Efficacy of liver stiffness measurement and platelet count in screening for high grade varies in patients with cirrhosis

Agarwal, Ankit; Rout, G. R.; Vuyyuru, Sudheer K.; Gunjan, Deepak; Kedia, Saurabh; Nayak, B.; Shalimar, S.

doi:10.1016/s0168-8278(18)31733-1

Cited by 1 publication

(4 citation statements)

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“…The time interval between the index test and reference standard ranged from less than 24 hours to 12 months, but in most studies it was 12 months. Eighteen studies 33,35,38,[41][42][43][46][47][48][49][50][51][53][54][55][56][57][58] were reported in abstract form only.…”

Section: Resultsmentioning

confidence: 99%

“…Fifteen studies [31][32][33][35][36][37][38][40][41][42][43][44]47,52,53 were considered at high risk of bias because of an inappropriate time interval. Eleven studies 30,46,[48][49][50][51][54][55][56][57][58] provided no relevant details and were deemed at unclear risk of bias.…”

Section: Quality Assessmentmentioning

confidence: 99%

“…Finally, concerns regarding applicability also mostly were associated with patient selection. Ten studies 33,35,43,46,[53][54][55][56]58,59 were at high risk of bias because they included patients with more advanced liver disease (cirrhosis or liver stiffness values !12 kPa), and hence were slightly different than patients targeted by the review question.…”

Section: Quality Assessmentmentioning

confidence: 99%

“…patients) provided data for HRVs and 14 studies27,31,32,[34][35][36]41,46,52,[54][55][56][57]59 (3000 patients) provided data for any size varices. Expanded Baveno VI criteria were assessed in 12 studies27,37,39,40,44,[48][49][50]52,53,59,60 …”

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confidence: 99%

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Performance of Baveno VI and Expanded Baveno VI Criteria for Excluding High-Risk Varices in Patients With Chronic Liver Diseases: A Systematic Review and Meta-analysis

Stafylidou

Paschos

Katsoula

et al. 2019

Clinical Gastroenterology and Hepatology

105

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This article has an accompanying continuing medical education activity, also eligible for MOC credit, on page e109. Learning Objective-Upon completion of this activity, successful learners will be able to identify the appropriate test for screening and surveillance for esophageal varices in patients with compensated advanced chronic liver disease (cACLD). BACKGROUND & AIMS:We aimed to assess the accuracy of Baveno VI criteria for identification of high-risk varices (HRVs) and varices of any size in patients with compensated advanced chronic liver disease (cACLD). METHODS:We performed a systematic search of publications through December 2018 for studies that assessed the accuracy of Baveno VI criteria for screening for varices in patients with cACLD. We used hierarchical models to synthesize evidence. We also conducted a post hoc analysis to assess the accuracy of Expanded Baveno VI criteria. We appraised the confidence in estimates using the Grading of Recommendations Assessment, Development and Evaluation approach. RESULTS:We identified 30 studies (8469 participants). Pooled values of Baveno VI criteria for HRVs (26 studies) were a sensitivity of 0.97 (95% CI, 0.95-0.98) and a specificity of 0.32 (95% CI, 0.26-0.39). Pooled sensitivity of Expanded Baveno VI criteria for HRVs (12 studies) was 0.90 (95% CI, 0.85-0.93) and specificity was 0.51 (95% CI, 0.45-0.57). In 1000 patients with cACLD, with a prevalence of HRVs of 20%, Baveno VI criteria would prevent endoscopy in 262 patients, but 6 patients with HRVs would be missed. Instead, use of the Expanded Baveno VI criteria would result in 428 patients avoiding endoscopy, but 20 patients with HRVs would be missed. The credibility of our findings is moderate or low, mainly owing to the retrospective design of most studies. CONCLUSIONS:Baveno VI criteria have high diagnostic accuracy as a triage test for screening for HRVs in patients with cACLD. Expanded Baveno VI criteria could reduce the proportion of unnecessary endoscopies further, nevertheless with a higher rate of missed HRVs.

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