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To investigate the diagnostic performance of liver stiffness (LS) measured by 2D-SWE for predicting esophageal varices (EV) and high-risk varices (HRV) in patients with hepatitis B virus (HBV)-related compensated advanced chronic liver disease (cACLD). In total, 268 patients with HBV-related cACLD who underwent 2D-SWE and esophagogastroduodenoscopy (EGD) were retrospectively evaluated. The new criteria for ruling out HRV were tested in the training cohort with 175 patients and validated in the validation cohort with 93 patients. The AUROCs of LS for predicting EV and HRV were 0.90(0.86–0.95) and 0.93(0.89–0.96) respectively. LS (OR, 1.64 (95% CI: 1.31–2.07); P &lt; 0.0001), PLT (OR, 0.94 (95% CI: 0.91–0.97); P &lt; 0.0001) and albumin (OR, 0.75 (95% CI: 0.62–0.90); P = 0.02) were independent factors for the presence of HRV. The Baveno VI criteria of LS &lt; 20 kPa and PLT &gt; 150 × 10 9  /L saved 15.1%–17.1% EGD screening with 0–4.3% HRV miss rate. LS &lt; 16 kPa and PLT &gt; 60 × 10 9  /L spared 51.4%–52.7% EGD screening with 3.8%–4.3% HRV miss rate. Baveno VI criteria is suitable for 2D-SWE to rule out HRV. LS &lt; 16 kPa and PLT &gt; 60 × 10 9  /L could be a reliable model for ruling out HRV in patients with HBV-related cACLD.

Two-dimensional shear wave elastography for sparing endoscopy screening in patients with HBV-related compensated advanced chronic liver disease