Role and clinical meaning of non-invasive tests in the evaluation of portal hypertension in patients with advanced chronic liver disease

Abstract

Portal hypertension (PH) is the main driver of complications in patients with advanced chronic liver disease (ACLD). Correctly identifying the presence and severity of PH is crucial for the management and prognosis of compensated ACLD (cACLD) patients. Over the last 20 years, several non-invasive tests (NITs) have been proposed for PH assessment; among these, liver (LSM) and spleen (SSM) stiffness measurement by transient elastography are the most validated and accurate predictors of clinically significant PH (CSPH) and its complications, such as gastroesophageal varices, clinical decompensation and hepatocellular carcinoma. The inclusion of NITs in the official recommendations of the Baveno VI Consensus, as valid and trustworthy tools to assess PH in cACLD patients, represents one of the major advances in hepatology of the last years. For instance, the recently proposed Baveno VI Criteria (LSM<20 kPa and platelet count >150 × 109/L) have proven to be a valid strategy to rule out the presence of high-risk varices (HRV) and identify patients that can safely avoid screening upper endoscopy (EGD). In conclusion, further studies are necessary to fully explore the potential of NITs and maximize their use in everyday clinical practice.