Diagnostic performance of splenic stiffness measurement for prediction of esophageal/gastric varices in pediatric portal hypertension: A systematic review and meta-analysis

Kalpana Panda; Devi Prasad Dash; Bramhadatta Pattnaik; Jimmy Narayan; S Rakesh Kumar; Prateek Kumar Panda

doi:10.1007/s12664-025-01915-z

Diagnostic performance of splenic stiffness measurement for prediction of esophageal/gastric varices in pediatric portal hypertension: A systematic review and meta-analysis

Indian J Gastroenterol. 2026 Feb 20. doi: 10.1007/s12664-025-01915-z. Online ahead of print.

Authors

Kalpana Panda¹, Devi Prasad Dash², Bramhadatta Pattnaik³, Jimmy Narayan⁴, S Rakesh Kumar⁴, Prateek Kumar Panda⁵

Affiliations

¹ Division of Pediatric Gastroenterology and Hepatology, Institute of Medical Sciences and SUM Hospital, Bhubaneswar, 751 003, India. drkalpanapanda@gmail.com.
² Department of Critical Care Medicine, Kalinga Institute of Medical Sciences, Bhubaneswar, 751 024, India.
³ Department of Surgical Gastroenterology, All India Institute of Medical Sciences, Bhubaneswar, 751 019, India.
⁴ Department of Gastroenterology and Hepatology, Institute of Medical Sciences and SUM Hospital, Bhubaneswar, 751003, India.
⁵ Department of Pediatrics, All India Institute of Medical Sciences, Rishikesh, 249 203, India.

PMID: 41718928
DOI: 10.1007/s12664-025-01915-z

Abstract

Background and objectives: Esophageal/gastric varices (EV), especially clinically significant varices (CSV), represent life-threatening complications of pediatric portal hypertension (PH), necessitating timely detection. While esophagogastroduodenoscopy (EGD) remains the gold standard, its invasive nature and requirement for sedation in children highlight the need for reliable non-invasive alternatives for screening and risk stratification. Splenic stiffness measurement (SSM) has emerged as a potential tool. This systematic review and meta-analysis aimed to evaluate diagnostic accuracy of SSM for detecting EV and CSV in pediatric PH.

Methods: A comprehensive search of PubMed, Scopus and Embase was performed up to January 2025. Studies assessing SSM via elastography in pediatric (< 18 years) PH, with EGD as reference standard for EV/CSV detection, were included. Data was synthesized using hierarchical summary receiver operating characteristic (HSROC) model to estimate pooled sensitivity, specificity, diagnostic odds ratio (DOR) and area under the receiver operating characteristic curve (AUROC). Risk of bias was evaluated using Quality Assessment of Studies of Diagnostic Accuracy (QUADAS-2) tool.

Results: Ten studies encompassing 618 patients were analyzed. For EV prediction (3 studies, n = 158), pooled sensitivity, specificity and DOR were 0.80 (95% CI: 0.70-0.88), 0.89 (95% CI: 0.80-0.95) and 26.22 (95% CI: 5.39-98.83), respectively, with AUROC 0.838 (95% CI: 0.806-0.864). For CSV (7 studies, n = 460), values were 0.86 (95% CI: 0.81-0.90), 0.82 (95% CI: 0.76-0.87) and 31.00 (95% CI:12.33-80.21) with AUROC 0.905 (95% CI: 0.882-0.924), indicating very good diagnostic performance. Substantial heterogeneity noted for pooled sensitivity (I² = 69.2%, p = 0.0006) for CSV prediction. Sub-group analysis revealed that etiology of PH, elastography techniques and ethnicity of study population were sources of heterogeneity. SSM showed superior accuracy in non-cirrhotic PH (DOR: 48.61 [95% CI: 13.62-188.37]) than cirrhotic PH (DOR: 18.89 [95% CI: 8.65-40.53]).

Conclusion: SSM demonstrates good diagnostic accuracy for non-invasive variceal predictionin pediatric PH. However, further multicentre studies with standardized protocols and disease-specific cut-offs for pediatric population are necessary for its integration in routine clinical practice as a screening tool.

Keywords: Elastography; Esophageal varices; Gastric varices; Pediatric; Portal hypertension.

Publication types

Review