# Splenic stiffness does not predict esophageal varices in children with portal hypertension

## TL;DR

This study finds that splenic stiffness measured by ultrasound does not reliably predict esophageal varices in children with portal hypertension.

## Contribution

This is the first validation study showing that splenic stiffness is not a reliable predictor of pediatric esophageal varices.

## Key findings

- Splenic stiffness had a high predictive value in the derivation cohort but failed validation in the second group.
- Liver stiffness and a clinical prediction rule showed more consistent results across both cohorts.
- No single ultrasound parameter accurately predicts esophageal varices in children.

## Abstract

To investigate ultrasound parameters, particularly splenic stiffness, as predictors of pediatric esophageal varices.

We included all children aged 0–19 years who underwent esophagogastroduodenoscopy, for variceal screening or surveillance, and abdominopelvic ultrasound with splenic elastography measurement. We also recorded biological parameters (platelets count, albumin) to determine a clinical prediction rule (CPR). Derivation and validation cohorts were defined according to measurement date. Receiver‐operating characteristic (ROC) statistics and sensitivity, specificity, positive predictive value, and negative predictive value for the optimal threshold value were calculated, and used to assess the performance of each parameter.

Eighty derivation cohort children and 58 validation cohort children formed the study sample. Cohort characteristics did not differ for age, sex, distribution of varices but differ for some etiologies, abdominal surgery, spleen size, splenic stiffness measurement (SSM), ascites, and the presence of spontaneous portosystemic shunts. In the derivation cohort, splenic stiffness was the best independent predictor of esophageal varices, with an area under the ROC curve (AUC) of 0.83, a sensitivity of 0.90, and specificity of 0.73 at a threshold of 22 kPa. In the validation cohort, SSM was no longer significantly associated with esophageal varices at endoscopy, had a lower sensitivity of 0.26, and no other threshold could be found. Liver stiffness measurement (LSM) and CPR had a correct predictive value (AUC 0.70 for LSM; 0.78 for CPR in the derivation cohort and 0.64 for LSM; 0.71 for CPR in the validation cohort) for esophageal varices.

SSM cannot be used as a single parameter to predict esophageal varices. LSM and CPR despite their lower AUC appear to much more robust measures with consistent results across cohorts.

Esophagogastroduodenoscopy, the gold standard, is an invasive procedure for diagnosing pediatric esophageal varices.Abdominal ultrasound coupled with elastography allows measurement of the degree of hepatic and splenic fibrosis.Although splenic stiffness is considered a good predictor of pediatric esophageal varices, validation studies have not been performed.

Esophagogastroduodenoscopy, the gold standard, is an invasive procedure for diagnosing pediatric esophageal varices.

Abdominal ultrasound coupled with elastography allows measurement of the degree of hepatic and splenic fibrosis.

Although splenic stiffness is considered a good predictor of pediatric esophageal varices, validation studies have not been performed.

No single ultrasound parameter accurately predicts pediatric esophageal varices.In this validation study, which is the first of its kind, splenic stiffness does not predict esophageal varices in children with portal hypertension.

No single ultrasound parameter accurately predicts pediatric esophageal varices.

In this validation study, which is the first of its kind, splenic stiffness does not predict esophageal varices in children with portal hypertension.