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Letter
Ruling in and ruling out with elastography in compensated advanced chronic liver disease
  1. Salvador Augustin1,2,
  2. Mónica Pons1,
  3. Joan Genesca1,2
  1. 1 Liver Unit, Department of Internal Medicine, Hospital Universitari Vall d'Hebron, Vall d'Hebron Institut de Recerca (VHIR), Universitat Autònoma de Barcelona, Barcelona, Spain
  2. 2 Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (CIBERehd), Instituto de Salud Carlos III, Madrid, Spain
  1. Correspondence to Dr Salvador Augustin, Liver Unit, Department of Internal Medicine, Hospital Universitari Vall d'Hebron, Passeig Vall d'Hebron 119-129, Barcelona 08035, Spain; salva.augustin{at}gmail.com

https://doi.org/10.1136/gutjnl-2016-311775

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    The recent letter by Jansen et al 1 presenting an algorithm to rule out clinically significant portal hypertension (CSPH) by combining shear-wave elastography of liver (L-SWE) and spleen (S-SWE) is an important contribution to the increasing knowledge regarding non-invasive assessment of patients with compensated advanced chronic liver disease (cACLD). Baveno VI recommendations focused on transient elastography as a tool to rule in CSPH in patients with the authors cACLD of viral etiology,2 ,3 but there is no doubt that other related elastography techniques should work similarly. Also, recent UK guidelines on variceal bleeding introduced elastography for variceal screening and diagnosis.4

    In their study, the authors concluded that combining L-SWE <16 kPa with S-SWE <26.6 kPa showed a very high sensitivity (98.6%), with a remarkable negative predictive value for CSPH (96.3%). However, we have a few comments about the design and interpretation of results that we hope may enhance the transferability of these excellent results to …

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    Footnotes

    • Contributors The three authors made substantial contributions to the conception or design of the work and interpretation of data. JG made the drafting of the work; SA and MP revised it critically for important intellectual content. The published version of the letter was approved by all three authors.

    • Funding SA is a recipient of a JR grant from Instituto de Salud Carlos III, Spain. MP is a recipient of a PFIS grant from Instituto de Salud Carlos III. JG is a recipient of a Research Intensification grant from Instituto de Salud Carlos III. MP is a PhD student at Universitat Autònoma de Barcelona, Spain. The study was partially funded by grants PI12/01759 and PI15/00066 from Instituto de Salud Carlos III, Spain, and cofinanced by the European Regional Development Fund (FEDER). CIBERehd is supported by Instituto de Salud Carlos III, Spain.

    • Competing interests None declared.

    • Provenance and peer review Not commissioned; internally peer reviewed.