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Invasive and non-invasive assessment of portal hypertension

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Abstract

Portal hypertension is the central driver of complications in patients with chronic liver diseases and cirrhosis. The diagnosis of portal hypertension has important prognostic and clinical implications. In particular, screening for varices in patients with portal hypertension can effectively reduce the morbidity and mortality of variceal bleeding. In this article, we review the invasive and non-invasive methods to assess portal hypertension. Hepatic venous pressure gradient remains the gold standard to measure portal pressure but is invasive and seldom performed outside expert centers and research settings. In recent years, a number of non-invasive tests of fibrosis have shown good correlation with liver histology. They also show promise in identifying patients with portal hypertension and large varices. As a result, the latest Baveno VI consensus guidelines endorse the use of liver stiffness measurement by transient elastography and platelet count as initial assessment to select patients for varices screening. On the other hand, the performance of non-invasive tests in assessing the response to non-selective beta-blockers or transjugular intrahepatic portosystemic shunting is either suboptimal or unclear.

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Abbreviations

ALT:

Alanine aminotransferase

APRI:

AST-to-platelet ratio index

AST:

Aspartate aminotransferase

AUROC:

Area under the receiver-operating characteristics curve

CT:

Computed tomography

FHVP:

Free hepatic vein pressure

HCC:

Hepatocellular carcinoma

HVPG:

Hepatic vein pressure gradient

IVCP:

Inferior vena cava pressures

MRE:

Magnetic resonance elastography

MRI:

Magnetic resonance imaging

TIPSS:

Transjugular intrahepatic porto-systemic shunt

WHVP:

Wedged hepatic vein pressure

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Authors and Affiliations

  1. Department of Medicine and Therapeutics, 9/F, Clinical Sciences Building, Prince of Wales Hospital, 30-32 Ngan Shing Street, Shatin, Hong Kong, China

    Jonathan Chung-Fai Leung, Thomson Chi-Wang Loong, James Pang, Jeremy Lok Wei & Vincent Wai-Sun Wong

  2. State Key Laboratory of Digestive Disease, The Chinese University of Hong Kong, Hong Kong, China

    Vincent Wai-Sun Wong

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  1. Jonathan Chung-Fai Leung
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  2. Thomson Chi-Wang Loong
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  3. James Pang
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  4. Jeremy Lok Wei
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  5. Vincent Wai-Sun Wong
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Correspondence to Vincent Wai-Sun Wong.

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Vincent Wong has served as an advisory board member for Perspectum Diagnostics and a speaker for Echosens. The other authors report no conflict of interest.

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Leung, J.CF., Loong, T.CW., Pang, J. et al. Invasive and non-invasive assessment of portal hypertension. Hepatol Int 12 (Suppl 1), 44–55 (2018). https://doi.org/10.1007/s12072-017-9795-0

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