Elastography-based screening for esophageal varices in patients with advanced chronic liver disease.

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.

Déclaration de conflit d'intérêts

Conflict-of-interest statement: Dr. Paternostro has nothing to disclose in regard to this manuscript. Dr. Reiberger received grants from Abbvie, grants, personal fees and other support from Boehringer-Ingelheim, grants and personal fees from Gore, grants, personal fees and other from Gilead, grants, personal fees and other from MSD, grants from Philips - all outside the submitted work. Dr. Bucsics received other support from Abbvie, personal fees and other from MSD, other from Bayer, grants from Austrian Society for Gastroenterology and Hepatology (ÖGGH) - all outside the submitted work.