To investigate the value of transient elastography in predicting the severity of gastroesophageal varices (GOV) in patients with liver cirrhosis.

A total of 502 patients with liver cirrhosis from two centers were enrolled. Based on endoscopic findings, they were classified into four groups: no GOV, mild GOV, moderate GOV, and severe GOV. Platelet count (PLT), prothrombin time (PT), and abdominal ultrasound parameters were collected. Univariate and multivariate logistic regression analyses were performed to identify independent risk factors for the occurrence and progression of GOV. Liver stiffness measurement (LSM) was obtained using transient elastography, and its distribution across different GOV grades was analyzed. The predictive performance of LSM combined with PLT and spleen diameter (SD) for GOV severity was evaluated using receiver operating characteristic (ROC) curve analysis.

Among the 502 patients with liver cirrhosis, 356 cases had GOV. Multivariate logistic regression showed that PLT and SD were independent risk factors for both the occurrence and progression of GOV (both P<0.05). LSM values in the mild and moderate GOV groups were significantly higher than those in the no GOV group (both P<0.01), but no significant differences were observed among the mild, moderate, and severe GOV groups. In stratified analyses combining LSM with PLT and SD, the proportion of low-risk combinations (PLT>150×10⁹/L and LSM<15 kPa; or SD<10 cm and LSM 15~25 kPa) decreased progressively with increasing GOV severity, whereas the proportion of high-risk combinations (LSM>25 kPa with PLT 100~150×10⁹/L or SD>15 cm) increased significantly. ROC curve analysis showed that the combination of LSM, PLT, and SD achieved an AUC of 0.843 for predicting moderate to severe GOV, which was superior to LSPS.

Transient elastography combined with PLT and SD measured by abdominal ultrasound can accurately predict the occurrence of moderate and severe GOV in patients with liver cirrhosis, and can be used to identify high-risk populations for esophageal and gastric variceal rupture bleeding.