Diagnostic performance of splenic stiffness measurement for prediction of esophageal/gastric varices in pediatric portal hypertension: A systematic review and meta-analysis.

In 30 seconds

This systematic review and meta-analysis assessed splenic stiffness measurement (SSM) for detecting esophageal/gastric varices (EV) and clinically significant varices (CSV) in children with portal hypertension, using endoscopy as the reference standard. Ten studies involving 618 patients were included. For CSV, pooled sensitivity was 0.86 (95% CI: 0.81-0.90), specificity was 0.82 (95% CI: 0.76-0.87), and AUROC was 0.905 (95% CI: 0.882-0.924). The authors judged SSM to have good diagnostic accuracy, while noting that further standardization and multicentre evaluation are needed before routine screening use.

Key findings

• For EV prediction, pooled sensitivity was 0.80 (95% CI: 0.70-0.88) and specificity was 0.89 (95% CI: 0.80-0.95).
• For CSV prediction, pooled sensitivity was 0.86 (95% CI: 0.81-0.90), specificity was 0.82 (95% CI: 0.76-0.87), and AUROC was 0.905 (95% CI: 0.882-0.924).
• CSV sensitivity showed substantial heterogeneity (I 2 = 69.2%, p = 0.0006); etiology, elastography technique, and ethnicity were identified as sources.
• SSM accuracy was higher in non-cirrhotic than cirrhotic portal hypertension (DOR: 48.61 [95% CI: 13.62-188.37] vs 18.89 [95% CI: 8.65-40.53]).

Why it matters

Endoscopy is the reference standard for identifying varices but is invasive and requires sedation in children. SSM offers a non-invasive approach with good pooled diagnostic performance, particularly for clinically significant varices. Its potential value for screening and risk stratification is tempered by heterogeneity across studies, so accuracy estimates may not transfer uniformly across populations or measurement methods.

What to keep in mind

The authors call for multicentre studies with standardized protocols and disease-specific pediatric cut-offs. Substantial heterogeneity was present for pooled CSV sensitivity.