In patients who meet Baveno VII CSPH rule-in by LSM but have potential confounders (e.g., heart failure/congestion, cholestasis, recent alcohol use), how do you decide whether LSM is sufficient to start and follow NSBB versus escalating to spleen stiffness, MRE, or HVPG?

I would like to answer by stating that the Baveno VIII consensus has been published in the Journal of Hepatology.

First statement: LSM >10 kPa should be performed in fasting conditions; we use a minimum of 3 hours and complemented by another validated NIT of advanced fibrosis. Second statement: LSM ...

Heart failure and congestion (depending on the cause) may be contraindications to the use of carvedilol. In cases of ongoing alcohol use, would wait as to where the patient settles after alcohol abstinence and then do LSM. That would apply to acute cholestasis as well. If chronic cholestasis, can go...

Excellent dialogue. I learned a lot.