Spleen stiffness accurately tracks early and sustained portal pressure changes after transjugular intrahepatic portosystemic shunt

doi:10.4240/wjgs.v18.i5.118030

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World Journal of Gastrointestinal Surgery

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1948-9366

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Baishideng Publishing Group Inc, 7041 Koll Center Parkway, Suite 160, Pleasanton, CA 94566, USA

Retrospective Study

Copyright: ©Author(s) 2026. This article is an open access article distributed under the terms and conditions of the Creative Commons Attribution-NonCommercial (CC BY-NC 4.0) license. No commercial re-use. See permissions. Published by Baishideng Publishing Group Inc.

World J Gastrointest Surg. May 27, 2026; 18(5): 118030
Published online May 27, 2026. doi: 10.4240/wjgs.v18.i5.118030

Spleen stiffness accurately tracks early and sustained portal pressure changes after transjugular intrahepatic portosystemic shunt

Rui-Quan Zhou, Pei-Jun Yang, Li-Guo Liu, Jian-Bin Zhang, Zhi-Dong Ye, Hai-Dong Tan

Rui-Quan Zhou, Pei-Jun Yang, Li-Guo Liu, Hai-Dong Tan, Second Department of Hepatopancreatobiliary Surgery, China-Japan Friendship Hospital, Beijing 100029, China

Jian-Bin Zhang, Zhi-Dong Ye, Department of Cardiovascular Surgery, China-Japan Friendship Hospital, Beijing 100029, China

Co-first authors: Rui-Quan Zhou and Pei-Jun Yang.

Co-corresponding authors: Zhi-Dong Ye and Hai-Dong Tan.

Author contributions: Zhou RQ designed and performed research; Yang PJ analyzed data and provided biostatistical review; Liu LG contributed to methodology development and data visualization; Zhang JB and Ye ZD conducted vascular surgery procedures and recruited patients; Ye ZD and Tan HD reviewed and edited the manuscript. Zhou RQ and Yang PJ contributed equally to this work as co-first authors. The designation of Ye ZD and Tan HD as co-corresponding authors is justified by their complementary and equally essential contributions to the conception, execution, and oversight of this study. Ye ZD, from the Department of Cardiovascular Surgery, played a pivotal role in the procedural aspects of TIPS placement and hemodynamic data acquisition, while Tan HD, Chief Physician of the Second Department of Hepatopancreatobiliary Surgery, led patient selection, clinical management, and interpretation of liver disease-related outcomes. Both provided critical intellectual input, supervised data analysis, and jointly ensured the scientific integrity and clinical relevance of the research. Given their shared leadership across interventional and hepatological domains-central to the multidisciplinary nature of TIPS evaluation-dual corresponding authorship accurately reflects their equal responsibility and contribution to this work.

Supported by General Project of the Chinese Association of Rehabilitation Medicine 2023 Annual Science and Technology Development Program, No. 2024-HX-21.

Institutional review board statement: The study protocol was approved by our Institutional Review Board of China-Japan Friendship Hospital (No. 2024-KY-090).

Informed consent statement: The informed consent for the study was obtained from all the patients.

Conflict-of-interest statement: The authors declare that they have no conflict of interest.

Data sharing statement: Due to ethical and legal restrictions related to patient confidentiality, the full dataset cannot be publicly shared. De-identified data are available upon reasonable request to Hai-Dong Tan at hpblt_cjfh@126.com, with approval from the Institutional Review Board of China-Japan Friendship Hospital.

Corresponding author: Hai-Dong Tan, MD, Chief Physician, Second Department of Hepatopancreatobiliary Surgery, China-Japan Friendship Hospital, No. 2 Yinghua Dongjie, Beijing 100029, China. hpblt_cjfh@126.com

Received: December 23, 2025
Revised: January 16, 2026
Accepted: February 12, 2026
Published online: May 27, 2026
Processing time: 156 Days and 23.8 Hours

Abstract

BACKGROUND

Clinically significant portal hypertension (CSPH) drives major complications in cirrhosis. While hepatic venous pressure gradient is the gold standard for CSPH diagnosis, its invasiveness limits routine use. Liver stiffness measurement (LSM) and spleen stiffness measurement (SSM) offer non-invasive alternatives, but their utility in tracking transjugular intrahepatic portosystemic shunt (TIPS)-induced hemodynamic changes remains unclear.

AIM

To assess the correlation of LSM/SSM with baseline portocaval pressure gradient (PPG) and ΔPPG, and to evalutate their predictive value for hemodynamic success (post-PPG ≤ 10 mmHg).

METHODS

We retrospectively analyzed 39 patients underwent TIPS. LSM and SSM were measured via vibration-controlled transient elastography pre- and post-TIPS. PPG was recorded invasively during the procedure. Correlations between stiffness parameters and PPG were assessed using Spearman’s test; diagnostic performance was evaluated by receiver operating characteristic analysis.

RESULTS

PPG dropped from 17.6 ± 4.1 mmHg to 7.0 ± 2.3 mmHg (P < 0.001). SSM decreased significantly (61.7 ± 17.1 kPa to 26.9 ± 11.6 kPa; P < 0.001) and correlated with baseline PPG (r = 0.41, P < 0.001) and ΔPPG (r = -0.57, P < 0.001). LSM showed no significant correlation with PPG or ΔPPG. None of the stiffness metrics reliably predicted successful TIPS response (all area under the curve < 0.7).

CONCLUSION

SSM dynamically reflects TIPS-induced portal pressure changes, outperforming LSM as a non-invasive marker. Despite limited predictive value here (small cohort, etiological heterogeneity), it remains valuable for TIPS monitoring when invasive measures are impractical.

Keywords: Portal hypertension; Transjugular intrahepatic portosystemic shunt; Spleen stiffness measurement; Liver stiffness measurement; Clinically significant portal hypertension; Vibration-controlled transient elastography

Core Tip: This study demonstrates that spleen stiffness measurement (SSM), assessed by vibration-controlled transient elastography, strongly correlates with both baseline portal pressure and its reduction after transjugular intrahepatic portosystemic shunt (TIPS), outperforming liver stiffness measurement. Although neither parameter reliably predicts successful hemodynamic response to TIPS, SSM emerges as a robust non-invasive tool for monitoring portal pressure changes over time, particularly valuable when repeated invasive measurements are impractical.