Transient Elastography (Fibroscan) in Patients with Non-cirrhotic Portal Fibrosis

Abstract

Background: Non-cirrhotic portal hypertension (NCPH) is a common cause of variceal bleed in developing countries. Transient elastography (TE) using Fibroscan is a useful technique for evaluation of fibrosis in patients with liver disease. There is a paucity of studies evaluating TE in patients with Non-cirrhotic portal fibrosis (NCPF) and none in Asian population. Aim of this study was to evaluate role of TE in NCPF.

Methods: Retrospective data of consecutive patients of NCPF as per Asian pacific association for the study of liver (APASL) guidelines were noted. All patients had liver biopsy, TE, computed tomography of abdomen and hepatic venous pressure gradient (HVPG). Twenty age and gender matched healthy subjects and forty age matched patients with cirrhosis with Child's A were taken as controls.

Results: A total of 20 patients with age [median 29.5 (13-50) years], Male:Female = 11:9 with a diagnosis of NCPF were enrolled from January 2011 to December 2015. Of 20 patients 18 patients had variceal bleed and required endoscopic band ligation. There was no difference in haemoglobin and platelet count between patients with cirrhosis and NCPF, but total leucocyte count was significantly lower in patients with NCPF compared to patients with cirrhosis (3.2 vs 6.7 × 103/cumm, P = 0.01). TE (Fibroscan) was high in patients with NCPF compared to healthy controls (6.8 vs 4.7 kPa, P = 0.001) but it was significantly low compared to cirrhotic patients (6.8 vs 52.3 kPa, P = 0.001). HVPG is significant low in patients with NCPF compared to patients with cirrhosis (5.0 vs 16.0 mmHg, P = 0.001).

Conclusion: Transient elastography (Fibroscan) is significantly low in patients with NCPF compared to patients with cirrhosis. It is a very useful non-invasive technique to differentiate between Child's A cirrhosis and non-cirrhotic portal fibrosis.

Keywords: APASL, Asian pacific association for the study of liver; EVL, endoscopic variceal ligation; FHVP, free hepatic venous pressure; HVPG, hepatic venous pressure gradient; IPH, idiopathic portal hypertension; IQR, interquartile range; LS, liver stiffness; NCPF; NCPF, non-cirrhotic portal fibrosis; PHT, portal hypertension; SR, success rate; TE, transient elastography; TM, time motion; WHVP, wedged (occluded) hepatic venous pressure; fibroscan; transient elastography.

Figures

Figure 1

Box Plot diagram showing Transient elastography in patients with cirrhosis, controls and non-cirrhotic portal fibrosis.