Liver stiffness measurement of endoscopy versus transjugular intrahepatic portosystem shunt treatment of variceal bleeding: a prospective cohort study

Abstract To compare the liver stiffness measurement (LSM) of transient elastography (TE) before and after treatment by endoscopyplus propranolol and transjugular intrahepatic portosystem shunt (TIPS) respectively for patients with variceal bleeding. This was a single-center, prospective, cohort study. A total of 78 patients with bleeding from gastroesophageal varices between September 2018 to December 2020 were treated with endoscopy plus propranolol (ET group, n=37) and TIPS (TIPS group, n=41) respectively. All patients underwent clinical examination, blood tests, computed tomography and TE. Fibrosis index based on four factors (FIB-4) and aspartate aminotransferase-to-platelet ratio (APRI) were calculated for each patient. Variceal eradication was achieved after treatment by endoscopy in ET group. The portal pressure gradient (PPG) was 20.15±5.20 mmHg (range 14-34 mmHg) and 6.59±3.41 mmHg (range 2-14 mmHg) before and after treatment in TIPS group (P<0.0001). The LSM values of the ET group and TIPS group at baseline and 24 months after treatment were 23.70±12.07 vs 29.92±16.77 (P=0.005) and 30.23±22.00 vs 13.792±8.14 (P<0.001). The COX regression analysis in TIPS group manifested that PPG was only one of the related factors of LSM decline. Based on the results of transient elastography, TIPS treatment can partially reverse decompensated liver cirrhosis.