P65 Sorting through the stiffness: the role of splenic stiffness measurement to refine variceal screening decisions in a real-world cohort

<h3>Introduction</h3> Identifying patients at risk of variceal bleeding while avoiding unnecessary endoscopies is an area of priority in advanced chronic liver disease. Splenic stiffness (SS) is included in the Baveno VII guidelines, with a cut-off of ≤40kPa identifying those requiring screening by Baveno VI criteria (liver stiffness ≥20kPa or platelet count ≤150) in whom endoscopy can be safely avoided. SS measurement is not available to most clinicians, however, to inform decision-making. We aimed to study its utility in the real-world setting of a level 2 hepatology unit, to confirm feasibility and identify how it might contribute to our service. <h3>Methods</h3> Over a period of 9 months, SS was measured alongside liver stiffness in all patients attending an outpatient fibroscan clinic. Data was recorded on age, BMI, aetiology of liver disease, alcohol intake, platelet count, use of non-selective beta blockers, and presence of varices at endoscopy if performed within the last 3 years. Patients with previous TIPSS and those without risk of clinically significant portal hypertension (CSPH) by either measurement were excluded. SS data was available to clinicians but its role in patient management remained at their discretion. <h3>Results</h3> 136 eligible patients were identified. The additional scans did not alter the capacity of the clinic or patient tolerance. 43 (31.6%) were identified as requiring OGD by Baveno VI criteria, but not according to SS. Of these, 23 had not undergone OGD within 3 years, 9 had varices present but only 2 (4.7%) had high-risk varices. 8 (5.9%) had SS &gt;40kPa without meeting Baveno VI criteria for screening. 3 of these had undergone OGD, with grade 1 varices in 1 patient. 2 patients had grade 1 varices identified without meeting either Baveno VI or SS criteria for CSPH. 3 patients with known non-cirrhotic portal hypertension (NCPH), not included in this cohort, had SS &gt;40kPa corresponding to grade 1 or 2 varices at OGD. <h3>Discussion</h3> Routine measurement of SS is feasible in a real-world clinical setting. Our results are comparable to others in identifying more patients at low risk of variceal bleeding than Baveno VI alone. SS in our cohort identified 1 patient with grade 1–2 varices which was missed by Baveno VI. SS alone missed 9 such patients, suggesting it as a useful adjunct to, but not replacement for, Baveno VI, and in particular for selected groups at high risk of NCPH. <h3>References</h3> Vanderschueren, <i>et al</i>. Spleen stiffness-based algorithms are superior to baveno VI criteria to rule out varices needing treatment in patients with advanced chronic liver disease. <i>The American Journal of Gastroenterology</i>. August 2024;119(8):1515–1524,. Baveno VII – Renewing consensus in portal hypertension. De Franchis, RobertoAbraldes, Juan G, <i>et al. Journal of Hepatology</i><b>76</b>(4):959–974