Noninvasive scores for the prediction of esophageal varices and risk stratification in patients with cirrhosis

Abstract

The primary purpose of variceal screening in patients with cirrhosis is to detect gastroesophageal varices at high risk of hemorrhage and implement preventative intervention(s). It was previously recommended that all patients with cirrhosis undergo initial and periodic longitudinal variceal screening via upper endoscopy. However, there has been growing interest and methods to identify patients with cirrhosis who may not have clinically significant portal hypertension and therefore be unlikely to have varices requiring intervention or benefit from upper endoscopy. Because the population of patients with compensated advanced chronic liver disease continues to grow, it is neither beneficial nor cost-effective to perform endoscopic variceal screening in all patients. Therefore, there is ongoing research into the development of methods to non-invasively risk stratify patients with cirrhosis for the presence of high-risk esophageal varices and effectively limit the population that undergoes endoscopic variceal screening. This is particularly important and timely in light of increasing healthcare reform and barriers to healthcare. In this review, we discuss and compare, with respect to test characteristics and clinical applicability, the available methods used to non-invasively predict the presence of esophageal varices.

Association of ABO Blood Type with Bleeding Severity in Patients with Acute Gastroesophageal Variceal Bleeding

“…In hospitalized patients with upper gastrointestinal bleeding, increasing age, hemodynamic instability at presentation, and liver cirrhosis will increase the risk of in-hospital mortality [32]. Because of the higher risk of death, there are many studies exploring the prediction methods of esophageal varices [33][34][35]. In addition, band ligation is the main treatment of acute EV bleeding, but some patients are not suitable for ligation.…”

Validation of the EVendo score for the prediction of varices in cirrhotic patients

“…Examples of these include platelet count-to-spleen diameter ratio, liver or spleen stiffness, combination algorithms, and scores such as aspartate aminotransferase (AST)-to-platelet ratio index (APRI), AST-to-alanine aminotransferase (ALT) ratio (AAR), fibrosis 4 index (FIB-4), and the King, Lok, and Liaoning scores. [ 9 10 11 12 ] One of the recommended modalities in the new guidelines and most validated method is the Baveno VI consensus criteria, which rely on liver stiffness measurement (LSM) and platelet counts. This suggests that in compensated cirrhosis, patients with both LSM <20 kPa and platelet count >150 × 10 9 cells/L can safely avoid screening EGD.…”