## 4 Discussion  
Numerous studies have reported a good correlation between the size of the spleen and the presence of esophageal varices [17; 22]. In a study from 2019, [PERSON] et al. [17] evaluated whether SS measurement could rule out the presence of HRVs in patients with cirrhosis, avoiding an upper gastrointestinal endoscopy, and concluded that 2D-SWE of the spleen is a reliable method for ruling out the presence of HRVs in cirrhotic patients. [PERSON] et al. [11] investigated whether liver stiffness (LS) measured by two-dimensional shear-wave elastography (2D-SWE) and platelet count (PLT) could rule out high-risk varices in patients with compensated advanced chronic liver disease (cACLD). They concluded that the Baveno VI criteria can be applied to LS measurement by 2D-SWE, because LS measured by 2D-SWE is a reliable predictive factor for all-size varices and high-risk varices in patients with compensated advanced chronic liver disease. The new criteria of LS \(<\) 16 kPa and PLT \(>\) 100 \(\times\) 10\({}^{9}\)/L could be a potential model to avoid further endoscopic screening, with a \(<\)5% miss rate for high-risk varices. However, it has been shown that, although splenomegaly is commonly present in patients with advanced liver disease, a significant percentage of patients with hepatic cirrhosis do not have HRVs [23]. In our study, univariate and multivariate analyses confirmed several significant correlations between clinical, laboratory, ultrasonographic, and elastographic parameters and the presence of HRVs. Hence, the PV caliber, SBD, albumin levels, total bilirubin levels, INR, platelet count, LS, and SS were qualified as significant predictors of HRVs. Furthermore, SS was proven to be an independent predictor of HRVs (AUROC 0.987, \(p<\) 0.001, OR 4.985, 95% CI: 1.57-15.73, \(p=0.006\)), with a calculated cutoff value of 17.95 kPa. Currently, the performance improvement of the methods of measuring spleen stiffness is being pursued, given that two recent meta-analyses have shown the superiority of this technique for the risk of variecal bleeding, compared to the measurement of liver stiffness [24]. It is emphasized that the use of spleen stiffness values could be more efficient than the Baveno VI or LS criteria in assessing the risk of bleeding in these patients, according to such literature data. [PERSON] et al. [12] assessed the diagnostic performance of liver stiffness and SS measured by point shear-wave elastography (pSWE) and 2D-SWE in the detection of high-risk esophageal varices and compared their diagnostic accuracy, and they concluded that LS and SS measured by pSWE and 2D-SWE have good accuracy in predicting HREVs. However, [PERSON] et al. [13] evaluated the agreement/accuracy of p-SWE and 2D-SWE for liver fibrosis staging using TE as the reference, in a retrospective study that analyzed data from people with chronic liver diseases subjected to TE, p-SWE, and 2D-SWE, and they concluded that LSM by p-SWE and 2D-SWE techniques was correlated with TE, but LSM by p-SWE seemed to be more accurate than 2D-SWE for identifying patients with more advanced fibrosis. In a study from 2018, [PERSON] et al. [24] suggested a model of combined assessment of spleen and liver stiffness by transient elastography, which could represent an initial screening strategy for patients with advanced chronic liver disease, with the purpose of \begin{table}
\begin{tabular}{c c c c c c c c} \hline \hline
**Variable** & **B** & **Standard Error** & **Wald** & **df** & \(p\) **Value** & \
\begin{tabular}{c} **OR** \\ **Exp(B)** \\ \end{tabular} &
\begin{tabular}{c} **95\% CI for EXP(B)** \\ **Lower** \\ \end{tabular} \\ \hline SS & 1.606 & 0.587 & 7.5 & 1 & 0.006 & 4.985 & 1.579 & 15.736 \\ \hline \hline \end{tabular}
\end{table} 
Table 4: Wald test and OR for SS. detecting esophageal varices with increased risk of bleeding, as well as the appropriate therapeutic approach [24].