Editorial
Copyright ©The Author(s) 2017. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Gastroenterol. Jan 7, 2017; 23(1): 1-10
Published online Jan 7, 2017. doi: 10.3748/wjg.v23.i1.1
Clinical role of non-invasive assessment of portal hypertension
Massimo Bolognesi, Marco Di Pascoli, David Sacerdoti
Massimo Bolognesi, Marco Di Pascoli, David Sacerdoti, Department of Medicine, University of Padova, I-35128 Padova, Italy
Author contributions: Bolognesi M wrote the manuscript; Di Pascoli M and Sacerdoti D contributed to the intellectual content and revision of the manuscript; all authors approved the final version of the manuscript.
Conflict-of-interest statement: The authors have no conflict of interests.
Open-Access: This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Correspondence to: Massimo Bolognesi, MD, PhD, Associate Professor of Internal Medicine, Department of Medicine, University of Padova, Azienda Ospedaliera Università di Padova, Clinica Medica 5, Via Giustininani 2, I-35128 Padova, Italy. massimo.bolognesi@unipd.it
Telephone: +39-49-8212383 Fax: +39-49-8754179
Received: August 22, 2016
Peer-review started: August 24, 2016
First decision: September 12, 2016
Revised: September 27, 2016
Accepted: October 30, 2016
Article in press: October 31, 2016
Published online: January 7, 2017
Abstract

Measurement of portal pressure is pivotal in the evaluation of patients with liver cirrhosis. The measurement of the hepatic venous pressure gradient represents the reference method by which portal pressure is estimated. However, it is an invasive procedure that requires significant hospital resources, including experienced staff, and is associated with considerable cost. Non-invasive methods that can be reliably used to estimate the presence and the degree of portal hypertension are urgently needed in clinical practice. Biochemical and morphological parameters have been proposed for this purpose, but have shown disappointing results overall. Splanchnic Doppler ultrasonography and the analysis of microbubble contrast agent kinetics with contrast-enhanced ultrasonography have shown better accuracy for the evaluation of patients with portal hypertension. A key advancement in the non-invasive evaluation of portal hypertension has been the introduction in clinical practice of methods able to measure stiffness in the liver, as well as stiffness/congestion in the spleen. According to the data published to date, it appears to be possible to rule out clinically significant portal hypertension in patients with cirrhosis (i.e., hepatic venous pressure gradient ≥ 10 mmHg) with a level of clinically-acceptable accuracy by combining measurements of liver stiffness and spleen stiffness along with Doppler ultrasound evaluation. It is probable that the combination of these methods may also allow for the identification of patients with the most serious degree of portal hypertension, and ongoing research is helping to ensure progress in this field.

Keywords: Portal hypertension, Splenic stiffness, Liver stiffness, Splenic arterial resistance indices, Sonography, Doppler ultrasound, Cirrhosis, Transient elastography, Esophageal varices

Core tip: This Editorial analyzes the newest and promising methods for estimating portal pressure non-invasively in cirrhotic patients with portal hypertension. Measurements of liver and spleen stiffness, combined with Doppler ultrasound evaluation, allow for the identification of patients without clinically-significant portal hypertension and are also promising for estimation of the degree of portal pressure in patients with portal hypertension.