The Emerging Role of SSM and Other Noninvasive Modalities in the Diagnosis and Management of Portal Hypertension

• Portal hypertension (PHT) can be accessed via invasive or noninvasive tests.
• Noninvasive tests are promising in predicting the presence of clinically significant portal hypertension (CSPH) and excluding patients not needing endoscopy. Current invasive measures for identifying patients at high risk of CSPH and decompensation include biopsy and hepatic venous pressure gradient (HVPG).
• Developing noninvasive measures for the identification of patients at high risk of CSPH and decompensation includes plasma biomarkers (vWF-AG, APRI, ELF, ICG-r15), liver stiffness measurement (LSM) and spleen stiffness measurement (SSM).
• SSM <21 kPa rules out CSPH, while SSM >50 kPa rules-in CSPH.
• For the assessment of PHT-HVPG is the gold standard; vWF is promising; spleen stiffness is reliable, and machine learning is promising.
• SSM/LSM are promising noninvasive tests for knowing the response to beta-blockers