Role of Spleen Stiffness Measurement by 2D-Shear Wave Elastography in Ruling Out the Presence of High-Risk Varices in Cirrhotic Patients

  • Dimitrios S. KaragiannakisEmail author
  • Theodoros Voulgaris
  • Evgenia Koureta
  • Elissavet Chloupi
  • George V. Papatheodoridis
  • John Vlachogiannakos
Original Article


Background and Aim

To evaluate if spleen stiffness measurement (SSM) can rule out the presence of high-risk varices in patients with cirrhosis, avoiding an upper gastrointestinal endoscopy (UGE).


We enrolled 71 cirrhotic patients irrespective of liver disease’s etiology. 2D shear wave elastography (SWE) of spleen and UGE was performed. High-risk varices (HRV) were defined as esophageal varices ≥ 5 mm and/or red spots and any gastric varices.


Esophageal varices were documented in 37 (52.1%) and HRV in 25 (35.2%) patients. SSM was not technically feasible in 7/71 patients (9.8%). From the remaining 64 patients, when those with cholestatic liver disease were excluded (n = 17), SSM < 35.8 kPa was found to exclude well the existence of HRV offering an AUROC of 0.854 (p < 0.001), sensitivity 88.9%, negative predictive value (NPV) 91.3%, specificity 72.4%, and positive predictive value (PPV) 66.7%. Only 2/47 patients (4.3%) were misclassified, and 23 (48.9%) could avoid endoscopy. In the total cohort of 64 patients, SSM < 33.7 kPa was found to exclude well the presence of HRV offering AUROC 0.792 (p < 0.001), sensitivity 91.7%, specificity 60%, NPV 92.3%, and PPV 57.9%. The misclassification rate was 3.1% (2/64), while 26/64 (40.6%) could avoid endoscopy.


2D-SWE of spleen is a reliable method for ruling out the presence of HRV in cirrhotic patients. If larger studies confirm our results, a large number of endoscopies could be avoided.


Spleen stiffness Variceal bleeding Cirrhosis Portal hypertension 



Hepatic venous pressure gradient


Clinically significant portal hypertension


Gastroesophageal varices


High-risk varices


Upper gastrointestinal endoscopy


Liver stiffness measurements


Transient elastography


Spleen stiffness measurement


Shear wave elastography


Hepatocellular carcinoma


Transjugular intrahepatic portosystemic shunt


International normalized ratio


Aspartate aminotransferase


Alanine aminotransferase


Model for end stage liver disease


Standard deviation


Area under receiving operating characteristic


Positive predictive value


Negative predictive value


Acoustic radiation force impulse imaging


Compliance with ethical standards

Conflict of interest

All the authors have no financial or other conflict of interest to declare concerning this manuscript.


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© Springer Science+Business Media, LLC, part of Springer Nature 2019

Authors and Affiliations

  1. 1.Academic Department of Gastroenterology, Laiko General Hospital, Medical School of NationalKapodistrian University of AthensAthensGreece

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