AIM: This study aims to evaluate the significance of sound touch elastography (STE) of the liver and spleen in assessing the efficacy of Budd-Chiari syndrome (BCS) by comparing the changes in hepatic and splenic elastic values between healthy individuals and BCS patients before and after interventional therapy. METHODS: This study included 229 BCS patients treated in the Interventional Department of the Affiliated Hospital of Xuzhou Medical University between May 2023 and April 2024. However, 45 healthy participants were included as controls. Based on the type of vascular obstruction, the patients were classified into three categories: hepatic venous type (n = 71), inferior vena cava type (n = 115), and mixed type (n = 43). Both the control individuals and BCS patients underwent the liver stiffness measurement (LSM) and spleen stiffness measurement (SSM) at our hospital. Differences in LSM and SSM values were comparatively analyzed between healthy subjects and BCS patients, before and after interventional therapy. Furthermore, the correlation between hepatic and splenic elastic values and the Child-Pugh grades and free hepatic vein pressure (FHVP) was determined across all three BCS subtypes. RESULTS: The LSM and SSM values were significantly lower in the healthy subjects than those observed in BCS patients (p < 0.001). The LSM values in BCS patients at 2 days, 1 month, and 3 months after the procedure were significantly reduced compared to the previous values (p < 0.001, <0.001, =0.044). Furthermore, no statistically significant difference was observed in LSM values determined at 6 and 3 months postoperatively (p = 0.100). Similarly, the SSM value was substantially lower in BCS patients at 2 days postoperatively than the value observed at 2 days preoperatively (p < 0.001). Moreover, ∆LSM1 (LSM at 2 days postoperatively – LSM at 2 days preoperatively) was significantly greater than ∆LSM2 (LSM at 1 month postoperatively – LSM at 2 days postoperatively) (p = 0.024). In contrast, no statistically significant differences were observed between ∆LSM2 and ∆LSM3, or ∆LSM3 and ∆LSM4 (p = 0.752, 1.000). Moreover, there were no significant differences between ∆LSM%1 (∆LSM1/LSM at 2 days preoperatively) and ∆LSM%2 (∆LSM2/LSM at 2 days postoperatively), ∆LSM%2 and ∆LSM%3, or ∆LSM%3 and ∆LSM%4 (p = 0.606, 0.181, 0.891). One month after the procedure, the absolute values of ∆LSM and ∆LSM% were substantially lower in recurrent patients than in non-recurrent patients (p = 0.042, 0.007). Preoperative LSM and SSM were positively correlated with the Child-Pugh grade (r = 0.423, 0.457, p < 0.001), with significant reduction found in FHVP after the procedure (p < 0.001). Preoperative and postoperative LSM and ∆LSM1 were positively correlated with preoperative and postoperative FHVP and ∆FHVP (r = 0.662, 0.595, 0.536, p < 0.001, <0.001, =0.007). CONCLUSIONS: The LSM and SSM values in BCS patients were greater than those in healthy subjects and demonstrated a positive correlation with Child-Pugh grade and FHVP. Furthermore, LSM and SSM values decreased significantly after interventional therapy. Hence, STE could be used to assess treatment efficacy in BCS patients.