Transient elastography versus hepatic venous pressure gradient for diagnosing portal hypertension: a systematic review and meta-analysis

Abstract

Background/AimsTransient elastography (TE) has been proposed as a promising noninvasive alternative to hepatic venous pressure gradient (HVPG) for detecting portal hypertension (PH). However, previous studies have yielded conflicting results. We gathered evidence from literature on the clinical usefulness of TE versus HVPG for assessing PH.MethodsWe conducted a systematic review by searching databases for relevant literature evaluating the clinical usefulness of non-invasive TE for assessing PH in patients with cirrhosis. A literature search in Ovid Medline, EMBASE and the Cochrane Library was performed for all studies published prior to December 30, 2015.ResultsEight studies (1,356 patients) met our inclusion criteria. For the detection of PH (HVPG ≥6 mmHg), the summary sensitivity and specificity were 0.88 (95% confidence interval [CI] 0.86-0.90) and 0.74 (95% CI 0.67-0.81), respectively. Regarding clinically significant PH (HVPG ≥10 mmHg), the summary sensitivity and specificity were 0.85 (95% CI 0.63-0.97) and 0.71 (95% CI 0.50-0.93), respectively. The overall correlation estimate of TE and HVPG was large (0.75, 95% CI: 0.65; 0.82, P<0.0001).ConclusionsTE showed high accuracy and correlation for detecting the severity of PH. Therefore, TE shows promise as a reliable and non-invasive procedure for the evaluation of PH that should be integrated into clinical practice.

Validation of the Baveno VI and the expanded Baveno VI criteria to identify patients who could avoid screening endoscopy

“…Serum platelet count and LSM strongly correlate with fibrosis stage and portal hypertension . LSM has proven accuracy for discriminating patients with and without clinically significant portal hypertension, with a mean area under the receiver operating curve of 0.93 in a meta‐analysis . LSM and platelet count are simple, non‐invasive and objective variables.…”

Varices on computed tomography are surrogate of clinically significant portal hypertension and can predict survival in compensated cirrhosis patients

“…Currently, HVPG measurement has been considered as the reference of standard method for evaluating and grading of PH . Even though several non‐invasive methods such as transient elastography showed fair diagnostic accuracy to detect CSPH, HVPG measurement should remain as gold standard for the diagnosis of CSPH, and HVPG has been one of the most accurate surrogate indicator of prognosis in cirrhosis patients . However, due to invasive nature of examination and need of special equipment and skilled expertise, the widespread routine clinical use of HVPG measurement has been limited .…”

“…Currently, measurement of the hepatic venous pressure gradient (HVPG) is considered as reference of standard method for evaluating PH, and HVPG ≥ 10 mmHg indicates the presence of clinically significant PH (CSPH) . In addition, HVPG has been considered as the best surrogate indicator of prognosis in patients with cirrhosis . However, HVPG measurement is invasive examination with procedure related complication although the incidence of complication is quite low (<1% of patients) and the nature of complication is minor such as transient cardiac arrhythmias, local pain, and vagal reaction in most of patients; thus, HVPG is not routinely done in all centers .…”

Transient elastography can be integrated into routine clinical practice for the evaluation of portal hypertension?

“…As variceal bleeding is the most important complication of PH, the relationship between TE values and the presence of esophageal varices has been also investigated in several studies [13,21,22], which reported significant correlations between TE values and the presence of esophageal varices. Furthermore, Kim et al [23] conducted a systematic review and meta-analysis to identify the clinical usefulness of non-invasive TE for assessing PH as an alternative to HVPG in patients with CLD. The diagnostic accuracy of TE for CSPH was high (correlation 0.7480, 95% confidence interval: 0.6464; 0.8236, P <0.0001).…”

“…Although a systematic review and meta-analysis by Kim et al [23] showed the overall clinical usefulness of non-invasive TE for assessing PH as an alternative to HVPG in patients with CLD, that study had potential limitations. First, only eight studies were included, so the robustness of the conclusions in terms of the evaluation of the usefulness and performance of TE might be limited.…”