Ultrasound and point shear-wave elastography assessment for predicting esophageal varices in schistosomiasis-associated non-cirrhotic portal hypertension

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PURPOSE: To evaluate the usefulness of ultrasonography and liver and spleen elastography (point shear-wave elastography) for predicting the presence of esophageal varices in patients with schistosomiasis-associated non-cirrhotic portal hypertension (NCPH), and to identify which non-invasive parameters best correlate with the presence of esophageal varices. METHODS: A prospective and cross-sectional study involving patients with NCPH related to schistosomiasis, with and without upper gastrointestinal bleeding history, conducted at the Gastroenterology Division on a referall hospital in Pernambuco, Brazil. All patients underwent upper abdominal ultrasonography and hepatic and splenic stiffness by pSWE, both performed with Siemens Acuson S2000 system, and upper gastrointestinal endoscopy. RESULTS: Among 71 patients, the median age was 57 years, and 50.7% were male. The majority (77.5%) presented with the hepatosplenic clinical form, and 76.1% exhibited advanced periportal fibrosis (PPF) patterns (E and F). Esophageal varices were identified in 46 patients (64.8%), predominantly small-caliber. Splenic index (p = 0.002), splenic vein diameter (p < 0.001) and splenic stiffness on pSWE (p < 0.001) were associated with the occurrence of varices. Nevertheless, liver-related parameters were not as suitable. ROC curve analysis demonstrated excellent diagnostic performance of the splenic parameters, with AUCs of 0.800 for spleen stiffness, 0.783 for splenic vein diameter, and 0.821 for the combined model (splenic index + spleen stiffness). DeLong's test demonstrated no statistically significant differences between spleen stiffness, splenic vein diameter, and the combined model. CONCLUSIONS: Ultrasonography and elastography-derived splenic parameters represent valuable non-invasive approaches for predicting the presence of esophageal varices in schistosomiasis-associated NCPH. The consistently high diagnostic performance observed across spleen stiffness, splenic vein diameter, and the combined model supports their use as complementary tools for risk stratification and may reduce reliance on upper gastrointestinal endoscopy.

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