Non-invasive diagnosis and follow-up of portal hypertension

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 (R) <= 0.58, or Fibrometer (R) <= 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. (C) 2021 Published by Elsevier Masson SAS.