Prediction of high-risk esophageal varices in patients with chronic liver disease with point and 2D shear wave elastography: a systematic review and meta-analysis

ObjectiveTo assess the diagnostic performance of liver stiffness (LS) and spleen stiffness (SS) measured by point shear wave elastography (pSWE) and 2D shear wave elastography (2D-SWE) in the detection of high-risk esophageal varices (HREV) and to compare their diagnostic accuracy.MethodsThrough systematic search of PubMed, Embase, and Web of Science databases, we included 17 articles reporting the diagnostic performance of LS or SS measured by pSWE or 2D-SWE for HREV. We used a bivariate random-effects model to estimate pooled sensitivity, specificity, positive likelihood ratio (PLR), negative likelihood ratio (NLR), area under summary receiver operator characteristic curve (AUSROC), and diagnostic odds ratio (DOR).ResultsFor LS, there was no significant difference between the pooled sensitivity, 0.89 (95% confidence interval CI, 0.81–0.94) vs. 0.8 (95% CI, 0.72–0.86) (p = 0.13), and specificity, 0.81 (95% CI, 0.73–0.87) vs. 0.73 (95% CI, 0.65–0.79) (p = 0.07) of pSWE and 2D-SWE. The AUSROC and DOR of pSWE were higher than those of 2D-SWE: 0.92 (95% CI, 0.89–0.94) vs. 0.84 (95% CI, 0.80–0.87), p = 0.03, 33 (95% CI, 25–61) vs. 11 (95% CI, 5–22), (p < 0.01). For SS, there was no significant difference between the pooled sensitivity 0.91 (95% CI, 0.78–0.96) vs. 0.89 (95% CI, 0.80–0.94) (p = 0.43); specificity, 0.79 (95% CI, 0.72–0.84) vs. 0.72 (95% CI, 0.63–0.79) (p = 0.06); and DOR, 35 (95% CI, 13–100) vs. 20 (95% CI, 8–50) (p = 0.16) of pSWE and 2D-SWE.ConclusionLS and SS measured by pSWE and 2D-SWE have good accuracy in predicting HREV.Key Points• There is modest difference between the diagnostic performance of LS and SS measured by pSWE and 2D-SWE.• LS and SS measured by pSWE and 2D-SWE both have high sensitivity, specificity, and AUSROC for the evaluation of HREV in patients with CLD.• pSWE and 2D-SWE are promising tools for noninvasive monitoring risk of esophageal varices bleeding of CLD patients.