Objectives: Investigate the use of spleen stiffness measurements (SSM), measured by transient elastograpghy (TE), for the prediction of clinically significant varices (CSV) in children with portal hypertension. Methods: This observational cohort study included children selected for endoscopy, as per department protocol, between September 2015- June 2016. Those included underwent single TE fibroscan for liver stiffness measurements (LSM) and SSM. Clinical and laboratory data were collected and variceal prediction scores were calculated at time of elastography. Results: In total 67 children (32 male) underwent TE. 52 children (25 male) had chronic liver disease (CLD), 15 (7 male) portal vein thrombosis (PVT). In all children SSM was the best predictor of CSV+ve, with an optimal cut-off value of 38.0kPa (AUROC = 0.92, sensitivity = 89%, specificity = 82%, p
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