Determination of Correlation Between Spleen Stiffness and Endoscopic Esophageal Variceal Grading in Patients with Portal Hypertension, in a Tertiary Care Center in Western India

Abstract

 Introduction: Esophageal varices (EV) represent a critical cause of acute upper

gastrointestinal bleeding (UGIB), particularly in patients with cirrhosis. The high morbidity and mortality associated with variceal bleeding necessitate accurate and timely diagnosis. Traditional diagnostic methods, such as endoscopy, are invasive. Non-invasive methods like spleen stiffness measurement (SSM) via elastography offer a promising alternative. Objective: The study aims to evaluate the effectiveness of SSM as a non-invasive predictor of esophageal varices' presence and severity in patients with portal hypertension. Additionally, it seeks to correlate SSM with endoscopic variceal grading and compare liver stiffness measurement (LSM), spleen size, liver size, and blood parameters with variceal grading. Methods: A prospective cross-sectional observational study was conducted at a tertiary care center in Western India from January 2023 to March 2024. Sixty patients with clinically diagnosed cirrhosis and suspected portal hypertension were included. SSM and LSM were assessed using ultrasound elastography. Endoscopic variceal grading was performed to evaluate the correlation with stiffness measurements and other clinical parameters. Results: SSM signicantly correlated with esophageal variceal grading (Rsquared: 0.651, p < 0.001). Higher SSM values were associated with more severe varices. Liver stiffness, spleen size, and platelet count also showed signicant correlations with variceal severity, with SSM being the most reliable non-invasive marker. The analysis further demonstrated that elastography-based measurements could reduce the need for invasive procedures like endoscopy in stratifying variceal severity. Conclusion: SSM is a reliable non-invasive method for predicting the presence and severity of esophageal varices in patients with portal hypertension. Incorporating SSM into routine clinical practice could reduce the need for invasive diagnostic procedures, enhancing patient care and management. Future research should focus on validating these ndings in larger cohorts and exploring the broader applications of SSM in managing portal hypertension complications.