Chronic Portal-Vein Thrombosis and Spleen Stiffness: Journal of Hepatology | September 2026

What Did the Study Find?

The international VALDIG study evaluated 346 patients with chronic noncirrhotic portal-vein thrombosis (PVT) to determine whether spleen stiffness could identify patients unlikely to harbor high-risk varices.

• Spleen stiffness ≤40 kPa by VCTE effectively ruled out high-risk varices.
• In the derivation cohort, sensitivity and NPV were both 97%.
• The high NPV was reproduced in validation at 96%.
• Using this threshold could potentially avoid 41–43% of screening endoscopies.
• Only 3–5% of high-risk varices would have been missed.
• This provides a disease-specific non-invasive strategy where conventional cirrhosis-derived liver-stiffness criteria perform poorly.

Why Does It Matter?

Patients with chronic PVT may undergo repeated endoscopic surveillance over many years. A reliable non-invasive gatekeeper could substantially reduce this burden.

GastroAGI Takeaway

Spleen stiffness may become the gatekeeper to endoscopy in chronic noncirrhotic PVT. A ≤40-kPa threshold could potentially spare around 40% of screening procedures while maintaining a high NPV for high-risk varices. The strategy is highly promising, but implementation validation is needed before replacing routine endoscopic screening, particularly given the small residual risk of missed high-risk varices.