Published online Jan 21, 2019. doi: 10.3748/wjg.v25.i3.308
Peer-review started: October 10, 2018
First decision: November 17, 2018
Revised: November 27, 2018
Accepted: December 19, 2018
Article in press: December 19, 2018
Published online: January 21, 2019
Elastography-based liver stiffness measurement (LSM) is a non-invasive tool for estimating liver fibrosis but also provides an estimate for the severity of portal hypertension in patients with advanced chronic liver disease (ACLD). The presence of varices and especially of varices needing treatment (VNT) indicates distinct prognostic stages in patients with compensated ACLD (cACLD). The Baveno VI guidelines suggested a simple algorithm based on LSM < 20 kPa (by transient elastography, TE) and platelet count > 150 G/L for ruling-out VNT in patients with cACLD. These (and other) TE-based LSM cut-offs have been evaluated for VNT screening in different liver disease etiologies. Novel point shear-wave elastography (pSWE) and two-dimensional shear wave elastography (2D-SWE) methodologies for LSM have also been evaluated for their ability to screen for “any” varices and for VNT. Finally, the measurement of spleen stiffness (SSM) by elastography (mainly by pSWE and 2D-SWE) may represent another valuable screening tool for varices. Here, we summarize the current literature on elastography-based prediction of “any” varices and VNT. Finally, we have summarized the published LSM and SSM cut-offs in clinically useful scale cards.
Core tip: Elastography-based measurement of liver stiffness (LSM) and spleen stiffness (SSM) represent valuable non-invasive screening tools for esophageal varices (EVs). Transient elastography (TE) has been widely validated, and the combined TE-based LSM < 20 kPa and platelet count (PLT) > 150 G/L algorithm is able to rule-out varices-needing-treatment (VNTs). While LSM and SSM by novel shear wave elastography devices and magnetic resonance elastography (MRE) may be more accurate to reflect the risk of EV and VNT, their value in clinical practice remains to be established.