Background/Aims : This study was conducted to evaluate the efficacy of transient elastography (FibroscanⓇ) for predicting esophageal varices and esophageal variceal hemorrhage in patients with chronic liver diseases. Methods : We studied 245 patients (mean age: 50.1 years, male/female: 181/64) with chronic liver diseases to determine the relation between the clinical or serologic markers associated with liver fibrosis and tissue elastography, and these tests were performed in Feb 2007. The causes of chronic liver diseases were hepatitis B virus in 139 (56.7%), hepatitis C virus in 30 (12.2%), alcohol in 38 (15.5%), nonalcoholic fatty liver disease in 23 (9.4%), autoimmune liver disease in 3 (1.2%), and unknown 12 (4.9%). Results : Transient elastography was correlated with APRI (r=0.712) and the grades of esophageal varices (r=0.635). The AUROC values of transient elastography were 0.916 (95% CI: 0.838-0.954) for the presence of esophageal varices, 0.875 (95% CI: 0.819-0.931) for the esophageal varices grade ≥2, and 0.895 (95% CI: 0.846-0.945) for esophageal variceal hemorrhage. The cutoff values for 90% specificity were 15.3 kPa for esophageal varices, 20.7 kPa for esophageal varices grade ≥2 and 34.8 kPa for esophageal variceal hemorrhage, while the negative predictive values were 90%, 94% and 97%, respectively. Conclusions : Transient elastography was correlated with the presence of esophageal varices, the grades of esophageal varices and the presence of esophageal variceal hemorrhage. Therefore, this data may help to screen those patients how might undergo upper gastrointestinal endoscopy. (Korean J Med 74:491-499, 2008)

Background/Aims : This study was conducted to evaluate the efficacy of transient elastography (FibroscanⓇ) for predicting esophageal varices and esophageal variceal hemorrhage in patients with chronic liver diseases. Methods : We studied 245 patients (mean age: 50.1 years, male/female: 181/64) with chronic liver diseases to determine the relation between the clinical or serologic markers associated with liver fibrosis and tissue elastography, and these tests were performed in Feb 2007. The causes of chronic liver diseases were hepatitis B virus in 139 (56.7%), hepatitis C virus in 30 (12.2%), alcohol in 38 (15.5%), nonalcoholic fatty liver disease in 23 (9.4%), autoimmune liver disease in 3 (1.2%), and unknown 12 (4.9%). Results : Transient elastography was correlated with APRI (r=0.712) and the grades of esophageal varices (r=0.635). The AUROC values of transient elastography were 0.916 (95% CI: 0.838-0.954) for the presence of esophageal varices, 0.875 (95% CI: 0.819-0.931) for the esophageal varices grade ≥2, and 0.895 (95% CI: 0.846-0.945) for esophageal variceal hemorrhage. The cutoff values for 90% specificity were 15.3 kPa for esophageal varices, 20.7 kPa for esophageal varices grade ≥2 and 34.8 kPa for esophageal variceal hemorrhage, while the negative predictive values were 90%, 94% and 97%, respectively. Conclusions : Transient elastography was correlated with the presence of esophageal varices, the grades of esophageal varices and the presence of esophageal variceal hemorrhage. Therefore, this data may help to screen those patients how might undergo upper gastrointestinal endoscopy. (Korean J Med 74:491-499, 2008)

목적 : 순간 탄성 측정법은 간의 탄력도를 객관적이고 정량적으로 측정할 수 있는 검사법으로 간섬유화 및 간경변증의 진단에 유용하다고 알려져 있다. 그러나 간경변증의 합병증인 식도정맥류 및 식도정맥류 출혈을 예측할 수 있는지는 불분명하다. 저자들은 순간 탄성 측정법이 식도정맥류와 식도정맥류 출혈을 예측할 수 있는지 알아보았다. 방법 : 2007년 1월 만성 간질환을 가진 245명(평균 50.1세, 남/여 181/64)의 환자에서 APRI와 같은 혈청학 표지자 또는 식도정맥류와 같은 임상적 표지자와 순간 탄성 측정법의 상관관계를 분석하였다. 기저 간질환의 원인으로는 만성 B형간염 139명(56.7%), 만성 C형간염 30명(12.2%), 알코올성 간질환 38명(15.5%), 비알코올성 지방간질환이 23명(9.4%), 자가면역성간질환 3명(1.2%), 불명 12명(4.9%)이었다. 결과 : 순간 탄성 측정과 가장 상관관계가 높은 혈청학적 지표는 APRI였고(r=0.712), 임상적 지표로는 식도정맥류(r=0.631), 식도정맥류 출혈의 과거력(r=0.414)이 관련있었다. 식도정맥류와 식도정맥류 출혈의 AUROC 값은 각각 0.916, 0.895였다. 특이도 90%를 기준으로 할 때, 식도정맥류의 존재를 예측할 수 있는 cutoff 값은 15.3 kPa, 2도이상의 식도정맥류는 20.7 kPa, 식도정맥류 출혈은 34.8 kPa이었고 이때의 음성예측도는 각각  90%, 94%, 97%였다. 결론 : 순간 탄성 측정법은 만성 간질환에서 식도정맥류의 존재와 정도, 식도정맥류 출혈과 높은 상관관계가 있어 상부 내시경 검사가 필요한 환자를 선별하는데 유용한 비침습적 도구라고 생각한다.

Esophageal varices; Hemorrhage; Liver cirrhosis; Transient elastography