Spleen‐dedicated stiffness measurement performed well to rule out high‐risk varices in HBV‐related hepatocellular carcinoma

Summary Background Esophagogastroduodenoscopy (EGD) is required to screen for high‐risk varices (HRV) in patients with hepatocellular carcinoma (HCC), especially since overall survival rates have dramatically improved with new systemic therapies. Aim To assess the Baveno VI and Baveno VII algorithms' ability to rule out HRV in hepatitis B virus (HBV)‐related HCC Methods We prospectively enrolled consecutive patients with HBV related, compensated cirrhosis and newly diagnosed HCC who underwent liver stiffness measurement, spleen stiffness measurement (SSM) using a 100‐Hz shear wave frequency, and EGD. Results From September 2021 to August 2023, we enrolled 219 patients with HCC, with 107 (48.9%) Barcelona Clinic Liver Cancer (BCLC) A, 28 (12.8%) BCLC B and 84 (38.3%) BCLC C, respectively. HRV prevalence was 28.8% (63/219). Baveno VI criteria safely (HRV missing rate, 3.2%) avoided 27.4% unnecessary EGDs, while the Baveno VII algorithm avoided 49.3% with HRV missing rate at 7.9% (5/63). The SSM ≤40 kPa avoided 47.5% of EGDs safely (HRV missing rate, 4.8%), significantly better than the Baveno VI criteria ( p < 0.001) and comparable to the Baveno VII algorithm ( p = 0.390). The SSM ≤40 kPa safely avoided EGDs in patient subgroups within Milan criteria, with portal vein tumour thrombosis or BCLC B/C or candidates for systemic therapy. Conclusions We validated that the SSM ≤40 kPa using a 100‐Hz probe could safely eliminate more unnecessary EGDs than the Baveno VI criteria in patients with HBV‐related HCC. However, the efficacy of the Baveno VII algorithm in patients with HCC requires further investigation.