Spleen stiffness could spare four in ten endoscopies in non-cirrhotic portal vein thrombosis

The edition in brief

In 346 patients with chronic portal vein thrombosis without cirrhosis from 16 VALDIG centres, spleen stiffness measured by transient elastography was the only independent predictor of high-risk varices. A cut-off of 40 kPa or less would have spared 41–43% of screening endoscopies while missing 3–5% of high-risk varices (negative predictive value 96–97%). Liver stiffness cut-offs used in cirrhosis do not apply here. The US Multi-Society Task Force on Colorectal Cancer describes serrated polyposis syndrome as the commonest polyposis syndrome and often unrecognised; it recommends meticulous clearance and frequent surveillance, surgery only for cancer or unmanageable polyp burden, germline testing only when another hereditary syndrome is suspected, and colonoscopy for first-degree relatives. A meta-analysis of 11 studies and 1958 patients with acute-on-chronic liver failure found non-bioartificial liver support associated with lower 28-day mortality (RR 0.72), with the clearest benefit at MELD 25–32; the pooled data include non-randomised cohorts. Enhanced recovery pathways in IBD surgery shortened stay by about 1.6 days without more readmissions. The pearl recaps when endoscopy can be skipped in compensated cirrhosis.