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Multicenter Study
. 2025 Feb 1;81(2):546-559.
doi: 10.1097/HEP.0000000000001004. Epub 2024 Jul 2.

Performance of spleen stiffness measurement to rule out high-risk varices in patients with porto-sinusoidal vascular disorder

Lucile Moga  1   2 , Valérie Paradis  2   3 , Joel Ferreira-Silva  4   5 , Koushik Gudavalli  6 , Federica Indulti  7 , Elton Dajti  8   9 , Oana Nicoara-Farcau  10   11 , Giulia Tosetti  12 , Antonina Antonenko  13 , Andreea Fodor  10 , Judit Vidal-González  14 , Laura Turco  15 , Francisco Capinha  16 , Laure Elkrief  17 , Teresa Monllor-Nunell  18 , Odile Goria  19 , Lorenz Balcar  20 , Adrien Lannes  21 , Vincent Mallet  22 , Armelle Poujol-Robert  23 , Dominique Thabut  24   25 , Pauline Houssel-Debry  26 , Yu Jun Wong  27   28 , Maxime Ronot  29 , Valérie Vilgrain  29 , Sai Prasanth Rampally  6 , Audrey Payancé  1   2 , Laurent Castera  2   30 , Thomas Reiberger  20 , José Ferrusquía-Acosta  18 , Carlos Noronha Ferreira  16 , Giovanni Vitale  15 , Macarena Simon-Talero  14 , Bogdan Procopet  10 , Annalisa Berzigotti  13 , Riccardo Caccia  12 , Fanny Turon  31 , Filippo Schepis  7 , Federico Ravaioli  8   9 , Antonio Colecchia  7 , Arun Valsan  6 , Guilherme Macedo  4   5 , Aurélie Plessier  1   2 , Pierre-Emmanuel Rautou  1   2 ; ERN RARE-LIVER; a study of VALDIG, an EASL consortium
Affiliations
Multicenter Study

Performance of spleen stiffness measurement to rule out high-risk varices in patients with porto-sinusoidal vascular disorder

Lucile Moga et al. Hepatology. .

Abstract

Background and aims: Baveno VII consensus suggests that screening endoscopy can be spared in patients with compensated cirrhosis when spleen stiffness measurement (SSM) by vibration-controlled transient elastography (VCTE) is ≤40 kPa as they have a low probability of high-risk varices (HRV). Conversely, screening endoscopy is required in all patients with porto-sinusoidal vascular disorder (PSVD). This study aimed to evaluate the performance of SSM-VCTE to rule out HRV in patients with PSVD and signs of portal hypertension.

Approach and results: We retrospectively included patients with PSVD, ≥1 sign of portal hypertension, without a history of variceal bleeding, who underwent an SSM-VCTE within 2 years before or after an upper endoscopy in 21 VALDIG centers, divided into a derivation and a validation cohort. One hundred fifty-four patients were included in the derivation cohort; 43% had HRV. By multivariable logistic regression analysis, SSM-VCTE >40 kPa and serum bilirubin ≥1 mg/dL were associated with HRV. SSM-VCTE ≤40 kPa combined with bilirubin <1 mg/dL had a sensitivity of 96% to rule out HRV and could spare 38% of screening endoscopies, with 4% of HRV missed, and a 95% negative predictive value. In the validation cohort, including 155 patients, SSM combined with bilirubin could spare 21% of screening endoscopies, with 4% of HRV missed and a 94% negative predictive value.

Conclusions: This study gathering a total of 309 patients with PSVD showed that SSM-VCTE ≤40 kPa combined with bilirubin <1 mg/dL identifies patients with PSVD and portal hypertension with a probability of HRV <5%, in whom screening endoscopy can be spared.

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