Transient elastography can be integrated into routine clinical practice for the evaluation of portal hypertension?

Portal hypertension (PH) is a major consequence of liver tissue fibrogenesis in chronic liver disease (CLD). During progression of CLD, the intrahepatic vasculature is remodeled and excess endogenous vasodilators are released, causing splanchnic arteriolar vasodilatation. Consequently, blood flow in the portal venous system would be increased, leading to PH. As the degree of PH becomes severe, it can result in complications such as the development of esophageal varices, variceal bleeding, ascites, spontaneous bacterial peritonitis and hepatorenal syndrome. Particularly in patients with decompensated cirrhosis, PH is responsible for significant morbidity and mortality. In this regard, precise assessment of PH allows accurate prediction of prognosis and is essential for managing CLD appropriately. Measurement of the hepatic venous pressure gradient (HVPG), the gradient between the wedged (i.e., balloon-occluded) hepatic venous pressure and the free hepatic venous pressure, has been accepted as the reference standard for assessing the degree of PH. Clinically significant PH (CSPH) defined as HVPG ≥10 mmHg, has been associated with formation of esophageal varices and poor prognosis. However, the routine use of this method in the clinical setting has been limited by its invasiveness and the need for expertise and specialized equipment such as angio-intervention unit. Thus, alternative approaches with acceptable diagnostic performance that allow clinicians to assess PH in patients with cirrhosis noninvasively have been needed. Liver stiffness (LS) assessed using transient elastography (TE) was recently demonstrated to be a reliable and accurate noninvasive tool for assessing the degree of liver fibrosis. Recent largescale longitudinal studies also showed a significant association between LS value and the risk of development of hepatocellular carcinoma (HCC) or cirrhotic complication in patients with chronic hepatitis B (CHB). Theoretically, TE also reflects a progressive rise in portal pressure due to increased hepatic vascular resistance related to hepatic fibrosis. Accumulating evidence suggests that TE adequately reflects the findings of HVPG, indicating that it is a useful modality for evaluating PH and cirrhotic complications. TE has good performance for discriminating between patients with and without CSPH (area under the receiver operating characteristic curve [AUROC] 0.82–0.94). In addition, a TE value See Article on Page 34 Transient elastography can be integrated into routine clinical practice for the evaluation of portal hypertension?