Validating, deconstructing and refining Baveno criteria for ruling out high-risk varices in patients with compensated cirrhosis.
Guidelines recommend variceal screening in patients with cirrhosis to identify varices at high risk of bleeding requiring primary prophylaxis. Non-invasive criteria to rule out high-risk varices will avoid unnecessary endoscopies. Recent Baveno VI criteria define patients with compensated cirrhosis in whom endoscopy can be avoided as those with a liver stiffness by transient elastography <20 kPa and a platelet count >150 000/mm3.AIMS: To validate Baveno criteria in two cohorts with a different prevalence of high-risk varices and to determine whether alternate parameters not including liver stiffness would be equal/more accurate in ruling out high-risk varices.



Retrospective study evaluating patients with liver stiffness >10 kPa who had liver stiffness and endoscopy within 1 year of each other.



This study included 161 patients from the US cohort (14 [9%] with high-risk varices) and 101 patients from an Italian cohort (17 [17%] with high-risk varices). Of patients meeting Baveno criteria (41 in the US, 16 in Italy), none had high-risk varices and therefore 26% (US) and 16% (Italy) endoscopies could have been avoided. Sensitivity and negative predictive value were 100%. A stepwise strategy using platelet count >150 000 and MELD=6, increased the number of endoscopies avoided to 54% (US) while maintaining a sensitivity and negative predictive value of 100%. Excellent sensitivity and negative predictive value were validated in the Italian cohort and in another cohort of patients with a clinical diagnosis of cirrhosis.



This study validates Baveno VI criteria, particularly in sites with a low prevalence of high-risk varices and describes a new accurate strategy that does not include liver stiffness.
Section of Digestive Diseases, VA-Connecticut Healthcare System, West Haven, CT, USA.|Section of Digestive Diseases, Yale School of Medicine, New Haven, CT, USA.
Parastoo
0000-0002-8346-2221
P
Jangouk
Section of Digestive Diseases, VA-Connecticut Healthcare System, West Haven, CT, USA.|Section of Digestive Diseases, Yale School of Medicine, New Haven, CT, USA.|Division of Gastroenterology, Azienda Ospedaliero-Universitaria di Modena and University of Modena and Reggio Emilia, Modena, Italy.
Laura
L
Turco
Section of Digestive Diseases, VA-Connecticut Healthcare System, West Haven, CT, USA.|Section of Digestive Diseases, Yale School of Medicine, New Haven, CT, USA.|Department of Medicine, Federal University of Sao Carlos, Sao Carlos, Brazil.
Ana
A
De Oliveira
Division of Gastroenterology, Azienda Ospedaliero-Universitaria di Modena and University of Modena and Reggio Emilia, Modena, Italy.
Filippo
F
Schepis
Division of Gastroenterology, Azienda Ospedaliero-Universitaria di Modena and University of Modena and Reggio Emilia, Modena, Italy.
Erica
E
Villa
Section of Digestive Diseases, VA-Connecticut Healthcare System, West Haven, CT, USA.|Section of Digestive Diseases, Yale School of Medicine, New Haven, CT, USA.
Guadalupe
G
Garcia-Tsao
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D054459:Elasticity Imaging Techniques; D004932:Esophageal and Gastric Varices / Q000150:complications*; D005260:Female; D006471:Gastrointestinal Hemorrhage / Q000209:etiology*; D006801:Humans; D007558:Italy; D008103:Liver Cirrhosis / Q000097:blood / Q000150:complications* / Q000000981:diagnostic imaging; D008297:Male; D008875:Middle Aged; D010976:Platelet Count; D012189:Retrospective Studies; D018570:Risk Assessment; D014481:United States
cirrhosis; endoscopy; high-risk varices; non-invasive; transient elastography