Table 1.

Summary of prospective studies and meta-analyses on the diagnostic value of transient elastography for the diagnosis of any varices and “varices needing treatment”

Author, journal, year	Design and etiology	N patients overall N patients with any EV (%) N patients with VNT (%)	TE-cutoffs and AUC any EV/VNT	Main conclusions (specificity/sensitivity, PPV/NPV)	Additional parameters used in the study and comments
Foucher, Gut, 2006 [17]	Prospective Mixed etiology	n = 144 patients with F3/F4 fibrosis n with any EV: n/a n = 42 (29%)/85 (59%) with VNT	LSM: Any: n/a VNT 27.5 kPa, AUC 0.73	LSM: Any: n/a VNT: Sens. 88%, Spec. 53%, PPV 45%, NPV 90%	• The main focus was diagnosis of fibrosis stages using TE
Kazemi, J Hepatol, 2006 [18]	Prospective Mixed etiology	N = 165 patients analyzed n = 74 (44.8%) with EV n = 47 (28.5%) with VNT	LSM: Any 13.9 kPa, AUC 0.84 VNT 19.0 kPa, AUC 0.83,	LSM: Any: Sens. 92%, Spec. 39%, PPV 55%, NPV 85% VNT Sens. 89%, Spec. 59%, PPV 47%, NPV 93%	• Parameters: PLT, spleen diameter, PLT, LSM/spleen size
Vizzutti, Hepatology, 2007 [19]	Prospective Etiology: HCV	n = 61 patients analyzed n = 30 (49.2%) with esophageal EV n = 18 (38.2%) with large EV/VNT	LSM: Any 17.6 kPa, AUC 0.76 VNT 27.4 kPa, AUC 0.76	LSM: Any Sens. 90%, spec. 43%, PPV 77%, NPV 66% VNT Sens. 70%, spec. 78%, PPV 90%, NPV 55%
Bureau, Aliment Pharmacol Ther, 2008 [20]	Prospective Mixed etiology	n = 150 patients analyzed n = 64 (42.6%) with EV n = 43 (28.6%) with VNT	LSM: Any 21.1 kPa, AUC 0.85 VNT/large 29.3 kPa AUC 0.76	LSM: Any Sens. 84%, Spec. 71% VNT Sens. 81%, Spec. 61%	• Parameters: Prothrombin index • VNT: large EV
Castéra, J Hepatol, 2009 [21]	Prospective Etiology: HCV	n = 70 patients with cirrhosis analyzed n = 25 with EV n = 13 with VNT	LSM: * Any 13.9 kPa (Kazemi 2006) 17.6 kPa (Vizutti 2007) 21.5 kPa, AUC 0.96 * VNT 19 kPa (Kazemi 2006) 21.5 kPa, AUC 0.87 30 kPa, AUC 0.87	LSM: *Any: Cutoff 13.9 kPa: Sens. 96%, Spec. 39%, PPV 49%, NPV 94% Cutoff 17.6 kPa: Sens. 84%, Spec. 61%, PPV 57%, NPV 86% Cutoff 21.5 kPa: Sens. 76%, Spec. 78%, PPV 68%, NPV 84% *VNT: Cutoff 19.0 kPa: Sens. 85%, Spec. 62%, PPV 35%, NPV 94% Cutoff 21.5 kPa: Sens. 85%, Spec. 68%, PPV 39%, NPV 95% Cutoff 30.5 kPa: Sens. 77%, Spec. 5%, PPV 56%, NPV 94%10	• Parameters: PLT, FibroTest, prothrombin index, AST/ALT ratio, APRI, Lok index
Kim, Am J Gastroenterol, 2010 [22]	Prospective Etiology: HBV	n = 391 n = 184 (47%) with EV n = 133 (34%) with VNT	LSM: n/a LSPS: Any: n/a VNT 3.5, AUC 0.95	LSM: n/a LSPS: VNT: Cutoff 3.5: Sens. 88%, Spec. 91%, PPV 82%, NPV 94% VNT: Cutoff 5.5: Sens. 72%, Spec. 98% PPV 94%, NPV 88%	• Diagnostic accuracy varies with severity of cirrhosis: LPS: AUC 0.94 (Child-Pugh A), AUC 0.88 (Child-Pugh B/C). • Included cirrhosis Child-Pugh A-C, training cohort and validation cohort
Nguyen-Khac, Alcohol Clin Exp Res, 2010 [23]	Prospective Mixed etiologies	n = 183 patients analyzed n = 41 (22%) with large EV/VNT	LSM: VNT 48 kPa; AUC 0.75 VNT (ALD) 47.2 kPa, AUC 0.77 VNT (viral) 19.8 kPa, AUC 0.73	LSM: VNT: Sens. 73%, Spec. 73%, PPV 44%, NPV 90% VNT (ALD): Sens. 85%, Spec. 64%, PPV 44%, NPV 93% VNT (viral): Sens. 89%, Spec. 55%, PPV 27%, NPV 96%
Stefanescu, J Gastroenterol Hepatol, 2011 [24]	Prospective Etiology: ALD and/or HCV or healthy controls	n = 137 with cirrhosis analyzed n = 116 (85%) with EV n = 60 (44%) with VNT	LSM: Any 28 kPa, AUC 0.75 SSM: Any 46.4 kPa, AUC 0.78 LSM + SSM: Any: LSM 19 kPa, SSM 55 kPa	LSM: Any: Sens. 74%, Spec. 64%, PPV 92%, NPV 31% SSM: Any: Sens. 84%, Spec. 71%, PPV 94%, NPV 46% LSM (19 kPa) + SSM (55 kPa): Any: Sens. 93%, Spec. 40%, PPV 95%, NPV 33%	• Parameters: PLT/spleen size ratio; LSM × SSM • VNT: cutoffs n/a
Stefanescu, J Gastrointest Liver Dis, 2011 [25]	Prospective Etiology: ALD and/or HCV	n = 231 patients analyzed n = 157 (68%) with EV n = 68 (30%) with VNT	LSM: Any 19 kPa, AUC 0.66 VNT 38 kPa, AUC 0.69	LSM: Any: Sens. 84%, Spec. 32%, PPV 72%, NPV 49% VNT: Sens. 56%, Spec. 75%, PPV 47%, NPV 81%	• Included cirrhosis • Excluded decompensated cirrhosis, co-infection with viral hepatitis • Parameters: APRI, Forns Index, Lok Score, FIB4 • VNT: grades 2–3 EV
Chen, J Gastroenterol Hepatol, 2012 [26]	Prospective Etiology: HBV	n = 222 patients analyzed n = 96 (43%) with EV n = 82 (40%) with VNT	LSM: VNT 17.1 kPa, AUC 0.73 (all) VNT 36.1 kPa, AUC 0.92 (ALT > 5 × ULN) VNT 7.9 kPa, AUC 0.79 (Child-Pugh A, rule out EV) VNT 34.6 kPa (Child-Pugh A, rule in EV) LSPS: VNT Cutoff 3.5, cutoff 5.5; AUC 0.81	LSM: VNT: Cutoff 17.1 kPa: Sens. 90%, Spec. 44%, PPV 47%, NPV 88% VNT: Cutoff 36.1 kPa: PPV 73%, NPV 100% VNT: Cutoff 7.9 kPa: Sens. 97%, NPV 95% VNT: Cutoff 34.6 kPa: Spec. 94%, PPV 73% LSPS: VNT: Cutoff 3.5: Sens. 78%, NPV 86% (exclusion) VNT: Cutoff 5.5: Spec. 90%, PPV 76% (inclusion)	• Included cirrhosis • Excluded history of variceal bleeding, NSBB therapy, TIPS • VNT: medium or large EV, or small with RSS, or decompensated cirrhosis • Parameters: USLS; LSM × ALT, LSM × Child-Pugh, LSPS, age-PLT-AST/ALT ratio, PLT/spleen diameter ratio
Wang, J Gastroenterol Hepatol, 2012 [27]	Prospective Etiology: HBV	n = 126 patients analyzed n = 48 (38%) with EV n = 13 (10%) with VNT	LSM: Any 12.0 kPa, AUC 0.79 VNT 21.0 kPa, AUC 0.87	LSM: Any: Sens. 67%, Spec. 77%, PPV 64%, NPV 79% VNT: Sens. 77%, Spec. 87%, PPV 40%, NPV 97%	• Parameters: • APRI, PLT, AST/ALT ratio
Colecchia, Gastroenterology, 2012 [28]	Prospective Etiology: HCV	n = 100 patients analyzed n = 53 (53%)with EV n = 26 (26%) with VNT	LSM (AUC 0.90): Any: cutoff 16.4 kPa Any: cutoff 25.0 kPa SSM (AUC 0.94): Any: cutoff 41.3 kPa Any: cutoff 55.0 kPa LSPS (AUC 0.91) Any: cutoff 1.32 Any: cutoff 3.83	LSM: Any: cutoff 16.4 kPa; Sens. 96%, Spec. 60% (rule out) Any: cutoff 25.0 kPa, Sens. 57%, Spec. 98% (rule in) SSM: Any: cutoff 41.3 kPa, Sens. 98%, Spec. 66% (rule out) Any: cutoff 55.0 kPa, Sens. 72%, Spec. 96% (rule in) LSPS: Any: cutoff 1.32: Sens. 98%, Spec. 64% (rule out) Any: cutoff 3.83: Sens. 60%, Spec. 98% (rule in)	• LSM and SSM for detection of HVPG > 12 mmHg and EV • Parameters: • LSPS, PLT/spleen size
Calvaruso, J Viral Hepat, 2013 [29]	Prospective Etiology: HCV	n = 96 patients analyzed n = 54 (56.3%) with EV n = 26 (27.1%) with VNT	LSM: Any 17.0 kPa, AUC 0.71 VNT 19.0 kPa, AUC 0.71 Modified SSM (0-150 kPa): Any 50.0 kPa, AUC 0.70 VNT 54.0 kPa, AUC 0.82	LSM: Any: Sens. 71%, Spec. 57%, PPV 67%, NPV 62% VNT: Sens. 72% Spec. 55%, PPV 38%, NPV 84% Modified SSM: Any: Sens. 65%, Spec. 61%, PPV 69%, NPV 57% VNT: Sens. 80%, Spec. 70%, PPV 47%, NPV 90%	• Modified SSM: values 0–150 kPa • Parameters: Gender, age, AST, ALT, PLT, AST/ALT ratio, APRI, spleen diameter
Shi, Liver Int, 2013 [30]	Meta-analysis All etiologies, with sub-analyses for viral etiology (HCV + HBV)	n = 3644 patients analyzed n = 1786? (49.0%) with EV n = 1166? (32.0%) with VNT	LSM (pooled): Any: Cutoffs 15.1–28.0 kPa; AUC 0.84 VNT: Cutoffs: 17.8–48.0 kPa; AUC 0.78	LSM (pooled): Any: Cutoffs 15.1–28.0 kPa: Sens. 87%, Spec. 53%, PPV 79%, NPV 64% VNT: Cutoffs: 17.8–48.0 kPa: Sens. 86%, Spec. 59%,, PPV 79%, NPV 66%
Sharma, Am J Gastroenterol, 2013 [31]	Prospective Mixed etiologies	n = 174 patients analyzed n = 124 patients with EV n = 78 with large EV/VNT	LSM: Any 27.3 kPa, AUC 0.91 VNT: n/a SSM: Any 40.8 kPa, AUC 0.90 LSPS: Any 3.09, AUC 0.87	LSM: Any: Sens. 91%, Spec. 72%, PPV 89%, NPV 76% SSM: Any: Sens. 94%, Spec. 76%, PPV 91%, NPV 84% LSPS: Any: Sens. 89%, Spec. 76%, PPV and NPV not reported	• Only LS und SS independently associated with presence of EV; • SSM: can differentiate between large and small EV • LSM: Cannot differentiate between large and small EV • Included cirrhosis • Excluded decompensated cirrhosis, ACLF, active alcohol abuse • Parameters: LSPS, PLT/spleen diameter ratio
Binţinţan, Med Ultrason, 2015 [32]	Prospective Etiology: viral and/or ALD	n = 60 patients with cirrhosis n = 47 (78%) with EV n = 32 (53%) with VNT	LSM: Any 15 kPa, AUC 0.96 VNT 28.8 kPa, AUC 0.90	LSM: Any: Sens. 95%, Spec. 100%, PPV 100%, NPV 86% VNT: Sens. 87%, Spec. 83%, PPV 84%, NPV 86%	• Parameters: hemodynamic liver index, portal vascular resistance, spleno-portal index
Hu, Ultrasound Med Biol, 2015 [33]	Prospective Etiology: viral (HBV, HCV)	n = 200 patients analyzed n = 110 (55%) with EV n = 69 (35%) with large EV	LSM: Any 20.3 kPa, AUC 0.84 VNT 25.6 kPa, AUC 0.86	LSM: Any: Sens. 84%, Spec. 73%, PPV 72%, NPV 91% VNT: Sens. 86%, Spec. 72%, PPV 79%, NPV 81%	• VNT: grade 2 or 3 EV • Parameters: LSM x PLT (no detailed description available)
Marot, Liver Int, 2017 [34]	Meta-analysis Mixed etiologies	n = 3364 n = (49.0%) with EV n = (32.0%) with VNT	LSM: Any 20 kPa* LSM and PLT (150 G/L): VNT 20 kPa × PLT 150 G/L*	LSM and PLT (150 G/L): Any: Sens. 89%, Spec. 38%, PPV 43%, NPV 86% VNT: Sens. 93%, Spec. 30%, PPV 14%, NPV 97%	• Focus on risk of bleeding rather than finding cutoffs for prediction of EV • VNT: variable definition between studies
Pu, J Gastroenterol, 2017 [35]	Meta-analysis Mixed etiologies	n = 2697 patients analyzed Patients with EV: n/a	LSM (pooled): Any 20 kPa, AUC 0.83 VNT 30 kPa, AUC 0.83	LSM: Any (pooled): Sens. 84%, Spec. 62%, Any: Cutoff 20 kPa: Sens. 83%, Spec. 68%, PPV: n/a, NPV: n/a VNT (pooled): Sens. 78%, Spec. 76%, VNT: Cutoff 30 kPa: Sens. 73%, Spec. 74%, PPV: n/a, NPV: n/a	• VNT: large EV
Llop, J Gastroenterol Hepatol, 2017 [36]	Retrospective analysis of prospective data Mixed etiology	n = 161 patients analyzed n = 25 (15.5%) with EV VNT: n/a	LSM Any 20.0 kPa* LSM + PLT:* Any 20.0 kPa x PLT 150 G/L* LSPS: Any: cutoff 3.21;	LSM: Any: Cutoff 20 kPa*: Sens. 76%, Spec. 71%, PPV 32%, NPV 94% LSM and PLT (150 G/L)*: Any: Cutoff 20 kPa*: Sens. 88%, Spec. 38%, PPV 21%, NPV 94% LSPS: Any: Sens. 36%, Spec. 84%, PPV 30%, NPV 88%	• TE is the best single method to predict EV; LSPS had high and Baveno VI criteria low risk of misclassifying patients with EV • Included LSM >10 kPa • Excluded decompensated cirrhosis • Parameters: PLT, spleen diameter, LSPS, variceal risk index • Augustin algorithm, Baveno VI • AUC was calculated but not reported
Wong, Liver Int, 2018 [37]	Prospective	LSM: Total n = 274/548 n = 51 (18.6%) with EV n = 11 (4.0%) with VNT	LSM: Any 12.5 kPa* VNT 20.0 kPa × PLT 150 G/L* SSM: VNT 41.3 kPa	LSM: Any: Cutoff 20 kPa*: Sens 96%, Spec. 91%, PPV 26%, NPV 47% VNT: Cutoff 12.5 kPa: Sens. 98%, NPV: 94% VNT: Cutoff 20 kPa*: Sens. 91%, Spec. 18.1%, PPV 10%, NPV 96% SSM: Any 98%, NPV 94%	• LSM (12.5 kPa) × SSM (41.3 kPa)
Manatsathit, J Gastroenterol Hepatol, 2018 [38]	Meta-analysis Mixed etiologies	Any EV: n = 1681/3001 (56% of LSM) and n = 968/1911 (51% of SSM) with EV VNT: n = 1466/4337 (34% of LSM) and n = 383/1119 (34% of SSM) with VNT	LSM (pooled): Any: AUC 0.82 VNT: AUC 0.83 SSM (pooled): Any: AUC 0.90 VNT: AUC 0.81 LSPS (pooled): Any: AUC 0.85 VNT: AUC 0.86	LSM (pooled): Sens. 84%, Spec. 64% Any: Sens. 85%, Spec. 64% VNT: Sens. 85%, Spec. 63% SSM (pooled): Sens. 91% Spec. 66% Any: Sens. 90%, Spec. 73% VNT: Sens. 87%, Spec. 52% LSPS (pooled): Any: Sens. 91%, Spec. 67% VNT: Sens. 82%, Spec. 87%	• Sub-analyses regarding method (TE, ARFI, others), etiology (ALD vs viral), ethnicity (Asian vs Western), and cACLD vs decompensated cirrhosis • No cutoffs calculated!

ALD, alcoholic liver disease; ACLF, acute on chronic liver failure; APRI, AST to PLT ratio index; ARFI, acoustic radiation force impulse; AUC, area under the (receiver operating) curve; cACLD, compensated advanced chronic liver disease; EV, esophageal varices; F, fibrosis stage; FIB4, fibrosis 4 (score); kPa, kilopascal (unit); LS(M), liver stiffness (measurement); LSPS, liver-stiffness-to-spleen-diameter-to-platelet-ratio score; NPV, negative predictive value; PLT, platelet count; PPV, positive predictive value; RSS, red spot sign; SS(M), spleen stiffness (measurement); TE, transient elastography; TIPS, transjugular intrahepatic portosystemic shunt; ULN, upper limit of normal; USLS, ultrasound and liver stiffness score; VNT, varices in need of treatment

The asterisk * refers to validation data for the cutoff recommend by the Baveno VI consensus conference