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How to Screen?

  • Conference paper
Portal Hypertension VI

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Abstract

There are two clinically relevant questions when screening for portal hypertension: first, identification of patients at high risk for clinically significant portal hypertension (CSPH; defined by an hepatic venous pressure gradient (HVPG) ≥ 10 mmHg); second, identification of patients at high risk for esophageal varices (OV). Thanks to the improvements in the noninvasive methods, most patients are currently diagnosed in a very initial stage of cirrhosis, in which clinically CSPH and OV are often absent. In this new scenario, a large proportion of HVPG measurements and screening endoscopies may be unnecessary. Among available noninvasive methods, liver stiffness measurement using transient elastography (TE) has been the most extensively studied. The diagnostic performance of TE for predicting OV is not as good as for CSPH (AUROC 0.84 and 0.93, respectively). TE is better at ruling in than ruling out CSPH, whereas it is better at ruling out than ruling in OV. Strategies combining liver stiffness measurement with platelet count and spleen diameter could be useful to rule out OV. Finally, the evidence accumulated so far indicates that noninvasive methods cannot replace HVPG for a detailed portal hypertension evaluation and upper GI endoscopy for detecting OV. However, in settings where HVPG is not available, TE could be considered to stratify the risk of CSPH. Similarly, strategies combining TE with platelet count and spleen diameter could be useful to rule out OV in patients at low risk of having portal hypertension.

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  1. Department of Hepatology, Hôpital Beaujon, Assistance Publique –Hôpitaux de Paris, INSERM U773, University of Paris-VII, 100 boulevard du General Leclerc, Clichy, 92110, France

    Laurent Castera MD, PhD

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  1. Gastroenterology Unit, Luigi Sacco University Hospital, Milan, Italy

    Roberto de Franchis

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Castera, L. (2016). How to Screen?. In: de Franchis, R. (eds) Portal Hypertension VI. Springer, Cham. https://doi.org/10.1007/978-3-319-23018-4_6

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  • DOI: https://doi.org/10.1007/978-3-319-23018-4_6

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