Splenic Elastography as a Predictor of Gastroesophageal Varices in Cirrhosis

Gastroesophageal varices are a major complication of portal hypertension in cirrhosis, associated with high morbidity and mortality. Noninvasive predictors are needed to reduce reliance on endoscopy. Splenic elastography has emerged as a potential tool to assess portal hypertension severity.

We conducted prospective, descriptive cross-sectional study at Hospital Roosevelt, Guatemala, in 2024, including 78 patients with recent diagnosis of cirrhosis confirmed by ultrasonography. Patients with hepatocellular carcinoma, acute decompensation, or conditions interfering with splenic stiffness measurement were excluded. Splenic stiffness was measured using transient elastography with the M probe. Endoscopy was performed within two weeks. Diagnostic accuracy for gastroesophageal varices was assessed using ROC analysis.

Mean age was 56.1 years (SD 12.6), and 70.5% were female. The most frequent etiology was viral hepatitis (30.77%), followed by alcohol-related liver disease (19.23%) and metabolic dysfunction-associated steatotic liver disease (MASLD, 11.53%). Most patients were Child-Pugh A (80.76%), with a mean MELD-Na of 11.99 (SD 5.46). Gastroesophageal varices were present in 57.69%, and large varices in 26.92%. Splenic elastography showed an AUC of 0.72 (95% CI: 0.59-0.83), with sensitivity of 82.22% and specificity of 66.67% at ≥27 kPa. Median stiffness increased progressively with variceal size, from 25 kPa in absence of varices to 50 kPa in large varices (P <0.001). No significant correlation was found with Child-Pugh class (P=0.538) or MELD-Na (P =0.121).

Splenic elastography demonstrated moderate accuracy for predicting gastroesophageal varices in cirrhosis. Stiffness values correlated significantly with variceal size, supporting its role as a noninvasive marker of variceal severity. Larger external validation studies are warranted.