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Effect of General Anesthesia on Liver and Spleen Stiffness for Predicting High-Risk Varices in Biliary Atresia
Shinya Yokoyama1, Takashi Honda1, Yoji Ishizu1
1Nagoya University Graduate School of Medicine Department of Gastroenterology and Hepatology, Nagoya, Aichi, Japan.
Insights
Liver and spleen stiffness measurements can predict high-risk varices in biliary atresia patients. Anesthesia affects spleen stiffness measurements, but liver stiffness remains reliable, suggesting potential for sedation in future assessments.
Area of Science:
- Pediatric Gastroenterology
- Hepatology
- Medical Imaging
Background:
- Liver and spleen stiffness (LS and SS) measurements are valuable for predicting high-risk varices (HRVs) in biliary atresia (BA).
- Accurate LS and SS measurements in children can be challenging due to difficulties in breath-holding.
- This study investigates LS and SS measurement accuracy under general anesthesia versus awake states for predicting HRVs in pediatric BA patients.
Purpose of the Study:
- To evaluate the diagnostic accuracy of LS and SS measurements obtained under general anesthesia during brief ventilation pauses.
- To compare these measurements with those obtained in the awake state for predicting HRVs in children with BA.
- To assess the reliability of LS and SS measurements in predicting HRVs in pediatric BA.
Main Methods:
- A cross-sectional prospective study involving 43 pediatric BA patients (≤15 years) undergoing esophagogastroduodenoscopy.
- LS and SS were measured in both awake and anesthetized states (during brief ventilation pauses).
- HRVs were defined as large esophagogastric varices or varices with red color signs.
Main Results:
- Patients with HRVs showed significantly higher awake-LS, awake-SS, anesthesia-LS, and anesthesia-SS compared to non-HRVs patients.
- Area under the curve (AUC) values for predicting HRVs were: awake-LS (0.784), awake-SS (0.794), anesthesia-LS (0.814), and anesthesia-SS (0.698).
- A strong positive correlation was found between awake-LS and anesthesia-LS (ρ=0.894), while a weak correlation was observed for SS (ρ=0.468).
Conclusions:
- General anesthesia and mechanical ventilation significantly affect spleen stiffness measurements in pediatric BA patients.
- Liver stiffness measurements under general anesthesia remain reliable for predicting HRVs in this population.
- Further research into mild sedation may optimize measurement conditions for SS in pediatric BA patients.
Aim:
Liver and spleen stiffness (LS and SS) measurements in predicting high risk varices (HRVs) are reported useful in biliary atresia (BA). In children, inability to temporarily hold their breath may pose challenges in obtaining accurate measurements. This cross-sectional prospective study aimed to evaluate the diagnostic accuracy of LS and SS measurements obtained under general anesthesia during brief pauses in ventilation compared with those obtained in the awake state, in predicting HRVs.
Methods:
Among patients with BA aged 15 years or younger who underwent esophagogastroduodenoscopy under general anesthesia for evaluation of varices, 43 patients with LS and SS measured both in the awake and anaesthetized states were enrolled. HRVs were defined as large esophagogastric varices or esophagogastric varices of any size with red color signs.
Results:
The median age was 4 years. Nineteen patients had HRVs. In the HRVs group compared with the non-HRVs group, awake-LS, awake-SS, anesthesia-LS, and anesthesia-SS were significantly higher: 2.23 versus 1.71, 4.40 versus 3.45, 2.56 versus 1.73, and 4.13 versus 3.62 m/s, respectively. The area under the curve for awake-LS, awake-SS, anesthesia-LS, and anesthesia-SS were 0.784, 0.794, 0.814, and 0.698, respectively. Awake-LS and anesthesia-LS showed a strong positive correlation (ρ = 0.894), whereas awake-SS and anesthesia-SS showed a weak correlation (ρ = 0.468).
Conclusions:
As anesthetics and mechanical ventilation affect abdominal hemodynamics, SS measurements obtained under general anesthesia deviated from those obtained during the awake state. Further research is needed to determine whether mild sedation could help optimize measurement conditions.
Trial Registration:
This study was registered on the University Hospital Medical Information Network (UMIN000033123).
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