Baveno VI and Expanded Baveno VI criteria successfully predicts the absence of high‐risk gastro‐oesophageal varices in a Chilean cohort

Gaete, María Inés; Díaz, Luis Antonio; Arenas, Alex; González, Katherine; Cattaneo, M.; Fuster, Francisco; Henríquez, Romina; Soza, Alejandro; Arrese, Marco; Barrera, Francisco; Arab, Juan Pablo; Benítez, Carlos

doi:10.1111/liv.14373

Cited by 22 publications

(13 citation statements)

References 31 publications

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“…The Baveno VI consensus recommended avoiding gastroscopy when LSM < 20 kPa and PLT > 150,000/L. Our study also validated the effectiveness and safety of the B6C, which was consistent with other published literatures 23,[33][34][35] . However, the number of patients who can benefit from the B6C was still small, and our results shown that it was only 27.7%.…”

Section: Discussionsupporting

confidence: 91%

Validation and comparison of non-invasive prediction models based on liver stiffness measurement to identify patients who could avoid gastroscopy

Wen

2021

Sci Rep

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Several non‐invasive tests (NITs) based on liver stiffness measurement (LSM) have been developed to rule out varices needing treatment (VNT), including the Baveno VI criteria (B6C), the expanded Baveno VI criteria (EB6C), the LSM-spleen diameter to platelet ratio score (LSPS), and the VariScreen algorithm. We aimed to validate and compare those NITs in patients with compensated advanced chronic liver disease (cACLD). This retrospective study enrolled 354 patients with cACLD; LSM, platelet count (PLT), international normalized ratio (INR), gastroscopy and spleen diameter (SD) were collected. VNT prevalence was 28.5%. In comparison, patients with VNT included higher LSM, INR, and SD and lower PLT. Gastroscopies were spared for 27.7% of patients using the B6C with 1.0% VNT missed rate, 47.2% of patients using the EB6C with 5.9% VNT missed rate, 57.6% of patients using the LSPS with 9.9% VNT missed rate, and 45.5% of patients using the VariScreen algorithm with 3.0% VNT missed rate. Only the B6C and the VariScreen algorithm could safely avoid gastroscopies, and the VariScreen algorithm spared more gastroscopies than the B6C. The results were consistent with the previous when performed subgroup analysis. In conclusion, the VariScreen algorithm performed the best and can be used in clinical.

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Section: Discussionsupporting

confidence: 91%

Validation and comparison of non-invasive prediction models based on liver stiffness measurement to identify patients who could avoid gastroscopy

Wen

2021

Sci Rep

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“…The Expanded Baveno VI criteria would have spared 23.3% of unnecessary EGDs and missed 4.8% of HRV. The number of spared EGDs is lower than the number reported in previous studies [7,13,14,19]. The lower number of spared EGDs may be explained by the bias in selection of patients and the high prevalence of HRV, which may have led to a low NPV and influenced the diagnostic performance [18].…”

Section: Discussionmentioning

confidence: 73%

“…TE was only available for the Beijing cohort. LSM was assessed according to the manufacturer's FibroScan standard procedure [ 14 , 15 ], performed by one expert operator (Li Li) at Beijing Shijitan Hospital (>100 procedures). LSM was considered valid when there were at least 10 measurements with an interquartile range to median ratio (IQR/M) ≤ 30% [ 16 ].…”

Section: Methodsmentioning

confidence: 99%

Validation of the Combined Model Based on Platelet Count and Albumin to Rule out High-Risk Varices in Liver Cirrhosis

Duan

et al. 2020

BioMed Research International

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Background. The Baveno VI criteria based on platelet count and liver stiffness, measured by transient elastography (TE), have been proposed to rule out high-risk varices (HRV) defined as medium or large-sized varices or the presence of high-risk stigmata (cherry red spots and red wale marks). However, TE is not available in all hospitals. Recently, the Rete Sicilia Selezione Terapia hepatitis C virus (RESIST-HCV) criteria recommended that cirrhotic patients with a platelet count>120000/μL and serum albumin>36 g/L could avoid esophagogastroduodenoscopy (EGD) screening for HRV. Aim. We aimed to validate the performance of the RESIST-HCV criteria in two cohorts predominantly characterized with hepatitis B infection. Methods. Patients with compensated cirrhosis who had blood tests within three months of performing EGD and TE were enrolled retrospectively from two centers. RESIST-HCV criteria were applied to identify patients who did not require EGD screening. Results. This study included 188 patients from the Xingtai cohort (28 (14.9%) with HRV) and 104 patients from the Beijing cohort (19 (18.3%) with HRV). Of the patients who met the RESIST-HCV criteria (83 in the Xingtai cohort and 26 in the Beijing cohort), 0 and 1 had HRV, respectively, accounting for 44.1% (Xingtai cohort) and 25% (Beijing cohort) of endoscopies that were unnecessary. In the combined cohort, 109 (37.3%) patients met the RESIST-HCV criteria, only 1 (0.9%) HRV was missed, and the negative predictive value was 99.1%. Baveno VI and Expanded Baveno VI criteria spared 15.6% and 23.3% of EGDs, respectively, while missing 0% and 4.8% of HRV, respectively. Conclusions. In our population, the combined criteria based on platelet count and serum albumin performed well, saving 30-40% of EGDs and correctly identifying 99.1% of patients who could safely avoid screening endoscopies for high-risk varices in compensated cirrhotic patients.

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“…Therefore, in the recent study [14] , the American Liver Research Association proposed a new standard that endoscopy is not required when the LSM< 25kpa and the PLT>110×10 9 /L. Subsequently, different studies veri ed the diagnostic value of the two standards [15] . In a study of 1035 patients with compensatory advanced chronic liver disease, the extended standard (51.7%) could avoid more endoscopy than the original standard (27.6%), but the extended standard also missed more high-risk varices (6.8%, 3.8%).…”

Section: Discussionmentioning

confidence: 99%

Liver stiffness and platelet count to assess the risk of bleeding from esophageal and gastric varices in liver cirrhosis

Zhang

Mao

et al. 2022

Preprint

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Background The Baveno VI portal hypertension consensus recommended that liver stiffness measurement (LSM) < 20kPa and platelet count (PLT) > 150×109/L may avoid screening endoscopy in 40% of patients with compensated cirrhosis. We aimed to use transient elastography (TE) to measure liver stiffness, combined with PLT to assess the risk of bleeding from esophageal and gastric varices in patients with liver cirrhosis, and to establish a new standard for Chinese patients. Methods Adult patients with compensated liver cirrhosis treated in 8 clinical research centers from 2018 to 2020 were enrolled and randomly divided into the training cohort and the validation cohort. Patients from the training cohort were used to study the performance of different PLT and LSM, to ensure great endoscopic avoidance rate and very low varicose veins need to be treated (VNT) missed rate. At the same time, the new standard was verified in the validation cohort patients. Results A total of 260 patients (166(63.8%) hepatitis B and 229 (88.07%) Child-Pugh class A) were analyzed. In the training cohort (n = 137) with hepatitis B as the main etiology (63.8%), the LSM < 25kPa and PLT > 120×109/L were the best standards. Under this standard, 23.4% of patients could avoid unnecessary endoscopy screening, and 3.1% of patients missed VNT. In the validation cohort (n = 123), under the TOUCH standard, 24.4% of patients could avoid screening endoscopy, and the risk of missed VNT was within an acceptable range (3.4%). Conclusions The new standard based on instantaneous elastography technology could identify patients with compensatory cirrhosis with low risk of varicose veins and some patients may avoid screening endoscopy.

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Baveno VI and Expanded Baveno VI criteria successfully predicts the absence of high‐risk gastro‐oesophageal varices in a Chilean cohort

Cited by 22 publications

References 31 publications

Validation and comparison of non-invasive prediction models based on liver stiffness measurement to identify patients who could avoid gastroscopy

Validation and comparison of non-invasive prediction models based on liver stiffness measurement to identify patients who could avoid gastroscopy

Validation of the Combined Model Based on Platelet Count and Albumin to Rule out High-Risk Varices in Liver Cirrhosis

Liver stiffness and platelet count to assess the risk of bleeding from esophageal and gastric varices in liver cirrhosis

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