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Updated: Jan 14, 2026
Measurement of the Hepatic Venous Pressure Gradient and Transjugular Liver Biopsy
Published on: June 18, 2020
Splenic stiffness does not predict esophageal varices in children with portal hypertension
Margaux Jezequel1,2, Mohamed El Fayoumi3, Madeleine Aumar1
1Department of Pediatric Gastroenterology Hepatology and Nutrition CHU Lille, Univ. Lille, Inserm U1286 - INFINITE - Institute for Translational Research in Inflammation, Lille, France.
Insights
Splenic stiffness measurement (SSM) is unreliable for predicting pediatric esophageal varices. Liver stiffness measurement (LSM) and a clinical prediction rule (CPR) offer more robust and consistent prediction across patient groups.
Area of Science:
- Pediatric Gastroenterology
- Medical Imaging
- Hepatology
Background:
- Pediatric esophageal varices are a serious complication of portal hypertension.
- Accurate non-invasive prediction of esophageal varices is crucial for timely management.
- Ultrasound parameters, including splenic stiffness, have been explored as potential predictors.
Purpose of the Study:
- To evaluate ultrasound parameters, specifically splenic stiffness measurement (SSM), as predictors of pediatric esophageal varices.
- To compare the predictive performance of SSM against liver stiffness measurement (LSM) and a clinical prediction rule (CPR).
Main Methods:
- A cohort study including children aged 0-19 years undergoing esophagogastroduodenoscopy and abdominopelvic ultrasound with splenic elastography.
- Splenic stiffness measurement (SSM), liver stiffness measurement (LSM), and biological parameters (platelets, albumin) were recorded.
- Receiver-operating characteristic (ROC) analysis was used to assess the predictive performance of each parameter.
Main Results:
- In the derivation cohort, SSM showed high predictive value (AUC 0.83), but this was not replicated in the validation cohort (sensitivity 0.26).
- Liver stiffness measurement (LSM) and the clinical prediction rule (CPR) demonstrated consistent, albeit lower, predictive values across both cohorts (AUCs ranging from 0.64 to 0.78).
- Splenic stiffness measurement (SSM) alone was found to be an unreliable predictor of pediatric esophageal varices in independent validation.
Conclusions:
- Splenic stiffness measurement (SSM) is not a reliable standalone predictor for pediatric esophageal varices.
- Liver stiffness measurement (LSM) and clinical prediction rules (CPR) offer more robust and consistent predictive capabilities for esophageal varices in children.
- Further research may focus on refining CPRs incorporating LSM for improved non-invasive screening.
Objective:
To investigate ultrasound parameters, particularly splenic stiffness, as predictors of pediatric esophageal varices.
Methods:
We included all children aged 0-19 years who underwent esophagogastroduodenoscopy, for variceal screening or surveillance, and abdominopelvic ultrasound with splenic elastography measurement. We also recorded biological parameters (platelets count, albumin) to determine a clinical prediction rule (CPR). Derivation and validation cohorts were defined according to measurement date. Receiver-operating characteristic (ROC) statistics and sensitivity, specificity, positive predictive value, and negative predictive value for the optimal threshold value were calculated, and used to assess the performance of each parameter.
Results:
Eighty derivation cohort children and 58 validation cohort children formed the study sample. Cohort characteristics did not differ for age, sex, distribution of varices but differ for some etiologies, abdominal surgery, spleen size, splenic stiffness measurement (SSM), ascites, and the presence of spontaneous portosystemic shunts. In the derivation cohort, splenic stiffness was the best independent predictor of esophageal varices, with an area under the ROC curve (AUC) of 0.83, a sensitivity of 0.90, and specificity of 0.73 at a threshold of 22 kPa. In the validation cohort, SSM was no longer significantly associated with esophageal varices at endoscopy, had a lower sensitivity of 0.26, and no other threshold could be found. Liver stiffness measurement (LSM) and CPR had a correct predictive value (AUC 0.70 for LSM; 0.78 for CPR in the derivation cohort and 0.64 for LSM; 0.71 for CPR in the validation cohort) for esophageal varices.
Conclusions:
SSM cannot be used as a single parameter to predict esophageal varices. LSM and CPR despite their lower AUC appear to much more robust measures with consistent results across cohorts.
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