A significant proportion of patients with a very high risk of CSPH, and a population with a very low risk of VNT can be identified with simple, noninvasive tests, suggesting that these can be used to individualize medical care. (Hepatology 2016;64:2173-2184).

This manuscript describes the use of ultrasound elastography, with the exception of liver applications, and represents an update of the 2013 EFSUMB (European Federation of Societies for Ultrasound in Medicine and Biology) Guidelines and Recommendations on the clinical use of elastography.

The new Expanded-Baveno VI criteria spare more endoscopies than the original criteria with a minimal risk of missing VNT in most of the main etiologies of cACLD. (Hepatology 2017;66:1980-1988).

Spleen stiffness can be assessed using transient elastography, its value increasing as the liver disease progresses. In liver cirrhosis patients spleen stiffness can predict the presence, but not the grade of esophageal varices. Esophageal varices' presence can be better predicted if both spleen and liver stiffness measurements are used.

Objectives: Portal vein thrombosis (PVT) is a frequent complication of cirrhosis. Benefit, safety, and duration of anticoagulant treatment in this setting are controversial issues. The aim of this study was to analyze the course of PVT in a large cohort of cirrhotic patients undergoing or not anticoagulation therapy. Methods: The data of 182 patients who presented between January 2008 and March 2016 with cirrhosis and PVT with at least 3 months of follow-up after the first PVT detection were analyzed. Eighty-one patients received anticoagulants and 101 were untreated per physician discretion. Results: The extension of the thrombosis decreased by >50% in 46 (56.8%, with complete recanalization in 31/46) patients under anticoagulation and in 26 (25.7%) untreated patients. Of the 46 patients who underwent recanalization, 17 (36%) suffered recurrent thrombosis after stopping anticoagulation therapy. Kaplan–Meier analysis showed a higher survival rate in the treated group (p = 0.010). At multivariate analysis, anticoagulation was an independent factor associated with longer survival (HR:0.30, CI:0.10–0.91, p = 0.014). The Child–Turcotte–Pugh classes B/C negatively influenced survival (hazard ratio, (HR):3.09, confidence interval (CI):1.14–8.36, p = 0.027 for Child–Turcotte–Pugh B and HR:9.27, CI:2.67–32.23, p < 0.001 for Child–Turcotte–Pugh C). Bleeding complications occurred in 22 (21.8%) untreated and 16 (19.7%) treated patients, but in only four cases was it judged to be related to the anticoagulant treatment. No death was reported as a consequence of the bleeding events. Conclusions: Anticoagulant treatment is a safe and effective treatment leading to partial or complete recanalization of the portal venous system in 56.8% of cases, improving the survival of patients with cirrhosis and PVT. Discontinuation of the therapy is associated with a high rate of PVT recurrence.

Objectives: We aimed to explore the prevalence of portal hypertension in the most common etiologies of patients with compensated advanced chronic liver disease (cACLD) and develop classification rules, based on liver stiffness measurement (LSM), that could be readily used to diagnose or exclude clinically significant portal hypertension (CSPH) in clinical practice. Methods: International cohort study including patients with paired LSM/hepatic venous pressure gradient (HVPG), LSM ≥10kPa and no prior decompensation. Portal hypertension was defined by an HVPG>5 mmHg. A positive predictive value (PPV) ≥90% was considered to validate LSM cut-offs for CSPH (HVPG≥10 mmHg), while a negative predictive value ≥90% ruled out CSPH. Results: 836 patients were evaluated: hepatitis C (HCV, n=358), non-alcoholic steatohepatitis (NASH, n=248), alcohol (ALD, n=203) and hepatitis B (HBV, n=27). Portal hypertension prevalence was >90% in all cACLD etiologies, except for NASH patients (60.9%), being even lower in NASH obese patients (53.3%); these lower prevalences of portal hypertension in NASH patients were maintained across different strata of LSM values. LSM≥25 kPa was the best cut-off to rule in CSPH in ALD, HBV, HCV and non-obese NASH patients, while in obese NASH patients the PPV was only 62.8%. A new model for NASH patients (ANTICIPATE-NASH model) to predict CSPH considering BMI, LSM and platelet count was developed and a nomogram constructed. LSM≤15 kPa plus platelets ≥150x10 9 /L ruled out CSPH in most etiologies. Conclusions: Patients with cACLD of NASH etiology, especially obese NASH patients, present lower prevalences of portal hypertension compared to other cACLD etiologies. LSM≥25 kPa is sufficient to rule in CSPH in most etiologies, including non-obese NASH patients, but not in obese NASH patients. Response to Reviewers:Point-by-point answers to reviewers' comments: Editor/Editorial Board Comments: Editors: After reviewing the manuscript and the comments from the peer reviewers, we would like to ask the authors to address the following issues raised by the editors:1. Was there any correlation of their findings with EGD, and specifically with the absence/presence of high-risk esophageal varices warranting prophylaxis with betablockers or endoscopic band ligation? This a very good point, but information regarding endoscopy was not requested to the participating centers (only LSM and HVPG were available) and it was not an objective of this study. Only the "ANTICIPATE" cohort had endoscopy data and this has been published in the "Anticipate" paper (Hepatology 2016; 64:2173-84) and the Expanded Baveno paper (Hepatology 2017; 66:1980-8).2. Can the authors please convert lab values in table 1 from SI to conventional units? Done.3. We request the authors provide clearer instructions on how to use the nomogram from figure 3. Maybe they can provide an example or improve the instructions, something similar to what was described for the nomogram in figure 4 of the Hepatology 2016 paper on the "Anticipate" study. Thank you for the...

See Covering the Cover synopsis on page 379.BACKGROUND AND AIMS: Current guidelines recommend surveillance for patients with nondysplastic Barrett's esophagus (NDBE) but do not include a recommended age for discontinuing surveillance. This study aimed to determine the optimal age for last surveillance of NDBE patients stratified by sex and level of comorbidity. METHODS: We used 3 independently developed models to simulate patients diagnosed with NDBE, varying in age, sex, and comorbidity level (no, mild, moderate, and severe). All patients had received regular surveillance until their current age. We calculated incremental costs and quality-adjusted life-years (QALYs) gained from 1 additional endoscopic surveillance at the current age versus not performing surveillance at that age. We determined the optimal age to end surveillance as the age at which incremental costeffectiveness ratio of 1 more surveillance was just less than

Background & Aims: Several non-invasive tests (NITs) have been developed to diagnose oesophageal varices (EV), including the recent Baveno VI criteria to rule out high-risk varices (HRV). Spleen stiffness measurement (SSM) with the standard FibroScan® (SSM@50Hz) has been evaluated. However, the EV grading could be underestimated because of a ceiling threshold (75 kPa) of the SSM@50Hz. The aims were to evaluate SSM by a novel spleen-dedicated FibroScan® (SSM@100Hz) for EV diagnosis compared with SSM@50Hz, other validated NITs and Baveno VI criteria.Methods: This prospective multicentre study consecutively enrolled patients with chronic liver disease; blood data, endoscopy, liver stiffness measurement (LSM), SSM@50Hz and SSM@100Hz were collected.Results: Two hundred and sixty patients met inclusion criteria. SSM@100Hz success rate was significantly higher than that of SSM@50Hz (92.5% vs 76.0%, P < .001). SSM@100Hz accuracy for the presence of EV (AUC = 0.728) and HRV (AUC = 0.756) was higher than in other NITs. SSM@100Hz AUC for large EV (0.782) was higher than SSM@50Hz (0.720, P = .027). AUC for HRV with SSM@100Hz (0.780) was higher than with LSM (0.615, P < .001). The spared endoscopy rate of Baveno VI criteria (8.1%) was significantly increased by the combination to SSM@50Hz (26.5%) or SSM@100Hz (38.9%, P < .001 vs others). The missed HRV rate was, respectively, 0% and 4.7% for combinations.Conclusions: SSM@100Hz is a new performant non-invasive marker for EV and HRV providing a higher accuracy than SSM@50Hz and other NITs. The combination of Baveno VI criteria and SSM@100Hz significantly increased the spared endoscopy