Pediatric gastroenterology, hepatology & nutrition · 2026
Diagnostic Accuracy of Liver Stiffness Measurement as a Non-Invasive Tool for Variceal Screening in Pediatric Chronic Liver Disease: A Systematic Review and Meta-Analysis.
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Panda Kalpana, Dash Devi Prasad, Pattnaik Bramhadatta, Gautam Vipul, Panda Prateek Kumar
Аннотация
PURPOSE: Chronic liver disease (CLD) in children often leads to portal hypertension and varices. Upper GI endoscopy (UGIE) is gold standard for variceal detection; however, it is invasive and requires anesthesia. Liver stiffness measurement (LSM) has emerged as a promising non-invasive alternative for variceal screening. This systematic review and meta-analysis was conducted to evaluate diagnostic accuracy of LSM for predicting any grade of esophageal and/or gastric varices (Vx) and high-risk varices (HRVx) in pediatric CLD.
METHODS: A systematic search of PubMed, Scopus, and Embase was conducted to include studies reporting LSM-based diagnostic accuracy data for Vx/HRVx prediction in CLD patients ≤18 years, with UGIE as reference standard. Pooled sensitivity, specificity, diagnostic odds ratio (DOR), and area under receiver operating characteristic curve (AUC) were estimated.
RESULTS: Twelve studies (n=647) were included. For prediction of Vx (six studies, n=327), LSM demonstrated pooled sensitivity of 0.85 (95% confidence intervals [CI]: 0.78-0.90), specificity of 0.74 (95% CI: 0.67-0.80), DOR of 16.35 (95% CI: 7.06-40.24), and AUC of 0.847. For HRVx (seven studies, n=369), pooled sensitivity, specificity, DOR and AUC were 0.81 (95% CI: 0.74-0.87), 0.79 (95% CI: 0.73-0.84), 14.19 (95% CI: 5.14-35.98) and 0.862, respectively. Considerable heterogeneity (I2=73.5%) was noted in specificity for HRVx. Subgroup analyses identified LSM modality, cutoff values, ethnicity, and variceal prevalence as sources of heterogeneity.
CONCLUSION: LSM holds promise as a non-invasive tool for variceal screening in pediatric CLD. However, it should be regarded as a complement rather than a replacement for endoscopy until standardized protocols with prospectively validated thresholds are established.
METHODS: A systematic search of PubMed, Scopus, and Embase was conducted to include studies reporting LSM-based diagnostic accuracy data for Vx/HRVx prediction in CLD patients ≤18 years, with UGIE as reference standard. Pooled sensitivity, specificity, diagnostic odds ratio (DOR), and area under receiver operating characteristic curve (AUC) were estimated.
RESULTS: Twelve studies (n=647) were included. For prediction of Vx (six studies, n=327), LSM demonstrated pooled sensitivity of 0.85 (95% confidence intervals [CI]: 0.78-0.90), specificity of 0.74 (95% CI: 0.67-0.80), DOR of 16.35 (95% CI: 7.06-40.24), and AUC of 0.847. For HRVx (seven studies, n=369), pooled sensitivity, specificity, DOR and AUC were 0.81 (95% CI: 0.74-0.87), 0.79 (95% CI: 0.73-0.84), 14.19 (95% CI: 5.14-35.98) and 0.862, respectively. Considerable heterogeneity (I2=73.5%) was noted in specificity for HRVx. Subgroup analyses identified LSM modality, cutoff values, ethnicity, and variceal prevalence as sources of heterogeneity.
CONCLUSION: LSM holds promise as a non-invasive tool for variceal screening in pediatric CLD. However, it should be regarded as a complement rather than a replacement for endoscopy until standardized protocols with prospectively validated thresholds are established.