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

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 metaanalysis 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 (I 2 =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.