Diagnostic Accuracy of Liver Stiffness Measurement as a Non-Invasive Tool for Variceal Screening in Pediatric Chronic...

Chronic liver disease (CLD) in children often leads to portal hypertension and varices. Upper GI endoscopy (UGIE) is gold standard for variceal detection; however, it is invasive and requires anesthesia. Liver stiffness measurement (LSM) has emerged as a promising non-invasive alternative for variceal screening. This systematic review and meta-analysis was conducted to evaluate diagnostic accuracy of LSM for predicting any grade of esophageal and/or gastric varices (Vx) and high-risk varices (HRVx) in pediatric CLD.

A systematic search of PubMed, Scopus, and Embase was conducted to include studies reporting LSM-based diagnostic accuracy data for Vx/HRVx prediction in CLD patients ≤18 years, with UGIE as reference standard. Pooled sensitivity, specificity, diagnostic odds ratio (DOR), and area under receiver operating characteristic curve (AUC) were estimated.

Twelve studies (n=647) were included. For prediction of Vx (six studies, n=327), LSM demonstrated pooled sensitivity of 0.85 (95% confidence intervals [CI]: 0.78-0.90), specificity of 0.74 (95% CI: 0.67-0.80), DOR of 16.35 (95% CI: 7.06-40.24), and AUC of 0.847. For HRVx (seven studies, n=369), pooled sensitivity, specificity, DOR and AUC were 0.81 (95% CI: 0.74-0.87), 0.79 (95% CI: 0.73-0.84), 14.19 (95% CI: 5.14-35.98) and 0.862, respectively. Considerable heterogeneity (I²=73.5%) was noted in specificity for HRVx. Subgroup analyses identified LSM modality, cutoff values, ethnicity, and variceal prevalence as sources of heterogeneity.

LSM holds promise as a non-invasive tool for variceal screening in pediatric CLD. However, it should be regarded as a complement rather than a replacement for endoscopy until standardized protocols with prospectively validated thresholds are established.