title: Validation of the Baveno VI criteria to identify low risk cirrhotic patients not requiring endoscopic surveillance for varices.
abstract: The Baveno VI guidelines propose that cirrhotic patients with a liver stiffness measurement (LSM) <20kPa and a platelet count >150,000/μl can avoid screening endoscopy as their combination is highly specific for excluding clinically significant varices. The aim of the study was to validate these criteria.
  
  
  
  Transient elastography data was collected from two institutions from 2006-2015. Inclusion criteria were a LSM ⩾10kPa and an upper gastrointestinal endoscopy within 12months, with a diagnosis of compensated chronic liver disease. Exclusion criteria were porto-mesenteric-splenic vein thrombosis and non-cirrhotic portal hypertension. Varices were graded as low risk (grade <2) or high risk (grade ⩾2).
  
  
  
  The study included 310 patients (169 (55%) hepatitis C, and 275 (89%) Child-Pugh A). Varices were present in 23% cases, with 5% prevalence of high risk varices. Overall 102/310 (33%) met the Baveno VI criteria. Within this group 11% had varices and 2% had high risk varices, representing 2/15 (13%) of all high risk varices. The Baveno VI criteria gave a sensitivity 0.87, specificity 0.34, positive predictive value 0.06, negative predictive value 0.98, positive likelihood ratio 1.31 and negative likelihood ratio 0.39. The AUROC for LSM and platelet count combined was 0.746.
  
  
  
  The Baveno VI criteria performed well correctly identifying 98% of patients who could safely avoid endoscopy.
  
  
  
  This study examines the effectives of a recent set of guidelines published by the Baveno VI conference, which states that patients with chronic liver disease and a low liver stiffness (<20kPa) and high platelet count (>150) are at low risk of having varices and do not need a screening endoscopy. Varices are a complication of cirrhosis, confer a risk of serious bleeding, and can be diagnosed and treated by endoscopy. Our study reviewed the clinical records of patients who have had liver stiffness scans and endoscopy over a 9-year period at two hospitals. The results show that only about 2% of patients who meet the Baveno VI criteria will be miss-classified as not having varices.
authors.affiliation: Department of Hepatology, Royal Free Hospital NHS Trust, United Kingdom; Department of Hepatology, Imperial College Healthcare NHS Trust, United Kingdom.
authors.forename: James B
authors.initials: JB
authors.lastname: Maurice
authors.affiliation: Department of Hepatology, Royal Free Hospital NHS Trust, United Kingdom.
authors.forename: Edgar
authors.initials: E
authors.lastname: Brodkin
authors.affiliation: Department of Hepatology, Royal Free Hospital NHS Trust, United Kingdom.
authors.forename: Frances
authors.initials: F
authors.lastname: Arnold
authors.affiliation: Department of Hepatology, Royal Free Hospital NHS Trust, United Kingdom.
authors.forename: Annalan
authors.initials: A
authors.lastname: Navaratnam
authors.affiliation: Department of Hepatology, Imperial College Healthcare NHS Trust, United Kingdom.
authors.forename: Heidi
authors.initials: H
authors.lastname: Paine
authors.affiliation: Department of Hepatology, Royal Free Hospital NHS Trust, United Kingdom.
authors.forename: Sabrina
authors.initials: S
authors.lastname: Khawar
authors.affiliation: Department of Hepatology, Imperial College Healthcare NHS Trust, United Kingdom.
authors.forename: Ameet
authors.initials: A
authors.lastname: Dhar
authors.affiliation: Department of Hepatology, Royal Free Hospital NHS Trust, United Kingdom.
authors.forename: David
authors.initials: D
authors.lastname: Patch
authors.affiliation: Department of Hepatology, Royal Free Hospital NHS Trust, United Kingdom.
authors.forename: James
authors.initials: J
authors.lastname: O'Beirne
authors.affiliation: Department of Hepatology, Royal Free Hospital NHS Trust, United Kingdom; Institute for Liver and Digestive Health, University College London, United Kingdom.
authors.forename: Raj
authors.initials: R
authors.lastname: Mookerjee
authors.affiliation: Department of Hepatology, Royal Free Hospital NHS Trust, United Kingdom; Institute for Liver and Digestive Health, University College London, United Kingdom.
authors.forename: Massimo
authors.initials: M
authors.lastname: Pinzani
authors.affiliation: Department of Hepatology, Royal Free Hospital NHS Trust, United Kingdom; Institute for Liver and Digestive Health, University College London, United Kingdom.
authors.forename: Emmanouil
authors.initials: E
authors.lastname: Tsochatzis
authors.affiliation: Department of Hepatology, Royal Free Hospital NHS Trust, United Kingdom. Electronic address: Rachel.westbrook@nhs.net.
authors.forename: Rachel H
authors.initials: RH
authors.lastname: Westbrook
mesh_terms: D054459:Elasticity Imaging Techniques; D004724:Endoscopy; D004932:Esophageal and Gastric Varices; D006801:Humans; D008103:Liver Cirrhosis; D014648:Varicose Veins
keywords: Cirrhosis; Non-invasive investigations; Oesophageal varices; Portal hypertension; Transient elastography