Non-invasive diagnosis and follow-up of portal hypertension.

Abstract

Compensated advanced chronic liver disease (cACLD) describes the spectrum of advanced fibrosis/cirrhosis in asymptomatic patients at risk of developing clinically significant portal hypertension (CSPH, defined by a hepatic venous pressure gradient (HVPG) ≥10 mmHg). Patients with cACLD are at high risk of liver-related morbidity and mortality. In patients at risk of chronic liver disease, cACLD is strongly suggested by a liver stiffness (LSM) value >15 kPa or clinical/biological/radiological signs of portal hypertension, and ruled out by LSM <10 kPa, or Fibrotest® ≤0.58, or Fibrometer® ≤0.786. Patients with chronic liver disease (excluding vascular diseases) with a LSM <10 kPa are at low risk of developing portal hypertension complications. The presence of CSPH can be strongly suspected when LSM is ≥20 kPa. In a patient without clinical, endoscopic or radiological features of portal hypertension, measurement of the HVPG is recommended before major liver or intra-abdominal surgery, before extra-hepatic transplantation and in patients with unexplained ascites. Endoscopic screening for oesophageal varices can be avoided in patients with LSM <20 kPa and a platelet count >150 G/L (favourable Baveno VI criteria) at the time of diagnosis. There is no non-invasive method alternative for oeso-gastroduodenal endoscopy in patients with unfavourable Baveno criteria (liver stiffness ≥20 kPa or platelet count ≤50 G/l). Platelet count and liver stiffness measurements must be performed once a year in patients with cACLD with favourable Baveno VI criteria at the time of diagnosis. A screening oeso-gastroduodenal endoscopy is recommended if Baveno VI criteria become unfavourable.

• Authors: Dominique Thabut, Delphine Weil, Charlotte Bouzbib, Marika Rudler, Christophe Cassinotto, Laurent Castéra, Thomas Serste, Frédéric Oberti, Nathalie Ganne-Carrié, Victor de Lédinghen, Marc Bourlière, Christophe Bureau
• Journal: Clinics and research in hepatology and gastroenterology (Clin Res Hepatol Gastroenterol) Vol. 46 Issue 8 Pg. 101767 (10 2022) ISSN: 2210-741X [Electronic] France
• PMID: 34332128 (Publication Type: Practice Guideline)
• Copyright: Copyright © 2021. Published by Elsevier Masson SAS.

Topics

• Elasticity Imaging Techniques (methods)
• Endoscopy, Gastrointestinal
• Esophageal and Gastric Varices (complications)
• Follow-Up Studies
• Humans
• Hypertension, Portal (complications, diagnosis)
• Liver Cirrhosis (complications, diagnosis)