## 4 Discussion
Applying the cutoff value identified for SS (\(\leq\)46 kPa) would have led to the avoidance of endoscopic evaluation for 35.8% of patients, while the use of the Baveno VI criteria would have led to the avoidance of EDS for 21.7% of patients. The combination of SS with the Baveno VI criteria would have led to the avoidance of endoscopy for an additional 22.5% of patients (43.8%), with a false negative diagnosis rate \(<\) 5% [24]. The results of our study are consistent with the data from the literature, proving that there were statistically significant differences between the SS values measured by 2D-SWE.GE elastography in the two subplots. The cutoff value calculated for SS relative to the risk of bleeding was 17.95 kPa. As a result, this method can be successfully used for assessing the severity of portal hypertension in patients with advanced chronic liver disease. The cutoff threshold of SS measured by the 2D-SWE.GE elastography reported here was significantly lower compared to the one presented by the data reported in studies that used 2D-SWE.SSI elastography (25.6 kPa) [25]. This difference can be explained by the fact that, although using the same principle, the device used for the 2D-SWE.SSI elastography (Aixplorer(r) ultrasound system, SuperSonic Image) is based on different software than the one used for 2D-SWE.GE (LOGIQ E9, GE Healthcare). In support of this assertion, there are also data from the literature showing that although both 2D-SWE elastography techniques have good feasibility and a very good correlation with the evaluation by transient elastography (validated method), the values obtained by 2D-SWE.GE are significantly smaller than those obtained by 2D-SWE.SSI [26; 27; 28]. Several studies have investigated the role of 2D.SWE.SSI elastography--an elastographic method similar to the 2D-SWE.GE method used in our study. [PERSON] et al. [10] used 2D-SWE.SSI elastography to determine the cutoff values of SS (26.33 kPa) for clinically significant portal hypertension in a batch of 158 patients with liver cirrhosis. The cutoff value of 26.33 kPa was associated with a sensitivity of 79.7% and specificity of 84.2%, with a value of 0.84 of the ROC curve for diagnostic accuracy. Cutoff values \(<\) 21.7 kPa have been reported for the exclusion of risk for clinically significant portal hypertension, while 35.6 kPa was the cutoff for the inclusion of patients in the risk category [10]. [PERSON] et al. [8] used 2D-SWE.SSI elastography to determine the threshold value (of risk for the installation of clinically significant hepatic portal hypertension) of SS in a batch of 55 patients with compensated liver cirrhosis. The authors of the study reported a cutoff value of exclusion below 22.7 kPa and a cutoff value of inclusion of 40 kPa for patients from the risk category, with values of 90% sensitivity and specificity, along with a value of 0.725 for the ROC curve's diagnostic accuracy [8]. [PERSON] et al. [7] used 2D-SWE.SSI elastography to determine the cutoff values of SS (regarding the risk of installation of clinically significant hepatic portal hypertension) in a batch of 79 patients with hepatic cirrhosis (compensated in most patients). The authors of the study reported a cutoff value of 34.7 kPa, with values of 40% for sensitivity and 100% for specificity, along with a value of 0.630 for the ROC curve's diagnostic accuracy [7]. The results of our study are similar to those reported by recent studies of 2D-SWE and pSWE elastography, the results of which recommend incorporating SS measurement into non-invasive algorithms by using validated software and optimized measurement scales to increase accuracy in the diagnosis of portal hypertension in patients diagnosed with compensated liver cirrhosis [28; 29; 30]. We did not include body mass index and waist circumference in our analysis, although they are correlated with steatosis and fibrosis, taking into consideration the data published by [PERSON] et al. [31] and [PERSON] et al. [32] stating that anthropometric measurements are not associated with SS.