: Esophageal varices (EV) are common complications in patients with advanced chronic liver disease (ACLD). Non-invasive parameters to exclude EV in patients with ACLD would be desirable. The aim of this study was the evaluation of liver stiffness measurement (LSM) using 2D-shear wave elastography (GE Logiq E9) and other non-invasive parameters as predictors for EV. Methods: Hundred patients with ACLD were enrolled. Abdominal sonography, including measurement of gall bladder wall thickness (GBWT), spleen diameter and LSM, gastroscopy and blood test results were evaluated. Statistical analyses were performed for the association between EV and non-invasive parameters. Results: Fifty-one per cent of the patients had EV. The mean LSM (14.6 kPa) and GBWT (3.88 mm) in the group with EV were significantly higher than in the group without EV (10.6 kPa; 2.94 mm; p < .01). Performing area under the receiver operating characteristic curve, LSM has a better diagnostic performance (0.781) than GBWT (0.707), spleen diameter (0.672) and platelet count (0.635). Combining LSM (cut-off 13.58 kPa) and GBWT (cut-off 3.07 mm) resulted in a sensitivity of 86.3% and a specificity of 71.4% for the presence of EV. A sensitivity of 100% (negative predictive value 1.0) was achieved at LSM >9 kPa or GBWT >4 mm. Following these criteria in our current study population, 18% of the gastroscopies could have been avoided. Conclusions: Combining LSM with non-invasive parameters, especially GBWT, improves the diagnostic accuracy for predicting EV. We suggest reconsidering screening gastroscopy in patients with ACLD who show LSM <9 kPa and GBWT <4 mm due to the very low risk of having varices.

Gall bladder wall thickening as non-invasive screening parameter for esophageal varices - a comparative endoscopic - sonographic study.

BACKGROUND: The mortality due to hemorrhage of esophageal varices (EV) is still high. The predominant cause for EV is liver cirrhosis, which has a high prevalence in Western Europe. Therefore, non-invasive screening markers for the presence of EV are of interest. Here, we aim to investigate whether non-inflammatory gall bladder wall thickening (GBWT) may serve as predictor for the presence of EV in comparison and combination with other non-invasive clinical and laboratory parameters. METHODS: One hundred ninety four patients were retrospectively enrolled in the study. Abdominal ultrasound, upper endoscopy and blood tests were evaluated. GBWT, spleen size and the presence of ascites were evaluated by ultrasound. Platelet count and Child-Pugh-score were also recorded. The study population was categorized in two groups: 122 patients without esophageal varices (non EV) compared to 72 patients with EV were analyzed by uni-and multivariate analysis. RESULTS: In the EV group 46% showed a non-inflammatory GBWT of ≥4 mm, compared to 12% in the non-EV group (p < 0.01). GBWT was significantly higher in EV patients compared to the non-EV group (mean: 4.4 mm vs. 2.8 mm, p < 0.0001), and multivariate analysis confirmed GBWT as independent predictor for EV (p < 0.04). The platelets/GBWT ratio (cut-off > 46.2) had a sensitivity and specificity of 78 and 86%, PPV 76% and NPV of 87%, and ROC analysis calculated the AUC of 0.864 (CI 0.809-0.919). CONCLUSIONS: GBWT occurs significantly more often in patients with EV. However, because of the low sensitivity, combination with other non-invasive parameters such as platelet count is recommended.

Gall Bladder Wall Thickening in Dengue Fever - Aid in Labelling Dengue Hemorrhagic Fever and a Marker of Severity.

Introduction Dengue fever is a mosquito-borne viral disease spread by the bite of the Aedes aegypti mosquito. Dengue epidemics have contributed to a great economic burden, especially in South-East Asia. This study aimed to determine gall bladder wall thickness (GBWT) in patients with dengue fever, assess its sensitivity and specificity to identify dengue hemorrhagic fever, and also compare gall bladder wall thickening (GWBT) with platelets, hematocrit, and leucocyte count. Materials and methods This prospective observational study was conducted in the dengue ward of Benazir Bhutto Hospital, Rawalpindi, Pakistan, from September 2019 to January 2020, i.e., four months. Patients admitted to the dengue ward diagnosed as seropositive and provided consent were enrolled into the study. Laboratory investigations (blood complete picture, liver function tests, renal function tests) were collected and recorded. Ultrasonography was performed on admission and subsequently during a hospital stay. Patients were divided into two groups: those with gall bladder wall thickness ≤ 3mm and Ëƒ3mm. All data were entered and analyzed on SPSS version 24 (IBM Inc., Armonk, USA). Results Out of 180 patients, 122 (67.8%) were male, and 58 (32.2%) female. The mean age was 33 ± 13 years. One hundred and six patients (58.9%) were diagnosed with dengue fever, 68 (37.8%) - dengue hemorrhagic fever, and six (3.3%) - dengue shock syndrome. The most common finding was gall bladder wall thickness ˃3mm (69/180; 38.3%) followed by ascites (38.1%). Sixty-two patients out of 69 (89.9%) with GBWT ˃3mm were managed as dengue hemorrhagic fever (p=0.000). Alanine transaminase (ALT), platelet, and total leukocyte count (TLC) were associated positively with an edematous gall bladder wall (p<0.005). The mean gall bladder wall thickness for dengue hemorrhagic fever was 6.4mm ± 2.5 mm. A GBWT value of 3.5mm was found to have 94.6% specificity and 91.2% sensitivity. Conclusion Gall bladder wall edema is strongly correlated with dengue hemorrhagic fever. Hence it should be assessed in all patients with dengue fever.

Patterns of Gall Bladder Wall Thickening in Dengue Fever: A Mirror of the Severity of Disease.

BACKGROUND: Dengue fever is a major public health problem with an increased incidence in recent years. Gall bladder wall thickening has been reported as one of the most common findings in dengue fever. There is a paucity of literature regarding the various patterns of gall bladder wall thickening in dengue fever and their significance in predicting the severity of disease. METHODOLOGY AND SIGNIFICANT FINDINGS: Out of 93 seropositive patients included in the study, 54 patients with dengue fever had gall bladder wall thickening. 4 patterns of gall bladder wall thickening are demonstrated in this study. A uniform echogenic pattern in 20 patients, striated or tram track pattern in 11 patients, an asymmetric pattern in 2 patients and a honeycombing pattern in 21 patients. The range of patterns of wall thickening included normal wall thickening or uniform echogenic wall thickening in DF without warning signs, a striated or tram track pattern, and a honeycomb pattern in severe DF. Serial ultrasound done on consecutive alternate days revealed a change in the pattern of gall bladder wall thickening according to the severity of disease. CONCLUSION: The present study revealed 4 distinct patterns of gall bladder wall thickening. The uniform echogenic pattern was found to be more prevalent in dengue fever without warning signs, while the honeycomb pattern was found to be more prevalent in severe dengue fever. A change in the pattern of gall bladder wall thickening on subsequent serial ultrasound can predict the severity of the disease.

Is Ultrasound a Useful Tool to Predict Severe Dengue Infection?

OBJECTIVES: To study the role of ultrasound in children with dengue fever and determine its role in predicting the severity of the disease. METHODS: This was a retrospective hospital based study conducted from 1(st) August 2012 to January 31(st) 2015 at a tertiary care hospital in Puducherry. RESULTS: Two hundred and fifty four children were admitted with dengue fever and among them non-severe dengue and severe dengue were seen in 62.6 % and 37.4 % respectively. Mean age of presentation was 7.0 (3.3) years. M: F ratio was 1.2:1 Ultrasound was performed on all children with dengue fever during the critical period of illness as an early sign of plasma leakage and at the time of discharge. The diagnosis was confirmed by NS1 antigen and dengue serology. Ultrasonography showed positive findings in 156 cases (61.4 %) during the critical period of illness. Ultrasound findings were analyzed using logistic regression among severe and non-severe dengue and P value of <0.05 was taken as significant. The common ultrasound findings that were significantly associated with severe dengue infection on univariate analysis were gall bladder wall thickening, ascites, pleural effusion, pericardial effusion, pericholecystic fluid, hepatomegaly, splenomegaly and mesenteric adenopathy. On multivariate analysis, gall bladder thickening and hepatomegaly were significantly associated with severe dengue infection. Gall bladder wall thickening (GBWT) with honeycombing pattern was the most specific finding in severe dengue infection in the study and significantly associated with severe thrombocytopenia (Platelet count <50,000/mm(3)). The clinical improvement coincided with resolving of the ultrasound findings at the time of discharge. CONCLUSIONS: Ultrasound can be used as an early predictor as well as an important prognostic sign for severe dengue infection especially during an epidemic.

Grosor de la pared vesicular en pacientes con hipertensión portal: Utilidad clínica

Introducción: El engrosamiento de la pared vesicular se halla poco frecuente en el ultrasonido abdominal de pacientes con cirrosis hepática e hipertensión portal. En este trabajo se determinó cual es su importancia en relación con la presencia de varices esofágicas y otras variables. Pacientes y Métodos: Estudio prospectivo y comparativo con un grupo de pacientes con Cirrosis hepática e hipertensión portal y otro control sin Enfermedad hepática. Se realizaron pruebas hepáticas, ultrasonido abdominal, doppler de la vena porta y endoscopia digestiva superior. Resultados: Se evaluaron 25 pacientes: 14 casos y 11 controles, edad promedio 46,28 + 17,47 vs 38,27 +10,63. Las diferencias entre ellos fueron: Diámetro de vena porta 10,78 + 2,54 vs 8,63 + 1,80 mm, p=0,02; Albúmina sérica 3,16 + 0,83 vs 4,13 + 0,48 gms., p=0,003 y grosor de pared vesicular 3,51 + 1,45 vs 1,77 + 0,45mm, p=0,0009). La sensibilidad del engrosamiento de la pared vesicular para el diagnóstico de varices esofágicas resultó 80 %, especificidad 93,3 %, Valor predictivo positivo 89 % y valor predictivo negativo 88 %. Se encontró asociación entre grosor de la pared vesicular, albúmina (r=0,5347, p=0,005) y el diámetro de la porta (r=0,4105, p= 0,041). No hubo diferencias en cuanto a Velocidad sistólica máxima p=0,13; Velocidad diastólica final p=0,22; ¸ndice de resistencia p=0,15, Flujo sanguíneo portal: p=0,94. No se logró demostrar relación entre el Grosor de pared vesicular y el Child Pugh (r=0,25, p= 0,386). Conclusiones: Existe relación entre el grosor de la pared vesicular y la presencia de varices esofágicas en los pacientes con cirrosis hepática.

Objetive: The thickening of the gall bladder wall is little common in the abdominal ultrasound of patients with liver cirrhosis and portal hypertension. In this work it was determined its importance in relation with the presence of esophageal varices and other variables. Patients and Methods: A prospective and comparative study was made (cases and controls). A group of patients with liver Cirrhosis and portal hypertension and another control without liver Disease. Were made Liver tests, abdominal ultrasound, Doppler of the porta vein and upper endoscopy. Results: Evaluated 25 patients; 14 cases patients, and 11 patients controls, mean age 46.28 ± 17.47 vs 38.27 ± 10, 63. Differences between them were: Vein diameter porta 10.78 + 2.54 vs 8.63 + 1.80mm, p=0,02; Seric albumin 3.16 + 0.83 vs. 4.13 + 0.48 gm, p=0,003 and gall bladder wall thickness 3.51 + 1.45 versus 1.77 + 0,45mm, p=0,0009. The sensitivity of the thickening gall bladder wall for the diagnosis of esophageal varices was of 80%, specificity 93.3%, predictive value positive 89% and predictive value negative 88%. Association was found between thickness of the gall bladder wall and albumin (r=0,5347, p=0,005) and the diameter of the porta (r=0,4105, p= 0.041). There was not differences respect to speed systolic Maximum p=0,13; diastolic speed final p=0,22; resistance index p=0,15; blood Flow portal: p=0,94. No profit to demonstrate between the Thickness of gall bladder wall and the Child Pugh (r=0, 25, p= 0.386).Conclusions: Relationship betwen the gall bladder wall thickening and the presence of esophageal varices in patients with cirrhosis of the liver and portal hypertension.