Related Experiment Video
Updated: Apr 6, 2026
Measurement of the Hepatic Venous Pressure Gradient and Transjugular Liver Biopsy
Published on: June 18, 2020
Liver stiffness plus platelet count can be used to exclude high-risk oesophageal varices
Nik S Ding1, Tin Nguyen1, David M Iser1
1Department of Gastroenterology, St Vincent's Hospital Melbourne and the University of Melbourne, Melbourne, VIC, Australia.
Insights
A simple clinical rule using liver stiffness measurement (LSM) and platelet count (Pl) can safely exclude high-risk gastro-oesophageal varices (GOV) in cirrhosis patients. This avoids unnecessary endoscopic screening for many patients with compensated cirrhosis.
Area of Science:
- Hepatology
- Gastroenterology
- Medical Diagnostics
Background:
- Endoscopic screening for high-risk gastro-oesophageal varices (GOV) is recommended for compensated cirrhotic patients.
- Transient elastography identifies more cirrhosis patients without portal hypertension, necessitating refined screening strategies.
- Current methods may lead to unnecessary endoscopies.
Purpose of the Study:
- To develop a simple clinical rule to exclude high-risk GOV in Child-Pugh A cirrhosis patients.
- To utilize liver stiffness measurement (LSM) and platelet count (Pl) for this purpose.
- To reduce the need for invasive endoscopic screening.
Main Methods:
- Retrospective analysis of 71 Child-Pugh A cirrhosis patients diagnosed by transient elastography (LSM >13.6 kPa).
- Development and validation of a predictive model using LSM ± platelet count to exclude high-risk GOV.
- Validation in a second cohort of 200 patients from independent centers.
Main Results:
- High-risk GOV were present in 15% (training) and 8% (validation) cohorts.
- A combined model of LSM and Pl count was more accurate in excluding high-risk GOV than either alone.
- LSM ≤25 kPa and Pl ≥100 demonstrated 100% negative predictive value in both cohorts, identifying 39% of patients.
Conclusions:
- The combination of LSM ≤25 kPa and Pl ≥100 effectively excludes high-risk GOV in Child-Pugh A cirrhosis.
- This clinical rule can be implemented to guide screening decisions.
- It offers a non-invasive approach to risk stratification, potentially reducing endoscopic procedures.
Background/Aims:
Endoscopic screening for high-risk gastro-oesophageal varices (GOV) is recommended for compensated cirrhotic patients with transient elastography identifying increasing numbers of patients with cirrhosis without portal hypertension. Using liver stiffness measurement (LSM) ± platelet count, the aim was to develop a simple clinical rule to exclude the presence of high-risk GOV in patients with Child-Pugh A cirrhosis.
Methods:
A retrospective analysis of 71 patients with Child-Pugh A cirrhosis diagnosed by transient elastography (LSM >13.6 kPa) who underwent screening gastroscopy was conducted. A predictive model using LSM ± platelet count was assessed to exclude the presence of high-risk GOV (diameter >5 mm and/or the presence of high-risk stigmata) and validated using a second cohort of 200 patients from two independent centres.
Results:
High-risk GOV were present in 10 (15%) and 16 (8%) of the training and validation cohorts, respectively, which was associated with LSM and Pl count (P < 0.05). A combined model based on LSM and Pl count was more accurate for excluding the presence of high-risk GOV than either alone (training cohort AUROC: 0.87 [0.77-0.96] vs. 0.78 [0.65-0.92] for LSM and 0.71 [0.52-0.90] for platelets) with the combination of LSM ≤25 kPa and Pl ≥100 having a NPV of 100% in both the training and validation cohorts. A total of 107 (39%) patients meet this criterion.
Conclusion:
The combination of LSM ≤25 kPa and Pl ≥100 can be used in clinical practice to exclude the presence of high-risk GOV in patients with Child-Pugh A cirrhosis.
More Related Videos
Related Concept Videos
01:28Esophageal Varices-II: Clinical Features and Management
In the initial assessment, a thorough review of the patient's medical history is vital to identify risk factors such as liver disease, alcohol...
01:24Esophageal Varices-I: Introduction
01:25Ultrasound II: Endoscopic Ultrasound and FibroScan
Endoscopic Ultrasound (EUS):
01:21Barrett Esophagus-II: Clinical Manifestations and Management
To diagnose Barrett's esophagus, healthcare providers often recommend an endoscopy for those showing symptoms of acid reflux. The procedure...
01:26Esophageal Strictures-II: Clinical Features and Management
Healthcare providers should gather a comprehensive medical history and conduct a physical examination for diagnosis. If esophageal stricture is...
01:22Effect of Hepatic Disease on Pharmacokinetics: Pathophysiologic Assessment and Liver Function Test