Splenic Elastography as a Non-Invasive Screening Tool for Esophageal Varices in People With Cirrhosis Treated at a Referral Center

Esophageal varices are severe complications of portal hypertension in individuals with cirrhosis. Upper digestive endoscopy (UDE) is the gold standard for detection, but it is invasive, carries adverse events, and often contributes to low adherence. Splenic elastography using 2D Shear Wave Elastography (2D-SWE) has emerged as a promising, non-invasive alternative to estimate portal pressure and predict esophageal varices. This study aims to evaluate the accuracy of splenic elastography (2D-SWE) in predicting esophageal varices in people with compensated cirrhosis using the Samsung RS85 Prestige device. Cross-sectional study with 107 individuals with advanced cirrhosis (F4) of different etiologies (HCV, HBV, HIV, steatosis, and others). All underwent hepatic and splenic elastography and UDE. After UDE, individuals were classified as cirrhotic without varices (n = 69; 65%) or with varices (n = 38; 35%). Median liver and spleen stiffness values were compared between groups, and the diagnostic performance of splenic elastography was assessed. Most participants were male (69%), with a median BMI of 29.5 kg/m². People with cirrhosis and varices, compared with cirrhotic individuals without varices, had significantly higher liver stiffness (15.0 vs. 11.2 kPa; p=0.0038) and especially higher spleen stiffness (34.5 vs 20.1 kPa; p<0.0001). The area under the ROC curve (AUC) for spleen stiffness was 0.96, indicating excellent performance. Cutoff points between 25.9 and 30.3 kPa showed sensitivity and specificity ≥80%; 25.9 kPa had sensitivity 100% and specificity 84.1%, and 30.3 kPa had sensitivity 81.8% and specificity 95.7%. Based on these findings, the authors recommend a 25.9 kPa cutoff to rule out varices due to its high sensitivity, and a 30.3 kPa cutoff to reduce false positives due to its high specificity. Splenic elastography using 2D-SWE demonstrated high performance for screening esophageal varices in individuals with cirrhosis. Implementing a safer, non-invasive method can reduce the need for UDE in monitoring and screening, improving acceptability and optimizing resources.