Platelet count and abdominal dynamic CT are useful in predicting and screening for gastroesophageal varices after Fontan surgery.

OBJECTIVE: Patients who undergo Fontan surgery for complex cardiac anomalies are prone to developing liver and gastrointestinal complications. In particular, gastroesophageal varices (GEVs) can occur, but their prevalence is unknown. We aimed to elucidate the occurrence of GEVs and the predicting parameters of GEVs in these patients. MATERIALS AND METHODS: Twenty-seven patients (median age, 14.8 years; median time since surgery, 12.9 years) who had undergone the Fontan surgery and were examined by abdominal dynamic computed tomography (CT) for the routine follow-up were included in the study. Radiological findings including GEVs and extraintestinal complications were retrospectively evaluated by experienced radiologists in a blinded manner. Relationships between blood-biochemical and demographic parameters and the presence of GEVs were statistically analyzed. RESULTS: Dynamic CT revealed gastric varices (n = 3, 11.1%), esophageal varices (n = 1, 3.7%), and gastrorenal shunts (n = 5, 18.5%). All patients with gastric varices had gastrorenal shunts. All gastric varices were endoscopically confirmed as being isolated and enlarged, with indications for preventive interventional therapy. A platelet count lower than 119 × 109 /L was identified as a predictor of GEV (area under the receiver operating curve, 0.946; sensitivity, 100%; and specificity, 87%). CONCLUSIONS: GEVs are important complications that should not be ignored in patients who have undergone a Fontan procedure. Platelet counts lower than 119 × 109 /L may help to prompt patient screening by using abdominal dynamic CT to identify GEVs and their draining collateral veins in these patients.

Assessing liver stiffness with conventional cut-off values overestimates liver fibrosis staging in patients who received the Fontan procedure.

AIM: Patients who undergo the Fontan procedure for complex congenital heart disease are prone to liver cirrhosis. Liver stiffness (LS) reflects liver fibrosis stage in patients with chronic viral hepatitis; however, its accuracy in predicting liver fibrosis stage in Fontan patients is controversial. We aimed to clarify the correlation between LS and liver fibrosis stage in Fontan patients. METHODS: Fifty-eight Fontan patients were prospectively measured for LS with transient elastography. We undertook liver biopsy, cardiac catheterization, and laboratory tests in 22 of these patients (median age, 14.7 years; range, 9.9-32.1 years) with LS > 11.0 kPa (median, 19.2 kPa; range, 12.2-39.8 kPa); these elevated LS values suggest liver cirrhosis. RESULTS: Histologically, all patients showed mild-to-severe portal and sinusoidal fibrosis but no cirrhosis. Statistically, LS did not predict histological liver fibrosis scores (p = 0.175). Liver stiffness was not correlated with central venous pressure (p = 0.456) or with the hepatic venous pressure gradient (HVPG; p = 0.062), although the p value for HVPG was only slightly above the threshold for significance. CONCLUSIONS: Fontan patients are prone to developing both portal and sinusoidal fibrosis. Liver stiffness could be influenced by HVPG, and using the conventional cut-off values for LS overestimates and overtreats liver fibrosis in these patients.

Effects of obesity reduction on transient elastography-based parameters in pediatric non-alcoholic fatty liver disease.

AIM: To clarify the effects of obesity reduction on non-alcoholic fatty liver disease (NAFLD) in obese children. METHODS: Twenty-six obese pediatric NAFLD patients (median age, 13.0 years; range, 6.4-16.6 years), who underwent obesity management supported by regular hospital visits and/or hospital admission, were studied to explore how reductions in weight and body mass index (BMI) percentile affected two transient elastography-based parameters: controlled attenuation parameter (CAP) and liver stiffness (LS), which reflect the degree of hepatic fat deposition and liver fibrosis, respectively. RESULTS: Univariate analysis revealed that CAP reduction was correlated positively with baseline CAP and reductions in weight and BMI percentile (r = 0.320-0.525), whereas LS reduction was correlated positively with baseline LS and reductions in weight, BMI percentile, aspartate transaminase, and alanine aminotransferase (r = 0.385-0.625). Multivariate analysis revealed that baseline CAP and reduction in weight were significantly associated with CAP reduction, whereas reduction in weight and alanine aminotransferase were significantly associated with LS reduction. Short-term weight control by hospital admission (24.9 ±â€¯9.5 days) provided significantly higher reductions in weight and BMI percentile (both P < 0.001) and was associated with reductions of CAP and LS (P = 0.04 and 0.01) compared with regular hospital visit-supported self-directed weight management (0.9 ±â€¯0.8 years). CONCLUSIONS: Weight reduction in obese pediatric NAFLD patients resulted in reduced hepatic fat deposition and liver stiffness. Weight control by short-term hospital admission is an alternative approach to regular hospital visit-supported self-directed weight management in NAFLD patients who fail to reduce obesity.