Early Changes in Spleen Stiffness After Endoscopic Treatment Are Associated with Esophageal Variceal Recurrence: A Pilot Study

Background: Spleen stiffness (SS) is a noninvasive marker of portal hypertension; however, the clinical significance of early changes in SS after endoscopic treatment for esophageal varices remains unclear. We evaluated whether SS and its early post-treatment changes are associated with variceal recurrence. Methods: This retrospective pilot study included 20 patients who underwent endoscopic treatment for esophageal varices. Liver stiffness (LS) and spleen stiffness (SS) were measured before treatment, approximately 1 week after the final treatment session (1W), and at 1 month and 1 year after treatment. The clinical outcome of interest was variceal recurrence within 1 year. Early changes in stiffness were calculated from 1W to 1M (Δ1M − 1W). Results: Eleven patients (55.0%) developed variceal recurrence. LS did not differ significantly between the non-recurrence and recurrence groups at any time point during follow-up. SS was comparable between the groups before treatment and at 1W but was significantly higher in the recurrence group at 1M (median [IQR], 2.75 [2.70–2.86] vs. 3.40 [3.06–3.81] m/s in the non-recurrence and recurrence groups, respectively; p = 0.003). ΔSS-VTQ (1M − 1W) was significantly greater in the recurrence group than in the non-recurrence group (−0.13 [−0.62–−0.04] vs. 0.25 [−0.05–0.40] m/s, respectively; p = 0.013), whereas no significant between-group differences were observed in changes in LS. Conclusions: SS at 1 month after endoscopic treatment and its early post-treatment change were associated with variceal recurrence. Serial assessment of SS may provide useful information for early post-treatment risk assessment, although validation in larger prospective studies is needed.