Non-invasive Assessment of Clinically Significant Portal Hypertension

Abstract

Abstract Purpose of Review Clinically significant portal hypertension (CSPH) is a serious clinical condition causing decompensation and potentially fatal complications especially in the presence of advanced liver disease. This article aims to critically review the current literature on non-invasive assessment of CSPH. Recent Findings The Baveno VII consensus encouraged non-invasive assessment of CSPH to identify patients at risk and avoid unnecessary screening endoscopies. Novel machine learning and omics-based laboratory scores have been introduced, which can be combined with liver stiffness measurement (LSM). Spleen stiffness measurement (SSM) is an increasingly used novel elastography modality. Elastography and cross-sectional imaging methods have reached similar predictive power, while the accuracy of non-invasive tests can only be improved when used sequentially. Summary In this review, we provide a detailed discussion of advantages and limitations of non-invasive assessment of CSPH, highlighting their diagnostic accuracy, reproducibility, and feasibility in clinical practice.