Abstract
The main goal of the present review is to summarize current strategies to predict the presence of clinically significant portal hypertension (CSPH), varices, and decompensation with noninvasive methods, mainly focusing in transient elastography (TE) which is the most validated tool. TE has demonstrated to predict the presence of CSPH. Values >20–25 kPa rule in the presence of CSPH with a probability >90%. On the other hand, when combined with platelet count, TE has been shown to rule out the presence of high-risk varices. In fact, patients with compensated advanced chronic liver disease (cACLD) with TE 150 × 109/L have a very low risk of having varices needing treatment and endoscopy can be safely avoided. TE also can predict the risk of decompensation especially when repeated measures are performed. TE is easy to perform in clinical daily practice and it has been incorporated in clinical guidelines for the management of patients with advanced chronic liver disease. Current evidences and future improvements will greatly reduce the use of invasive procedures in cACLD patients.
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