In compensated advanced chronic liver disease, patients with liver stiffness below 20 kPa and a platelet count above 150 × 10⁹/L have a very low risk of varices needing treatment and can avoid screening endoscopy, with annual repetition of elastography and platelets. Spleen stiffness of 40 kPa or less can spare further endoscopies in those who do not meet that rule. Patients already on a non-selective beta-blocker for portal hypertension do not need screening endoscopy for varices.
- Liver stiffness <20 kPa plus platelets >150 × 10⁹/L: endoscopy can be avoided.
- Repeat elastography and platelets yearly.
- Spleen stiffness ≤40 kPa adds a further rule-out where available.
- These rules apply to compensated cirrhosis, not to decompensated disease.
Why it matters
Non-invasive rules save many patients a procedure without missing varices that need treatment.
Read the rest in the app
You have read your two free briefings this month. The app carries all 27 specialties, every morning, free — and this finding is waiting in it.
Scan to keep reading on your phone. No account needed to start.
Tomorrow morning, before your first patient
One edition a day for gastroenterology & hepatology, written by the desk, every claim tied to its paper. Six minutes.
Get the app — free