Original Article

Usefulness of Endoscopic Ultrasound Strain Elastography for Measuring Liver Stiffness and the Role of Blood Cytokeratin 18 Levels as a Surrogate Marker of Fibrosis

Volume 36 · Issue 10 Publish Date: June 16, 2025
Deniz Guney Duman ORCID Yesim Ozen Alahdab ORCID Coskun Ozer Demirtas ORCID Yusuf Yılmaz ORCID Feyza Dilber ORCID Filiz Ture Ozdemir ORCID Caglayan Keklikkiran ORCID Haluk Tarik Kani ORCID Umut Emre Aykut ORCID Osman Cavit Ozdogan
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Turkish Journal of Gastroenterology

Volume 36 · Issue 10

Pages: 692-699

History

Published Online: June 16, 2025

Creative Commons License

This work is licensed under a Creative Commons Attribution 4.0 International License.

Copyright © 2025 Deniz Guney Duman, Yesim Ozen Alahdab, Coskun Ozer Demirtas, Yusuf Yılmaz, Feyza Dilber, Filiz Ture Ozdemir, Caglayan Keklikkiran, Haluk Tarik Kani, Umut Emre Aykut, Osman Cavit Ozdogan

Deniz Guney Duman ORCID
Division of Gastroenterology and Hepatology, Marmara University School of Medicine, İstanbul, Türkiye
Yesim Ozen Alahdab ORCID
Division of Gastroenterology and Hepatology, Marmara University School of Medicine, İstanbul, Türkiye
Coskun Ozer Demirtas ORCID
Division of Gastroenterology and Hepatology, Marmara University School of Medicine, İstanbul, Türkiye
Yusuf Yılmaz ORCID
Department of Gastroenterology, Recep Tayyip Erdoğan University School of Medicine, Rize, Türkiye
Feyza Dilber ORCID
Division of Gastroenterology and Hepatology, Marmara University School of Medicine, İstanbul, Türkiye
Filiz Ture Ozdemir ORCID
Division of Hematology and Immunology, Marmara University School of Medicine, İstanbul, Türkiye
Caglayan Keklikkiran ORCID
Department of Gastroenterology, Recep Tayyip Erdoğan University School of Medicine, Rize, Türkiye
Haluk Tarik Kani ORCID
Division of Gastroenterology and Hepatology, Marmara University School of Medicine, İstanbul, Türkiye
Umut Emre Aykut ORCID
Division of Gastroenterology and Hepatology, Marmara University School of Medicine, İstanbul, Türkiye
Osman Cavit Ozdogan
Division of Gastroenterology and Hepatology, Marmara University School of Medicine, İstanbul, Türkiye
Duman, D. G., Alahdab, Y. O., Demirtas, C. O., Yılmaz, Y., Dilber, F., Ozdemir, F. T., … Ozdogan, O. C. (2025). Usefulness of Endoscopic Ultrasound Strain Elastography for Measuring Liver Stiffness and the Role of Blood Cytokeratin 18 Levels as a Surrogate Marker of Fibrosis. Turkish Journal of Gastroenterology, 36(10), 692–699. https://doi.org/10.5152/tjg.2025.24070
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Abstract

Background/Aims: The role of semi-quantitative strain ratio (SR) using real-time endoscopic ultrasound strain elastography (EUS-E) in chronic liver disease (CLD) and cirrhosis is yet to be determined. Herein, the aim was to assess the usefulness of EUS-E to detect CLD and cirrhosis.

Materials and Methods: Patients with cirrhosis and non-cirrhotic CLD were enrolled prospectively. Patients without liver disease and undergoing EUS examinations for non-hepatic indications were taken as control group. Strain ratio was calculated from strains of hepatic vein and liver parenchyma. Fibrosis-4 (FIB-4) and aspartate aminotransferase (AST)-to-Platelet Ratio Index (APRI) scores were recorded, and blood cytokeratin-18 (CK-18) levels were measured to assess hepatic fibrosis. A clinical evaluation was also conducted.

Results: One hundred participants (control: 49, CLD: 33, cirrhotic: 18) were included. The SR and liver parenchyma strains in cirrhotics were significantly higher than those in the CLD (P < .001) and control (P < .001) groups. Strain ratio threshold set at 5.67 had a sensitivity of 94.4% and a specificity of 95.9% to differentiate cirrhotics from control patients. An SR threshold of 10.65 had a sensitivity of 94.4% and a specificity of 84.8% in differentiating cirrhotics from CLD patients. The SR showed a strong positive correlation with FIB-4 and APRI scores, but not with CK-18 levels.

Conclusions: Strain ratio thresholds of 5.67 and 10.65 obtained by EUS-E are useful to differentiate cirrhotics from non-cirrhotic CLD patients and liver-disease-free subjects, respectively. This pilot study is the first one evaluating the role of EUS-E in liver diseases, and future studies involving patients having CLD of specific etiologies are warranted.

 

Cite this article as: Duman DG, Alahdab YO, Demirtas CO, et al. Usefulness of endoscopic ultrasound strain elastography for measuring liver stiffness and the role of blood cytokeratin 18 levels as a surrogate marker of fibrosis. Turk J Gastroenterol. 2025;36(10):692-699.

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Article Info
Published In
Journal Turkish Journal of Gastroenterology
Volume / Issue Volume 36 · Issue 10
Pages 692-699
DOI 10.5152/tjg.2025.24070
History
Published Online June 16, 2025
License
Creative Commons License

This work is licensed under a Creative Commons Attribution 4.0 International License.

Copyright
Copyright (c) 2025 Deniz Guney Duman, Yesim Ozen Alahdab, Coskun Ozer Demirtas, Yusuf Yılmaz, Feyza Dilber, Filiz Ture Ozdemir, Caglayan Keklikkiran, Haluk Tarik Kani, Umut Emre Aykut, Osman Cavit Ozdogan
Affiliations
Deniz Guney Duman ORCID
Division of Gastroenterology and Hepatology, Marmara University School of Medicine, İstanbul, Türkiye
Yesim Ozen Alahdab ORCID
Division of Gastroenterology and Hepatology, Marmara University School of Medicine, İstanbul, Türkiye
Coskun Ozer Demirtas ORCID
Division of Gastroenterology and Hepatology, Marmara University School of Medicine, İstanbul, Türkiye
Yusuf Yılmaz ORCID
Department of Gastroenterology, Recep Tayyip Erdoğan University School of Medicine, Rize, Türkiye
Feyza Dilber ORCID
Division of Gastroenterology and Hepatology, Marmara University School of Medicine, İstanbul, Türkiye
Filiz Ture Ozdemir ORCID
Division of Hematology and Immunology, Marmara University School of Medicine, İstanbul, Türkiye
Caglayan Keklikkiran ORCID
Department of Gastroenterology, Recep Tayyip Erdoğan University School of Medicine, Rize, Türkiye
Haluk Tarik Kani ORCID
Division of Gastroenterology and Hepatology, Marmara University School of Medicine, İstanbul, Türkiye
Umut Emre Aykut ORCID
Division of Gastroenterology and Hepatology, Marmara University School of Medicine, İstanbul, Türkiye
Osman Cavit Ozdogan
Division of Gastroenterology and Hepatology, Marmara University School of Medicine, İstanbul, Türkiye
Cite this Article
Duman, D. G., Alahdab, Y. O., Demirtas, C. O., Yılmaz, Y., Dilber, F., Ozdemir, F. T., … Ozdogan, O. C. (2025). Usefulness of Endoscopic Ultrasound Strain Elastography for Measuring Liver Stiffness and the Role of Blood Cytokeratin 18 Levels as a Surrogate Marker of Fibrosis. Turkish Journal of Gastroenterology, 36(10), 692–699. https://doi.org/10.5152/tjg.2025.24070
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